County health rankings in Kentucky show few changes, but ranks are less important than the trove of data they reflect

By Tara Kaprowy
Kentucky Health News

The health evaluation tool that calls itself "the annual check-up of over 3,000 counties in the nation" was released today, showing little change from last year in how Kentucky counties compare when it comes to factors like obesity, smoking rates and mortality. But the data provide plenty of fresh angles for stories about the health status of individual counties and regions.

The County Health Rankings for Kentucky, which are compiled by the University of Wisconsin Population Health Institute in collaboration with the Robert Wood Johnson Foundation, ranked Appalachian counties at the bottom and Central Kentucky counties in the Lexington and Louisville markets at the top. The far western portion of the state ranked lower as well.

The rankings fall into two categories: health outcomes and health factors. Health outcomes, left, include factors such as premature death rates, low birthweight and how many days of the past 30 that someone said they felt bad physically or mentally. Boone, Oldham and Calloway counties ranked first, second and third in health outcomes category, and Wolfe, Martin and Owsley were at the bottom.

In health factors, right, Woodford, Boone and Fayette counties were first, second and third, and Jackson, Clay and McCreary at the bottom of the list. Health factors include the percentage of adults who smoke, are obese or drink excessively; and assess a county's health care landscape: the number of primary-care providers and what percentage of adults are uninsured, for example. Social and economic factors in this ranking include unemployment rates, high-school graduation rates, percentage of children in poverty, pollution rates, access to healthy food and the number of recreational facilities. (The last item replaced the number of liquor stores. "Some of the data were not available for the availability of alcohol and it was difficult to interpret," said Dr. Patrick Remington, project director and associate dean for public health at the University of Wisconsin. The change could have affected the rankings, because Kentucky has many "dry" counties and liquor stores often cluster in "wet" counties adjacent to dry ones.)

Interestingly, the rankings between the two categories vary considerably. Fayette County, for example, ranked third in the health factors list but 10th in the health outcomes assessment. McCracken County was listed eleventh in the health factors list but 45th in health outcomes.

Though Appalachian counties in Kentucky, West Virginia and Tennessee generally ranked very low, there was one very bright spot: Morgan County, which ranked 23rd in health outcomes despite being surrounded by counties that were down in the 100s. It also ranked high last year.

While the rankings didn't change drastically from last year, there was some deviation downward in the Southern Kentucky, including Adair, Clinton, Cumberland and Wayne counties. But Shawn Crabtree, executive director of the Lake Cumberland District Health Department, didn't see much reason for concern. "Naturally, the rank of counties are going to go up and down each time," he said. "I don't know that the communities are any sicker or that anyone is doing anything any different."

Crabtree said it is important to remember the assessment is ranking one county against another, not making a comment on if counties are getting healthier or not. "That's not to say our area isn't an unhealthy area; it is," he said. "That doesn't mean we don't need to improve; we do."

Also, statistical data from counties with small populations can greatly affect rankings. "That number is a little bit volatile," Remington said of certain disease numbers. "It's not a survey, it's the actual experience of what happened." He added, "When you present a statistic for an entire community, you realize it's an average. This is like a screening test. It tells people in a community where the problem areas are, but it really doesn't make the diagnosis."

 

Researchers assembled the snapshot county portraits with information from several sources, including the Behavioral Risk Factor Surveillance System, a random telephone survey by the Centers for Disease Control and Prevention. They also used data from the National Center for Education Statistics, the National Center for Health Statistics and the Census Bureau's American Community Survey and Small Area Income and Poverty Estimates. For a complete list of sources, click here.

Given the number of sources used and the conclusions drawn, researchers hope the data will spur community interest and, ultimately change. In a conference call with reporters, Mayor Joe Reardon of Kansas City, Kan., said, "It was a call to action for me personally and a wake-up call for our community."

Feds say they will post data on performance of dialysis centers

"Federal regulators say they are moving to make once-confidential data about the performance of kidney dialysis clinics more readily available to the public," reports Robin Fields of ProPublica, the nonprofit, investigative news group that posted the data online in December. (ProPublica map locates Kentucky dialysis facilities with dark blue dots; gray areas are lakes and national forests)

Last year, a ProPublica investigation showed inferior care and little oversight in some facilities. Officials with the Centers for Medicare and Medicaid Services told Sen. Charles Grassley, R-Iowa, they are now making public their statistical compilations on the country's 5,000 dialysis clinics. This has never been done before, though CMS "has used public money to collect and analyze the data in the reports for more than a decade," Fields reports. CMS is planning on posting the reports on Medicare's Dialysis Facility Compare website. ProPublica has already posted those reports, which can be viewed by clicking here.

ProPublica's investigation reviewed eight years of inspection records for more than 1,500 clinics and "turned up hundreds of lapses in care, some of which led to patient injuries and death," Fields reports. It also found hundreds of clinics had not been inspected for five years or more, though they are supposed to be checked every three years. Upon learning of the investigation, Grassley asked CMS about what it was doing to improve things.

CMS officials conceded that inspections were inadequate in more than a third of the states. Tougher standards had reportedly been implemented to make the inspections more comprehensive; they are apparently needed. In the past two fiscal years, 15 percent of facilities inspected had "deficiencies serious enough to warrant termination from the Medicare program if left uncorrected," Fields said. (Read more)

People with low health literacy are more likely to get sick, die

Health literacy rates are increasingly gaining the attention of providers, organizations and lawmakers. A new report based on study of medical literature says people who are unable to understand and act on issues related to their own health care have poorer health and a higher risk of death.

Adults with low health literacy are less likely to get a flu shot, understand medical labels and instructions, and have a greater likelihood of taking medicine incorrectly, the report says. Also, women with low health literacy are less likely to get mammograms. Overall, the report indicates that minorities have lower health literacy rates than the rest of the population.

More than 75 million English-speaking adults across the nation have difficulty understanding and using basic health information. That was the focus of the second annual Kentucky Health Literacy Summit last week.

The report, which was released Monday, updates 2004 literature that reviewed the findings of more than 100 studies. It was compiled by the Agency for Healthcare Research and Quality in the U.S. Department of Health and Human Services.

In May 2010, the department launched an action plan that asks stakeholders to simplify their health-related handouts, forms and websites by removing jargon and complicated explanations. It also calls for improving patient-provider communication. (Read more)

Rural hospitals in Kentucky say health reform will hurt them

Though the new national health-care law may increase the number of insured Americans by 32 million, rural hospitals in Kentucky aren't expecting a revenue windfall. That's because half of the people who will be newly covered will be Medicaid patients, "who have been big losers for hospitals in cash-strapped states where Medicaid payments do not cover costs," The New York Times' Milt Freudenheim reports.

