Bullitt County health board will appeal judge's ruling against smoking ban, with financial help from Clark County

The Bullitt County Board of Health will appeal a local judge's ruling that it lacks the authority to impose a smoking ban, and it will get some help from the board in Clark County, one of four where bans have been enacted by health boards instead of county fiscal courts.

The $5,000 will come not from tax dollars, but from "money received from the University of Kentucky for consulting services provided by Health Department Director Scott Lockard," Rachel Parsons of The Winchester Sun reports. UK "contracted with the Clark County Health Department so Lockard could work with the university and other local public health directors on smoke-free issues."

If the Bullitt County ruling is upheld, the decision could invalidate regulations enacted by health departments in Clark, Madison, Woodford and Hopkins counties. At the Court of Appeals, “If they uphold the lower court’s ruling, then we will have an injunction against our ruling until it goes to the Supreme Court, so we will suspend the enforcement of it until we get a final determination,” Lockard said. “We fully anticipate that the ruling will be in favor of the boards of health, because this is just a very narrow interpretation.” (Read more)

Now is the time to get flu vaccine, state health officials warn

State public health officials are encouraging Kentuckians to be vaccinated for flu now to reduce the spread of the illness. Steve Davis, M.D., acting commissioner of the Department for Public Health, said in a news release, “Getting the flu vaccine each year is the best way to protect against the flu’s spread and severity.”

The Centers for Disease Control and Prevention’s Advisory Committee on Immunization Practices recommends flu vaccine for anyone older than 6 months. People who should especially receive the flu vaccine, because they may be at higher risk for complications or negative consequences, include:
• Children age 6 months to 19 years;
• Pregnant women;
• People 50 years old or older;
• People of any age with chronic health problems;
• People who live in nursing homes and other long-term care facilities;
• Health care workers;
• Caregivers of or people who live with a person at high risk for complications from the flu; and
• Out-of-home caregivers of or people who live with children less than 6 months old.

Healthy, non-pregnant people age 2-49 years can get either the flu shot or the nasal vaccine spray. Children younger than 9 who are being vaccinated against flu for the first time should receive a second dose four or more weeks after their first vaccination.

Flu is a very contagious disease caused by a virus. About 23,000 Americans die from seasonal flu and its complications in an average year, but actual numbers vary from year to year.

In addition to the flu vaccine, officials encourage all adults 65 or older and others in high-risk groups to ask their health care provider about the pneumococcal vaccine. This vaccine can help prevent a type of pneumonia, one of the flu’s most serious and potentially deadly complications.

For more information on influenza or the availability of flu vaccine, please contact your local health department or visit www.healthalerts.ky.gov.

New survey shows dramatic increase in employer-sponsored health insurance rates

The average cost of employer-sponsored health insurance has increased 9 percent for family coverage and 8 percent for individual coverage since last year, a new study by the Kaiser Family Foundation and the Health Research & Education Trust shows. "Both increases are the largest since 2005," Tony Pugh of McClatchy Newspapers writes, surpassing the national 2 percent increase in wages and 3.2 percent increase in inflation.

Since 2001, family coverage premiums have escalated 113 percent while workers' wages have only risen 34 percent and inflation – 27 percent, Pugh reports. Researchers are unclear if the increase in premiums is temporary or whether higher increases will continue. "We really don't know, and we won't know until next year," Drew Altman, president and CEO of the Kaiser Family Foundation told Pugh.

Employers pay on average about 72 percent toward family coverage and 82 percent for single coverage, Pugh reports, leaving workers paying 28 percent for family and 18 percent for single coverage. Of those surveyed, about 31 percent of covered workers were in high-deductible plans, a 10 percent increase from 2006.

Increasing costs in medical care is "the main culprit behind the rate increases," Karen Ignagni, president of America's Health Insurance Plans told Pugh. "Insurers' expectation of stronger economic recovery" and insurers' fears of increased costs from the 2010 Affordable Care Act may be driving higher premiums, Pugh reports.

Despite insurers' fears, an analysis by Kaiser and the federal government suggest that the 2010 Affordable Care Act accounts for only 1 to 2 percentage points of the increase. Only two measures, coverage of adult children to age 26 and no patient cost-sharing coverage on certain preventive medical services, were implemented thus far with the remaining provisions taking effect in 2014, Pugh reports. This month, insurers will be required to publicly disclose information about rate increases of 10 percent or more for review by state or federal officials to determine if the increase is warranted. (Read more)

Caregivers of wounded soldiers find their lives are also changed; getting compensation

The wars in Iraq and Afghanistan disproportionately affect rural areas, which provide more than the average number of recruits. The soldiers who make it home alive come back changed, with traumatic brain damage, post-traumatic stress syndrome or other injuries that require full-time care. Mostly wives and older parents are left bearing the burden.

Catrin Einhorn of The New York Times reports that many caregivers have to quit their jobs and are forced to spend their savings and retirement funds to pay for treatment. A growing number of caregivers suffer from anxiety, depression and exhaustion as a result of their new routines. Rosie Babin, 51-year-old mother of a severely wounded 22-year-old son, was managing an accounting office before her son's injury. Though she's happy to have her son home alive, she now has to take blood-pressure medicine and sleeping pills. "I felt like I went from this high-energy, force-to-be-reckoned-with businesswoman to a casualty of war," Babin told Einhorn. "And I was working furiously at not feeling like a victim of war."

According to research by Joan Griffin, a research investigator with the Minneapolis Veterans Affairs Health Care System, most of the injured are in their 20s and 30s, making this the first time since Vietnam the V.A. has seen such an influx of youth, which extending the length of care to years and sometimes decades. On average, Griffin found that family members spend more than 40 hours a week providing care, making it nearly impossible for them to keep a job.

Organizations like the Wounded Warrior Project have tried to ease the financial burden on these families by lobbying Congress to provide direct compensation and other benefits to caregivers and their families. In 2010, the veteran's agency approved 1,222 applications and awarded monthly stipends of $1,600 to $1,800 to caregivers. Along with the money, they can receive health insurance and counseling, Einhorn reports. This law only applies to caregivers of service members injured after Sept. 11, 2001, and it's uncertain who will qualify and how compensation will be determined.
(Read more)

Hospitals merging to shore up finances and, as federal health-reform law encourages, improve patient outcomes

With one expert calling it "merger mania," Robert Hadley of The Lane Report looks at how Kentucky hospitals and hospital systems are banding together as they brace for reimbursement changes mandated in the new health care law.

The most discussed merger is that of Louisville's Jewish Hospital & St. Mary's HealthCare, Lexington-based St. Joseph Health System and University Medical Center at the University of Louisville. "At stake in the plan is not only the sale of a physical asset (University Hospital) that belongs to the commonwealth, but also potential changes in delivery of care that ceding control to a faith-based organization might bring," Hadley writes. Saint Joseph is owned by Catholic Health Initiatives, which follows the Catholic directives that prohibits abortion, sterilization and euthanasia.

Baptist Hospital East has since stepped in and said University of Louisville Medical School physicians are welcome to perform needed procedures at its facility.

Though complicated issues need to be addressed, hospitals are eager to merge regardless. Why? Financial viability, especially in the face of change as a result of the federal health-care reform law, sometimes called "Obamacare." Starting in 2013, hospitals will be reimbursed for Medicare and Medicaid procedures differently. Rather than be paid using a fee-for-service model, in which facilities are paid for each procedure performed, they will be paid based on quality and outcomes. If the outcomes are good, the facility will get paid more. The goal is to encourage care with good outcomes, rather than just pay for treatment, in which the incentive might be to over-treat in order to get more reimbursement.

"More and more of the reimbursements we receive in the future are going to be tied to performance, our quality and satisfaction scores," said Andy Sears, vice president of planning and system development for Baptist Healthcare System, which is looking to merge with Madisonville-based Trover Health System. "That's what the value-based purchasing coming out of Obamacare is all about. It's going to cause Baptist, Trover (Health System) and any other health-care organizations to begin to address how we're going to provide more value for the care we deliver."

