Monday, February 17, 2020

KET to air 'Undiagnosed: The Diabetes Epidemic' followed by a panel discussion about the disease on Monday, Feb. 24

Nearly half of Kentucky adults have diabetes or pre-diabetes -- and many of them don't know they have it.

To shine a light on this issue, Kentucky Educational Television is airing "Undiagnosed: The Diabetes Epidemic," a documentary that looks at the rising rates of diabetes and pre-diabetes in Kentucky, with a focus on what Kentuckians across the state are doing to reduce those rates.

More than one in eight Kentucky adults have been diagnosed with diabetes, according to the 2017 Kentucky Behavioral Risk Factor Survey. And 1.2 million, or 35.5 percent of the adult population, has pre-diabetes, a condition where blood glucose levels are higher than normal, but not yet high enough to be diagnosed as diabetes, according to the American Diabetes Association.


The 30-minute documentary will air Monday, Feb. 24 at 9 p.m., followed by a town-hall discussion with a panel of health and community officials, hosted by Dr. Wayne Tuckson of KET's "Kentucky Health."

Panelist include Dr. Connie White, deputy commissioner for clinical services with the state Department for Public Health; Dr. Fred Williams, a Louisville endocrinologist and a past president of the Kentucky Medical Association; Rev. Donald K. Gillett II, senior pastor at East Second Street Christian Church and the executive director of the Kentucky Council of Churches; and Richard Heine, co-facilitator with the Kentucky County Diabetes Coalition. 

The panel hits on a wide range of topics, including the importance of early screenings and interventions, the rise in diabetes rates among young people, the importance of communities to address this issue, and stigma about diabetes.

New federal policy means fewer life-saving liver transplants in Ky., say top medical officials at major universities, who are fighting it

By Mark Newman, Tom Miller and Kelly McMasters

A rushed proposal that became federal policy across the country this month will increase the cost and decrease access to life-saving care for patients in dire need of a liver transplant across much of the South and Midwest.

The result: People in Kentucky and largely rural areas of the country will be more likely to die because they won’t receive the care they need or would have had access to before this month.

As health care professionals and leaders of the state’s two academic medical centers, we are doing everything we can to delay or reverse this detrimental policy. Here’s what is happening and what is at stake for Kentucky:

On Feb. 4, the Organ Procurement and Transplantation Network, based on a recommendation from the United Network for Organ Sharing, implemented a new policy for how livers are allocated around the country for potential transplant. The OPTN sets transplantation policy at the direction of the U.S. Department of Health and Human Services.

The basic framework of this policy would mean more organs in rural states, like Kentucky, would be sent to larger inner-city medical centers that have higher populations. The idea was to create a policy that ensured more critically ill patients (within 500 nautical miles) received access to livers, rather than the patients in closer proximity.

While the transplant policy is well-intentioned, the fact is the governing board creating and directing the policy is dominated by officials from large urban, coastal areas. The resulting policy benefits those areas.

The process creating this program was rushed and the policy is deeply flawed.Even the framers of it concede there will be nearly a 30 percent drop in liver transplant volume in Kentucky as a result of this policy. We believe the drop will be even more significant, on the order of 40%.

Kentucky, as so many of us know, has a higher mortality rate for chronic liver disease such as cirrhosis than the national average. In rural areas of our state, the rate is even higher as access to care is more limited.

Several things -- all negative -- will occur in Kentucky and other rural areas of the country:
•This new policy will decrease access to livers for transplant even further.
•It will increase costs, the result of a more inefficient system because of rising costs for flights, fuel and transportation for Kentuckians and others who will have to travel farther to receive transplantation services.
•It will result in longer waiting periods and poorer health outcomes for Kentuckians and others who have to wait longer for donated livers.
•Others, who have to wait and who don’t have time, will be more likely to die.

We stand with a network of academic medical centers throughout the South and Midwest, including Emory University, the University of Michigan, Vanderbilt University and the University of Virginia, that have filed a lawsuit, asking to prohibit the federal government from implementing the policy. Although the federal court in Atlanta declined to stop the government from implementing the policy on Feb. 4, the fight is far from over.

We are continuing to ask the court to order the federal government to seek additional input. Ultimately, the federal government must craft something more equitable for everyone in America, not just those in larger cities or on the coasts.

We have received support from many federal policymakers, led by Senate Majority Leader Mitch McConnell. However, we continue to appeal to others to do what they can, with the voices and power they have, to prevent or reverse implementation of this ill-advised and biased approach to transplantation care.

We need, and respectfully ask, those in power to listen and act. For so many people, time is running out.

Mark Newman is chief executive of UK HealthCare; Tom Miller is chief executive officer of UofL Health; Kelly McMasters is chair of UofL's surgery department.

