Wednesday, February 29, 2012

A look at the history of U.S. health care and health insurance

Health insurance in the U.S. has some of its roots in the World War II shipyards of Henry J. Kaiser, who built 747 vessels for the Navy. The war made workers scarce, so Kaiser needed a way to attract them and, once there, keep them healthy. He couldn't pay them more because wages were frozen, so he offered them health care, which was provided by doctors at company clinics and hospitals. In turn, he asked employees to kick in 50 cents a week for the benefit. (Photo: Kaiser Shipyards in Richmond, Calif., courtesy of Metals Corporation)

"The war ended, the workers quit the shipyards, leaving behind hospitals and doctors but no patients," Bob Rosenblatt reports for the Los Angeles Times. "So the company decided to open the system to the public — and that's how generations of Californians who never heard of Kaiser shipyards have since gotten medical care."

Kaiser's story is just one example of how America's health insurance system developed, Rosenblatt writes. As at the shipyards, most people still get coverage through their jobs and, unlike the rest of the industrialized world, not from the government.

In fact, there has long been a fight against having the government in charge of providing care, Rosenblatt contends. In 1918, when California proposed a constitutional amendment that would have organized a state-run program, doctors said "compulsory social health insurance" was "a dangerous device invented in Germany." The amendment lost, but many presidents pursued the issue. Franklin D. Roosevelt "flirted with the idea but never threw political muscle behind it," Rosenblatt reports. Harry S. Truman asked Congress to provide national health insurance, but could not bring it to a vote.

It was the model exemplified in the shipyards that was adopted, and "health insurance became a standard feature in labor contracts," Rosenblatt writes.

Things changed in 1965, when President Lyndon B. Johnson pushed through a heavily Democratic Congress what Rosenblatt calls "a legislative three-layer cake:" Medicare Part A, Medicare Part B, and the federal-state Medicaid program. The legislation was controversial, with fears that doctors would refuse to see Medicare patients and hospitals would refuse to dismantle segregated wards. "The doctors didn't strike," Rosenblatt writes. "And the hospitals were immediately integrated without protest."

In 1993, President Bill Clinton wanted to extend national health insurance to everyone, but Rosenblatt says "Congress felt excluded and insulted, and the plan never came to a floor vote in the House or Senate."

President Obama did the opposite and relied on the congressional process. "Key to the plan was a mandate that everyone buy into the system; it was the best way to spread out the costs of illness," Rosenblatt writes. It's that mandate up for debate in the Supreme Court next month, but even if the Affordable Care Act is subsequently thrown out, "people already enjoy some benefits and won't want to give them up," Rosenblatt writes.

"It seems a safe bet that some provisions in the Affordable Care Act will stay on the law books," Rosenblatt concludes. "This places a few more patches on the national healthcare quilt. That's the American way." (Read more)

State and companies were unprepared for quick move to managed care, state auditor concludes

Kentucky officials and the companies in charge were unprepared for the switch to Medicaid managed care, State Auditor Adam Edelen said Wednesday. He sent the Cabinet for Health and Family Services 10 recommendations to improve the system, which provides health care for 560,000 Kentuckians who are poor, disabled or elderly.

Since the legislative session began, providers and patients have bitterly complained that the three new managed-care companies are "too slow to reimburse providers" and have "cumbersome pre-authorization processes to allow treatment," reports Beth Musgrave for the Lexington Herald-Leader. The state moved to managed care Nov. 1, a move meant to save the state $1.3 billion in three years.

In addition to the recommendations, Edelen said he will form a Medicaid auditing unit designed to improve the system. He recommended: hiring more managed-care staff to fix backed up claims payments and treatment authorizations, developing a system to measure whether providers are receiving payments in a timely way, and considering removing mental health services from the contracts. Kelly Gunning of the National Alliance on Mental Illness told lawmakers last week that she had asked mental health to be removed from the contracts in January, saying it had not worked in other states either. The companies are reportedly asking psychiatric patients to switch medications, even if the ones they are already on are working. The move has "meant that more people with serious mental illness have had to return to state psychiatric treatment centers," Musgrave reports.

Edelen said Kentucky officials "did not learn from the 1997 launch of Kentucky's first managed care contract — Passport in the Louisville area — and seemed ill-prepared to monitor and enforce the three new managed care contracts," Musgrave reports. Under managed care, the companies are paid a predetermined per-patient, per-month amount regardless of what care is needed. Because they won't be paid using a fee-for-service model — believed to be more costly — and will try to streamline care, managed care is meant to save money. (Read more)

House Judiciary Committee approves two bills to curb synthetic, Rx drug abuse

Cracking down on drugs is one of the most pressing topics of the 2012 General Assembly, and lawmakers showed they were serious about it this afternoon. (Associated Press photo by Ed Reinke of House Judiciary Committee Chairman Rep. John Tilley, D-Hopkinsville)

In an effort to get a handle on prescription drug abuse — and so-called pill mills that supply the addictive medications — the House Judiciary Committee approved a bill that will place controls on pain management clinics, reports Jack Brammer of the Lexington Herald-Leader. House Bill 4 also puts the power to police the problem into the hands of the attorney general; cracks down on prescribers who have had trouble with the law for drug-related crime; requires that the clinics be owned by people who have a medical background; and will get a detailed look at how many deaths are occurring by having coroners report any death caused from the use of drugs or drug overdoses.

