Tuesday, January 31, 2012

Medical records of 1,018 patients stolen at Lexington Clinic, but no apparent identity theft

One of the fears of electronic health records is that personal information can be stolen en masse, a possibility that became a reality when a laptop computer was stolen at the Lexington Clinic.

The machine was taken Dec. 7 from the clinic's neurology department at the St. Joseph Office Park. Letters were sent to the 1,018 affected patients last week about the theft, Mary Meehan of the Lexington Herald-Leader reports.

The laptop contained the names, contact information and diagnoses from patients from as long as five years go. Not among the data were Social Security numbers, credit card or bank account numbers. So far, there is no sign of identify theft. 

The clinic said it took six weeks to informing patients because it took time to "pinpoint exactly what information was on the laptop, which was used in conjunction with the clinic's electromyography machine," Meehan reports.

Another theft happened at UK HealthCare in June, when the medical records of 3,000 patients were taken from the Department of Pediatrics' newborn screening program. Patients were not informed of that breach until two months later. (Read more)

455 deficiencies found in 72 Kentucky nursing homes in fourth quarter of 2011

State inspectors found 455 deficiencies in 72 Kentucky nursing homes in the fourth quarter of 2011, with one facility accounting for 25 of them alone: Kindred Transitional Care & Rehab-Fountain Circle in Winchester.

The information was released by Kentuckians for Nursing Home Reform, a nonprofit organization that advocates for nursing home residents and obtains the data regularly through open-records requests to the Kentucky Cabinet for Health and Family Services and distributes it statewide. The information is posted as part of Medicare's nursing-home comparison data.

According to the Centers for Medicare and Medicaid Services, the average number of deficiencies for a nursing home inspected in the U.S. is eight and the average in Kentucky is seven. 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 regulatory standards. The state Office of Inspector General website has more data, such as the results of inspections and the ownership of each facility.

Nursing homes with 10 or more deficiencies in the fourth quarter of 2011 were:
Bridge Point Care and Rehabilitation Center, Florence (22)
Pineville Community Hospital (17)
North Hardin Health & Rehabilitation Center, Radcliff (15)
Richmond Place Rehabilitation and Health Center, Lexington (13)
Hart County Health Care Center, Horse Cave (13)
Parkview Nursing and Rehabilitation Center, Pikeville (13)
West Liberty Nursing & Rehabilitation Center (13)
Redbanks, Henderson (12)
Knox County Hospital, Barbourville (11)
The Forum at Brookside, Louisville (11)
Bradford Square Care and Rehabilitation Center, Frankfort (10)
Florence Park Care Center (10)
Boyd Nursing and Rehabilitation Center, Ashland (10)
Corbin Health & Rehabilitation Center (10)

For more information about Kentuckians for Nursing Home Reform, click here.

Monday, January 30, 2012

A couple's journey with infertility; similar tale likely in your town

Laura Ungar of The Courier-Journal follows the story of Kelly and James Durst, who turned to in vitro fertilization when they had trouble conceiving a child.

The Dursts are "among the 12 percent of reproductive-age couples in the United States who couldn't conceive without help," Ungar reports.

In April 2010, they gave birth to son Cooper, one of more than 675,000 babies born in the U.S. through assisted reproduction techniques since 1985. "He is literally the light of our lives," Kelly said. "He's why we try to make things better each day."

Ungar follows the Dursts' journey to have a second child, this time using the frozen embryos that were created at the time of Cooper's conception. The embryos will be placed in Kelly's womb.

Given the growing prevalence of assisted reproduction techniques, stories like the Dursts' can likely be found in nearly every community and make for a compelling read. (Read more)

Prescription pill abuse summit Wednesday at UK hospital

A prescription pill abuse summit will be Wednesday at the University of Kentucky Albert B. Chandler Hospital, featuring many notable speakers.

They will include: Gov. Steve Beshear; Wilfredo Ferrer, U.S. attorney from the Southern District of Florida; Van Ingram, executive director of Kentucky's Office of Drug Control Policy; police chiefs and law enforcement officials; and health care professionals.

"We think this summit will help lay the foundation for a future that will lead to increased communication and awareness among all the societal entities that are engaged in this fight," said U.S. Attorney Kerry B. Harvey of teh eastern District of Kentucky.

The summit is from 8:30 a.m. to 5 p.m. at Pavilion A auditorium. For more information, call Harvey's office at 859-685-4805. (Read more)

FDA wants to reduce standard for fluoride in public drinking water

Lowering the amount of fluoride in drinking water, as proposed in January by the Food and Drug Administration, will increase medical expenses and harm the poor and the poorly educated the most, a mother writes in an op-ed piece in the New York Times.

Jane E. Brody delves into the concept of fluoridation, pointing out its benefits. "In the early years, rates of tooth decay among the young dropped by 60 percent in communities that adopted fluoridation," she writes. "Every $1 invested in fluoridation saves approximately $38 in dental treatment costs."

Though fluoride was initially thought to become incorporated into developing teeth, it was later found that its benefit is topical, meaning it works on teeth already formed. "Fluoride, which is present in saliva and concentrates in dental plaque, inhibits the action of acid on tooth minerals," she writes. "It also promotes remineralization by sticking to tooth surfaces, where it attracts calcium ions present in saliva."

Still, there remains controversy about whether or not fluoride is safe, with the substance being accused of causing everything from heart disease to Alzheimer's disease. "None of these supposed risks has ever been established in scientifically valid studies," Brody writes. "The only proven risk, a condition called fluorosis, which results in white and sometimes brownish markings on the teeth from too much fluoride, rarely results from a normal intake of fluoridated water."

Since fluoride is also available in other substances, like toothpaste, the FDA proposed reducing the amount of fluoride in public drinking water to 0.7 milligrams per liter, from a range from 0.7 to 1.2 milligrams. Brody feels the move is a mistake: "Fluoridation confers the greatest benefit to those who need it most: the poor and poorly educated and those with limited access to regular dental care," she writes. "In the years ahead, removal of fluoride from drinking water will almost certainly cost taxpayers millions of dollars in increased Medicaid expenditures." (Read more)

In Kentucky, there is 100 percent fluoridation in public drinking water systems, though perhaps half a million residents get their water from wells, springs or cisterns.

Kentucky ranks 37th, Louisville 33rd in percentage of commuters who bike or walk to work

Kentucky ranks 37th in the nation for its number of commuters who bike or walk to work. Of the 51 largest cities in the county, Louisville ranks 33rd.

These are the findings of the Bicycling and Walking in the United States: 2012 Benchmarking Report, compiled by the Alliance for Biking & Walking. As well as looking at commuter numbers, it also examined how safe those commuters are and where transportation funding is being spent on "alternative means of local travel," reports Jeannine Stein of the Los Angeles Times. (Times photo by Wally Skalij)

Alaska, despite its cold climate, has the highest percentage of commuters who bike or walk to work. Boston has the highest ranking among cities. The lowest are Alabama and Fort Worth, Tex.

Across the country, 12 percent of all trips are on foot (10.5 percent) or by bicycle (1 percent), though from 2000 to 2009, the number of cycling commuters increased by 57 percent. While numbers are growing, safety is a concern. In the 51 largest cities, 12.7 percent of trips are by foot and 1.1 percent are by bicycle, but 26.9 percent of traffic fatalities are pedestrians and 3.1 percent are bicyclists.

Despite the risk, the report makes a connection with biking or walking and health. It points out cycling and walking levels fell 66 percent between 1960 and 2009, while obesity levels increased by 156 percent. The picture was more grim when it came to children. Between 1966 and 2009, the number of children who biked or walked to school fell by 75 percent, while the percentage of obese children rose by 276 percent.