Saturday, February 15, 2020

Bills to help health departments with pensions pass House; some counties will have to increase their public-health taxes

By Melissa Patrick
Kentucky Health News

Two bills that were presented as part of a "three-phase approach" to create a sustainable solution to local health departments' pension crisis passed the state House Feb. 13. The third part of the plan involves the state budget.

The budget committee chair, Republican Rep. Steven Rudy of Paducah, cautioned House members that passage of the bills and the House's version of the budget, which will include funding for the bills, didn't mean the pension woes were over, because all of it must also be approved in the Senate.

"Our friends down the hallway will have a bite of this apple," he said. "So to put everybody's mind at ease, it's still a serious issue. We still don't have the permanent fix. But without Phase 1 and Phase 2, we can't get to phase three."

The first bill that passed would completely change the way health departments, regional universities and quasi-governmental agencies pay for their pension liabilities. It passed without dissent.

Rep. DuPlessis explains HB 171. (LRC Public Information photo) 
House Bill 171, sponsored by Rep. Jim DuPlessis, R-Elizabethtown, would move these entities away from the current "percentage of pay" formula, to a model that requires them to pay only what they owe the pension system, divided evenly over the next 27 years. This is often called "level dollar funding."

"This bill assigns their actual liability where they pay no more and no less that what they already owe," DuPlessis told Kentucky Health News in an interview.

The plan is also designed to keep employees in the system; many health departments have shifted to contract labor to reduce their pension payments. It would require all new employees to have a pension obligation of 10.35%, which is dubbed the "normal cost." So, in essence, the departments would get two pension bills to cover their pension costs, one for the unfunded liability for current and past employees and the other for new employees.

DuPlessis said these structural changes to the program will stabilize it. "If we don't take the bull by the horns and fix this, it's going to get to a point where nobody can make their payments," he said.

This proposal stems from a law that was passed during a special legislative session last summer, giving health departments, regional universities and quasi-governmental agencies the choice of staying in the Kentucky Retirement System and paying the full obligations or leaving the system, either by paying a lump sum or buying their way out over time. Those that choose to leave would need to move employees to a 401(k)-type plan.

The departments have said none of these choices are viable, and none have left KRS. The state Department for Public Health has said that without some relief from their pension obligations, dozens of health departments are at risk of closing.

Action is needed. The legislature has frozen health departments' pension contributions at 49.47 percent for the past two years, but on July 1, the day the next two-year budget starts, this is set to jump to 93%, a level many say would force them to close. Gov. Andy Beshear has proposed funding to make the effective rate 67%.

Rep. Joe Graviss, D-Versailles, one of the legislation's three sponsors, told House members that he was "extremely grateful" for the funding, "and I hope that we can keep and add to the money that the governor has allocated to help these organizations -- because they are going to need it. Let's not mince words, it is true, they will need some support."

An actuarial report shows that 14 of the 60 district and county health departments in KRS will owe more money under the 27-year schedule; the rest will owe less.

Randy Gooch, director of the Jessamine County Public Health Department, told Kentucky Health News Feb. 9 that about six departments would need state assistance to help pay pension obligations. He cautioned that this analysis has many moving parts.

DuPlessis told House members that while the original bill had language in it for a subsidy pool to help the entities that needed it, that language has been removed and that help will now be managed in the budget. "There will be a line item for every one of those entities and how much money they will receive," he said.

DuPlessis confirmed that the current plan is to help health departments that aren't able to meet their pension obligations, but in order for them to get that help, their counties must have a health tax of at least 8 cents per $100 assessed property value.

"So if you are below the 8 cents, you're going to have to raise your local taxes if you can't make your payments," he said. "That's fair because the local taxes will pay for the local service -- health departments are a local service."

The state has established a minimum health tax of 1.8 cents per $100 worth of property, with a cap of 10 cents per $100. Several public-health directors have said they have been told that only one county in a district health department would need to levy the 8-cent tax to qualify the district for state help.

A floor amendment was added to the bill that says any health department leaving its district would be responsible for its portion of the pension liability.

A spreadsheet of health departments and taxes that support each of them is at www.uky.edu/comminfostudies/irjci/Kylocalhealthtaxes.xlsx.

The second bill would overhaul the state's public-health system, including how health departments are funded and how they would prioritize their resources.

Rep. Moser presents HB 129.
(Photo by LRC Public Information)
House Bill 129, sponsored by Rep. Kim Moser, R-Taylor Mill, passed with a committee substitute on an 88-1 vote, with Rep. Chad McCoy, R-Bardstown, voting against the measure. It is meant to work concurrently with HB 171 and is called the Public Health Transformation Plan.

"Primarily, this creates sustainability of our health departments," Moser said. "It controls the cost and it relieves the instability that we are seeing now in the current system."

The current system funds each health department with the same formula, regardless of its ability to generate local funds. The new formula would take that into account, making it more equitable. In other words, departments that have more resources would get less state funding under this model.