"We should repeal it all and start over," said Milton Brooks, administrator of Pineville Community Hospital. "Most hospitals are barely breaking even. When you take a couple of million dollars out of our pocketbooks, we're gone." The Kentucky Hospital Association has said the law will cost its hospitals $1.28 billion over 10 years because of "reduced Medicaid payments for more Medicaid patients as well as lower federal payments to make up for losses," Freudenheim reports. The KHA is not calling for repeal, but is asking for some changes to the law.

Some major national players support the new health care law, including the American Hospital Association, the Catholic Health Association, the Federation of American Hospitals, the National Association of Children's Hospitals and the Association of American Medical Colleges. (Read more)

More N. Ky. kids taken from homes due to parents' drug use

An increasing number of children in Greater Cincinnati are being taken from their homes because their parents are drug users.

In Campbell County, Kentucky, 68 children were removed from their homes last year compared to 49 in 2008, a 39 percent increase in two years, The Cincinnati Enquirer's Barrett J. Brunsman reports. In the same period in Boone County, the number increased by 34 percent, from 38 to 51. In Kenton County, 346 children were taken last year compared to 286 in 2008, a 21 percent increase.

Ohio counties near Cincinnati showed larger increases and also showed that children are increasingly being removed because their parents are using heroin and other opiates. Kentucky does not track what substances parents use, and doesn't keep statistics on the number of babies who are born addicted, but Anya Weber, a spokeswoman for the Kentucky Cabinet for Health and Family Services, said drug or alcohol abuse by a parent or guardian is a factor in 80 percent of all cases of children who are removed.

Because of the increases, foster parents such as Mark and Denise Strimple (Enquirer photo by Carrie Cochran) are needed. "We always need more," said Brian Gregg, a spokesman for the Hamilton County Department of Job and Family Services. "Not just us, the whole region. I can't put a number on it. A lot of foster parents end up adopting children in their care, and that takes them out of the mix." (Read more)

Providers recommend restricting 3 cancer drugs in Medicaid

In an effort to save money, health officials are considering a move that would restrict three cancer drugs for the 800,000 Kentuckians who are enrolled in Medicaid.

Patients could still get the drugs but would need advance approval from Medicaid. The move was recommended to Cabinet for Health and Family Services Secretary Janie Miller by a committee of health care providers. Committee member and oncologist Dr. Cora Veza said the drugs are not commonly prescribed "and she did not believe the recommendation would limit the treatment of Medicaid cancer patients," The Associated Press reports.

As the number of Medicaid enrollments increases due to the recession, other states are reportedly considering making similar moves. (Read more)

Health literacy is 'at a tipping point' as an issue to be confronted, federal official tells second Kentucky Health Literacy Summit

By Tara Kaprowy, Kentucky Health News

BOWLING GREEN, Ky. – The idea that people will be healthier if they can better navigate the boggy, confusing landscape of health care and insurance is gaining traction in Kentucky – which, relatively speaking, has poor health and low literacy.

On Thursday and Friday, scores of health professionals and their allies in the health-literacy cause gathered in Bowling Green for the annual Kentucky Health Literacy Summit. It was the second such gathering, but the first was by invitation, so this was the first opportunity for anyone interested in health literacy to attend a statewide conference about it. The first conference resulted in the formation of Health Literacy Kentucky, an alliance of more than 35 groups.

Health literacy is the "degree that an individual can obtain, communicate, process and understand" basic health information, said Dr. Linda Harris, a Bowling Green native who leads the health communication unit in the U.S. Department of Health and Human Services. Only 12 percent of U.S. adults are considered proficient in health literacy, while 21 percent have basic knowledge and 14 percent are below basic. About half of adults have intermediate knowledge, between basic and proficient.

Health literacy has become an increasing problem as health care has become more technical and complex, and as America has more people for whom English is a second language. If people can't understand what they're being told about their health, they are more likely to get sick -- and less likely to get better once they're ill, Harris said.

She illustrated her point with the story of "Mrs. Jones," a composite individual with issues requiring health literacy: a 62-year-old woman with diabetes, heart failure, low income and a history of depression. She gets sick, goes to the doctor, is prescribed several medications she doesn't know how to take, avoids taking them and eventually needs to be hospitalized. Then she is given a second set of prescriptions that she also doesn't understand. She is re-hospitalized "and the cycle continues," Harris said.

Harris said the issue is at a "tipping point" because it has gone from simply being discussed among advocates to being made policy in legislation like the Patient Protection and Affordable Care Act; the National Action Plan for Health Literacy, the Plain Writing Act of 2010; and Healthy People 2020. "We really think this is the moment," Harris said. "It's not just those people who have been laboring in the vineyards for so long."

Insurance companies making headway

Some of the most innovative health-literacy work is being done by insurance companies, most of which are taking steps to make sure their policyholders understand the forms and documents they're sending them, Humana Inc. marketing consultant Betsy Shirey said. In the past year, Humana has simplified more than 400 of its documents, most of which have been rewritten at a sixth-grade level, as determined by a computerized assessment tool, she said.

To test the rewritten materials, Humana had some of its Medicare members look at the new documents. One person said a form could be simplified if it only had a date at the bottom of it. "They told us about really simple things, and yet we hadn't done it," Shirey said.

The new forms are better designed, with headlines and age-appropriate photography, and "always have a P.S., because everyone always reads the P.S," Shirey said. The document that gives patients a rundown of their to-date expenses, medications and doctors' visits looks like a credit-card statement. "You have a complete picture both financial and medical," Shirey said.

(Humana was the major sponsor of the summit, along with the University of Kentucky and Western Kentucky University.)

Revelations among providers

Simplifying documents was also the goal at People's Community Clinic in Texas, when Special Projects Supervisor Dana Carpenter came across a form that detailed how to take birth control pills. "Someone with a Ph.D. would have trouble understanding it," she said. With help from patients, Carpenter simplified the form, adding photos and "plenty of white space."

About 80 percent of the clinic's patients are Hispanic, so Carpenter was shocked to learn that, when she called the clinic, there was no telephone prompt asking the caller if they wanted to converse in Spanish. "You had to listen to the entire English menu before it would roll into Spanish," she said, and the clinic's directional signs were all in English and hidden by clutter. New signage is bilingual and prominently displayed.

Christine Nagy and Diane Sprowl said they went through a similar process in a joint venture between Western Kentucky University and the Barren River District Health Department. The goal was to get participants in the Women, Infants and Children food program to eat more fruits and vegetables. Patients were asked to fill out surveys, which needed to be designed for people who did not speak English well. Nagy, Sprowl and WKU students designed materials with bullet points, white space and culturally appropriate graphics. They kept the reading level low by using words with few syllables. They also met with patients face to face to help avoid communication breakdown.

Oral communication

More than just rewriting forms, health literacy involves making sure people understand what they're being told. To that end, insurance firms like Humana and providers like the People's Community Clinic are teaching employees how to communicate in a simple, uniform way. Often this involves the "teach-back technique," where you "have them explain back what you've gone over," said Dr. David Susman, psychology services coordinator at Eastern State Hospital.