"Pressure to leverage cost savings as reimbursement declines while being able to afford facility expansion are the two primary reasons" for the Baptist-Trover merger, Hadley reports. "As a single hospital in a rural community, Trover is finding it difficult to attract capital investment, much like University Hospital."

The Jewish-St. Joseph-University Hospital merger will mean at least a $200 million cash infusion for University Hospital alone, and nearly $1 billion of capital investment, including information technology, over the next five years, said Dr. Dan Varga, chief medical officer at St. Joseph Health System.

Essentially, with new changes coming, there is power in numbers. "Trover is a big organization and clinic," Sears said. "But they're facing the same situation a lot of stand-alone facilities are facing. Business is declining, reimbursements are declining, and when you don't have payments in, you can't take care of capital needs." (Read more)

Funds awarded to educate East End Lexingtonians about food, health

Getting community elders to talk to youth about gardening and cooking is one of the missions to be accomplished in Lexington's East End neighborhood from a $52,000 grant.

The funds will create a virtual center where community members can go to learn about food and health. "Our goal is to improve decision making about food through information," said Steve Austin, vice president of the Blue Grass Community Foundation, which was awarded the money by the John S. and James L. Knight Foundation.

"Residents will have the opportunity to talk about what they need to make better food choices," the Lexington Herald-Leader reports. "A digital food information center will then be created so people can go online and learn about all things related to food." Printed information will also be available.

Adults and children living in the neighborhood will interview older members of the community about gardening, food preparation, cooking methods and entrepreneurship. "If we succeed here, we can do it across the city," Austin said. "We can transform Lexington, no matter where people live, to make better decisions about food." (Read more)

Child abuse rates have risen significantly since the economy went into recession, survey in Ky. and 3 other states shows

Child abuse rose as the economy went into recession, shows a study of reported abuse to children under 5 in Kentucky, Ohio, Pennsylvania and Washington.

From 2004 to December 2007, before the financial meltdown, the rate of abusive head trauma in the four states was 8.9 per 100,000 children. During 2008 and 2009, the number jumped to 14.7 per 100,000. Though the study established no cause-and-effect relationship between financial difficulties and an increase in abuse, "earlier research has tied parental stress to child maltreatment," Frederik Joelving of Reuters Health reports.

The study "showed that from 2004 to 2009, there were 422 children diagnosed with what doctors call 'abusive head trauma.' The majority ended up in intensive care units, and 16 percent died of their injuries," Joelving reports. The average child examined in the study was 9 months old.

"The number-one perpetrators are fathers and male caretakers; very few perpetrators are mothers," said Rachel Berger, a child-abuse expert at nationally recognized Children's Hospital in Pittsburgh and co-author of the study. "It's the people that mothers give their kids to that end up being the perpetrator(s)." (Read more)

Lexington council turns to wellness center to cut insurance costs

Following a national trend to improve employee health so companies can cut health-insurance costs, the Lexington-Fayette Urban County Council agreed Tuesday to set up a wellness center for city employees.

The center will "be voluntary and free for employees, retirees and dependents covered by the city's health insurance plan," reports Beverly Fortune of the Lexington Herald-Leader. Acute and primary care, chronic-disease management and preventive screenings will be among the services provided at the center, the location of which has not yet been chosen. It is estimated to cost $1.3 million.

Chattanooga opened a similar center in 2006. Its health insurance costs were increasing about 20 percent annually, with health benefits costing the city $16 million that year. Today, the city is saving about $5 million a year, said Madeline Green, director of risk management and incentives for the city. (Read more)

A million more young adults have health coverage; law cited

One million more young adults ages 19 to 25 had health insurance in the first quarter of 2011 than in the same period a year ago, data from the National Health Interview Survey show.

The increase is largely due to the federal health-reform law, which allows children to remain on their parents' health insurance plans until age 26, a press release from the U.S. Department of Health and Human Services said. No other age group had a significant increase in coverage. (Read more)

Feds give Ky. $3 million to hold health insurers accountable

Kentucky will receive more than $3.2 million in federal grants to help state officials track health-insurance premium increases and make insurers more accountable.

The funds are part of guidelines set forth in the Patient Protection and Affordable Care Act, the federal health reform law. It requires makes rate increases of 10 percent or more in the individual and small-group market subject to approval by experts who will determine if the increases are reasonable. The law also requires insurers to to justify to the public rates that are considered unreasonable.

The Kentucky Department of Insurance will use the federal funds to expand the scope of its rate reviews; improve transparency by establishing a tool on its website that will give consumers access to rate filings without an open records request; hire new staff, and improve its technology. (Read more)

Some worry that patient care will get shortchanged as Kentucky Medicaid moves to managed care

While moving Kentucky's Medicaid patients to managed care for will likely reduce costs to the taxpayers, patient care shouldn't be shortchaged in the effort to save a buck, Deb McGrath writes in an op-ed piece in The Courier-Journal.

"It is critical for quality patient care to always remain a priority," writes McGrath, executive director of the Epilepsy Foundation of Kentuckiana. "All citizens, including the 540,000 Kentuckians under the new managed care plans, deserve access to the best possible care recommended by their doctors."

McGrath is concerned about the "fail first" policy, also known as step therapy. "In this practice, the insurer will initially cover only the least costly medication in any drug class, forcing doctors to prescribe these medications first," she writes. "This is problematic because many times there are different medications that the physician feels would be the most effective treatment."

The policy can adversely affect Kentucky's 90,000 patients who have epilepsy, a disease that comprises 40 different seizure types and epileptic syndromes. "Fail first is not something a person with epilepsy wants to hear, especially when this policy can compromise their well-being and even their life," McGrath writes. "I urge Gov. Steve Beshear, the Cabinet for Health and Family Services, our state legislators and the new managed care organizations to keep patient care in mind as they get ready to implement this new system on Nov. 1." (Read more)

Medicaid's move to managed care delayed until Nov. 1; hospitals need more time to sign contracts

The move to managed care, which the state has touted as the answer to improve the quality of its Medicaid system and solve a budget deficit, has been delayed by a month in response to the Kentucky Hospital Association saying hospitals need more time to sign contracts and prepare for implementation.

"We have made great progress in Medicaid managed care since we first announced the contract awards in July," said Janie Miller, secretary for the Cabinet for Health and Family Services. "Thousands of providers have signed up with the managed care organizations ... but we still need the hospitals to sign contracts before we can implement managed care across the commonwealth."

Mike Rust, president of the KHA, said of about 100 hospitals that will be affected by the changes, only about 20 have signed contracts so far, reports Deborah Yetter of The Courier-Journal.

Four managed-care organizations, including the previously established Passport Health Plan in Jefferson and surrounding counties, will take over health-care management of the state's 730,000 Medicaid recipients. The companies will be paid a per-patient, per-month amount set by contract negotiations. Because they won't be paid using a fee-for-service model — believed to be more costly — and will try to streamline care, the move is expected to save $1.3 billion in the next three years, Miller has said.

Earlier this month, Kentucky got the green light from the federal Centers for Medicaid and Medicare Services to proceed with the transition to managed care. (Read more)

Law enforcement and allies getting ducks in row in 2nd bid to pass bill to require a prescription to buy pseudoephedrine

By Tara Kaprowy
Kentucky Health News

With police finding 20 percent more meth labs in Kentucky than a year ago, they and others are again encouraging state legislators to make pseudoephedrine less available by requiring a prescription for it. And the senator who tried that last year says he is talking with his colleagues to see what can pass in the 2012 General Assembly.

Supporters of the bill to quash "meds for meth" met in Laurel County last week, where the incidence of meth labs recently became the state's highest, Bill Estep of the Lexington Herald-Leader reports. They unveiled an educational campaign intended to teach people about the dangers and costs of the deadly drug. Their campaign includes a video produced by the Kentucky State Police, Operation UNITE, the High Intensity Drug Trafficking Areas Program and the Kentucky National Guard.