The bill also identifies "core public health" services, which every health department would be required to provide and requires departments to perform community health assessments, which many of them already do, to determine their local public health priorities beyond the core requirements. These local priorities would have to meet certain criteria for the department to address them, and would need to be funded separately.

"This public health transformation initiative will result in a more simplified and a very focused public health model," Moser said. "It will prevent duplication of services. It encourages shared resources and it creates an expertise to really create that economy of scale or that fair and equitable system that we need across the state. This proposal will also increase accountability and transparency at both the state and the local levels within the system."

The bill codifies the existing 1.8 cents per $100 property tax as the floor, with a cap of 10 cents per $100. It also gives health departments one year to increase their environmental fees by up to 25% before the current 5% yearly cap is put back in place. This would allow health departments to bring those fees in line with what the service actually costs.

spreadsheet prepared by the Kentucky Health Department Association estimates that 14 of the 61 health departments would get less state funding, and the rest would get more, using a formula based on a county's population, its ability to support its health department with its current taxing authority, how many employees the county would need to provide only the health services required by law, and an estimated increase in environmental fees.

Moser said it is estimated that health departments' pension-liability contribution deficit could be as high as $38.5 million, and that "18 of our local health departments, which represent 41 counties, will face fiscal insolvency during the fiscal year 2020 without significant financial and operational changes."

Ky. flu cases creep up for the third week in a row; nine more Kentuckians have died from flu; it's not too late to get a flu shot

CDCP poster; for a larger version, click on it.
Kentucky Health News

Amid all the headlines about the novel coronavirus, health experts warn that there is a much more prevalent and potentially deadly virus killing people in Kentucky: influenza. Through the week ended Feb. 8, Kentucky had reported 17,203 cases of flu this season, with 50 deaths from it, four of them people under 18, according to the state Department for Public Health.

In an op-ed for the Lexington Herald-Leader, Dr. Brent Wright, president of the Kentucky Medical Association, and Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, reminded Kentuckians that it's not too late to get a flu shot to protect themselves from the virus.

They also noted that even if you get the flu, the vaccine helps decrease your symptoms. The annual shot is recommended for all over 6 months of age. They offered some practical advice to protect yourself and others:

"If you think you have the flu, consult with your physician as soon as possible, as there are antiviral medications available that can help. The flu is spread mainly through tiny air droplets, so be sure to wash your hands thoroughly, cover your mouth and nose when you sneeze and cough and avoid contact with others while you are sick."

The week ended Feb. 8 was the third in a row that flu cases have inched up in Kentucky, after dropping for three weeks in January.

The latest weekly report shows that Kentucky counted 2,101 new cases, a slight increase from the 1,815 reported the previous week and the 1,739 the week before that. The actual number of cases is higher because not all flu cases are counted; flu does not have to be reported, and five counties did not contribute to the latest report.

The state saw nine more deaths from the flu in the week ended Feb. 8; one victim was under 18. That brought the season total to 50.

Last year at this time, there were 9,263 cases of the flu reported in Kentucky and 25 deaths from it, including one under the age of 18.

Hotspots continue around the state, and while Perry County saw a bit of a reprieve in the Feb. 1 report, its numbers jumped up again during the week ended Feb. 8. It saw 76 new cases, for a total of 900. Pike and Barren counties continue to be hit hard; Pike added 152 new cases, for a total of 960; Barren added 188, for a total of 927. Bullitt County has added more than 100 cases at least two weeks in a row; most recently it added 105, for a total of 754.

Other hotspots: Allen added 39, for a total of 301; Garrard added 41, for a total of 120; Greenup added 59, for a total of 211; Hardin added 67, for a total of 221; Hart added 30, for a total of 179; Knott added 35, for a total of 267; Knox added 38, for a total of 85; Leslie added 39, for a total of 330; and Warren added 56, for a total of 640.
MMWR = Morbidity and Mortality Weekly Report, Centers for Disease Control and Prevention

Friday, February 14, 2020

As state works to secure Medicaid managed-care contracts, Senate passes bill to only allow three of them, down from five

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Only three firms would get multi-billion-dollar contracts to manage Medicaid in Kentucky under a bill that passed the state Senate Feb. 12.

Five managed-care organization now oversee care for most Medicaid beneficiaries, and seven have submitted bids for the contracts that will be awarded later this year.

Sen. Stephen Meredith presents SB 30 to limit Medicaid managed-
care contracts to three.
(Photo from Legislative Public Information Office)
Senate Bill 30, sponsored by Sen. Stephen Meredith, R-Leitchfield, would limit the number of MCO contracts to three. The bill went to the House on a 29-7 vote after Meredith argued it is needed to reduce administrative burdens for health-care providers.

"Let's reduce the bureaucracy," said Meredith, a retired hospital administrator. "We don't need five managed-care organizations; they bring no value to the system whatsoever. All they do is deny and delay payment."

The bill has an emergency clause to make it take effect immediately if passed into law. That would keep the administration of Democratic Gov. Andy Beshear, which is working to secure its MCO contracts, from signing more than three.