Susman said it's important to look for clues that a person is having difficulty understanding, such as incomplete forms, lack of adherence to directions, or even looking in a pill bottle to determine what pill they're taking rather than reading the label.

Ultimately, the goal is to keep patients from the fate of Mrs. Jones. "No one is going to say, 'Oh by the way, I have limited health literacy,'" Susman said. "And no one complains about information being too simple."

For a list of advance registrants for the summit, click here.

Annual county health rankings will be released Wednesday

The national County Health Rankings for 2011 will be released Wednesday, March 30. The rankings give a snapshot view of every county in the nation by examining factors such as rates of obesity, smoking, uninsured adults and various diseases.

The Robert Wood Johnson Foundation will host a live teleconference that day to brief news media about the data. Speakers will include James Marks, senior vice president and director of the Health Group at the RWJF; project director Patrick Remington, associate dean for public health at the University of Wisconsin; and Joe Reardon, mayor of Kansas City, Kan.

The conference will be held from 10 to 11 a.m. EDT. For free registration, click here. To view the County Health Rankings for 2010, click here. The rankings are used to produce a county-by-county Health Outcomes Map for each state. Here is Kentucky's for last year; for an interactive version, which enables county-by-county information, click anywhere on the map.

Communities, crusaders for smoking bans honored at ceremony

The Bullitt County Health Department, the City of Bowling Green and the 2010 edition of the Campbell County Fiscal Court won 2011 Smoke-free Indoor Air Excellence awards from the Kentucky Center for Smoke-free Policy at a ceremony in Lexington Thursday. All recently passed smoking bans; a newly elected fiscal court in Campbell County repealed the ban there. The ban in Bullitt County faces a lawsuit from the Fiscal Court.

The Kenton County Fiscal Court and the City of Oak Grove received the 2011 Smoke-free Indoor Air Endeavor award. Those jurisdictions enacted bans that do not apply to bars.

Dr. Melissa Walton-Shirley, left, received the Dr. David B. Stevens Smoke-Free Advocate of the Year award. Walton-Shirley has been a private-practice cardiologist in Glasgow for the past 20 years. She spearheaded the successful smoke-free movement in Glasgow, which won passage of a smoking ban in June 2010, and has pioneered a push to improve access to acute heart attack care for hospitals without requiring onsite surgery.

To date, anti-smoking ordinances or Board of Health regulations have been implemented in 29 Kentucky communities. In 18, the restrictions cover all workplaces, including restaurants and bars. Bullitt County is the most recent addition; its health department passed an ordinance March 22. Nearly one-third of Kentuckians are protected by comprehensive workplace laws, according to the Center for Smoke-free Policy, based in the College of Nursing at the University of Kentucky.

Beshear will use line-item veto on Medicaid bill to remove mandatory cuts in other state programs and school funding

Democrats appear to have prevailed in the State Capitol battle over the budget and Medicaid. (Update, March 25: Beshear issued the vetoes.)

After the Republican-controlled Senate passed a budget fix that included mandatory spending cuts across state government and basic school funding, and Gov. Steve Beshear said he would remove the cuts with line-item vetoes, the House passed the Senate's bill and the legislature sent it to the governor.

Legislators will return April 6 to give each chamber a chance to override the promised vetoes, but in a rare floor speech before the 86-1 vote, House Speaker Greg Stumbo, D-Prestonsburg, left, made clear that the House considers the deal done.

"He said the unusual maneuver was necessary because lawmakers must pass a bill that balances Medicaid before April 1 to avoid what Beshear has said would be 35 percent cuts in rates paid to Medicaid providers. Such a move, Stumbo said, would damage rural health care providers," Tom Loftus and Deborah Yetter report for The Courier-Journal. "House Republican Leader Jeff Hoover of Jamestown urged House members to vote for the bill, saying that small health care providers will be spared devastating cuts on April 1 and education funding won't be cut."

The House wanted to adjourn the special session, but the Senate declined. Senate President David Williams, who is running to oust Beshear in the November election, "noted that the legislation approved by both chambers Thursday says that lawmakers will not be paid during the veto period. Each day of the session, which was in its 11th day Thursday, costs taxpayers about $63,500," Beth Musgrave and Jack Brammer report for the Lexington Herald-Leader. (Read more)

Groups try education to allay confusion about health reform

Though the Patient Protection and Affordable Care Act celebrates its first birthday today, most Americans admit they are still largely confused by what its provisions will mean for them. To help increase understanding, many organizations are launching or expanding their educational efforts.

Kentucky Voices for Health has put together a brief, right, to promote understanding, addressing a range of issues from pre-existing conditions to Medicare drug donut holes. It outlines what provisions will take effect when, answers other commonly asked questions, and looks at how the new law will benefit Kentuckians.

The group, which does not lobby but comprises organizations that do, has also issued statements on how the new law protects small business, seniors, patients' rights and protecting women.

The Health Foundation of Greater Cincinnati has launched a public education effort, FOX19's Matt Miller reports. "Sections of the Affordable Care Act have already begun to take effect and the community needs information," said Kate Keller, foundation senior program officer. "We want to help people understand changes coming and new benefits for which they may be eligible."

The foundation will distribute informational pamphlets through community organizations and will feature a website about the new law. (Read more)

Bullitt County health board votes to make county smoke-free; Fiscal Court wants a judge to decide if a board has that power

Bullitt County's board of health voted to enact a countywide smoking ban Tuesday evening, but the county's Fiscal Court wants a judge to decide if the board has that authority.

"This is not about the smoking ban," Judge-Executive Melanie Roberts told WAVE-TV's Connie Leonard. "This is about which agency can enact legislation." Health Department Director Swannie Jett said fighting the ban is "ludicrous if you just think about the health impacts."

The Bullitt County Board of Health is not the first in Kentucky to enact such a ban. Health boards in Woodford, Hopkins, Madison and Clark counties did likewise. The move in Hopkins County did result in a legal battle, but the judge sided with the health department. (Read more)

Meanwhile, in a story healdined, "Smoking-ban advocates find Southern Kentucky a hard sell," the Lexington Herald-Leader's Bill Estep explains how a multi-county agency such as the Lake Cumberland District Health Department can enact a smoking ordinance. "A county health department that stands alone can approve a smoke-free law by regulation," he reports. "Counties under a district health department board can't, however; the multi-county board would have to approve such a regulation for the entire district." (Read more)

St. Joseph Health System CEO is leaving for Texas

The chief executive of Saint Joseph Health System is leaving his post June 1 to join a health group in Dallas. Eugene Woods, right, will become executive vice president and chief operating officer of Christus Health, a system with facilities in 60 southern U.S. cities.

St. Joseph is best known for its two Lexington hospitals, but it also has hospitals in Bardstown, Berea, London, Martin, and Mount Sterling, and an ambulatory care center in Nicholasville. The Catholic system expanded under Woods's watch to 1,012 beds, 5,000 employees and 1,300 physicians.