Despite the physical benefits of the activity, states spend just 1.6 percent of their federal transportation dollars on bicycling and walking, amounting to just $2.17 per capita, the report found.

Instead of biking or walking, people are still relying mostly on their cars. The report found 40 percent of trips in the United States in 2009 were shorter than two miles, but Americans used their cars for 87 percent of trips that were 1 to 2 miles in distance. When it came to trips up to 1 mile long, Americans still used their cars 62 percent of the time.

The report was funded by the Centers for Disease Control and Prevention, AARP and Planet Bike.

Should companies refuse to hire employees who smoke? Opposing views outlined

The growing controversy surrounding companies who refuse to hire employees who smoke is featured in two opposing opinion pieces in USA Today.

Paul Terpeluk, medical director of employee health services at Cleveland Clinic, explains why the policy makes sense for his company. "Consider that cigarette smoke contains hundreds of chemicals and compounds that are toxic and at least 69 that cause cancer," he writes. "To ignore this would be to undermine our commitment to health and wellness, which includes providing a healthy environment for our employees, visitors and patients. Plus, the policy has not proved to be an overwhelming obstacle for job applicants. Since it was instituted, less than 2 percent of job offers — about 300 out of 20,000 — have been rescinded due to positive nicotine tests." (Read more)

But a USA Today editorial expresses a different view, in response to Baylor Health Care System's move to stop hiring workers who smoke. "Intruding this deeply into people's privates lives raises questions that bear scrutiny," it reads. "Companies can charge smokers more for health coverage or ban smoking on the job. But punishing people for using a legal product on their own time crosses a troubling line."

The editorial makes an exception for health-care companies who want to practice what they preach. "But such practices are not confined to the health care industry, and they raise a broader issue: If employers routinely reject people who engage in risky, but legal, behavior on their own time, what about such things are overeating or drinking too much alcohol?" (Read more)

West Liberty City Council votes to ban smoking in city buildings, but question may be revisited

The West Liberty City Council voted narrowly last week to ban smoking in city buildings, reports Miranda Cantrell of the Licking Valley Courier.

Mayor Jim Rupe opposed the move, which passed 3-2 with one abstention. If the vote had been tied, Rupe could have broken it.

"Rupe, a smoker, advised council members to consider city employees who smoke, including City Clerk Sally Barker and some department heads," Cantrell reports. Council Members Mark Walter and Belinda Jordan said they were trying to help members of the public who use city buildings.

"Barker said the council will likely revisit the smoking issue at next month's meeting," Cantrell reports. "No effective date for the ban was suggested." (Read more)

Friday, January 27, 2012

Cabinet files appeal to prevent releasing full child abuse records; Beshear backs decision

On the day the state was supposed to release unadulterated records on deaths and near deaths from child abuse, under a court order, it filed an appeal to stop the process. And though Gov. Steve Beshear had ordered the Cabinet for Health and Family Services to release the records, yesterday he sided with its officials, saying in an op-ed piece sent to Kentucky newspapers he did not "think the judge's order was protective enough" of informants who often want to remain secret, such as relatives, health-care providers, teachers and law-enforcement officials. (Getty Images photo)

“You teach in a small community and suspect a student is being abused,” Beshear wrote. “Can you come forward without the newspaper naming you as the accuser?" Jon Fleischaker, attorney for The Courier-Journal and the Kentucky Press Association, said Beshear was “fear-mongering,” and noted that Shepherd’s order to release records applies only in cases in which children were killed or nearly killed from abuse or neglect, following a state law designed to hold the cabinet accountable for its child protective services.

Beshear wrote, “The cabinet has been accused of 'operating under a veil of secrecy' in a supposed attempt to protect inept workers and a poorly designed system. But this is not about shielding the system from scrutiny. We understand the need to be more transparent than in years past.” In December, the cabinet handed over 353 pages of records, but the names of at least eight children who died from abuse or neglect had been redacted, along with all the names of children who had been seriously injured, as well as much other information. The Courier-Journal, the Lexington Herald-Leader and the Todd County Standard had sued the cabinet for refusing to release the records. Twice before, Franklin Circuit Judge Phillip Shepherd ordered the cabinet to turn them over. Last week, Shepherd fined the agency $16,000 for its secretive treatment and delays. He also found the cabinet should pay more than $57,000 in legal fees for the newspapers. (Read more)

Yesterday, the cabinet filed its motion with the state Court of Appeals and "asked the court to block Shepherd's Jan. 19 order to release records, starting today, with limited redactions," reports the C-J's Deborah Yetter. In the meantime, the cabinet released about 90 internal reviews of child deaths and serious injuries incurred by abuse but with deletions it feels is necessary "to protect the best interests of the state's child welfare system," its motion read. (Read more)

Home-health industry is the latest to complain about late payments since state switched to managed-care Medicaid

Kentucky's new Medicaid managed-care system is three months late in making payments to home-health agencies, officials told the House Health and Welfare Committee Thursday.

Nurses Registry and Home Health has outstanding claims of $300,000 to $400,000, Jeannie Lemaster, chief compliance officer, told lawmakers. "Kip Bowmar, executive director of the Kentucky Home Health Association, said only 8 percent of the claims from the approximately 150 home-health agencies have been paid since the switch to managed care Nov. 1," reports Beth Musgrave of the Lexington Herald-Leader.

"If these problems don't get corrected, there is a likelihood that some agencies could go out of business," Bowmar said.

Therapists who work with abused, neglected and at-risk children have likewise told lawmakers of back payments. Independent pharmacists have said "reimbursement rates are much lower than they were under traditional Medicaid, which means they are having to lay off employees," Musgrave reports.

In November, Kentucky made the switch to managed care for its 500,000 Medicaid recipients outside the Louisville region. The move is expected to save the state more than $1 billion in the next three years. Three companies, Coventry Cares, Wellcare of Kentucky and Kentucky Spirit, broker the care and are paid on a per-patient, per-month rate.

Lemaster said most of her agency's problems are with Coventry, which has denied 82 percent of their claims. "Lemaster said that because there are differences in the managed care companies and what is being approved for payments, there are inequities in the Medicaid system," Musgrave reports. "Some people are receiving services and others aren't."

Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services, said problems related to the changeover are being ironed out. "The primary focus of the Medicaid program staff is and continues to be the prompt resolution of any issues that arise as we ease the transition of providers to managed care," she said. (Read more)

Lawmakers hear testimony about state's pill mill problem, discuss whether to put all prescription-drug issues into one bill

With a raid on a pain clinic in Paintsville making headlines yesterday morning, state legislators heard from community leaders and officials telling them to pass legislation to curb the proliferation of pill mills.

Lois Windhorst, best known as a leader of Mothers Against Drunk Driving, told the Senate Judiciary Committee about a family member she lost to prescription-drug abuse. "It just progressively got worse," she said. "She carried a big bag of pills with her wherever she went."

On the legislative agenda is Senate Bill 42, which "would require licenses for pain management clinics and doctors to own them," notes Greg Hall of The Courier-Journal. There are 77 pain clinics in the state, 33 of which are owned by people who have no medical background.

No vote was taken on the bill. Its sponsor, Sen. Jimmy Higdon, R-Lebanon, said he will revise it based on yesterday's testimony.

Sen. Ray Jones, D-Pikeville, argued for a more all-inclusive bill, which would include the premise of Higdon's bill; ban cash payment at clinics, as proposed in House Bill 251; and require doctors and pharmacists to use the state's electronic drug monitoring system known as KASPER, a bill that Attorney General Jack Conway and others are expected to push once it is filed.