Those contracts have already been offered once. Just days before Beshear took office, then-Gov. Matt Bevin's administration awarded the $8 billion in contracts to five insurance companies that excluded two companies with current contracts, Passport Health of Louisville and Anthem Inc., the state's largest health insurer. Both had said they would appeal the the awards. Beshear has since cancelled the contracts and reopened the bidding process.

Meredith has long lamented the burdens of manged care, particularly on rural hospitals, because they have such tight budgets. He said the United States spends 30 cents of every health-care dollar on administrative fees, five times what other industrialized nations spend.

And to those who would say, just fix the existing problems, Meredith pointed to a 2018 law that was supposed to improve the MCO credentialing and enrollment process, along with requiring monthly reports that showed claims, denials, and grievances. All those issues still exist, he said.

Minority Leader Morgan McGarvey, D-Louisville, voted against the measure and said that while he understands providers' ongoing frustrations, "My fear is that this bill wont' fix those problems."  He also did not like that this bill ties the hands of the executive branch.

Sen. Danny Carroll, R-Paducah, speaking for the bill, said that as someone who runs a small organization for children with disabilities, he battles with MCOs "every day" over wrongly denied claims and delays in payments. He said it would be helpful to only have to deal with three sets of rules, instead of five.

"It will make it less complicated. It will save money," Carroll said. "At a time when Medicaid reimbursements are so low, I think we owe it to providers at every level to allow them to save money wherever they can, and reducing administrative cost by limiting these numbers ... will allow money to be saved."   

Medical marijuana bill expected to pass House; Senate uncertain

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A medical-marijuana bill described by supporters as one of the tightest in the nation is out of committee and is expected to pass the state House. The Senate is another matter.

Reps. Jason Nemes and John Sims Jr. presented the medical
marijuana bill, HB 136, in the House Judiciary Committee.
(Photo from Legislative Public Information Office)
"This is a question for the Senate," Rep. Jason Nemes, R-Louisville, told reporters after the House Judiciary Committee approved the bill. "It's going to pass the House; I have no doubt about it."

House Bill 136 , with a committee substitute, passed Feb. 12 by a vote of 17-1-1, with Rep. Joseph Fisher, R-Fort Thomas, passing. Fisher had expressed concern about people driving under the influence of marijuana and how this would be effectively managed.

Rep. Kim Moser, R-Taylor Mill, was the lone no vote. Moser, who has consistently said she would like to see more evidence-based research on medical marijuana that includes guidelines for prescribing, called the medical-marijuana laws in other states a "popular national social experiment."

Senate President Robert Stivers, who has long been the key obstacle to the bill in the Senate, reiterated Feb. 12 that he thought there could be a "path forward" for this bill in the Senate, though he said they haven't talked about this bill yet. (Later in the day, Nemes said he had a long, encouraging conversation with Senate Majority Floor Leader Damon Thayer.)

Stivers said that while he recognized that there are some real medical benefits to it, he said he wished the federal government would conduct a three-tier, double-blind study so that people would know how it really needs to be used.

House Concurrent Resolution 5, sponsored by Rep. Danny Bentley, R-Russell, asks the federal government to expedite research on the safety and efficacy of medical marijuana. It has passed out of the House and has been assigned to the Senate Health and Welfare Committee.

"It's a balancing test of: Do the goods outweigh the bads?" Stivers said.

Kentucky would be the 34th state, plus the District of Columbia, with legalized medical marijuana. So far, only 11 states and D.C. have legalized it for recreational use. A recent poll shows that 90 percent of Kentucky adults favor legalizing medical marijuana, or cannabis.

The latest version of the bill removed a list of conditions that could be treated with cannabis or its psychoactive ingredient, THC, and says any list of conditions will be determined by a panel of doctors and advisers established under the state health department.

Dr. Jeffrey Block, an anesthesiologist with the University of Miami, offered a short list of conditions for which there is conclusive or substantial evidence that THC is an effective treatment, including intolerable nausea or vomiting, intractable epilepsy, intractable chronic pain and intolerable muscle spasm, particularly from multiple sclerosis.

The bill wouldn't allow patients to smoke marijuana. Nemes said this concession was necessary to get votes, even though smoking is usually the quickest and most efficient way to get the drug into the system. It also does not allow colorful packaging or formulations that would be attractive to children.

Nemes said 13.5 percent of the money that comes in from the program would be used to help those who can't afford it get medical marijuana, since insurance won't cover it. Another 13.5% would go to law enforcement. The bill also includes an opt-in or opt-out provision for local governments.

Eric Crawford, an advocate for medical marijuana, told the group that an automobile accident in 1994 had left him paralyzed, and he used marijuana instead of opioids for his constant pain and muscle spasms.

"Narcotics make me out of my mind. They make me high and unable to function at all," he said. "Cannabis allows me to get out of bed and make the most of my life."