The move comes in the midst of St. Joseph's negotiations for a merger with two hospitals in Louisville, Jewish Hospital and the University of Louisville. Woods said the merger discussions are going well, and St. Joseph's interim leadership will be announced in two or three weeks, the Lexington Herald-Leader's Linda Blackford reports.

Electronic health records are the new frontier in health care

By Tara Kaprowy
Kentucky Health News

Just two years ago, the acronym EHR didn't mean much to many people. But since Congress passed the health-care reform law last year, physicians and hospitals have become intimately acquainted with it — and patients may follow suit.

EHRs are electronic health records. They are quickly being adopted by hospitals and physicians as the federal government begins to pay out $19 billion in incentives: extra Medicare and Medicaid payments. Kentucky health care facilities and providers have been especially eager to sign up, perhaps because so few of the state's doctors had adopted EHRs. Kentucky doctors' offices were the least digitized in the nation last year, according to a national survey.

An EHR is a digitized copy of a person's health record, essentially replacing the file folder that has typically held handwritten information about a patient. It generally contains information about a patient's laboratory and radiology results, diagnoses, prescriptions and other treatment.

EHRs' advantage is their easier accessiblity. Rather than being locked in a doctor's office, the information, in theory, can be accessed by other health-care providers, regardless of which one the patient is seeing. "It's about the information always moving with you," said Nancy Szemraj, spokeswoman for the Office of the National Coordinator for Health Information Technology.

"That's like the pot of gold," said Jeff Brady, executive director of the Governor's Office of Electronic Health Information. "If you've been to six different hospitals and three different doctor's offices, literally all of that data can be viewed."

EHRs are expected to reduce unnecessary tests and treatment because they will list tests that have been performed, and to reduce the potential for medical errors, because they containing such cautionary information as the patient's allergies.

Protecting your information

One risk of electronic health records is the potential for the information being leaked, lost, altered or merely read by an unauthorized person. Leaks can be purposeful or by accident. In January, the private information of thousands of people who visited the Green River District Health Department in Owensboro was found online, where it had been mistakenly available for several months.

Brady acknowledged the danger of unauthorized access, but said safeguards have been taken to avoid it. Participating providers in the Kentucky Health Information Exchange, the state clearinghouse for EHRs, have to sign several agreements in which they attest the information they obtain will be used responsibly.

"The golden rule is this data will only be viewed by a provider who is providing care to a patient," Brady said. To make sure that is happening, he said, the software has an audit function, in which administrators are able to see who looks at a patient's data, when they did, from what computer and what piece of data they examined.

The national network will not be a database, and thus not in danger of being hacked, said Szemraj, of the national office. "It's simply a means to securely push and pull information as needed," she said, citing an example of a person traveling around the country and falling ill in New York City. "At that time, they would be able to tap into your medical record in your home base and say, 'I want to pull your medical information.' It's not literally sitting out there in a repository where anybody could hack into it."

To set up EHR systems, hospitals and doctors choose from a list of federally approved software. The programs don't "necessarily have to communicate with each other," Brady said, "but they do have to conform to certain standards that would allow them to communicate with a health information exchange."

The state's exchange has been operating in the pilot stage since April 2010. It will act as a "middleman" between hospitals and health care providers, Brady said. "We will be the hub and all information will flow from a provider, to us, back to another provider."

Under ideal circumstances, Brady said he hopes to see half of the state's hospitals and doctors' offices connected to the exchange by the end of the year, with the other half signed on by the end of 2012. That may be ambitious, since a recent survey showed Kentucky had the lowest percentage of doctors' offices that have adopted EHRs, just 38 percent, compared to 51 percent nationwide.

While Kentucky builds its exchange, other states are doing the same. Eventually, the goal is to create a National Health Information Network that will allow information to flow from state to state. That will be especially beneficial to Kentucky, Brady said, "because we have so many hospitals and medical facilities on our border. We're talking to Tennessee and Ohio about exchanging data with them. There's going to be a lot of development in the next 12 months."

But when will the state information exchange or national network be useable? Brady said no date has been set for the state exchange, and Szemraj said of the national network, "We are truly just beginning."

Cost savings?

The Obama administration and other supporters of the health-reform law say EHRs will save money. A 2005 study by the RAND Corp. indicated that implementing EHRs and networks could eventually save more than $81 billion per year by improving health care efficiency and safety, but that study was theoretical in nature and assumed 100 percent compliance, Drs. Jerome Groopman and Pamela Hartzband wrote in an op-ed piece in The Wall Street Journal.

Some data show EHRs do not necessarily improve patient care, the doctors wrote, pointing to a study published in the journal Circulation that reviewed the influence of EHRs on the quality of care received by more than 15,000 patients with heart failure. It concluded that "Current use of electronic health records results in little improvement in the quality of heart-failure care compared with paper-based systems."

Another study looked at the Department of Veterans Affairs' health information technology investments and estimated a potential value of $3.1 billion "in cumulative benefits net of investment costs." But Brandon Glenn of Medcity pointed out "the study's lead researcher stressed the dollar amount reflects only what's possible — not actual savings."

The prevailing opinion in the industry is that EHRs will save money, but no one is really sure how much. On the expectation of savings, the health-reform law calls for extra Medicare and Medicaid payments to providers as incentives to adopt the technology. Providers have until 2014 to adopt EHRs. If they don't, Medicare will start penalizing them by paying them less in Medicare payments.

A rural equalizer?

Since the Centers for Medicare and Medicaid Services started distributing EHR incentive payments in January, Kentucky hospitals and other health-care providers have received more than $18 million of about $38 million handed out nationwide so far. University of Kentucky Healthcare and Central Baptist Hospital, which together received $4.1 million, were the first facilities in the nation to receive the extra payments. In the next four years, Kentucky hospitals are expected to receive more than $100 million in incentives.

For a spreadsheet of incentives paid to Kentucky providers through last week, click here.

To receive the incentives, which can mean up to more than $60,000 for eligible professionals and millions for hospitals, applicants must prove their EHR systems are being used in a meaningful way. To show "meaningful use" in the first of three stages — the only stage that, so far, has been officially defined — eligible professionals must show "continuous quality improvement and ease of information exchange," according to regulations in the Federal Register. Professionals must meet 25 measures, hospitals 24, to prove meaningful use. One measure, for example, is the ability to send electronic data to the state's immunization registry.

The list of incentives already paid shows providers in the most rural to the most urban areas areas of Kentucky are switching over at equally rapid rates. In fact, two of the few hospitals already linked up to the Kentucky Health Information Exchange are Pikeville Medical Center and Murray-Calloway County Hospital, both outside metropolitan areas.

Brady said the Office of the National Coordinator for Health Information Technology "is very interested in rural areas, the critical-access hospitals, the very small but important hospitals . . . that typically get left out on technology. This an effort to bring them along and be the equalizer."