Jones "also said filling prescriptions from out of state should be required to check with registries in those states to guard against duplicate prescriptions," Hall reports.

Committee Chairman Tom Jensen, R-London, said there is much support to deal with the issue of prescription-drug abuse in this legislative session. Nearly 1,000 Kentuckians die each year due to prescription drug overdoses. (Read more)

Meds-for-meth bill could lead to overcrowding at doctors' office, Hopkinsville hospital official says

Making pseudoephedrine available only by prescription has led to fears of packed waiting rooms in doctors' offices, Dennis O'Neil writes for Hopkinsville's Kentucky New Era. (Photo of Sudafed pills by WebMD.com)

"It could lead to some overcrowding of primary care facilities that are already overcrowded," said James Goss, director of marking and community relations for Jennie Stuart Medical Center.

This session, three bills have been introduced to deal with pseudoephedrine, the key ingredient to make meth. House Bill 80 would prohibit anyone convicted with a meth-related charge from getting the drug without a prescription. The other two bills would prohibit anyone from getting the drug without a prescription, with the exception of pills in gel cap form.

Goss said he is worried a new law would inconvenience patients. "On its face, the bill seems well intended to protect the health and well being of the community," he said. "We are sympathetic to the pocketbook and convenience issues of our patients." (Read more)

State auditor will examine University Hospital's indigent-care trust

After the Jefferson County attorney said the fund lacked oversight, state Auditor Adam Edelen said he will audit and review the indigent-care trust in Louisville through which $32 million tax dollars flow. (Courier-Journal photo by John Rott)

The audit will determine "whether there are adequate resources to treat indigents in the Louisville area," reports Patrick Howington of The Courier-Journal. The issue came up recently when University Hospital, the recipient of the funds, tried to merge with two other hospital systems.

Earlier this month, County Attorney Mike O'Connell said the trust's board, which is appointed by the University of Louisville, "had not met in more than two years," Howington writes. The next day, U of L President James Ramsey asked Edelen to look into the trust's financial records.

Edelen spokeswoman Stephenie Steitzer said the lack of board meetings raises the question of "whether there is a proper and effective governance structure in place."

The trust receives $25 million each year from the state and $7 million from Louisville Metro Government. University Hospital uses those funds to treat poor, uninsured patients. Last year, the trust only paid for "about one-third of the facilities' charity care last year, which cost $88 million and involved more than 63,000 cases," Howington reports. (Read more)

Thursday, January 26, 2012

Bills would require more assessment before a patient can be admitted to a personal-care home

Legislation dubbed "Larry's Law" is aimed at preventing what happened to Larry Lee from happening again.

House Bill 307, filed by Democratic Rep. Terry Mills, right, "would require an individual to be examined and assessed by a medical professional before admission to a personal care home, and it would require further assessment of the degree of disability for an individual with an acquired brain injury who was being considered for placement," report Valarie Honeycutt Spears and Beth Musgrave of the Lexington Herald-Leader.

Senate Bill 115, filed by Republican Sen. Jimmy Higdon, left, would require that a potential resident be evaluated by a mental health professional before someone is admitted to a personal care home, a cost that would be picked up by the state. Higdon and Mills are both from Lebanon, where Larry Lee lived until he went to Falmouth Nursing Home in Pendleton County.

In August, Lee, right, disappeared from the home, one of 82 free-standing personal care homes in Kentucky. Lee, who had a brain injury from childhood, had been diagnosed with schizophrenia, bipolar disorder and diabetes. He was found dead four week after his disappearance on the banks of the Licking River, which flows through Falmouth.

A pre-admission assessment "is the only thing that we found that could have saved Larry Lee," Higdon said. "His condition was too severe. He should have never been in a personal care home." (Read more)

Police make second raid in a year at pain clinic in Paintsville

As lawmakers wrestle with what to do about prescription pill abuse in Kentucky, law enforcement continues to crack down on so-called "pill mills."

For the second time in less than a year, officers descended upon Care More Pain Management in Paintsville last Wednesday, arresting 29 people outside the clinic. "The raid was part of an ongoing investigation by Attorney General Jack Conway's office and the U.S. Drug Enforcement Administration into doctors who allegedly over-prescribe pain medications," report R.G. Dunlop and Laura Ungar of The Courier-Journal.

"We're been looking forward to this day for almost as long as I've been in office," five years, said Paintsville Mayor Bob Porter. "Hopefully, other people will think twice before they try to get into this business."

Dr. Richard Albert, who had practiced at the clinic, was arrested last Feb. 16 and pleaded guilty in December to conspiring to illegally prescribe about 50,000 Percocet tablets. Conway's office believes Albert was prescribing about 100,000 pills a month and seeing about 55 patients per day. (Read more)

USDA issues new school lunch rules; not as broad as first written, but will make meals healthier

The U.S. Department of Agriculture has released new, finalized requirements that will make school lunch a healthier meal for students.

The guidelines will mean:
• Students will be given both fruit and vegetables every school day.
• More foods will be made with whole grains.
• Students will be offered only fat-free or low-fat milk.
• Calories will be limited by portion size, based on the age of children being served.
• There will be less saturated fat and trans-fats in the food served.
• The amount of sodium will decrease gradually over the next 10 years.

Though the changes represent the first school-lunch overhaul in 15 years, they are not as comprehensive as the Obama administration initially wanted them to be. A bill passed late last year "would require the department to allow tomato paste on pizzas to be counted as a vegetable, as it is now," reports Mary Clare Jalonick of The Associated Press. "The initial draft of the department's guidelines, released a year ago, would have prevented that." Congress also kept USDA from limiting potatoes to two servings a week. Potato farmers and frozen-pizza companies lobbied hard against those proposals, some conservatives said the government shouldn't be telling children what to eat, and some school districts said the changes were too broad and too expensive.

Some of the changes will be incorporated by September, and others will be phased in. The changes affect lunches that are subsidized by the federal government in the National School Lunch Program, which serves 32 million children. Participation rates are very high in Kentucky. The Covington and Owsley County school districts have the highest percentage of students — 88 percent — eligible for free or reduced-price lunch. Magoffin County has the second highest with 86 percent followed by Newport (85 percent); Bell County (83 percent); and West Point Independent in Hardin County (81 percent). (Read more)

The changes are aimed in part at curbing childhood obesity. That has also been the target of measure to limit junk food in schools, which have been called into question. A recent study of almost 20,000 students found no link between junk food at school and weight gain in children. "The researchers examined the children's weight and found that in the eighth grade, 35.5 percent of kids in schools with junk food were overweight while 34.8 percent of those in schools without it were overweight — a statistically insignificant increase," reports Benjamin Radford of Discovery News. (Read more)

Free seminar on guardianship to be offered Feb. 26 in Lexington

Kentuckians for Nursing Home Reform will provide the opportunity to learn from experts about guardianship Feb. 26. More than 23,000 Kentuckians live in nursing homes.

Lexington attorneys Carolyn Kenton and Robert McClelland will speak, along with Virgiel Clayton, director of the Division of Guardianship in the Department of Aging and Independent Living.

The seminar, which is free and open to the public, will begin at 2 p.m. Feb. 26 at the Tates Creek Branch of the Lexington Public Library. For more information, click here.