"They're going to try to show that video as often as they can between now and January across the state to try to get a grassroots effort behind this bill," Estep said on KET's "Comment on Kentucky" Friday night. "They didn't start off early enough last time to get that to happen." Meanwhile, the number of reported meth labs in the state climbed to nearly 1,100 in 2010 and is on track to exceed 1,400 in 2011.

Pseudoephedrine is the key ingredient in manufacturing methamphetamine, which can be made by combining a few ingredients in a pop bottle. Last year, Sen. Tom Jensen, R-London, sponsored a bill to make "pseudo" available only by prescription. Jensen told Kentucky Health News Monday he is planning on introducing a bill in the upcoming session that "deals with pseudoephedrine and how to control that." "The details of that are not ready to be sent out yet," he said. "I'm negotiating with some other members to see if we can get support."

Pseudoephedrine is also a main ingredient in cold and allergy medicine. Opponents say making it a prescription-only medicine is unnecessarily inconvenient and could be costly. In a legislative brief, the Kentucky Chamber of Commerce said the proposed law would drive up insurance premiums for Kentucky employers and the taxpayers' cost of Medicaid. Their estimates show the new law would result in 17,000 more doctor visits per year. The chamber and other opponents are backed by the Consumer Healthcare Products Association, which was the top-spending lobby against Jensen's bill.

Only Oregon and Mississippi have passed laws making pseudoephedrine available only by prescription; both have seen the number of meth labs fall sharply. Mississippi, where a ban took effect in 2010, has seen a 66 percent drop, according to the Mississippi Bureau of Narcotics. Oregon has seen a 96 percent drop in meth labs in the five years since its law passed, said Jackie Steele, commonwealth's attorney for Laurel and Knox counties and a proponent of limiting pseudoephedrine access.

Opponents say the drops in Oregon and Mississippi have led to surges in adjoining states, and Steele said "They're probably correct. But I'm looking out for Laurel and Knox and the Commonwealth of Kentucky. I hope that everybody else gets on board so we don't have to worry about shuffling problems to another county or another state."

Though several individual municipalities in Missouri have made pseudoephedrine available only by prescription, Steele said that is not likely to happen in Kentucky counties since there would be "constitutional issues."

At the meeting in Laurel County last week, Abby Hale, co-director of the Laurel County Department of Public Safety and Emergency Management, said cleanup of a meth lab can cost up to $2,100 just in manpower and disposal, reports Nita Johnson of The Sentinel-Echo in London. If meth labs are inside a home, homeowners have to get the building decontaminated at their own expense, which can cost up to $3,000.

Statewide, Steele said the cost of meth is in the millions because of the expense of corrections; local health departments dealing with skin irritations and rashes; loss of learning time for kids in school; and putting children in foster care. "The Kentucky State Police spent $2 million in meth lab cleanups, not to prosecute them, just to clean the toxic dumps up," Steele said. "So you can see that the cost per year is staggering."

Funding available to help communities fight cervical cancer

For the second year, agencies, coalitions and community groups are invited to apply for funding to improve cervical cancer screening rates and human papillomavirus (HPV) vaccinations in their areas. Cervical Cancer-Free Kentucky, housed in the University of Kentucky College of Public Health, has funding available and will be awarding mini-grants in the coming year, Ann Blackford of the UK news service reports.

In August, 13 agencies received CCFKy funding ranging from $7,000 to 20,000 for projects that will help residents in 19 Kentucky counties.

"CCFKy saw great results from the first year of funded projects," said Dr. Baretta R. Casey, director of CCFKy. "The projects' outcomes convinced our team that increasing the number of funded agencies in the second year will move our mission of a cervical cancer-free Kentucky forward. Let's stop the deaths of women in Kentucky from this preventable and curable disease."

About 391 women are diagnosed with cervical cancer every year in Kentucky and 66 Kentucky women die. (Read more)

Bullitt judge strikes down health board's smoking ban; could lead to decision with statewide impact, if appealed

A Bullitt County judge has extinguished a countywide smoking ban that was supposed to go into effect Monday, saying the county health board overstepped its authority. The ruling could lead to a decision with statewide impact, determining whether county health boards have such power; a judge in another county approved a ban there and the ruling was not appealed.

Circuit Judge Rodney Burress called the ban void and unlawful, Charlie White of The Courier-Journal reports. "This court does not believe that type of 'Big Brother' conduct was anticipated by the Kentucky state legislature in its grant of power and authority to boards of health," Burress wrote.

"It's a win for business and a win for choice in Bullitt County," said Harlen Compton, one of the founders of Bullitt County Choice, a group of area business owners and residents.

The ban would have prohibited smoking in bars, restaurants and all public places. But even before the Bullitt County Board of Health passed the ban, the county's eight cities and its Fiscal Court sued the board, White reports.

Swannie Jett, the county's health director, said health officials were "very disappointed" and will decide in the coming weeks if they will appeal the decision.

Burress wrote that Bullitt County residents "are entitled to be governed by their elected representatives and should not be subjected to additional laws enacted by an administrative agency without an express grant of authority."

The health board passed the ban under Kentucky Revised Statute 212.230, which says health boards "shall" adopt, implement and enforce regulations necessary to protect public health. Opponents said such a far-reaching regulation as a smoking ban can only be legally passed by city councils or fiscal courts, White reports.

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

Last year, 17.4 percent of Kentuckians lived in poverty and 17.5 percent did not have health insurance

More than one in six Kentuckians lived in poverty last year and almost exactly the same number didn't have health insurance, preliminary U.S. Census numbers show.

The state's poverty rate was 17.4 percent and the uninsured rate was 17.5 percent. Nationwide, 15.1 percent of Americans lived in poverty and 16.3 percent were without health insurance in 2010, reports Valarie Honeycutt Spears of the Lexington Herald-Leader.

To be considered to be living below the poverty line, a family of four must earn less than $22,314 each year.

About 640,000 Kentuckians do not have health insurance. Those numbers have risen as employers have stopped offering coverage to employees, said Jason Bailey, director of the Kentucky Center for Economic Policy. In 2000, 65 percent of Kentuckians had employer-based insurance, but in 2010 only 57 percent did.

Medicaid, which provides coverage for the country's poor and disabled, covered almost 1 in 5 Kentuckians in 2010, up from 1 in 10 in 2000, Bailey said. "The percent of children covered by Medicaid in Kentucky rose 6 percentage points since 2007-08, to 40 percent, keeping the number of uninsured children low," Spears reports. (Read more)

Regulations allowing optometrists to use lasers pass; opponents may sue for violation of Open Meetings Act

Though ophthalmologists and the Kentucky Medical Association strongly objected, a legislative committee passed regulations Tuesday that will allow optometrists to perform some eye surgeries using lasers. In answer, opponents says "they might file legal action against the Kentucky Board of Optometric Examiners, which drafted the regulations, for failing to comply with the state's Open Meetings Act," reports Beth Musgrave of the Lexington Herald-Leader.

The regulations, authorized by Senate Bill 110 in this year's General Assembly, now go to another legislative panel for final approval. The bill has been cause for controversy, in large part because it passed through the legislature in a swift 12 days. Oklahoma is the only other state that gives similar operating privileges to optometrists.

Ophtalmologists said Tuesday the optometric board "used a task force appointed by the state optometric association, a trade group, to develop the regulations, and those meetings were held in secret with no public input," Musgrave reports. Legislators and optometrists disagreed, saying public comment was allowed at an open meeting in July, and the regulations were altered after task force members took the comments into consideration.

Dr. Woodford Van Meter, president of the Kentucky Academy of Eye Physicians and Surgeons, said patient safety is at risk of optometrists are allowed to perform the procedures, in part because the bill states they only have to receive 32 hours of training and show they can do the procedure once before they can use lasers. By contrast, Van Meter said ophthalmologists have 17,000 hours of surgical training and perform surgeries hundreds of times before being allowed to do them on their own.