Crawford said if HB 136 became law, "I would not be a criminal. I would not have to live in fear. I would not have to lay awake at night worrying about law enforcement coming to my home. I would not have to stress about going to jail, or losing my home, work or freedom."

Joe Trigg, a 30-year veteran with 15 deployments, said, "Thousands of other veterans and myself would benefit from this bill." But he also said, "House Bill 136 can do better and should do better."

First, he said because it is written so tightly, it will likely result in higher prices and a larger black market. He also suggested that the rules against smoking and limiting growing are a result of lobbying, and said that rules on how it can be grown do not benefit Kentucky farmers.

Kent Ostrander of the Family Foundation of Kentucky, urged caution and called for more evidence-based research, saying, "We cannot use anecdotal based assumptions" when it comes to medications.

The bill would make marijuana legal medicine in Kentucky on Jan. 1, 2021.

Federal appeals court strikes down Medicaid work requirements

Gov. Matt Bevin announced his plan in 2016. (WFPL photo)
A federal appeals court ruled Friday against the work requirements that then-Gov. Matt Bevin tried to impose on Medicaid enrollees who were not "medically frail" and had no dependents.

The Trump administration was arbitrary and capricious when it approved Bevin's plan and one in Arkansas, a three-judge panel of the U.S. Court of Appeals for the District of Columbia Circuit ruled unanimously.

The U.S. Department for Health and Human Services essentially ignored the main purpose of Medicaid, which “was to provide health-care coverage to populations that otherwise could not afford it,” wrote Senior Judge David Sentelle, who was appointed to the court by Ronald Reagan.  The Trump administration is expected to ask the Supreme Court to hear the case.

The ruling upheld several by a judge in the D.C. District Court, which scuttled a program Arkansas had started and kept Kentucky's from taking effect. Democratic Gov. Andy Beshear, who defeated Bevin in the November election, rescinded Kentucky's plan soon after taking office in December. Republicans control the state legislature but have shown no interest in enacting Bevin's plan.

The plan had been challenged by 16 Medicaid beneficiaries in the state, who noted the Bevin administration's initial forecast that Kentucky Medicaid rolls would have 95,000 fewer people in five years than without the plan, in large measure because of noncompliance with the requirements to work, attend school or perform community service 80 hours a month and report monthly.

Bill to cap insulin co-pays in some health plans to $100 per month per prescription moves to full House with 74 sponsors

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- A bill to limit the cost-sharing requirements for insulin prescriptions has passed out of committee and is before the full House.

Charlotte Whittaker, Rep. Danny Bentley and Mary Beth Lacey
 present HB 12. (Twitter photo by Lawrence Smith, WDRB-TV)  
House Bill 12, sponsored by Rep. Danny Bentley, R-Russell, would require state-regulated health-insurance plans to cap a patient's cost for a 30-day supply of each insulin prescription drug at $100 "regardless of the amount or type of insulin needed to meet the covered person's insulin needs." The bill does not include Medicaid, Medicare or self-insured government plans.

Insulin is a hormone that regulates the amount of glucose in the blood, and a lack of it causes diabetes. People with Type I diabetes can't make any insulin so they must inject it to control their blood sugar -- and to stay alive. People with Type II diabetes, which is more common, can produce some insulin, but not enough. Type II is usually treated with diet, exercise and oral medications.

More than one in eight Kentucky adults have been diagnosed with diabetes, according to the 2017 Kentucky Behavioral Risk Factor Survey. In that year, diabetes was the fifth leading cause of death in Kentucky, according to the federal Centers for Disease Control and Prevention.

Bentley, who is a pharmacist with Type I diabetes, said HB 12 is supported by the American Association of Retired Persons, the American Diabetes Association, the Kentucky Medical Association, the Kentucky Pharmacy Association and Insulin4All.

Holding up a $290 box of insulin, Bentley said it's not uncommon for a person to use up to five boxes a month, which could end up costing about $1,200 monthly without insurance. The woman who loaned him the box said she paid about $300 a month for her monthly supply or about $3,600 a year, with help from insurance. But that does not include all the other supplies and equipment she needs to treat her diabetes, which also comes at a great, ongoing cost.

Bentley said in the last 14 years, the cost of insulin has gone up 550 percent.

In a detailed blog post about how this cap would help many thousands of Kentuckians with diabetes, Dustin Pugel of the Kentucky Center for Economic Policy reports that from 2012 to 2016, insulin prices at point of sale more than doubled in Kentucky, growing from $352 to $721 for a 30-day supply.

He adds that nearly one in three Kentucky adults with health insurance have plans with large cost-sharing requirements, whether it's in the form of a high deductible, large co-payment or a plan that covers only a fixed percentage of the cost through co-insurance.

The bill passed unanimously out of the House Health and Family Services Committee Feb. 13 with a committee substitute. Including Bentley, the bipartisan bill has 74 sponsors. If passed into law, it would go into effect Jan. 1, 2021.