Second summit will shed light on health literacy

The second annual Kentucky Health Literacy Summit will be held in Bowling Green Thursday and Friday.

"The event will raise awareness about low health-literacy skills," The Courier-Journal's Darla Carter reports. "Skills include the ability to fill out forms, find health providers and services, and take medications correctly." It will also shed light on available resources, the patient perspective and practices at work.

Called "Health Literacy in Action," the event will run from noon Thursday to noon Friday at the Holiday Inn University Plaza. It is sponsored by Humana Inc., the University of Kentucky and Western Kentucky University. (Read more) The event's website is here.

Parents' insurance can now cover children up to age 26

Following the lead of the federal health-care law, Kentucky employers can now extend health coverage to their employees' adult children. The employees will not be subject to state taxes if they opt for the coverage, Business Insurance's Jerry Geisel reports.

Gov. Steve Beshear signed House Bill 255 last week. "The law requires employers to extend health care coverage to employee's adult children up to age 26," Geisel reports. "Under prior Kentucky law, an employee's child had to be younger than 19, or 24 if a full-time student, for the coverage to be provided on a tax-free basis."

Similar laws have been passed in Arizona and Maine this year. The extended coverage has been one of the most highlighted pieces of the Patient Protection and Affordable Care Act, which was signed into law a year ago tomorrow.

Near-unanimous House passes Medicaid plan; Senate mum

By an overwhelming margin of 94-4, the state House today passed a bipartisan bill to fix the state Medicaid budget, again putting the ball in the court of the Republicans who control the Senate. They declined to comment.

The House again adopted Democratic Gov. Steve Beshear's plan to transfer money from the second year of the budget amd make up the difference by instituting managed-care plans, but this time included what House Republican Leader Jeff Hoover called "triggered" cuts if Beshear falls short.

"Beshear would have to certify by Aug. 15 the amount he can save within Medicaid in the fiscal year that begins July 1," Beth Musgrave and Jack Brammer report for the Lexington Herald-Leader. "The bill also would let Beshear use about $23 million in one-time money to offset any shortfall if there are no savings in the Medicaid budget. Anything short of the remaining $116 million needed to balance the Medicaid budget would trigger cuts in most other parts of state government." The Courier-Journal's Tom Loftus and Deborah Yetter note, "Public schools, universities and a few other selected areas would be exempt." (Read more)

In a video interview posted via Facebook, Hoover said the bill is "a lot better" than the one the House passed 80-19 in the regular session. But he called it only "a first step" toward finding an agreement with the Senate, and said he expected the matter to again reach a House-Senate conference committee. He said House Republicans "want to move above the fray of the politics of this. . . . I hope and think that the Senate now recognizes that we're part of the process." Senate President David Williams was personally critical of the House GOP leader after Hoover rebuffed Williams' plan to make small cuts in basic school funding.

New website, www.SortingThroughTheSmoke.com, offers journalists local and state information on tobacco and health

Three Kentucky organizations are launching a website to serve as a one-stop shop for journalists covering tobacco and health issues in Kentucky, and for others interested in documenting the impact of Kentucky’s tobacco use on the health of the state's residents.

SortingThroughTheSmoke.com is administered by Kentucky Youth Advocates with assistance from the Institute for Rural Journalism and Community Issues and the Kentucky Center for Smoke-free Policy, both based at the University of Kentucky. The site provides state and county-level data, contact information for local and state experts, local and regional news coverage of the issues, and other resources to help tell the story behind tobacco and health in Kentucky.

The site is funded by the American Legacy Foundation, created with money from the 1998 settlement between states and cigarette manufacturers. It carries the same name as a series of 2009 workshops funded by the foundation and conducted by the Institute for Rural Journalism and Community Issues for Kentucky Youth Advocates. On the hot topic of smoking bans, it includes links to information from supporters of regulation and those who favor a libertarian, free-market approach.

New law on diabetes educators is only one of its kind in U.S.

The new Kentucky law requiring that diabetes educators be licensed is the only one of its kind in the country. The American Association of Diabetes Educators says the law will "enhance consumer protection and increase professional recognition," The Courier-Journal's Laura Ungar reports. The group would like to see similar license requirements in every state in the nation.

Senate Bill 71 was sponsored by state Sen. Alice Forgy Kerr, left, R-Lexington. It was signed by Gov. Steve Beshear earlier this week. It is one of two bills that passed this session that addresses diabetes, a growing problem in Kentucky. In 2009, Kentucky had the nation's fourth highest rate of diagnosed diabetes, state officials say. Senate Bill 63 charges several state agencies, including the Department of Public Health, with the responsibility of trying to reduce the incidence ofdiabetes in the state and improve diabetes care.

Diabetes educators, who can be nurses, dieticians, physicians or other health-care professionals, counsel patients about nutrition and physical activity, educate them about their medications and teach them how to monitor their blood glucose. (Read more)

Drink bottles, cans must now show calorie content on front

In an effort to educate people about how many calories they're sucking back, the front labels of packaged beverages in bottles or cans of 20 ounces or less must now show the total number of calories they contain.

"Beverage containers traditionally 'hid' the nutritional content at the back in a small square with small print and cleverly listed just calorie content per serving," said Dr. Jessica Bartfield, part of a physician-led team with Loyola University Health System that is trying to help people change behaviors that lead to them being overweight. "Unbeknownst to those who are happily guzzling their favorite cola or fruit drink, most packaged beverages contain multiple servings, and most Americans fail to do the math on the total calorie count."

In terms of caloric consumption when it comes to fruit and soft drinks, Bartfield shared some troubling statistics, which research research-reporting service Newswise listed:

• The average American consumes 22.5 teaspoons of added sugar each day. Half of that amount comes from soda and drinks, the National Health and Nutrition Examination Survey (1999-2004) showed.

• One in 10 overweight adults "consume 450 calories of sugar sweetened beverages per day, which is three times that of an average American. Cutting 450 calories per day would lead to about a 1 pound per week weight loss, close to 50 pounds in one year," Bartfield said. (Read more)

Maine gets health-reform exemption that Kentucky also wants

Maine has been granted an exemption that Kentucky is also seeking — one that will exclude it from being subject to the health reform's medical-care ratio rules.

The ratio requirement "mandates that at least 80 cents out of every premium dollar go toward patient care and quality improvement, rather than administrative costs and plan profits," Amednews.com's David Glendinning reports. Under the exemption, which has been granted until 2013, Maine insurers will only have to spend 65 percent of premiums on care.

The Department of Health and Human Services contends the Maine insurance market could not bear the impact of the new regulation. The state is only served by three major insurers, one of which threatened to pull out if the regulation stood. Kentucky, Florida, Nevada and New Hampshire have applied for similar exemptions. (Read more)

Forum on health-reform law to be held in Lexington March 21

In time for the one-year anniversary of the passage of the Patient Protection and Affordable Care Act, a forum will be held in Lexington to review the ins and outs of the law.