If the regulations pass, optometrists may be allowed to perform the surgeries by year's end. (Read more)

Work locally for health care solutions, experts say at annual policy forum; contrasting Medicaid approaches seen

By Tara Kaprowy
Kentucky Health News

After hearing experts say communities should take the lead in improving the quality of health care and lowering its cost — especially because there are so many unknowns about the new federal health care law — McCreary County mother and health activist Susan Taylor stepped up to the microphone Tuesday in Somerset.

"I hear what you're saying, but how do you go about getting our leaders motivated?" she asked a panel at the 2011 Howard L. Bost Memorial Health Policy Forum.

"That has sort of been my challenge," replied William Hazel, health and human resources secretary in Virginia. "It's an education process."

There were no simple answers, but experts, medical professionals and community members were willing to ask the tough questions and offer their views at the forum, sponsored by the Foundation for a Healthy Kentucky and named for a Kentuckian who played a major role in writing the Medicare law.

Again and again, experts said solutions can be found by going local, rather than focusing on goings-on in Washington or Frankfort. "My whole point is this: Make it work where you live and work and the whole country will want to be like that," said Len Nichols, left, professor of health policy and director of the Center for Health Policy Research and Ethics at George Mason University.

Nichols, the forum's keynoter, advised state legislators and rural Americans to stay calm about health care, focus on what can be measured and change accordingly. "Forget politics," he said. "Forget Obama. Don't watch TV at all. Focus on where you live."

He acknowledged that is easier said than done, because politicians can't talk about health reform "without making half the population mad and half the population scared." "People are scared, and why wouldn't they be scared?" he asked. "It looked and felt and still feels like the Great Depression."

But federal health reform is necessary, Nichols said, because the current system is unsustainable: 7 percent of the average family's income went toward paying health insurance premiums in 1987. By 2006, it had risen to 17 percent and by 2016, withough reform, it is projected to be 34 to 45 percent. Medicare is likewise unsustainable, Nichols said, with a projected 7.3 percent of the gross domestic product being spent on paying for Medicare alone by 2035.

While the majority of the new health law won't be implemented until 2014, and with repeal still a possibility if Obama loses the 2012 presidential election, community-based changes can contain health care costs.

In West Tennessee, businesses have banded together and formed the Memphis Business Group on Health, which represents 350,000 employers, employees and their families. The group chooses its providers based on value and performance and, because its numbers are significant, providers are willing to comply with the group's requirements. CEO Cristie Upshaw Travis said the private sector can "transform the market" by banding together in this way. "They've had absolutely no choice but to change how they do their benefits," she said.

Hospitals, physicians and health plans are all assessed using survey reporting instruments, whether that means an administrator answering questions about the number of pressure ulcers in a hospital or an insurance agent evaluating a plan on consumer engagement or chronic disease management. "Having this public report in our community has had an impact on the improvement, quality and efficiency of care," Travis said. "In one way, it gave them something to focus on."

In North Carolina, the state has turned to patient-centered medical homes for Medicaid patients. In this model, a family doctor's office becomes the hub of a patient's care. With the help of physician assistants and nurse practitioners, doctors use electronic health records to track patients between visits, communicate with specialists, monitor blood sugar and blood pressure and are actively involved in whether patients are getting enough exercise or taking their medicine.

There are 1,400 medical homes in North Carolina, the first of which was developed in a rural county in the late 1980s. "There was a huge access problem, the emergency room was overrun," said Tork Wade, executive director of Community Care of North Carolina. But by increasing access points, linking patients with a primary care physician and engaging community leaders — "That was another key thing," Wade said — the effort worked. "We got money to go to another 12 counties," Wade said. "(The model) responded to a real need, it wasn't just top down."

The state's embrace of Wade's non-profit program, which is effectively a managed-care plan for Medicaid, struck a contrast with Kentucky's current shift to a managed-care system run by competing, for-profit companies. "My problem with a competing system is that it doesn't lift all boats," Wade said at a breakout session, where advocates said the Kentucky plan seems more concerned with saving money than ensuring quality.

Kentucky Health and Human Services Secretary Janie Miller, left, a McCreary County native who gave openign remarks, said Medicaid should provide what patients need, "but there hasn't really been a strong, deliberate, structured method . . . to really assure we're getting the best bang for the buck."

Though the North Carolina program is now statewide, the key was that the answers came from the communities, Wade said: "It has to be local. If it doesn't work in the community, it's not going to work. So you might as well start there." Getting buy-in from rural communities was easier than in urban centers because "in urban areas there are competing health systems," Wade said. "In rural areas, there is a single system of care and a history of people working together."

Susan Taylor is going the local route by focusing on prevention with Get Healthy McCreary County, which the health department there formed in 2007. The mission is to create awareness about healthy living in the community and promote any events that relate to it.

Though the group has hosted a few events, including a cooking class for kids and an educational session on the health reform law, Taylor says she is having trouble generating interest. "I just think they haven't really realized how important our health is," she said. "Once we get sick, then we'll go to the doctor and worry about it. They don't understand prevention."

Taylor went to Tuesday's forum to find answers, but came away with more questions. As for the federal health care law fixing community problems, Taylor — whose personal interest even prompted her to get a copy of the 1,200-page health care law from her congressman — admitted she doesn't know if that will happen. "I think we saw that" at the forum, she said. "Even amongst the people who seem aware, still no one really know how it's going to play out."

Feds OK managed-care Medicaid; firms advertise for enrollees

The move to managed care for Kentucky's Medicaid patients is one step further to being implemented. The federal Centers for Medicaid and Medicare Services have approved the state's plan to have three managed-care organizations provide care for 560,000 people statewide, The Courier-Journal reports.

Services will not change for about 170,000 people in Jefferson and 15 nearby counties, who have been receiving managed care services through Passport Health Plan for several years. Local newspapers are running advertisements from the three managed-care companies seeking enrollees.

Moving to managed care is Gov. Steve Beshear's answer to fill a $166 million hole in the Medicaid budget, created by a lack of expected federal funding. The federal government pays more than 70 percent of Medicaid costs, bringing the expected savings to $1.3 billion over three years. Under a managed care model, the companies will be paid on a per-patient basis. State officials say there will be an incentive for the companies to keep costs down because the lump sum received for each patient will stay static, unlike in the fee-for-service model in which the state has paid for whatever bills are incurred. (Read more)

Is University Hospital public? Attorney general will decide; merger proposal raises question of church-state separation

Attorney General Jack Conway has been asked to decide "whether University Hospital is a public institution — an issue in the controversial plan to merge the University of Louisville’s main teaching hospital with two other health-care systems," Patrick Howington of The Courier-Journal reports.

ACLU of Kentucky and The Courier-Journal have appealed denials of of open-records requests they made to University Medical Center Inc., which does business as University Hospital. "UMC turned down both requests on grounds that it is a nonprofit corporation rather than a public agency and therefore isn’t subject to the act," Howington writes. An attorney general’s opinion on open records or open meetings has the force of law unless overturned in court.

Meanwhile, Howington also writes that "Some legal advocates and constitutional scholars say," citing court cases, that the hospital's "plan to follow Catholic health-care directives under a pending merger could violate the U.S. Constitution’s provision to keep state and religious matters separate." (Read more)

Some school districts say they can't afford new federal program to give free meals to all students

Many school districts are reportedly opting out of a new federal pilot program that provides free breakfast and lunch to all students attending schools where poverty rates are high. They say budget constraints, fear of losing other federal benefits, and the possiblity of having to raise taxes to maintain the program are keeping them from participating. Kentucky, Tennessee and Illinois were the three states chosen to implement the program first.

When the U. S. Department of Agriculture announced the Community Eligibility Program in March, officials called it a way to eliminate red tape for school districts and "make it easier for low-income students to receive meals in the National School Lunch and School Breakfast program." Districts would provide free meals to all students for four years, then claim reimbursement for them, as they do for students who already receive free or reduced meals, reports Heather Webb of the Salyersville Independent.