Charlotte Whittaker, volunteer state president of AARP Kentucky, said older Americans with diabetes are hit especially hard with these growing cost, noting that Medicare Part D enrollees take an average of four to five prescriptions per month, with an annual income of about $26,000.

"Prescription drugs don't work if you can't afford them -- that's the bottom line," she said, later adding, "No Kentuckian should be forced to choose between putting food on the table or buying a lifesaving medication."

Mary Beth Lacey of the American Diabetes Association reminded the panel that people who need insulin need it to live and to avoid devastating complications, like blindness, kidney failure, lower limb amputation, heart attack, stroke and even death

Lacey, who described herself as a 43-year survivor of Type I diabetes, showed the committee a device that allows her to constantly monitor her insulin level through her cell phone. She stressed that such technology should be available to everyone, but isn't when people with diabetes are still simply trying to figure out how to pay for their insulin.

"We should not be struggling to stay alive, we should be thriving," she said, "Without insulin, people with diabetes die, and scaling back on insulin can lead to costly and sometimes deadly complications."

Research shows that about one in seven adults under 65 diagnosed with diabetes skipped doses, took less of their medicine or delayed filling a prescription to save money. Lacey said research shows that for one in four insulin users say cost has affected their use of it.

Lacey said 1.7 million Kentuckians either have or are at risk of having diabetes. The ADA estimates that the cost of caring for diabetes in Kentucky based on 2017 data was greater than 6.1 billion a year. 

"By keeping insulin affordable, we can help keep people with diabetes out of the ER and the hospital and away from expensive and potentially disabling or deadly complications," she said.

She added that the ADA would like to see a $100 a month collective cap, rather than a $100 per month per prescription cap.

Rep. Robert Goforth, R-East Bernstadt, said he would like to see assistance for people who have no insurance, which Bentley said was not addressed in this bill. Bentley said HB 423, sponsored by Rep. Steve Sheldon, R-Bowling Green, also addresses the cost of insulin and would help the cash customer. He added that House Bills 398, 399, 400 and 423 also deal with the price of insulin.

Sheldon, a co-sponsor of HB 12, called it a great first step.

"Drug pricing all across this nation has gotten completely out of hand," he said. "Until we get away from the way we price all drugs, it's going to be difficult and insulin is probably the most extreme example."

The bill's fiscal note estimates that capping the co-pay for insulin to $100 each month will increase premiums for health plans, excluding Medicaid and the state employee plan, 7 to 24 cents per member per month.

Asked who would absorb this, Sheldon said because insulin prices are so inflated and because so many groups have "their hands in the cookie jar," the industry "will find a way to eat that 24 cents for sure."

Saint Joseph Hospital listed as one of America's 250 best

Saint Joseph Hospital of Lexington announced Feb. 13 that it was the only facility in Kentucky to be included in the lost of "America’s 250 Best Hospitals" list by Healthgrades 2020 for the second consecutive year. "The distinction places Saint Joseph Hospital in the top 5 percent of nearly 4,500 hospitals assessed nationwide for its superior clinical performance as measured by Healthgrades, the leading resource that connects consumers, physicians and health systems," the hospital said in a news release.

“This is an honor for our highly experienced and dedicated physicians and employees, who make awards like this possible,” hospital President Bruce Tassin said. “We are committed to providing our patients with quality care and services, and to be recognized among top 5 percent of hospitals in the country to receive this award is exciting for us all. We cannot thank our team enough for their hard work and dedication. As Lexington’s first hospital since 1877, we are honored to continue serving this community more than a century later.”

From 2016 through 2018, Medicare patients in hospitals receiving the 250 Best Hospitals award averaged a 26.6 percent lower risk of dying than if they were treated in hospitals that did not receive the award, as measured across 19 conditions and procedures for which death is the outcome.

In addition to being named one of America’s 250 Best Hospitals, Saint Joseph also was ranked in the best 100 hospitals, the top 2 percent, for pulmonary and cardiac care. Its sister hospital, Saint Joseph East in Lexington, won a pulmonary care award for the last two years.

Thursday, February 13, 2020

Bills aimed at reducing youth 'vaping' pass first hurdles

By Melissa Patrick
Kentucky Heath News

FRANKFORT, Ky. -- Two House bills aimed at reducing teen use of electronic cigarettes have cleared committee and are before the full House. One would place a 25 percent tax on the products, which is projected to bring in nearly $50 million in the next two-year state budget; the other adds regulations aimed at making it harder for teens to obtain e-cigarettes.

Abby Piper, with Jefferson County Public Schools; state
Rep. Jerry Miller; and Bonnie Hackbarth, of the Foundation
 for a Healthy Kentucky, presented HB 69 in committee.
The sponsor of both bills, Rep. Jerry Miller, R-Louisville, says both bills are needed, to protect independent "vape" shops. House Bill 32 has the tax and HB 69 the regulations.