Wednesday, January 25, 2012

In 11-1 vote, Somerset passes comprehensive smoking ban

Lighting up in Somerset, once a big tobacco town, will no longer be allowed in all enclosed public places. The city council voted 11-1 Monday evening to pass a smoking-ban ordinance, reports Heather Tomlinson of the Commonwealth Journal. (C-J photo)

The ordinance includes restaurants, bingo halls, gaming facilities, nursing homes and any place of employment. "It's a public health safety issue," said councilor Jerry Girdler, who lost his well-known brother Eddie two weeks ago to throat and lung cancer. "The facts back up that smoking is harmful to the people around them."

The meeting attracted a crowd of more than 50, many of whom voiced their opinions. Business owner Teresa Singleton said, "I am really shocked at the fact that the City of Somerset is considering taking away the rights of businesses to make those decisions on whether we want our place of business to be smoking or non-smoking. For you to take that on your own, I think that's a major step in the wrong direction."

Local podiatrist Pamela Jensen-Stanley disagreed. "I believe the ban is necessary," she said. "I think it's time that Somerset moves up and gets with the program." (Read more)

Monday, January 23, 2012

Florida-to-Appalachia 'pill pipeline' appears to be shriveling

Attorneys general from Florida and Kentucky say the prescription pill pipeline between the two states is beginning to close, reports Bill Estep of the Lexington Herald-Leader. They credit new programs and rules in Florida, but Kentucky AG Jack Conway says more work is needed "to attack the epidemic of prescription drug abuse in Kentucky." The pipeline has also supplied Ohio, West Virginia, Virginia and Tennessee.

Florida became the epicenter of the prescription drug trade to the Appalachian states because of lax regulation of pain clinics and tracking prescription drugs, Estep reports. People from the region traveled to Florida, stocked up on drugs, then returned home to sell them. In 2010, a police raid uncovered 1,400 files in a Florida doctor's office, and most were on Eastern Kentuckians. Police estimated that 60 percent of pills illegally sold in Kentucky were prescribed in Florida.

Florida officials have increased monitoring of prescription pills, boosted enforcement, required pain clinics to register with the state, started a prescription monitoring system and barred many clinics from dispensing pills. The results have been significant, Florida AG Pam Bondi said at a substance-abuse conference in Lexington. In 2010, 98 of the top 100 oxycodone prescribers were in Florida; only 11 are now. Registered pain clinics in the state have dropped from 943 to 579. (Read more)

UK opening new operating rooms, including high-tech hybrid

The region's first hybrid operating room, one that adds imaging and robotics to traditional surgery, is opening this week at the University of Kentucky Albert B. Chandler Hospital. The only other hybrid OR in Kentucky is at the Trover Clinic in Madisonville, according to Kristi Lopez of UK Public Relations.

News media are being invited to see demonstrations and tour the facility, as well as eight new operating rooms opening in the next phase of the hospital's construction, on Wednesday afternoon. Those on the 1:30 p.m. tour will include Dr. Michael Karpf, UK's executive vice president for health affairs; Ann Smith, the hospital's chief administrative officer; Dr. Joseph "Jay" Zwischenberger, UK HealthCare surgeon-in-chief; Dr. Bernard Boulanger, surgical services director; Dr. David Minion, a vascular and endovascular surgeon; and Dr. Justin Fraser, a neurosurgeon.

"Advantages to a hybrid operating room include greater accuracy of surgical procedures, reduced recovery time, and reduced risk of postoperative complications," a UK press advisory said. "Vascular and endovascular surgeries will begin being performed in the new OR in the next few weeks."

Journalists wanting to take the tour and watch the demonstrations should park in the UK HealthCare parking garage at South Limestone and Transcript Avenue and meet university public-relations representatives promptly at 1:30. For more information or assistance, call or text Lopez at 859-806-0445.

Sunday, January 22, 2012

Rockcastle County school board nixes ban on smoking at schools

While more than 30 Kentucky communities have banned smoking in enclosed public places, and about as many school districts have imposed a total ban, many districts remain resistant to the idea. This month the Rockcastle County Board of Education turned down a smoking ban that would have allowed designated smoking areas at athletic events but no smoke breaks for employees.

"Four of the five board members expressed opposition to the ban, including Mike Burdette, who said he didn't feel it was right to tell an adult they cannot use a legal product on grounds their taxes pay for," reported  the Mount Vernon Signal. Other board members said they didn't like the fact that the proposal from the administration did not include smoke breaks since employees "can't leave school during the day except for designated reasons."

The Signal reported that Superintendent Larry Hammond "put forth the argument that research has shown that second- and even third-hand smoke can be harmful to students," but only Board Chairman Martin Vanzant supported the proposal. To a member who suggested that the ban be delayed for two or three years, he said that would be "postponing the inevitable." (Read more)

In Kentucky, "All 174 school systems have restrictions of some sort on the use of tobacco products on their campuses, and any that allow staff smoking have designated areas," Brad Hughes of the Kentucky School Boards Association told Kentucky health News. "About 30 have a total ban."

Thursday, January 19, 2012

Opponents of meds-for-meth bill hold teleconference

Since they were not given the opportunity to speak at last week's legislative hearing about a move to make pseudoephedrine available mainly by prescription, opponents held a teleconference yesterday to air their opinions. It was hosted by representatives of the Consumer Healthcare Products Association, which represents makers of over-the-counter drugs.

Pat Davis, mother of six and wife of 4th District U.S. Rep. Geoff Davis, said "Our children are going to miss school, parents are going to miss time at work," if a prescription bill passes. Davis said she was disappointed she'd not been given the opportunity to speak last week. "There wasn't a single dissenting voice to be heard," she said. Legislators said they ran out of time and opponents would be given a chance to be heard.

Dr. Donald Neel, an Owensboro pediatrician, said he "recommends pseudoephedrine daily because it is the only safe and effective drug that we can recommend over the counter." He added, "It makes absolutely no sense for patients who need pseudoephedrine to have to come to the office, to take time off work. And we don't have time to see them." Neel said he feels "97 percent of his patients use the medicine legitimately,"

The bill at issue would require a prescription for pills containing pseudoephedrine but would not apply to medications using gelatin capsules, which are more difficult to use in meth making.

State Rep. Brent Yonts, D-Greenville, sponsor of an alternaitve bill, said the prescription measure goes too far. "Who do we punish? The soccer moms? Or the criminals?" he asked. His bill would only require the 5,500 people who have been convicted of a meth-related crime to have a prescription. It would also lower the amount of pseudoephedrine people can buy from 9 grams per month to 7.5 grams. It would continue to track the drug using MethCheck, which instantly tracks purchases at the point of sale. He called his effort "a common-sense approach."

Law enforcement and some legislators have criticized Yonts' bill because it won't alleviate "smurfing,"  meth cooks' payment of others to buy pseudoephedrine for them. But Yonts said MethCheck requires people buying the drug to hand over their driver's license and be placed in the system, allowing law enforcement to track who buys it often. "When they see these repeated efforts, they're going to be tracked down," he said, adding 30,000 stores and pharmacies use the system nationwide. "it's the right solution for Kentucky, and we can block criminals from getting this," he said.

Expect a bill that will require doctors to have KASPER accounts, state drug policy director says

By Tara Kaprowy
Kentucky Health News

A bill is likely to be filed in the General Assembly that will require drug prescribers to have an account with the state’s drug monitoring system known as KASPER, news that was met with applause at the Different Faces of Substance Abuse conference yesterday.

“We’ve got to get KASPER out of the dark,” said Van Ingram, executive director of the Kentucky Office of Drug Control Policy. “Let’s take the guesswork out of this, and let’s use the data proactively.”