Webb reports that officials of the Magoffin County Schools officials said they are not participating because they want "see how the program works in the districts that do participate." The reimbursement rate outlined in the program is less than normal rates, and in the county, it would cause the current rate of 86 percent to drop to 47 percent.

Of Kentucky's 174 school districts, 102 are eligible for the program. However, only 18 of those eligible districts are participating, The Licking Valley Courier (which is not online) reported in its Aug. 11 edition. It said the Morgan County Schools declined to take part because they would have to pay 25 percent of the cost and feared they might have to raise taxes to cover that.

Bailey Richards of the Hazard Herald reported that schools who do not have more than 60 percent of their students receiving free or reduced lunch can still participate in the program, but the respective school boards will have to pay the difference to cover all students. Perry County Schools Food Service Coordinator Linda Campbell told Richards her district could not afford to pay that difference, which would amount to about $300,000 a year out of its general fund.

Hazard Independent Schools Supt. Sandra Johnson told the Herald that she feared her district would lose funding from other government programs, like Title I and Family Resource Centers, which depend on the exact number of students receiving free meals, if they could no longer keep track of those numbers.

Eastern Ky. jumps on national gardening bandwagon, big time

In response to the downturn of the economy, people in Morgan County and the rest of Eastern Kentucky have turned to their roots — getting down in the dirt and growing a vegetable garden, reports Sabrina Tavernise of the New York Times. The offshoot is that people can improve their health by increasing fruit and vegetable consumption. (Times photo by Luke Sharrett)

Vegetable gardening has been on the rise nationally since 2008, which was around the time when Lehman Brothers collapsed, starting the turmoil ion the nation's financial system. "Our sales have skyrocketed," said George Ball, chief executive of Burpee, one of the country's major vegetable seed retailers.

Unlike in urban centers, where buying locally grown vegetables often comes with a exorbitant price tag, eating in rural areas is usually cheaper. Teacher Rebecca Frazier said she "she had cut her food bill in half by growing her own and preserving and by buying in bulk from local farmers," Tavernise reports.

Timothy Woods, professor of agricultural economics at the University of Kentucky, said the number of farmers' markets in Eastern Kentucky has doubled since 2004. "You won't see certified organic products or any fancy marketing" seen in urban areas, he said. "It's a very different world."

Sarah G. Fannin, on ground in photo, is an agriculture educator for UK's Cooperative Extension Service. She said the service has fielded twice the number of calls from people who are asking for gardening help in the past three years. "Ten years ago, we hadn't really been thinking about where our food was coming from other than the drive-through or the grocery store," she said. "Now there's more concern."

Though Tavernise points out gardening does not necessarily lead to improved health, Bridget C. Booske, a senior scientist at the University of Wisconsin Population Health Institute, said County Health Rankings show Morgan County people are living longer and a smaller number of babies are born underweight. Obesity and diabetes rates remain high, however, and locals believe those rates won't significantly improve until there are more jobs and less poverty in the area.

But to create another source of income, Fannin is urging farmers to turn to gardening. The first time Robert Bradley, a former coal miner who turned to farming, planted sweet potatoes, he doubted the effort. But they grew so well, it was has prompted other farmers to try it out too. (Read more)

Frontier Nursing Service sells Mary Breckinridge Hospital to Appalachian Regional Healthcare

Following the nationwide trend of independent hospitals joining larger organizations in order to stay viable, and ending an era, Hyden's Mary Breckinridge Hospital has been acquired by Appalachian Regional Healthcare.

The hospital was sold by the Frontier Nursing Service, which was founded in 1925 by Mary Breckinridge, whos eefforts greatly reduced infant mortality in the area. The hospital employs 150 people and will now be called Mary Breckinridge ARH Hospital, The Associated Press reports.

ARH President and CEO Jerry Haynes said the health system hopes to enhance health-care services in Leslie County. It is the 10th hospital in the Central Appalachian network, which began with takeover of United Mine Workers hospitals about 40 years ago. (Read more)

U of L prof earns $11.8 million grant renewal; has helped glean $100 million in federal grants in 17 years

A University of Louisville researcher has been awarded a $12.8 million grant to keep his adult stem cell project going.

The funds are from the National Institutes of Health and will allow Dr. Roberto Bolli, right, to continue to investigate how introducing genes into stem cells might improve stem-cell therapies; look at how diabetes affects stem cells; look at how proteins called cytokines affect stem cells during heart failure; and investigate the signaling pathways of stem cells in the body.

Bolli's project was granted $11.7 million in 2006. Since Bolli started working at U of L in 1994, he and his team have brought in more than $100 million in NIH grants. In one project, patients have reached the two-year mark after being infused with their own processed adult stem cells. That project is looking to find a way to use a patient's own cardiac stem cells to regenerate dead heart muscle after a heart attack.

"U of L has a mandate to become a national recognized metropolitan research university," President James Ramsey said. "One gauge is our faculty's ability to attract competitive grant fund from the NIH." Ramsey said the overall mission of the medical school is to improve the health of Kentuckians.

Opinions on health and safety issues differ among regions in Ky.

New data show Kentuckians' views on several major health-related issues vary depending on where they live. Those in Eastern Kentucky, the area with the highest poverty rate, are more likely to worry about having the money to pay for nutritious meals. They also have less access to affordable fruit and vegetables, and have a harder time finding safe places to exercise.

The data were compiled through the Kentucky Health Issues Poll, which was conducted by the Institute for Policy Research at the University of Cincinnati. It surveyed more than 1,600 Kentuckians selected at random.

Views on smoking also differ by region. People in Northern Kentucky are less likely to support a statewide smoking ban, while people in the greater Louisville area tend to be more in favor of it. The views reflect local smoking bans that are already in effect; Louisville has banned smoking in public places since 2008, but the movement has stalled in Northern Kentucky.

Northern Kentuckians are also less likely to support legislation that would ban cell phone use while driving. People living in Kentucky's two largest urban centers, Louisville and Lexington, are more likely to use their cell phones while driving. People in Lexington said they're more like to talk, text or send emails on their phones when behind the wheel, while people in Louisville are only more likely to talk. People in Eastern Kentucky are the least likely group to talk or text on a cell phone when operating a vehicle.

Almost 3 in 4 respondents said they would support a complete ban on cell phone use while driving. Nearly as many said they need more information in order to understand the Patient Protection and Affordable Care Act, the federal health-reform law.

The poll is jointly funded by the Foundation for a Healthy Kentucky and The Health Foundation of Greater Cincinnati. (Read more)

States all over the map in setting up health insurance exchanges; Kentucky officials say they await more federal guidance

A breakdown of where states stand in implementing pieces of the federal health-care reform law shows Kentucky lagging behind. But Kentucky officials say they're awaiting more direction from the federal government before they decide their next move.

A map compiled by the Center for Budget and Policy Priorities shows Kentucky is one of 11 states that did not even introduce legislation to form a health insurance exchange, considered one of the cornerstones of the new health care law. The center says 33 states have considered bills to establish an exchange, and 10 passed. Another nine have approved bills declaring the state's intent to establish them.

The state exchanges, which are to be launched in 2014, will act as insurance marketplaces. In the exchange, individuals and employees of small businesses can choose from several plans from companies such as Anthem or Bluecross/Blueshield, whose benefits coverage packages have been pre-approved by the state and federal governments.

As part of the new law, individuals with income as much as 400 percent above the poverty level may qualify to buy insurance from the exchange. Individuals that do qualify will be given federal subsidies to help pay their premiums, subsidies people can only get if they buy their insurance through the exchange. "They'll be incentivized to buy their insurance through it," said Carrie Banahan, executive director of the Office of Health Policy in the Cabinet for Health and Family Services.

So far, though, Kentucky has not made any moves toward setting up its exchange. Banahan said that is largely because the federal government has not decided what benefits the plans in the exchange must include. "They'll basically set up a minimum of what these plans need to include," she said. "We're still awaiting federal guidance."