"These are two pieces of a whole," he said. "While 32 may hurt independent vape shops, HB 69 will help independent vape shops."

HB 69 would require makers and retailers of "enhanced vapor products" with flavorings, other than tobacco or menthol, to register with the state Department of Alcoholic Beverage Control and pay a registration fee of $210 per location annually.

The bill refers to e-cigarettes as "enhanced vapor products," but they actually produce an aerosol that contains volatile organic compounds, ultrafine particles, heavy metals and potential cancer-causing agents, not a vapor.

HB 69 would also prohibit registered retailers or manufacturers of e-cigarettes from selling them online, through catalog sales or by phone; prohibit home delivery by outside vendors; require real-time age verification for purchase through an electronic third-party source no later than Jan. 1, 2021; require flavored products other than tobacco and menthol, and those with more than 4% nicotine content to only be sold in "vape" shops; and authorize fines on any person under 21 who tries to purchase e-,cigarettes or related products.

Miller added that the bill also allows the state to track purchases back to the store that sold them as a way to thwart those who might buy them in bulk and then sell them to minors.

"This bill simply seeks to regulate a product which adults should be able to use, but is such that it is very prone to abuse by underage people," Miller said. "We have a crisis of youth using these nicotine products, and that's what this bill is about."

Data from Kentucky Incentives for Prevention survey, graphic from
from Sept. 18 Department for Public Health PowerPoint presentation
The Kentucky Incentives Prevention Survey found that from 2016 to 2018, Kentucky teens nearly doubled their e-cig use, with more than one in four high-school seniors and one in seven eighth-graders reporting use in 2018.

The House Committee on Licencing, Occupations and Administrative Regulations Committee approved HB 69 Feb. 12 with no dissent.

Kentucky Smoke-Free Association Board Chair Tony LeBlanc defended the industry, which he said is considered "evil" in the U.S., but promoted in the United Kingdom as 95% safer than cigarettes, and a way to quit smoking, citing a 2013 British study that he acknowledged some have disputed.

"We're doing everything we can to keep these out of teen hands, but I'm telling you right now, this is a device that is saving lives. It's saving lives and people are trying to tax it and ban it and smear it through the mud. I don't understand," he said.

The British study was debunked in a recent American Journal of Public Health article, which included an appendix of research to back up its conclusions. It said, "The evidence-lacking estimate derived in 2013 cannot be valid today and should not be relied upon further."

After the meeting, Bonnie Hackbarth, vice-president of external affairs at the Foundation for a Healthy Kentucky, pointed out that it is illegal in the U.S. to advertise e-cigarettes as a smoking-cessation device, citing the recent 700-page U.S. Department of Health and Human Services report that says more research is needed before it can be concluded that e-cigs help people stop smoking.

E-cigarette tax 

The day before HB 69 passed, HB 32 passed out of the House Appropriations and Revenue Committee with a committee substitute that would impose a 25% wholesale tax on e-cigarettes, instead of the 27.5% it first proposed.

The bill would also raise the wholesale tax for "other tobacco products," such as cigars, to 25% from the current 15%, and add e-cigarettes to that list. It would also double the per-unit tax on non-smokeable and chewable products, as was proposed in Democratic Gov. Andy Beshear's budget.

Miller said the aim of the bill is to decrease youth e-cigarette use. "The most effective way to attack use by those under 21 is through raising the price," he said.

Representatives from the Kentucky Smoke Free Association, which represents about 400 independent vape shops statewide, told the panel that while they support the added regulations in HB 69 because they address teen access issues, they do not support the tax because it would hurt their businesses, while doing little to hurt leading e-cig maker Juul Labs or grocery and gas-station chains, which will still be allowed to sell e-cigs with tobacco and menthol.

"It's going to do nothing but hurt them and increase the [money in the] pockets of companies like Juul, who can absorb a 25% tax easily," said LeBlanc, who spoke at both meetings.

(Juul is not happy with the bills; recently it sent a message to its customers asking them to reach out to their legislators in opposition of the bills. The website includes a link to a message that states opposition to the bills.)

The opponents said their goal is to help people quit smoking cigarettes, and argued that the tax would discourage adults who want to use them as a smoking-cessation device. Further, they said it will push teens into purchasing their products online.

Jason Underwood, a lobbyist for the group, cited a study by the National Bureau of Economic Research that found higher e-cigarette taxes could lead to increased cigarette smoking. The study looked at Minnesota data, which imposed a 95% tax on e-cigs, much higher than proposed here.

Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky, endorsed the 25% tax.

"We know that raising the price of tobacco products is one of the most effective measures for reducing tobacco use," he said, adding later, "An excise tax of 25 percent of the wholesale price is close enough to the current tax on cigarettes and would lead to a substantial enough price increase to create a considerable reduction in youth vaping."