"This is not a debate about reform, but it is a chance for interested parties to get better educated by some of the top professionals in the field," said Mark Johnson, health equity team leader with the Lexington-Fayette County Health Department.

The forum will be held from 5 to 7 p.m. March 21 at the Lyric Theatre and Cultural Arts Center, 300 E. Third St. in Lexington. Speakers will include Jodi Mitchell, executive director of the Kentucky Voices for Health; the Rev. Marian M. Taylor, executive director of the Kentucky Council of Churches; and Anton J. Gunn, regional director of Region IV of the U.S. Department of Health and Human Services.

Other speakers will include Lexington Mayor Jim Gray; Councilman Chris Ford; the Rev. Troy Thomas, chair of the Black Church Coalition; and Dr. Rice Leach, acitng county health commissioner and former state health commissioner.

The event is sponsored by the health department, Kentucky Voices for Health and the Black Church Coalition. For more information, call Mark Johnson at 859-288-2391.

Madisonville hospital earns national award for program that helps pregnant women maintain, improve oral health

For its work in improving oral health in prenatal patients, the Center for Women's Health at Trover Health System in Madisonville has received a national award.

The William J. Gies Award for Outstanding Innovation is given to individuals and organizations dedicated to improving dental education, research and leadership. Trover Health System's program "Centering Pregnancy Smiles" focuses on educating women about the importance of maintaining their oral health while pregnant.

"Women may mistakenly think they can skip dental care when pregnant. However, now more than ever, regular oral health check-ups are very important," said LeAnn Todd-Langston, director of the Center for Women's Health. "Pregnancy causes hormonal changes that put women at increased risk of dental disease. Some studies even suggest that infections in the mouth, including gingivitis and cavities, may increase the risk of delivering early. Additionally, some studies have shown that the bacteria responsible for tooth decay are passed from the mother to the baby. By incorporating oral health education into the care our prenatal patients receive, we have been able to reduce the number of preterm and low birth-weight births at Trover." (Read more)

Judge rules Passport managed-care plan for Medicaid in Louisville region is subject to state Open Records Act

As Kentucky prepares to put more of its Medicaid program under a managed-care system to save money, a judge has ruled that the contractor running the program's only managed-care plan is a public agency subject to the state Open Records Act.

Ruling in a lawsuit filed by The Courier-Journal, Jefferson Circuit Judge Susan Schultz Gibson wrote, "Since Passport exists for the purpose of administering the Medicaid program on behalf of the Commonwealth, the sought records all appear to relate to Passport’s state-related operations."

Passport, which can appeal the ruling, declined to comment. A consortium of Louisville-area hospitals, physicians and other health care providers, it serves about 165,000 poor and disabled Medicaid patients in 16 counties in the Louisville region under a $740 million annual contract. The state administers the program but most of its money comes from the federal government.

"While it has been praised by lawmakers for providing good care and saving the state money, it came under fire last year after a critical audit by state Auditor Crit Luallen," Deborah Yetter writes for the Louisville newspaper. "The audit blasted Passport management for spending on meals, travel and lobbying, and it questioned the transfer of about $30 million in reserve funds to University Hospital and other physician groups and hospitals involved in Passport operations." (Read more)

Well-being index gives rankings for Kentucky's congressional districts and metropolitan areas; some are very bad

In keeping with its second-to-last state ranking in the 2010 Gallup-Healthways Well-Being Index, which assessed people's physical and emotional health across the country, one of Kentucky's congressional districts and its major metropolitan area have also ranked low.

Of 436 congressional districts nationwide, Kentucky's 5th District ranked 435th overall, and was dead last in the emotional-health and physical-health categories. The other districts' rankings were: 1st, 383rd; 2nd, 404th; 3rd, 312th; 4th, 415th and the 6th, 388th. Here's a table with breakouts and the 2009 rankings:

Of the 188 metropolitan areas assessed, Louisville ranked 170th, not much different from its 151st ranking in 2009. Lexington ranked 115th, way down from 15th. Among metro areas centered in other states, Cincinnati was 123rd; Clarksville, Tenn., was 162nd; Evansville was 172nd; and Huntington was 188th, dead last in the nation. It has scored poorly on several other health measurements.



The well-being index assessed respondents on their emotional health, physical health, life evaluation, work environment, healthy behaviors and basic access. Respondents answered a large spectrum of questions that pertained to their life now and how they expect it to be in five years. In the emotional-health category, for example, they were asked about how often they laugh, if they were treated with respect and if they experienced sadness, anger or depression. In the work-environment category, people were asked about how they are treated by their supervisor, if they are able to use their strengths while at work and if they're satisfied with their job.

Compared to the rest of the country, Kentucky as a whole ranked 49th, surpassing only West Virginia. Hawaii had the highest well-being index in the country.

It bears noting that the rankings are based on very narrow margins of difference, with many states' scores just a few tenths of 1 percentage point apart. While Kentucky's overall well-being index was 61.9 out of a possible 100 points, Hawaii, which ranked first in the country, had a score of 71. The 2010 score for the nation was 66.8. West Virginia's score was 61.7 points. Because the scores were so close together, precise rankings are uncertain. The ranges for congressional districts and cities are greater, but the error margins are larger.

The survey was based on random-digit dial telephone interviews with 352,840 adult Americans living in all 50 states and the District of Columbia. There were 5,881 Kentuckians who participated in the study. Of those, 1,046 live in the 5th Congressional District and 1,632 live in the Louisville area, which includes Jefferson County and the Indiana border. Interviews were conducted every day from January to December 2010.

The margin of sampling error for most states is plus or minus 1 to 2 percent, but is as high as plus or minus 4 percent for the smallest states. For results based on the total sample size, "one can say with 95 percent confidence that the maximum margin of sampling error is plus or minus 1 percentage point," says Elizabeth Mendes of Gallup.

Rogers, Florida colleague file measure to crack down on 'pill mills'

U.S. Rep. Harold "Hal" Rogers of Eastern Kentucky's 5th District continues to pressure the White House for more action to crack down on "crook doctors operating these pill mills," the Lexington Herald-Leader's Halimah Abdullah reports. (H-L photo by David Perry)

Along with U.S. Rep. Vern Buchanen, R-Fla., Rogers has filed a measure that would support state-based prescription drug monitoring efforts; use seized profits from the drug trade to support rehabilitation treatment; tighten prescription standards for some pain drugs; and make prison terms more lengthy and fines more expensive.

The Obama administration says it is doing its part and "is the first to publicly call the prescription abuse problem an epidemic," Abdullah reports. White House officials contend the administration has increased drug busts and has already poured millions into state-operated prescription monitoring programs. "We've been laser-focused on this issue since day one," said Rafael Lemaitre, a spokesman for the Office of National Drug Control Policy. (Read more)

Heavy smoking less common than 40 years ago

The percentage of people who smoked 20 or more cigarettes a day decreased significantly from 1965 to 2007 in the United States, according to a study in the March 16 issue of the Journal of the American Medical Association.