The bill would also propose using the Kentucky All-Schedule Prescription Electronic Reporting system to “mine data toward patients,” Ingram said, meaning analysts would look for people who have gone to an unusually high number of physicians or other providers within a short period of time, presumably to doctor shop for drugs.

Ingram said the KASPER Advisory Council, charged by Gov. Steve Beshear to identify prescribing thresholds in various medical disciplines, is discussing targeting providers who write 6,000 to 8,000 prescriptions a year — or the top 5 percent of prescribers. Kentucky’s Office of the Inspector General, which is in charge of maintaining KASPER, would find the information and refer it to the various licensing boards, which would then take appropriate action. The move is “quite a paradigm shift,” since it would be using data proactively, rather than reactively, Ingram said.

Since some providers aren’t in the same location for a year at a time, Ingram said the counsel will likely advise KASPER to be analyzed on a per-day basis, since many "problem prescribers are here for a day."

Dave Hopkins, KASPER program manager in the Office of Inspector General, said 6.6 percent of Kentuckians have used prescription drugs for non-medical purposes, second highest in the nation behind Oklahoma. He said 15,000 Americans die annually of overdoses involved in prescription drugs.

KASPER monitors all Schedule II, III, IV and V controlled substances that are dispensed in Kentucky, data that is required by law to be inputted by pharmacists and other dispensers. That translates to more than 11 million controlled substance prescriptions each year, Hopkins said.

To use KASPER, doctors and providers can request reports about specific patients and see their prescription history over the Internet. In 2004, 122,469 such reports were requested by providers. In 2011, that number jumped to more than 800,000. “When we started this in 1999, the Cabinet for Health and Family Services estimated there would be a maximum of 200,000 reports a year,” Hopkins said.

Still, while 95 percent of the reports were requested by prescribers, just 32 percent of them have KASPER accounts. And though pharmacies are required to input the information, just 26 percent of them have accounts.

Ingram would not say who would file a bill that would change those numbers, but he feels hopeful about changes to come. “I’m really excited for the first time in a long time that we’re going to get some things done,” he said.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Wednesday, January 18, 2012

Beshear spares some health-related funding in harsh budget

Though Gov. Steve Beshear recommended harsh, nearly across-the-board cuts in his state budget proposal yesterday, some areas relating to health were exempt.

Though the budget for Cabinet for Health and Family Services could be cut by 8.4 percent, its social service department would actually gain $21 million in the next two years. "Cabinet officials said that would allow them to hire about 300 new workers, about one-third of them front-line social workers," reports Tom Loftus of The Courier-Journal. The child welfare department has been under fire due to its handling of children who died or nearly died from child abuse.

Beshear's budget would also spare Medicaid, a $600 billion per year health plan paid for mainly by the federal government. The proposal would add $108 million in the next two years to the state's investment in the plan, which provides health care to the poor and disabled. "That's because of projected growth in the program, which already serves about 800,000 Kentuckians," Loftus reports.

The budget also protects mental-health programs, and, for the first time, adds funding for substance-abuse treatment as part of a Medicaid benefit. (Read more)

Kentucky center helps more than 1,000 providers get electronic health records

The Kentucky Regional Extension Center has helped more than 1,000 health care providers transition to electronic health records, with specialists advising providers so they can meet the federal standards of "Meaningful Use."

"Quick access to electronic health records can make the difference in a provider's ability to treat the patient, whether it means checking a patient's cholesterol during a routine examination or identifying a medication allergy during an emergency," said Dr. Carol Steltenkamp, who directs the KY-REC and is the chief medical officer and pediatrician at UK HealthCare.

The adoption of EHRs by providers doubled from 17 percent in 2008 to 34 percent in 2011, the National Center for Health Statistics reports. As of Nov. 30, 2011, the Centers for Medicare and Medicaid Services had paid out more than $920 million in Medicare EHR incentives and $916 in Medicaid incentives, UKNow reports. The use of electronic prescribing, which allows physicians to generate, transmit and file patient prescriptions, has increased from 0.8 percent in December 2006 to 40.2 percent in September 2011, the nation's largest e-prescribing network Surescripts reports. (Read more)

Monday, January 16, 2012

Kentuckians binge drink more often than residents of any other state, national survey for federal health agency finds

By Tara Kaprowy
Kentucky Health News

Kentuckians binge drink an average of about six times per month, more often than people living in any other state, a report by the Centers for Disease Control and Prevention found.

Binge drinking is defined as consuming four or more drinks for women and five or more drinks for men on one occasion. Nationwide, 17 percent of adults binge drink, up from 15 percent in a 2009 survey. That's one in six people, averaging four binges a month and eight drinks per binge (CDC graphic).

Excessive and binge drinking "causes more than 80,000 deaths in the United States each year, making it the third leading preventable cause of death," reports MSNBC. Binge drinkers are at an increased risk for liver disease, heart disease, of being in a car accident and engaging in violent behavior.

The report analyzed data from a 2010 telephone survey of 458,000 adults who described their previous 30 days of drinking. "Although the percentage of people reporting binge drinking was highest among young people, it was binge drinkers ages 65 and older who over-consumed the most often: this group reported an average of five to six episodes a month," MSNBC reports.

Though Kentuckians binge drink most often, residents of Wisconsin drink the most alcohol — up to 9 drinks on one occasion — and had the highest percentage, 25.6, of people who said they binge drink. Utah and West Virginia has the lowest share of people who say they binge drink, 10.9 percent. New Jersey had the lowest frequency, 3.6 times per month. (Read more)

Meanwhile, a study found drinking alcohol leads to the release of endorphins in parts of the brain that are responsible for feelings of pleasure and reward, says research-reporting service Newswise. "This is something that we've speculated about for 30 years, based on animal studies, but haven't observed in humans until now," said lead author Jennifer Mitchell, clinical project director at the Gallo Center at the University of California-San Francisco. "It provides the first direct evidence of how alcohol makes people feel good."

Excessive alcohol consumption costs the country about $223.5 billion per year, "mostly due to lost workplace productivity and increased health care costs," reports Sarah Kiff for The Washington Post. (Photo by Uselei Marcelino, Reuters)

A study by Canadian researchers has found that setting a minimum alcohol price can drive down those costs — and is more accepted by the public than imposing taxes. The researchers found "for every 10 percent hike in minimum alcohol price, they found people drank 3.4 percent less alcohol," Kiff reports. "For certain drinks, the effect was even more pronounced: Increasing the minimum price of wine by 10 percent correlates with an 8.9 percent drop in consumption. Beer, however, appeared relatively resilient to price fluctuations, with a 10 percent bump lowering consumption a paltry 1.5 percent."

England and Wales have passed legislation that prohibits the sale of below-cost alcohol. Scotland is considering a similar move. (Read more)

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Spend $1 on smoking cessation, save $3 in health costs, Massachusetts study finds

Every $1 spent on smoking cessation in Massachusetts, saved $3 in health costs, a study of low-income Bay State residents found. That could bode well for the impact of a new smoking-cessation benefit in Kentucky's Medicaid program.

Massachusetts added a smoking-cessation benefit to its Medicaid program in 2006 and "let members choose from any FDA-approved options," reports Martha Bebinger for National Public Radio.

Researchers at George Washington University "found that members who quit saved three times the cost of the program in fewer heart-related hospitalizations after just over one year," Bebinger reports. "The study does not take into account the benefits of avoiding cancer or other long term smoking related illnesses."

Kentucky ranked 36th in the nation for tobacco prevention spending. Though it received $389 million in tobacco-settlment funds in fiscal year 2012, and ranks first or second in tobacco use, Kentucky spent just $2.2 million of that on prevention of tobacco use. It recently added a smoking-cessation benefit to Medicaid, a program that is funded mainly by the federal government but administered by individual states.