Rep. Lynn Bechler, R-Marion, who cast the only vote against the tax bill, said he didn't think this "sin tax" was warranted because people are already taxed enough. He added that he had taken the testimony of the "vape" shop representatives to heart.

"I don't want to put those people out of work," he said. "So if we're putting people out of work and the epidemic isn't going to lessen, I don't understand the reason to do it."

Beshear's budget recommends a small increase in the existing tax on cigarettes and other tobacco products and a 10-cent-per-milliliter tax on vaping liquids. These hikes are projected to raise $57 million over the next two years.

E-cigarettes are subject to the state's 6 percent sales tax, but that's all; they are the only tobacco product in Kentucky that does not have an excise tax.

State health department issues caution regarding flooding

With polluted floodwaters rising in Kentucky, the state Department for Public Health is reminding residents of how to deal with it in healthful ways.

“We urge Kentuckians to use caution in flooded areas, and once floodwaters recede and the clean-up begins, to keep yourself and your family safe,” said Rebecca Gillis, director of the Division of Public Health Protection and Safety. “Taking the time to follow safety guidelines related to food safety, mold removal and other issues helps prevent unnecessary injury and illness.”

The guidelines include:

Flood Waters
  • Flood cleanup poses risks of wounds, so cleanup workers should be sure that they are up-to-date with tetanus vaccinations, ideally before starting cleanup activities. Adults need a tetanus booster shot every 10 years. Td or Tdap can be used; getting the Tdap instead of Td for one tetanus booster during adulthood is recommended to maintain protection against pertussis (whooping cough). Being up-to-date for tetanus vaccine can greatly simplify wound treatment.
  • Flood-related drowning can occur when people become trapped by rising flood waters or when voluntarily enter flooded areas. Never enter flood waters unless you are escaping immediate danger. Do not attempt to drive a vehicle through flood waters, even if they appear shallow. Monitor the weather conditions and water levels to avoid becoming surrounded by water.
  • Floods can damage utilities, leading to downed power lines and a risk of electrocution. Stay clear of damaged power lines. Natural gas and propane systems can produce dangerous gas leaks. If you smell gas, open doors and windows and evacuate the area.
Home Clean-up and Mold Removal
  • Wear proper safety equipment, such as work gloves, boots, helmets, eye and ear protection, and chainsaw chaps when operating power tools or machinery.
  • Ensure that all electrical tools are properly grounded and use ground-fault interrupters if available. Never use electrically powered tools in or near standing water.
  • Homeowners whose homes sustained water damage are urged to follow recommendations to limit mold growth. Mold fungi can be found both indoors and outside, and can accumulate in homes affected by water damage.
  • Signs of mold include discolored walls, possibly showing water damage, or green or black spots on walls. Mold also has a musty, earthy smell or a foul stench. Allergy sufferers tend to be most affected by it.
  • If mold is growing in your home, you will need to clean it up and fix the moisture problem. Mold can be removed from hard surfaces with commercial products, soap and water, or a bleach solution of no more than 1 cup of bleach in 1 gallon of water. Severe mold cases may require an expert.
  • Doors and windows should be open while cleaning affected areas. Use protective glasses or goggles, rubber boots and waterproof gloves, and wash clothing afterwards. If there is heavy mold growth, use a respirator or suitable mask to prevent breathing the mold. Remove all wet items that have been wet for more than 48 hours and cannot be cleaned and dried.
Food Safety
  • Think about food safety if you have been affected by power outages. Keep freezers closed to maintain proper temperature for frozen foods. A freezer will hold its appropriate temperature for approximately 48 hours when full, and for 24 hours when half full. If you have power outages, it is best to keep freezers closed to help keep frozen food from going bad.
  • Refrigerated foods should be safe as long as power is out for no more than four hours. Throw away any perishable food in your refrigerator, such as meat, poultry, lunch meats, fish, dairy products, eggs and any prepared or cooked foods that have been above 40 degrees Fahrenheit for two hours.
For more on health issues and flooding, visit https://www.cdc.gov/disasters/floods/index.html or
https://healthalerts.ky.gov/Pages/FloodSafety.aspx.

List of top 100 rural hospitals by health-care analytics firm's rural-health center includes those in Cynthiana and Winchester

Clark Regional Medical Center in Winchester and Harrison Memorial Hospital in Cynthiana were named on a list of top 100 rural and community hospitals for 2020.

The Chartis Center for Rural Health, owned by health-care analytics consultancy The Chartis Group, announced the list today at the Rural Health Policy Institute's annual conference. The RHPI is part of the National Rural Health Association.

The hospitals on each list are grouped by state, but not ranked, so there is no single "best" hospital. The rankings are based on Chartis' Hospital Strength Index, which considers performance based on 50 rural-relevant factors in eight broad market-, value-, and finance-based categories.

At the RHPI's annual Rural Health Conference in May, Chartis will recognize the top 20 rural and community hospitals on the list.