There was also a decline in the number of people who smoked 10 or more cigarettes a day. The declines were more significant in California than the rest of the country, in part due to the state's tough tobacco control programs, researchers concluded.

Before 1964, when the surgeon general first linked smoking and disease, Americans smoked an average of 1 pack — or 20 cigarettes — per day, the study shows. Researchers found that in 1965 "the prevalence of high intensity (20 or more cigarettes per day) of smoking among California adults did not differ from the remaining United States; prevalence of high-intensity smoking in California was 23.2 percent compared to 22.9 in the remaining United States, and these smokers represented 56 percent of all smokers," reports Newswise, a research-reporting service. By 2007, this prevalence was 2.6 percent in California and 7.2 percent in the rest of the country. As smoking rates have declined, so, too, have lung cancer death rates. (Read more)

Health Reform Source website answers questions about law

In time for the one-year anniversary of the enactment of the federal health-reform law, the Kaiser Family Foundation is advertising its Health Reform Source website, which offers comprehensive resources concerning the Patient Protection and Affordable Care Act.

The website answers questions about implementation, how reform can affect individual states, as well as research and analysis. It also features an official document finder and summaries of reports and studies.

Its latest addition is an interactive quiz, which allows visitors to test their knowledge about what is and what isn't in the new law. Take it!

Link found between kids watching food-based TV commercials and childhood obesity

Watching TV commercials, not the sedentary act of watching TV itself, contributes to obesity in children, according to a study published by the American Journal of Public Health.

The study found that the average child sees about 4,000 television commercials advertising food each year. During Saturday morning cartoons, kids see a food ad about every five minutes. Of that food advertised, about 95 percent of it is of poor nutritional value.

In the study, Associations of Television Content Type and Obesity in Children, researchers followed children from 1997 to 2002 to observe how different types of television might affect obesity rates. They found "television advertising, rather than viewing per se, is associated with obesity." During the five-year period, children saw an increasing amount of commercials and a decreasing amount of non-commercial programming. (Read more)

Inspectors found 389 deficiencies in 66 Kentucky nursing homes in last quarter of 2010

Inspectors found 389 deficiencies at 66 Kentucky nursing homes in the last three months of 2010. Ten of the nursing homes inspected had 10 or more deficiencies. Two of them, one in Elizabethtown and one in Winchester, had none.

Kentuckians for Nursing Home Reform, a non-profit organization that advocates for nursing home residents, obtained the data through an open-records request to the Kentucky Cabinet for Health and Family Services.

On average, inspectors find six deficiencies in Kentucky's nursing homes, according to Medicare's nursing-home comparison data. A recent report by the state inspector general in the Cabinet for Health and Family Services shows 25 nursing homes had more than six deficiencies and 10 of them had 10 or more deficiencies.

Inspections assess a facility on the care of residents and how that care is administered; on how staff and residents interact; and on its environment. Certified nursing homes must meet more than 180 regulator standards.

Though several proposals were considered by the General Assembly this year to improve the care of and protect nursing home residents, none passed.

The nursing homes inspected in the last three months of 2010 that had 10 or more deficiencies were: Britthaven of Pineville (17 deficiencies); Signature Healthcare of Pikeville (14); Signature Healthcare of East Louisville (13); West Liberty Nursing & Rehabilitation Center (13); Golden Living Center-Camelot, Louisville (12); Kingsbrook Lifecare Center, Ashland (12); Life Care Center of Morehead (12); Knox County Hospital, Barbourville (11); Nim Henson Geriatric Center, Jackson (11), and Villaspring of Erlanger (10).

Nursing facilities inspected recently with no defiencies were at Hardin Memorial Hospital, Elizabethtown; and Clark Regional Medical Center, Winchester.

Legislature passed few health-related bills; took small steps on child obesity, diabetes, elder abuse

There were proposals to combat childhood obesity, fight methamphetamine production, impose a statewide smoking ban and protect nursing home residents, but Kentucky lawmakers were reluctant to make changes through health-related legislation this year, with one big exception. Some small strides were made, but in large part much-heralded bills did not get much farther than committees.

The major exception was Senate Bill 110, sponsored by Senate Republican Floor Leader Robert Stivers of Manchester, left, which flew through the General Assembly at eyebrow-raising speed. The bill greatly expands the scope of care optometrists can provide to their patients, including a corrective laser procedure that optometrists can now do only in Oklahoma. Normally, that procedure can only be performed by ophthalmologists, who are trained medical doctors. The bill also allows optometrists to prescribe certain drugs and lets the state Board of Optometric Examiners define what procedures optometrists can legally perform, a more fundamental policy change.

The bill was cause for controversy also because of the amount of campaign contributions, totaling almost $400,000, that optometrists made to all but one legislator and Gov. Steve Beshear in the past two years.

One of the first bills to make headlines was House Bill 193, a proposal by state Rep. Susan Westrom, D-Lexington, left, to ban smoking statewide in public spaces and workplaces. Though hopes were never high it would pass, advocates said the time was right to introduce the idea to the General Assembly and educate legislators about the importance of a comprehensive law that would protect all employees, including restaurant and nightclub workers, from second-hand smoke. "Here's what's important: We don't want to settle for a half-baked law," said Amy Barkley, a director for the Campaign for Tobacco-Free Kids.

At the dawn of the session, state Rep. Addia Wuchner, R-Florence, right, introduced a pack of bills designed to fight childhood obesity. One would have required the assessment of elementary school children's body mass indices, or weight-to-height ratios. Another would have required that elementary school children receive 30 minutes of physical education a day. Neither of these proposals were able to gain traction, but Wuchner did win passage of House Concurrent Resolution 13 creating a legislative task force on childhood obesity. By examining child-care facilities, before-and after-school programs, physical education in schools and higher school nutrition standards, members will come up with strategies to get children eating more healthily and exercising more frequently.

Diabetes, which is often preceded by obesity, was also addressed in the form of Senate Bill 63, which charges several state offices, including the Department for Public Health, to try to reduce the incidence of the disease in the state and improve diabetes care, and Senate Bill 71, which establishes the Kentucky Board of Licensed Diabetes Educators and defines diabetes education.

The "meds-for-meth" bill, which would have required prescriptions for three popular decongestants used to make methamphetamine, drew a lot of attention — and pro and con advertising dollars — this year, but was not able to make headway after clearing the Senate Judiciary Committee 6-4 on Feb. 3. The sponsor, Sen. Tom Jensen, R-London, right, promised to broach the issue again next year. "We're waiting for something very terrible to happen by not acting on this," he said. "A tragedy's gonna happen here and then we're all really gonna feel bad."