1 percent of population accounts for 22 percent of health-care spending, study finds

Just 1 percent of Americans were responsible for 22 percent of the nation's $1.26 trillion in health-care costs in 2009, and 5 percent accounted for 50 percent of costs, a federal report has found.

The numbers may seem shocking, but the concentration has dropped in recent years; in 1996, the top 1 percent of the population accounted for 28 percent of health-care spending.

"The report's findings can be used to predict which consumers are most likely to drive up health care costs and determine the best ways to save money," reports Kelly Kennedy of USA Today. (Read more)

Rural women are less likely to complete vaccinations for cervical-cancer virus; study finds vaccine does not increase sexual activity

Women living in rural areas of the U.S. were far less likely to return for their follow-up doses after they get the initial injection of the human papillomavirus vaccine, a study in the Journal of Rural Health has found. (Photo by Pete Rodman, Bowling Green Daily News)

The study contrasted the rates of vaccination follow-up by young women recruited from two rural locations and one urban location. "Despite being free, the researchers concluded that uptake of booster doses by rural women was problematic," states an article in the Rural Center for AIDS/STD Prevention's "RAP Time" publication. "This barrier might be resolved by providing the HPV doses at easy-to-access locations in rural communities, such as large grocery stores and area events."

The HPV vaccine requires three doses. The women who went to the rural clinic were seven times less likely to return for at least one follow-up dose.

The vaccine, which has proven to prevent most cervical cancers, has been approved for use in women ages 9 to 26 years, as well as boys. The vaccine is generally given at the age of 11 or 12 and is effective only if administered before a person becomes sexually active. As many as 80 percent of men and women become infected with HPV during their lives, but most do not develop symptoms or illness.

The vaccine has been met with reluctance by parents, some of whom fear it encourages sexual activity, but a study published in the American Journal of Preventive Medicine found girls or women who received the vaccine "were no more likely to be sexually active or have more partners than those not vaccinated."

Last year, just 49 percent of adolescent girls nationwide had received at least the first dose of the vaccine, and only a third had gotten all three. In Kentucky, just 25 percent of adolescent females had gotten the first dose and fewer than 11 percent had received all three doses.

In Kentucky, the annual death rate caused by cervical cancer is 2.9 deaths per 100,000. In the United States, it's 2.4 per 100,000. "The U.S. is remaining stable. Kentucky's is actually falling," gynecologist Dr. Mark Yurchisin told Alyssa Harvey of the Bowling Green Daily News.

The decrease is being attributed to an increase in screenings. "In certain counties in Kentucky there is a high incidence, they implemented outreach clinics because they didn't have clinics where they could get Pap screenings done," Yurchisin said. "They can diagnose it at an earlier and treatable stage." (Read more)

Shigellosis cases are on the rise in Louisville

There have been 60 confirmed cases of shingellosis in Louisville in the past three months, compared to an average of 62 per year in the area. About half of the new cases are in children who are 3 years old and younger.

"Shingellosis is caused by Shingella bacteria, which leaves the body of an infected person through the stool and enters another person's body when hands, food or objects contaminated with stool are placed in the mouth," reports Laura Ungar of The Courier-Journal. Because of the mode of transmission, maintaining personal hygiene is important.

"Hand washing is by far the most effective way to prevent shigellosis," said Dr. LaQuandra Nesbitt, director of the Louisville Metro Department of Public Health & Wellness. "We urge everyone — particularly parents, children, childcare workers and teachers — to wash their hands often."

Symptoms, which can occur one to seven days after exposure, include watery or loose stools, sudden onset of fever, nausea, abdominal cramping or vomiting. (Read more)

More transparency, accountability needed regarding child abuse, group plans to tell legislators

To decrease the number of children who are killed or nearly killed by abuse and neglect, there needs to be improved transparency and accountability at the Cabinet for Health and Family Services. This was the top recommendation made by a group of social workers, legislators, judges and child advocates who gathered at the Summit to End Child Abuse Deaths, put on by Kentucky Youth Advocates Saturday.

The other recommendations were to increase funds for services such as "appointed advocates, substance abuse programs, in-house services and parent advocate programs," increase funds for more social workers and support; and improve collaboration between child welfare agencies, reported Linda Blackford of the Lexington Herald-Leader. The group will send a letter to the General Assembly listing these recommendations.

Child abuse became a major issue for the state's largest newspapers after the Herald-Leader and The Courier-Journal sued the cabinet to gain access to records in which children had died or nearly died because of abuse. The cabinet had long fought to keep the records closed, even after Franklin Circuit Judge Philip Shepherd repeatedly ruled the records be released. In November, Gov. Steve Beshear likewise ordered the release of the records, but the cabinet tried to backtrack.

"Instead of lies, we need leadership," said Sen. Julie Denton, R-Louisville, at Saturday's meeting. Denton has repeatedly been outspoken about the issue, even asking for the resignation of Cabinet Secretary Janie Miller. Miller briefly attended Saturday's session, praising the efforts at collaboration, but saying the cabinet is being hit hard by budget cuts. She said the cabinet has lost $80 million in funding the past four years, but has asked for $20 million in new money over the next two years to pay for 300 more positions in its Department for Community Based Services. (Read more)

Saturday, January 14, 2012

Recession has hit health departments hard: 23,000 jobs (15%) lost, core funding cut

Funding and job cuts as a result of the economic recession have weakened the impact public health departments have on their communities, says a series of articles published in the Journal of Public Health Management and Practice.

"Continued cuts to public health services will have an unsatisfactory impact on the health of individuals and the community," said Dr. Lloyd F. Novick, the journal's editor-in-chief. "There is a heightened vulnerability at the present time for adverse health outcomes. Above all, the realization of the vital need to maintain resources for our public health delivery system is imperative."

In 2009, 23,000 jobs in public health departments were eliminated, 15 percent of the total. By 2010, more than half the agencies had a cut in core funding. As they scramble to make do with their new bottom lines, more cuts are expected. "The current, alarming trend of diminishing resources, reduced workforce and impaired capacity to maintain public health programs pose major hurdles for local agencies, with consequences that will be felt well into the future," said Dr. Rachel Willard of the University of California.

To view an article on the impact of the 2008-2010 economic recession on local health departments, one on a local health department that is providing only essential services, and one on enhancing public health value in an era of declining resources, click here.

Electronic health records are helping nurses provide better care, big study finds

Electronic health records are helping nurses get better health outcomes and are improving nursing care, the first big study on the subject has found.

The study conducted by the University of Pennsylvania School of Nursing involved 16,000 nurses at 316 hospitals in California, Florida, Pennsylvania and New Jersey. It found that "implementation of an EHR may result in improved and more efficient nursing care, better care coordination, and patient safety," wrote lead author Ann Kutney-Lee, a health-outcomes researcher at Penn Nursing.

The study, which was published in the Journal of Nursing Administration, also found, "having a basic EHR was associated with better outcomes independently of nurse staffing, indicating that they both play an important role in quality of care."

Nurses in hospitals that had comprehensive EHR systems were "significantly less likely to report unfavorable patient safety issues, frequent medication errors, and low quality of care," research-reporting service Newswise reports.