Asked if the administration of Gov. Steve Beshear is delaying action so the health-care law won't become an issue in the Nov. 8 election, in which Beshear is seeking a second term, chief cabinet spokeswoman Jill Midkiff replied in an email, "The federal government has not issued final guidance through regulations on the exchange. States cannot make decisions to establish an exchanghe without knowing the requirements in order to determine programmatic and financial implications."

If states don't set up an exchange on their own, the federal government will do it for them, though Banahan said Kentucky officials are reluctant to let that happen. "The federal government is encouraging states to operate their own exchanges," she said. "They're looking at states to take the lead so they can model and craft their own exchange to meet the needs of their state. If the federal government came in, they don't know Kentuckians like we know Kentuckians."

As indicated by the map, several states have chosen to create an exchange by passing legislation. In some others, governors have done it through executive orders. Banahan said there is still time for Kentucky to weigh its options. "We haven't missed the boat," she said. "We're still just looking ... No final decisions have been made."

Other states' decisions do not necessarily follow party lines. Nevada and California passed exchange bills under the leadership of Republican governors. Delaware and Rhode Island, which have Democratic governors, have not budged on exchange legislation.

Only Florida and Louisiana have "expressly stated they won't build the marketplace," Sarah Kliff wrote for The Washington Post. Both have Republican governors, "But there are a lot of other states in the gray area above that could fall either way. If a few larger ones like Texas or New York aren't able to move forward in the next year or so, that's going to have the federal government playing a really big role in setting up what was meant to be a state-based law." (Read more)

Ultimately, whether Kentucky sets up its own exchange or the federal government does, Banahan said an exchange is needed. "We think it's a good thing that more people will have health insurance accessible to them," she said.

Kentucky's adult smoking rate falls below 25% for the first time

For the first time since state smoking rates were measured, fewer than one in four Kentucky adults are smokers, according to a report by the Centers for Disease Control and Prevention. The rate in 2010 was 24.8 percent, down from 28.7 percent in 2009. The rates are based on a national survey of 17,000 adults.

The national average of 19.3 percent, down 1.6 percent from 2005, is "slower than in the previous five-year period," the CDC reports in a release. This decline may be due in part to "increases in federal and state taxes on cigarettes and new clean air laws," Dr. Tim McAfee, director of the CDC's office on smoking and health told Lindsey Tanner of The Associated Press. (Read more)

Death of personal-care home resident has lawmakers from his hometown talking about stricter staffing rules

The death of a missing personal-care home resident has a bipartisan pair of Kentucky lawmakers from his home town of talking about setting staffng standards for Kentucky's personal-care homes or even nursing homes, which have successfully lobbied against such regulation.

Republican Sen. Jimmy Higdon and Democratic Rep. Terry Mills of Lebanon participated in the search that led to the discovery of Falmouth Nursing Home resident Larry Lee's body, Valarie Honeycutt Spears of the Lexington Herald-Leader reports. Following the search, they agreed tougher legislation is needed for personal-care homes.

State regulations on staffing for such homes are vague, stating staff-to-resident ratios should be based on the number of patients and the supervision required to meet their needs, Spears reports.

Higdon plans to address staff-to-resident ratios, resident activities, aging facilities and other problems through legislation. He said he may also support legislation that would create procedures for communities to follow when vulnerable community members go missing.

Mills wants the General Assembly to investigate staff-to-resident ratios for all long-term care facilities, including nursing homes. He said he and Higdon have discussed a "call for a task force to study conditions at personal-care homes." (Read more)

3 universites and federal agency join to improve oral health in Appalachian Kentucky

With money from the Appalachian Regional Commission and some of their own, three very different Kentucky universities will collaborate "to enhance sustainable, collaborative dental health education and care" in the state's eastern coalfield, where both are sorely lacking, they announced in a press release.

Morehead State University, the private University of Pikeville, and the University of Kentucky's College of Dentistry will design the Appalachian Rural Dental Educational Partnership Plan "to train more dentists to practice in rural areas and give them the tools necessary to set up thriving dental practices in Eastern Kentucky," the release said. The funding is $400,000 from ARC, $127,293 from UK, $82,035 from UPike and $47,873 from Morehead State.

“The majority of Eastern Kentuckians have struggled to sustain quality dental health, and one of the barriers to maintaining good dental health is poor access of quality dental care,” state Department for Local Government Commissioner Tony Wilder said. His agency handles ARC matters in Kentucky.

Said new UK President Eli Capilouto, a dentist by trade, “We know that if we can break a cycle of poor health, we can begin to break cycles of poverty. Cycles of despair can become legacies of hope. We also, increasingly, know that partnerships and greater collaboration are the best – and, perhaps, only – way to address major challenges.” He called the project a unique partnership among a federal agency, a governor and “the state’s flagship institution, Kentucky’s public institution dedicated to serving the people of Eastern Kentucky, and a critically important college with deep roots in Eastern Kentucky.” (Read more)

UK Hospital gets below average marks on patient satisfaction, infections; data on your local hospital are available online

Despite $900 million being invested in expanding the University of Kentucky Chandler Hospital, its patients at do not seem all that happy with the care they receive there.

In an op-ed piece in the Lexington Herald-Leader, Dr. Kevin Kavanagh of Somerset highlights the results of a survey on patients' hospital experiences. That survey ranked UK's hospital below state and national averages in nine of 10 measures. "Especially disturbing, only 66 percent said they would definitely recommend the institution, and only 56 percent stated their room and bathroom were 'always clean'," writes Kavanagh, chairman of Health Watch USA.

The UK hospital also did not fare well when it came to its assessment by the Centers for Medicare and Medicaid Services on hospital-acquired conditions. "UK had the highest reported rate of deadly vascular catheter infections in the state," Kavanagh writes. "UK also had an unacceptably high rate of falls and deep bed ulcers. These latter conditions should be zero."

Kavanagh concluded, "If there are quality problems at UK, it is of paramount importance that they are corrected since not only current patients are at risk but also the quality of the training experience of our future clinicians, which can affect care for years to come." (Read more)

Newspapers can access information about their area hospitals by clicking here. Viewers can choose up to three hospitals and see how they compare to one another in categories like: how well nurses communicate with patients; how quiet the areas around patients are; if patients would recommend the hospital; and if patients always received help as soon as it was wanted.

Newspapers can also see the results of the CMS assessment on hospital-acquired conditions for their area hospitals by clicking here and downloading the Hospital-Acquired Condition Rates zip file (scroll down to Kentucky hospitals). The file contains data on eight hospital-acquired conditions reported between Oct. 1, 2008 and June 30, 2010. Among the conditions reported are air embolism; blood incompatibility; catheter-associated infections; falls and trauma; foreign objects left in the body after surgery; pressure ulcers; uncontrolled blood sugar levels; and urinary tract infections.

Seven UK docs-to-be off to Morehead to train in rural medicine

Learning how to practice in rural areas is the goal of seven University of Kentucky medical students, who are off to Rural Physician Leadership Program in Morehead. (From left: Shea Poynter, Lesley Jackson, Katherine Johnson, Nathan Hudson, Katrina Winkler, Crystal Norgren and Miranda Smith)

The program "trains physicians to become practitioners and leaders for rural areas," Julie Meador writes for UKNow, the university's news service. "It was created in response to the growing health care needs evident in rural areas of Kentucky and the rest of the nation."

The training is primarily done at St. Claire Regional Medical Center and with physicians with the Northeast Area Health Education Center, who are serving as preceptors. The students will also take courses at Morehead State University's Department of Business and Public Affairs on the medical use of information technology, financial issues and debt management and community engagement for health policy.

Combating childhood obesity reinvigorates Barren County Chamber of Commerce health committee

Combating childhood obesity has become the focus of the health-care committee of the Glasgow-Barren County Chamber of Commerce, a panel that had otherwise lost its drive.