After several stories about elder abuse and nursing home neglect ran in the Lexington Herald-Leader and The Courier-Journal late last year, two bills were on the table to provide protection for those potentially in harm's way. But neither — whether that be requiring coroners to investigate nursing home deaths or making nursing home workers be subject to a background check — made any headway. House Bill 52, intended to prevent elder abuse by prohibiting a convicted adult abuser from inheriting from the victim after he or she dies, did pass.

Other health-related bills that passed:

• House Bill 121, which bans methylenedioxypyrovalerone, the primary ingredient on products marketed as "bath salts." The product is sold in stores and online under names like Cloud Nine, Red Dove, Blue Silk and Ivory Wave, and, if used inappropriately, can cause paranoia, hallucinations and violent behavior.

• House Bill 311, which allows physicians to submit electronic or faxed prescriptions for methamphetamine and Schedule II controlled substances. Previously, the prescriptions could only be written.

• House Bill 12, which allows mental health professionals to perform an examination using telehealth services. One of its amendments requires health care facilities to report data on health-facility acquired infections and to implement infection prevention programs.

• House Bill 362, which establishes licensing requirements for ginseng dealers.

• Senate Bill 40, which allows pharmacists to give flu shots to children 9 to 13.

• House Concurrent Resolution 138, which urges Congress to provide more resources to treating veterans and military personnel for post-traumatic stress disorder.

• Senate Bill 112, which limits the amount of a copayment or coinsurance that must be paid for services rendered by a physical therapist or occupational therapist to 20 percent of the total charge of the service.

Most Kentuckians want to treat drug offenders, not jail them

Days after a bill was passed that will reduce prison time for the state's low-risk, non-violent drug offenders, the 2010 Kentucky Health Issues Poll shows that seven in 10 Kentuckians favor replacing prison sentences with mandatory drug treatment and probation for people who commit non-violent crimes.

The poll also showed 71 percent of Kentuckians are in favor of doing the same for non-violent offenders who commit crimes under the influence of alcohol.

The results were released today, just days after Gov. Steve Beshear signed House Bill 463, probably the most important piece of legislation passed in the Gereal Assembly's just-ended session. The legislation is, in part, meant to help curb overcrowding in jail and prison populations. Kentucky's prison population has increased by 45 percent since 2000.

About 25 percent of inmates in federal, state and local jails and prison are incarcerated because of drug violations, National Center on Addiction and Substance Abuse data show. Another 4 percent are incarcerated because of alcohol law violations. These violations include drug/alcohol possession or use; substance trafficking; driving under the influence; drunkenness, vagrancy or disorderly conduct; and liquor law violations.

The poll was conducted Dec. 3-22 and Dec. 27-28 by the Institute for Policy Research at the University of Cincinnati. It interviewed a random sample of 1,677 adults, 1,469 by landline phones and 208 via cell phones. The poll was funded by the Foundation for a Healthy Kentucky and The Health Foundation of Greater Cincinnati. In 95 of 100 cases, the estimates are accurate within a 2.4 percent margin of error.

Respondents were asked more than 50 questions that covered a range of health-related topics, including financial stresses related to health care; characteristics of their neighborhood (examples: Is it easy to buy fresh produce or ride a bicycle?); degree of civic engagement, such as donation of blood, work on a community project or attendance at political meeting or rally; using cell phones while driving; health insurance coverage; the new health care law; and smoking policy.

Kentuckians among least happy and least healthy in U.S.

Kentuckians are among the least happy and healthy citizens in the country, with the state ranking second lowest in a survey that rates the emotional and physical health of Americans.

Only West Virginia had a lower well-being score, according to the 2010 Gallup-Healthways Well-Being Index. West Virginia ranked lowest in three of six measured categories, while Hawaii got the highest well-being scores in three of the six categories.

Kentucky ranked lowest in the country in the "healthy behaviors" category, which measures smoking rates, weekly consumption of fruit and vegetables and frequency of exercise. Of course, people who engage in unhealthy behaviors may not necessarily be unhappy.

The other categories include life evaluation, emotional health, work environment, physical health and basic access. Respondents answered a large spectrum of questions that pertained to their life now and how they expect it to be in five years. In the emotional-health category, for example, they were asked about how often they laugh, if they were treated with respect and if they experienced sadness, anger or depression. In the category of work environment, people were asked about how they are treated by their supervisor, if they are able to use their strengths while at work and if they're satisfied with their job.

The survey was based on random-digit-dial telephone interviews with 352,840 adult Americans living in all 50 states and in the District of Columbia. Interviews were conducted every day from January to December 2010. The margin of sampling error for most states is plus or minus 1 to 2 percent, but is as high as plus or minus 4 percent for the smallest states. For results based on the total sample size, "one can say with 95 percent confidence that the maximum margin of sampling error is plus or minus 1 percentage point," says Elizabeth Mendes of Gallup.

The range of scores was less than 10 points, and many states were close together, so precise rankings are uncertain. Kentucky's well-being score was 61.9 out of a possible 100 points. The 2010 score for the nation was 66.8. West Virginia's score was 61.7 points; Hawaii's was 71. Results for congressional districts and major cities will be released later this month. (Read more)

Senate blows the whistle on the session, leaving Medicaid at an impasse; Beshear says a special session will start Monday

By Al Cross
Institute for Rural Journalism and Community Issues

The state Senate is forcing an early end to the Kentucky General Assembly's regular session today, without fixing the budget gap in the Medicaid program for the poor and disabled. Even as legislators were still meeting, Gov. Steve Beshear said he would call a special session for Monday on the issue, and said Medicaid providers would get letters warning them that their Medicaid reimbursements could be cut 30 percent.

Thus did the Democratic governor raise the ante in a game where the stakes had already been raised by his likely opponent in the general election, Senate President David Williams, R-Burkesville. Doctors are major campaign contributors, but tend to give to Republicans, and they can be a potent lobbying force.

Beshear wants to move money from next year's Medicaid budget to this year's, which would pick up extra federal matching funds, and institute managed-care plans to save money in the fiscal year that begins July 1. Williams says Beshear has not proven that enough can be saved, and warns that the governor's plan will leave the state in much bigger budget trouble a year from now, early in the next gubernatorial term.

Williams, with two opponents in the May 17 Republican primary who have questioned his history on taxes, spending and debt, wants to meet the Medicaid deficit by with across-the-board cuts that would affect education -- a spending area that Beshear has left virtually untouched during a series of budget cuts.

Williams has often been a friend to education, but is at odds with the state and Jefferson County teachers' unions. Those groups are Kentucky's most powerful public-employee unions, a sector that Republicans in several other states have targeted in efforts to cut spending. For years, Williams has tried to change the state pension system from a defined-benefits plan to a defined-contribution plan.

Williams says ending the session early, without a recess and return to reconsider any bills vetoed by Beshear, will save hundreds of thousands of dollars, more than the likely cost of a special session. For coverage from the Lexington Herald-Leader, click here; from The Courier-Journal, here.