The most current estimates show just 12 percent of U.S. hospitals have an EHR system in place, but that will change with the Health Information Technology for Economic and Clinical Health Act. Starting in 2011, hospitals and physicians received incentive payments from Medicare and Medicaid to switch over to EHRs. The study did not measure outcomes in rural vs. urban settings "although we do know from other studies that hospitals that used electronic health records during this time period were less likely to be in rural areas," Kutney-Lee said. (Read more)

Thursday, January 12, 2012

Requiring prescription for pseudoephedrine is 'silver bullet' against meth, drug officials say; some lawmakers disagree

By Tara Kaprowy
Kentucky Health News

If Kentucky wants to arm itself with a "silver bullet" against methamphetamine, it needs to make pseudoephedrine available only prescription. That was the advice of top drug officials in Mississippi and Oklahoma, who testified before lawmakers Thursday. Opponents of the idea did not testify but legislators on their side had their say.

"This is a high-stakes cat and mouse game which has damaging results if we don't win," said Darryl Weaver, director of the Oklahoma Bureau of Narcotics. "The bottom line is: Do you want to track meth labs or do you want to eliminate meth labs?"

Marshall Fisher, director of the Mississippi Bureau of Narcotics agreed: "There is a silver bullet and the silver bullet wasn't tracking it; it wasn't limiting the amount. Weaver and Fisher testified at the request of the Senate and House Judiciary Committees, whose members heard exclusively from officials who support prescription-only policy.

Several related bills are on the table this year, including measures by state Rep. Linda Belcher, D-Shepherdsville, and state Sen. Tom Jensen, R-London, that would reclassify the drug to make it prescription-only. State Rep. Brent Yonts, D-Greenville, would apply the prescription rule only to people who have been convicted of a meth-related charge. The bill sponsored by Sen. Jerry Rhoads, D-Madisonville, would prohibit such offenders from buying the drug for five years.

Mississippi passed a prescription-only law 18 months ago and has seen a 67 percent drop in the number of its meth labs, Fisher said. Weaver said he is pushing for a prescription-only law in Oklahoma since its meth problem continues to grow, despite efforts to electronically track and limit sales of the drug.

All efforts have just been temporary fixes in Oklahoma, Weaver said, since they resulted in "smurfing," in which meth cooks pay others to buy pseudoephedrine for them. The same thing happened when that state instituted a drug registry, in which people who had been convicted of a meth-related crime were prohibited from buying pseudoephedrine without a prescription. The problem, Weaver said, is the tracking and registry "formed more of a conspirator group," where cooks were approaching the homeless and the previously uninvolved African American community to buy the drug for them.

Lt. Col. Joe Williams, executive director of the Appalachia High Intensity Drug Trafficking Area, said smurfing is a big problem in Kentucky too, and MethCheck, the tracking system in place now, does little good in helping law enforcement find meth labs. Meth labs "find us for the most part, we don't find them," he said. "Once we find a meth lab, we'll use the electronic tracking system and use that to trace back."

That runs counter to what Maj. Tony King of the Jefferson County Sheriff's Office said Monday on KET's Kentucky Tonight. In order for pseudoephedrine to be made available only by prescription, it must be reclassified as a legend drug. But those drugs are not tracked by MethCheck, which instantly tracks purchases at the point of sale, but by KASPER, the state's slower system for monitoring prescription drug abuse. "We will lose the ability to track these people and we will lose the ability to track these labs," he said.

Several lawmakers asked whether making pseudoephedrine available only by prescription would just result in doctor shopping and cold and allergy clinics popping up like so-called prescription pill mills. Williams said smurfers just won't take that risk. "It's very hard to fake snot in your nose," he said. "It's pretty easy to fake back pain."

Belcher's proposal would exempt pills in gel-cap format from the prescription rule, which prompted Rep. Sarah Beth Gregory, R-Monticello, to ask if that wouldn't eventually become a problem. Yonts pointed out that the U.S. Drug Enforcement Administration has said pseudoephedrine is "readily extractable" from gel caps. Weaver said he's "yet to see one lab that has been made with gel caps and liquids," he said, adding, "We have to find a balance between intrusion of government and what we need to stop the problem."

But it's that intrusion that has Yonts calling his measure the "middle ground," saying it protects "the soccer moms and Walmart moms" from having to constantly take their kids to the doctor but punishes the offenders. And while officials say only 15 cold medicines would be affected by requiring a prescription, leaving 137 other options, Yonts said medicines containing pseudoephedrine account for 63 percent of sales.

Williams said the average meth lab costs $2,100 in law enforcement, including manpower, overtime, equipment and waste disposal. With 1,146 labs found in Kentucky in 2011, that translates to $2.4 million. Sen. Robert Stivers, R-Manchester, said the problem is "a much larger cost to the taxpayers" since "the majority of these people are probably indigent care and the taxpayer is paying the bill for this."

Whatever the cost, Rep. Johnny Bell, D-Glasgow, called the issue "the most important" of the session. "I hope that we'll step forward and think about the human life and the impact it's having."

Representatives of the Consumer Healthcare Products Association said after the meeting that Pat Davis, identified as a mother of six from northern Kentucky, signed up to speak at the meeting but did not get to. She said she would have spoken about a prescription bill's "impact on consumers and parents, yet the committee was forced to watch videos of news reports and slides that have been seen several times already. It is apparent that the voices of consumers and parents aren’t important to the people running this process."

Wednesday, January 11, 2012

Health reform means millions more will be covered and more illness will be prevented, federal health official says at UK

By Tara Kaprowy
Kentucky Health News

What will the healthvcare system look like in 2020? Assistant Secretary of Health Dr. Howard Koh told a packed house in Lexington Monday that millions more people will have insurance, the patient will be at the center of a coordinated system, and there will be a great emphasis on prevention and public health "so the patient doesn't become the patient in the first place."

Koh talked about federal health-care reform during a panel discussion at the University of Kentucky's Albert B. Chandler Hospital. It also included Dr. Steve Hester, senior vice president of Norton Healthcare; Dr. Richard Lofgren, vice president of health care operations and chief clinical officer at UK HealthCare; and Stephen Wyatt, dean of UK's College of Public Health.

Koh said the current health-care system "is fragmented, it's episodic, it's not as coordinated as we would like, and there is still not enough attention to quality outcomes." But he said implementation of key parts of the health-care law would address those issues.

He said insurance is already more accessible, since companies can no longer refuse children with pre-existing conditions. By 2014, the same will be the case for adults. State insurance exchanges, which he called "a one-stop shop where buyers can compare plans," will inject "transparency in the whole market" and will ensure basic levels of coverage.

Insurance will also become more affordable, he said. The Medicare prescription "donut hole" is being covered; young adults can stay on their parents' plan until the age of 26; insurance companies must assure that 80 percent of their expenses go toward medical care and not overhead; and there will be a rate-review process, in which insurance companies wanting to increase their rates by 10 percent or more must formally defend their request.

Patient-centered medical homes will put the patient at the center of care and accountable care organizations, and "voluntary networks who have agreed to care for a defined Medicare population and also share in savings," will make coverage more coordinated, Koh said.

The law also puts systems in place for prevention and public health. On the individual level, new plans must cover "high-value preventive services and screenings," Koh said. Businesses are being encouraged to focus on wellness. The Centers for Disease Control and Prevention are offering community transformation grants so communities "can designs ways to make the healthy choice the easy choice," he said. And a national prevention counsel has been formed dedicated to public health.

The law also provides millions for health-care technology, which Hester said will revolutionize the health-care landscape and "the way we respond to patients." Koh agreed, saying a paper-based system "was another example of fragmentation. . . . prevSometimes you could find the chart, sometimes you couldn't. The electronic-based system will coordinate."

Hester said patients have recently become more equipped to accept the technology of electronic health records because they've become used to devices like smart phones. Logren said that, traditionally, patient records have been "proprietary." Electronic records will get information moving from place to place and will no longer be "owned."