The committee has started using the "We Can" childhood obesity prevention program, which has already been adopted by more than 1,000 communities nationwide. Designed for children 8 to 13, the program "offers a curriculum that can be used to teach parents about healthy eating," reports Gina Kinslow of the Glasgow Daily Times. The committee has now partnered with various organizations, including the Boys and Girls Club of Glasgow-Barren County, to get the word out and start educating parents.

"The 'We Can' education program provides parents and caregivers with tools, fun activities and more to help them encourage healthy eating, increased physical activity and reduced time sitting in from of the screen (TV or computer) in their entire family," said Kelly Lile Jenkins, director of the Boys and Girls Club. Nearly 1 in 6 American children between the ages of 2 and 19 are obese, an estimated to 12 million youth. Another 14.8 percent are overweight, committee chair Beverly Mortimer noted. (Read more)

Markey Cancer Center at UK says its patients have higher survival rates than those treated elsewhere in Ky. and the nation

"Patients at the University of Kentucky's Markey Cancer Center who have certain types of cancer have higher rates of survival than patients with the same cancers treated elsewhere in the state or even the nation according to new data released today," Business Lexington reports.

"Markey officials said the data shows that the center's patients have significantly better five-year survival rates than those Kentucky cancer patients who were treated elsewhere for brain, breast, liver, lung, ovarian, pancreatic and prostate cancer, as well as for stage IV colorectal cancer." (Read more)

September is national Childhood Obesity Awareness Month

September has been proclaimed national Childhood Obesity Awareness Month, with President Obama asking Americans to "take action by learning about and engaging in activities that promote healthy eating and greater physical activity by all our nation's children."

The U.S. childhood obesity rate has tripled since the 1970s, with 1 in 3 American children now either overweight or obese. As such, experts say one third of "children born in 2000 will develop Type 2 diabetes during their lifetime, with many others at risk of obesity-related illnesses including heart disease, high blood pressure, cancer and asthma," reports Julian Pecquet of congressional newspaper The Hill.

Childhood obesity is especially prevalent in Kentucky. The state has the the seventh highest obesity rate nationwide and the fourth highest rate of childhood obesity. Reporters can find by-county obesity rates by clicking here, but by-county childhood obesity rates are not available because counties are collecting data in different ways and at different ages, Sarah Walsh of the Foundation for a Healthy Kentucky said recently.

While the problem is a big one, there are initiatives underway to tackle it, including first lady Michelle Obama's "Let's Move," which helps communities make healthy food and exercise choices. It also includes a partnership with grocery stores to increase food choices in areas that do not have easy access to healthy foods. (Read more)

Free conference on Alzheimer's in Louisville Sept. 17

A Washington-based geriatric researcher will join University of Louisville researchers and clinicians a free conference examining Alzheimer’s disease from 9 a.m. to 3 p.m., Saturday, Sept. 17, at the Crowne Plaza Louisville Airport Hotel, 830 Phillips Lane, near the state fairgrounds.

“The Journey: Alzheimer’s Disease and Caregiving” will provide information on the risk factors for Alzheimer’s disease, the reasons why certain populations are at greater risk for developing it, and current practices in caregiving. Admission, parking and lunch are free to participants at but pre-registration is required by Sept. 15 to info@alz.org or 1-800-272-3900.

Thomas Obisesan, M.D., chief of geriatrics at Howard University Hospital, will open the meeting. His research is focused on finding a cure for Alzheimer’s and "disentangling the overlap of cardiovascular disease with Alzheimer’s disease risk," a U of L release says. The conference is supported with grants from Eisai Co. Ltd. and the Signature Research Institute. It is co-sponsored by the university and the Greater Kentucky and Southern Indiana Chapter of the Alzheimer’s Association.

The Courier-Journal, continuing to explore Louisville hospital merger, says many more questions still need answering

The proposed merger of the University of Louisville hospital with Jewish Hospital & St. Mary’s Healthcare and with St. Joseph Health System of Lexington, which follows the teachings of the Roman Catholic Church, continues to draw heavy attention from The Courier-Journal. Sunday's newspaper had a long column by editorial writer Pam Platt, and an editorial that online was packaged with a video discussion among the editorial board and U of L President James Ramsey, David Laird of Jewish and St. Mary’s, Dr. Daniel Varga of St. Joseph and James Taylor, CEO of University Hospital.

"On many levels, the merger . . . is appealing," the editorial began, saying the new system would be broader and more efficient and secure the three Louisville hospitals as they compete with Baptist Hospital-East and Norton Healthcare, which recently announced an affiliation arrangement with the University of Kentucky" hospital. "Two significant issues continue to make the merger problematic, however." In addition to the issues of reproductive care, the editorial wonders whether advances in medical science that conflict with Catholic teaching could cause the merger to "unwind," as hospital officials put it, and what the ramifications of that would be. (Read more)

In her column, Platt, right, focused on the merger's impact on women, saying it remains unclear. For example, "The partners say transportation will be provided for pregnant women wanting tubal ligations, as well as for their infants. But what will be the process for them accessing that? What are the details? . . . Many of us need more answers to additional questions . . . before we know if this merger is the answer not only for the business end of things, but for all the people who depend on the hospitals for their care." The merger needs state approval to proceed. (Read more)

At Nov. 11 conference in Lexington, Health Watch USA will focus on health-care transparency, patient advocacy

Health-care transparency and patient advocacy will be the focus at the 2011 Health Watch USA 2011 conference Nov. 11 in Lexington. Topics will include hospital-acquired infections and the importance of reporting them; the impact of transparency on an institution; barriers in the control of healthcare-acquired infections; and principles of transformational leadership will be among the topics discussed.

Speakers include Frances Griffin, a faculty member at the Institute for Healthcare Improvement, will be one of the many conference speakers and will speak about the IHI global trigger tool. Dr. Keith Sinclair, medical director at Bluegrass Oakwood in Somerset, will speak of how transparency has almost eliminated pressure sores at his facility. Award-winning author Maryn McKenna will speak of the history of MRSA and Dr. John Santa from Consumers Union will speak of the principles of transparency.

The registration fee is $50. The conference, which runs from 8:45 a.m. to 4:45 p.m., will be at Embassy Suites on Newtown Pike in Lexington. To register, click here.

Teens who drink sugary beverages add 300 calories a day to their diet, national survey finds

American teens who drink pop, energy drinks like Red Bull and other sugar-based beverages like Gatorade are consuming an average of 327 calories a day, the equivalent of two and a half cans of cola, according to an analysis conducted by the National Center for Health Statistics, part of the Centers for Disease Control and Prevention.

Data also show half of Americans drink sugary drinks on any given day, reports Nanci Hellmich of USA Today. Teens and young adults are drinking more of them than any other age group. About 25 percent of people drink at least 200 calories from them. Another 5 percent of the population age 2 and older consume nearly 600 calories a day from these drinks.

"Sugar-sweetened beverages are the No. 1 single source of calories in the American diet and account for about half of all added sugars that people consume," said Rachel Johnson, spokeswoman for the American Heart Association. "These are empty calories with no health benefits," said Barry Popkin, a nutrition professor at the University of North Carolina-Chapel Hill.

The findings stem from the National Health and Nutrition Examination Survey, which studies the eating and drinking habits of Americans. The results are from more than 17,000 in-person interviews about dietary habits conducted from 2005 to 2008. Added calories can lead to obesity, which increases the risk of diabetes and heart disease. (Read more)

Area Health Education Centers work behind scenes to make a difference, help bring health providers to rural areas

By Tara Kaprowy

Kentucky Health News

When student Holly de la Peña learned she'd been assigned to a physician's assistant rotation in rural southeastern Kentucky, she was a little nervous. Having grown up in Paris, Ky., near Lexington, and having never ventured much farther than the 30-minute drive to the University of Kentucky, the prospect of going to live for six weeks in a town she'd never visited with a family she'd never even met was intimidating. "I was very anxious to travel alone and stay in a strange environment and not have any friends in the area," she recalled. "It was a little scary."

But after arriving in London, Ky., de la Peña realized things were going to be just fine, thanks in no small part to the local Area Health Education Center that helped her. "They did everything for me," she said. "They gave me the connection of where to stay, they gave me information about the community. They even gave me a list of restaurants, activities that were offered and where certain churches were located." In fact, de la Peña found the experience so rewarding and she became so connected to the town, she and her husband decided to move to London shortly after her graduation. She's been practicing as a physician assistant there for the past 10 years.

Stories like de la Peña's are exactly what staff at Area Health Education Centers, which serve every county in the state, are hoping to hear. "It's gratifying to know that the work our staff pays off for our region," said Dwain Harris, director of Southern Kentucky AHEC. (Photo: Dr. Brian Ellis of Danville works with UK medical student Megan Song)

Though they can go unnoticed, AHECs have been working behind the scenes for decades. The program started as a federal initiative in 1971 and was designed to get more doctors working in rural areas. "Particularly rural communities had a hard time getting enough doctors," said Dr. Jim Norton, the UK medical school's associate dean for educational engagement. "They felt if medical students spent part of their time training in rural areas they might then practice in rural, underserved communities."

In 1972, Kentucky applied to receive money from the federal initiative. When it was denied, the state decided to set up its own system, calling it AHES — the Area Health Education System. That system was designed to serve and attract all types of health-care providers, not just medical students. "There was funding provided to support students when they went away from the mother ship to an underserved community," Norton said. "And there were staff scattered around the state that were the local contacts to help them find housing."

Around 1980, the University of Louisville and University of Kentucky decided to try again to receive federal funding. It was granted, and the state has been receiving about $700,000 every year since. In turn, the state kicks in about $2 million each year. AHES changed its name to AHEC when centers were set up across the state. Today, there are eight such centers, four in Western Kentucky administered by U of L and four in Eastern Kentucky administered by UK.

The main goal remains the same: link students in all types of health professions to rural and underserved training sites, such as clinics, hospitals and physician offices. From 2008 to 2010, student physicians, nurses, pharmacists, dentists and allied health professionals such as physician assistants received training at more than 10,000 AHEC-supported rotations. In 2009-2010, 1,727 students did AHEC rotations representing more than 8,700 student work weeks.

YOUTH PIPELINES

Over the years, the program has expanded. Now the work to attract health professionals to rural areas starts well before students are getting ready to graduate from college. Called health career pipeline programs, AHEC staffers work with middle- and high-school students to encourage them to pursue health careers. "We stress the importance of taking math and science courses, about how it's important not to take a year off after high school, and we allow them to shadow health care providers," said Carlos Marin, AHEC program administrator at UK. (Photo: Rockcastle Regional Hospital nurse Bill Wells demonstrates nursing skills on a mannequin during Southern Kentucky AHEC's 2011 summer health-careers camp.)

In the last school year, more than 23,000 kindergarten to 12th-grade students in Kentucky were exposed to some type of health career activity, including classroom presentations, camps, clubs and workshops.

De la Peña's 15-year-old son Evan is now part of the pipeline. This summer he attended an AHEC-sponsored science and health camp. He learned fundamental suturing techniques and how to start an IV, became CPR certified, and attended lectures by several health-care professionals. "Even if your child doesn't want to be a doctor, they're learning about all of these different professions that they wouldn't have the opportunity to learn about, unless someone in their family had that type of job," de la Peña said. "Plus, it lets them recognize the need in a small community."

SERVING THEIR COMMUNITIES

The AHECs' official motto is to "connect students to health careers, health professionals to communities and communities to better health," but each center works independently to meet local needs. Part of the work at the North Central AHEC, for example, is reaching out to its Hispanic community. At the Purchase AHEC, there is a vigorous oral health initiative. In Mount Vernon, maternal education is a major focus, with the Southern Kentucky AHEC hosting educational baby showers to help combat the area's high rate of premature births.

Northwest AHEC, which covers Louisville and seven nearby counties, helps people who lost their jobs get trained in health care professions and back to work. "We're working with the workforce development boards real closely," said Center Director Brenda Fitzpatrick. "We're helping displaced workers look at other careers because there is a slew of health care careers that will support this system. The health care industry is the fastest growing job industry right now. There's a whole new gamut out there for us."

RESULTS?

But do AHEC efforts reach the original goal, to get more health professionals working in underserved areas? Officials admit it's a difficult question to answer, partly because many students are now required to do rural rotations. "If you look at the history of it, from an anecdotal view, yes, it does work," Marin said. "The question is: Can we say X number of students have gone through AHECs and so have gone to rural communities? No. It's difficult because all of our students go through AHEC rotations."

Even asking a doctor why he or she decided to practice where he or she does can have a complicated answer. "The answer is going to be a whole lot of things," Norton said. "He might say, well, I grew up here. Or I did a rotation here. Or my family was here. To identify what is the cause is probably futile because there is a combination of factors."

De la Peña agreed. She and her husband already knew they wanted to return to small-town living when they had children, for example. But AHEC cemented the deal, and kept her in Kentucky. "With AHEC going out of their way to make your stay as accommodating as possible, to make you feel comfortable and giving you an opportunity to mesh with a community, that does establish some roots," she said. "You meet people, they befriend you, you keep in touch, you want to come back. And that can lead to future employment."

Foundation for a Healthy Kentucky receives $1 million grant in addition to $2 million already being used for matching grants

A federal agency has given the Foundation for a Healthy Kentucky $1 million, on top of an earlier $2 million, to make matching grants aimed at addressing the state's health challenges. The money comes from the Corporation for National and Community Services, which supports service and volunteering though grants and programs like AmeriCorps and Senior Corps.

The funds have "given us the opportunity to test innovative approaches that promote lasting change where the need is most critical," Foundation CEO and President Susan Zepeda said. "The continuation funding allows us to have an even greater impact in communities as we discover new information about how to address Kentucky's health challenges."

The $3 million is being matched by the foundation, and the $6 million in grants will be matched by the recipients, resulting in a $12 million impact. The foundation announced in February grants totaling $1 million for projects that will serve almost 9,000 Kentuckians in one year. The four grant recipients were Home of the Innocents in Louisville; St. Joseph Health System in Lexington; Cumberland Family Medical Center in Burkesville; and Montgomery County Health Department in Mt. Sterling. A fifth grant was awarded to Meade Activity Center in Brandenburg in June. Each organization received $250,000. (Read more)

Baptist Hospital East would allow U of L docs to perform tubal ligations there after merger with Catholic system

Since the merger between Jewish Hospital, University Medical Center and Saint Joseph Health Systems will prevent female patients from getting their tubes tied there — because St. Joseph is owned by a Catholic-based parent company — Baptist Hospital East will provide a facility where University of Louisville doctors can perform the procedure.

"This will ensure our ability to provide reproductive services for our patients after the merger occurs," said Dr. David Dunn, U of L executive vice president for health affairs, addressing perhaps the largest single concern about the merger. University Hospital CEO James Taylor called it a "very small" compromise. "We compromised only a location, not a population."

Through a $15 million fund "that will be set aside from the assets of University Hospital and given to U of L for that purpose once the merger closes," uninsured women will be able to have tubal ligations at Baptist, whether they're being done after giving birth via C-section or vaginally, reports Patrick Howington of The Courier-Journal. They can also be done even if the procedure is unrelated to childbirth. University of Hospital performed 301 tubal ligations last year.

University Hospital has historically provided care for indigent patients who cannot afford to get care elsewhere. Because these patients are not wealthy enough to choose which hospital they go to, they have no choice but to adhere to Catholic directives. Though the issue of female sterilization has been addressed, there is still the issue of how end-of-life care will be handled at University Hospital. That includes how living wills and the removal of a feeding tube will be dealt with.

The merger, which would create Kentucky's largest health-care system, still needs the approval of Gov. Steve Beshear and the Catholic Church. "We have a public institution with a public mission that has been supported by the public dollars and public leadership for many years," said state auditor Crit Luallen. "And we have to look at how a merger with a religious organization changes the public's access and the public's protection." (Read more)