Koh acknowledged one of the greatest challenges of the health-reform law is sustainability, but by 2020, he said "We will see stable funding and stable results" in public health and prevention. While the law has created divisiveness in the political arena, Koh said strong opinions about health care are a good thing because they generate discussion and passion. "We can debate many parts of the health reform law," he said, "but in the meantime, we are making progress."

In front-page editorial, rural weekly in Adair County demands that board members of county-owned hospital resign

In our experience, most weekly newspapers don't have editorial pages, much less editorials, so when one puts an editorial on the front page and also runs an editorial about the decision, and the work is well-written and well-argued, it's worth noting.

The Adair County Community Voice in Columbia, Ky., noted county government's bailout of the "collapsing" county-owned hospital; elected officials' request that they have "a say in any final decision to sell the hospital" and that "the hospital administration will try just as hard to keep the hospital independent as they will to sell it;" and some appointed board members' dislike of the requests.

"It seems like little to ask of someone who is $13 million in debt and asking you for $1.7 million," the editorial said, noting that one member said the board had been "a rubber stamp" for agents who secured the bonded debt. That admission "saves us the trouble of trying to prove that board members acted irresponsibly in overseeing the hospital’s business," the editorial said. "Now the question has to be, 'Why are they still on the board?'" It said the board not only "ran the hospital into the ground" but is "in control of a document that will show if any criminal activity took place," a forensic audit that gives board members "a personal stake in any damaging evidence that may come out."

In her explanatory editorial, Editor-Publisher Sharon Burton said she put the editorial out front because "We believe this is a critical time for our community, and we believe bad decisions will continue if the board is left as it is. We believe it’s our job to bring the issue to the forefront, and there is no better place to do that than on the front page of the Community Voice." The explanatory editorial also included useful background and perspective, including: "At small newspapers we don’t have the luxury of separating the people who cover the news from the people who write opinion pieces. Instead, we work hard to provide fair and unbiased coverage of local news. Then, we look at how that news impacts the people in our community and take a stand as needed on our editorial page."

Burton told us in an email that the editorial generated responses by phone, emails, Facebook messages "and of course being stopped at church and the grocery store," all of them positive except a letter from the daughter of a board member, which is running this week. The Community Voice doesn't put editorials or most news online, but PDFs of the pages with the editorials are available on the Institute for Rural Journalism and Community Issues website. The front page, with color, is 3.5 MB; the inside page is 682 KB.

Tuesday, January 10, 2012

Hopkinsville newspaper endorses smoking ban

The Kentucky New Era newspaper in Hopkinsville said in a recent editorial that if the state legislature doesn't enact a smoking ban, the city should.

The General Assembly "should not squander the opportunity or delay action on a law that could protect everyone against the health risks associated with exposure to secondhand smoke," the editorial said. "Legislators should not disregard the overwhelming scientific evidence of the effects of secondhand smoke. . . . Opponents of a smoking ban argue that they want to protect the rights of smokers. We believe those rights to not extend to smoking in places where non-smokers work, shop and eat." (Read more)

UK professor named chair of new national board that will grant accreditation to local, state and other health departments

Dr. F. Douglas Scutchfield, director of the National Coordinating Center for Public Health Services and Systems Research and the Peter P. Bosomworth Professor of Health Services Research and Policy at the University of Kentucky College of Public Health, has been named chair of the first Accreditation Committee of the Public Health Accreditation Board.

Jointly funded by the Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, the board was created to  administer the new accreditation process for state, local, tribal, and territorial health departments. The program was launched in September 2011, and health departments are already beginning to apply. The 11-member Accreditation Committee will make accreditation decisions on behalf of the PHAB board of directors, a UK press release said.

Monday, January 9, 2012

Require all to have a prescription for pseudoephedrine, or just meth criminals? Officials debate the issue on KET

By Tara Kaprowy
Kentucky Health News

If something isn't done now about the prevalence of methamphetamine in Kentucky, "We're going to lose a generation." That was one of the jarring comments from one of the public officials who discussed ways to limit access to pseudoephedrine, the key ingredient in meth, Monday evening on KET's Kentucky Tonight.

The issue is one of the most contentious in the legislative session that began last week. There are two bills on the table aimed at quashing the problem, both sponsored by House Democrats.

Rep. Linda Belcher of Shepherdsville would make pseudoephedrine available only by prescription, but exempt the gel-cap version of the decongestant. Her bill would expire in three years, to give legislators an opportunity to assess its effectiveness.

Rep. Brent Yonts of Greenville would merely require the 5,500 Kentuckians who have already been convicted on a meth-related charge to have a prescription for the drug.

Belcher argued on the program that Yonts' bill "doesn't go far enough, it doesn't do the job," because meth cooks can pay others to buy the drug over the counter, while Yonts said his bill is a "middle ground" compromise. He asked, "Do we punish the whole population of Kentucky or do we punish those who have violated the law?"

Clay County Sheriff Kevin Johnson called into the program and sided with Belcher, saying "As far as putting the crooks on a banned list, that's not going to help the problem." Chris Cohron, Warren County commonwealth's attorney, said officers with the Kentucky Narcotics Officers Association "overwhelmingly support" Belcher's effort.

Maj. Tony King of the Jefferson County Sheriff's Office took an opposing view In order for pseudoephedrine to be made available only by prescription, it must be reclassified as a legend drug, he said, but those drugs are not tracked by MethCheck — the system that instantly tracks pseudoephedrine purchases at the point of sale — but by KASPER, the state's slower system for monitoring prescription drug abuse. "We will lose the ability to track these people and we will lose the ability track these labs," he said.

Meth-lab numbers continue to go up in Kentucky, reaching nearly 1,100 in 2010. Cohron said that is not the case in Oregon, one of two states that has passed a prescription law. He noted that in 2004, there were 472 labs in Oregon and 571 in Kentucky. In 2010, there were 13 in Oregon, and nearly 1,100 in Kentucky. Still, Yonts said Belcher's bill would punish people in all Kentucky counties for the problems of a relatively few counties.

Yonts argued MethCheck is working now, and his bill would merely strengthen what's in place. He said MethCheck stopped more than 14,000 attempts to buy pseudoephedrine last year. "All our surrounding states will very quickly have our system," he said. "CVS and Walgreens will inter-connect. It's a system that instantly verifies. It works." Cohron countered that 100,000 attempts were blocked in Oklahoma, which has a similar system, "but meth labs are still going up by 10 percent a year there. "Being reactive instead of blocking it is not going to solve the problem," he said.

Some callers to the show said Belcher's bill should not exempt gel caps, from which pseudoephedrine is more difficult to produce. Belcher acknowledged her bill is also a compromise and that 97 percent of meth labs use the pill version. Yonts said exempting the gel caps "just opens the door to another problem."

Panelists also discussed the issue of cost. Yonts said the state stands to lose up to $1 million in tax revenue if pseudoephedrine is reclassified as a legend drug, because prescription medication is not subject to sales tax. Belcher said the cost will be far greater, $1 million in manpower alone. "If we're looking at a tight budget, I'd certainly like to take that $1 million and use it for something that is more productive," she said.

Both Yonts and Belcher said they expect their bills to be heard in committee soon. In the meantime, Cohron, who said a generation is at stake if nothing is done, underscored the importance of dealing with the issue without being romanced by drug companies and lobbyists. "We're talking about a billion-dollar industry," he said. "They will spare no expense and they will stop at nothing to defeat it because it a billion dollars on the line."

To watch the show via KET videostreaming, click here.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.