"We don't really know how bad (the problem) is," said House Speaker Greg Stumbo, the Prestonsburg Democrat who filed the bill. "I think it will astound us when we get the results in because I think it might double what we think the numbers are."

The committee also approved House Bill 482, which prohibits trafficking and possession of synthetic drugs that are sold as bath salts or incense in convenience stores and other places. The measure, sponsored by committee chairman John Tilley, D-Hopkinsville, was passed unanimously.

Both bills will now go to the full House for consideration. (Read more)

Meds-for-meth compromise bill introduced

Lawmakers said they would compromise on the idea of making pseudoephedrine available only by prescription, and they have. Senate Bill 3 would only require a prescription for medicines containing the drug after a patient has bought 3.6 grams of it per month and a maximum of 15 grams per year. Gelcaps and liquid forms of the drug would still be excluded. (Associated Press photo by John Flavell of recovering addict Melanda Adams and Senate Majority Floor Leader Robert Stivers, who introduced the bill)

Now, people are limited to buying 9 grams per month and 120 grams per year of cold and allergy medicines containing pseudoephedrine, which is the key ingredient to make meth. The bill would also prevent anyone who has been convicted of a meth-related crime from buying the drug without a prescription for five years.

Last week, Sen. Robert Stivers, R-Manchester, withdrew a bill that would have required a prescription for any purchases of the drug. Stivers introduced this new bill yesterday and told The Courier-Journal it gives people who use the medicines "adequate opportunity without incurring medical expenses or the cost of a prescription to access these on a monthly basis and an annual basis."

Opponents to the bill still feel it is too restrictive, with the Consumer Healthcare Products Association continuing "to oppose burdensome restrictions to over-the-counter cold and allergy medicines that thousands of law-abiding Kentuckians rely upon for relief," Elizabeth Funderburk, senior director of communications for the group that represents makers of over-the-counter medicine and dietary supplements, told the Louisville newspaper.

Opponent Pat Davis, mother of six and wife of 4th District U.S. Rep. Geoff Davis, railed against the new proposal. "I'm not sure why they're calling it a compromise bill because I'm not sure who they compromised with," she said. She pointed out if four members of her family were to get sick with a cold, and took Sudafed to treat it for seven days, that would amount to 13.44 grams of the medicine — nearly the annual limit. "Really what this bill is is the same bill," she said. "They're throwing out a few crumbs, which they're calling 15 grams."

Jackie Steele, commonwealth's attorney for Laurel and Knox counties, told the paper that the lower limits could lead to a reduction in meth labs, but not for long. "I hope this cures it," he said of the meth-lab problem. "I don't think it will."

In London, whose Walgreens has the highest sales of pseudoephedrine in the state, Police Chief Stewart Walker agreed with Steele. "The bad guy is always going to figure a way around this," he said. "(With the compromise) you probably leave the door partly open and there's so much more room for added work."

The Senate Judiciary Committee could consider the new bill Thursday, and the entire Senate could vote on it this week, Stivers told the Lexington Herald-Leader. (Read more) For The Courier-Journal's story, by Jessie Halladay and Tom Loftus, click here.

Tuesday, February 28, 2012

Webinar on local food projects is set for 2 p.m. Wednesday

An online tool that features the local and regional food projects in the works across the country, as well as case studies that show successful partnerships between producers, businesses and communities, will be unveiled by the U.S. Department of Agriculture in a webinar at 2 p.m. tomorrow.

The "Know Your Farmer, Know Your Food" compass is an interactive document and map. During the webinar, Agriculture Secretary Tom Vilsack and Deputy Secretary Kathleen Merrigan will discuss the instrument, as well as how local and regional food systems make money for local farmers, ranchers and food entrepreneurs. They will also discuss how responsible food systems increase the number of farms in the country and expand access to healthy food.

Know Your Farmer, Know Your Food was launched in September 2009. The initiative is meant to coordinate USDA resources and expertise on locally grown food.

To watch the webinar via live streaming, click here. Participate live by asking questions on Twitter to @usda and using the hash tag #KYF2. (Read more)

Video systems like Wii Fit not working against child obesity: study

Video games designed to encourage children to exercise don't do anything to prevent obesity, a study has concluded. It found that children either find a way to trick the games "into thinking they are moving around, or they make up for exercise by vegging out more later," reports Maggie Fox for the National Journal.

"It doesn't appear that there's any public-health value to having active video games available in stores — simply having those active video games available on the shelf or at home doesn't automatically lead to increased levels of physical activity in children," said Dr. Tom Baranowski.

Baranowski and his Baylor College of Medicine team studied 78 children, whom they gave the video system Wii to play with. "It's not clear whether those in the study group were more active as a result of the video games but compensated by being less active later, or if they found a way to manipulate the instruments to minimize the amount of physical activity," he said.

Other studies have shown the video systems are beneficial to some age groups, including seniors, Fox reports. The study is published in the journal Pediatrics. (Read more)

First lady didn't donate to breast cancer fund; Gov. Beshear announces collaboration to fight many cancers

Though First Lady Jane Beshear made headlines Monday when it was discovered neither she nor Gov. Steve Beshear had checked off a donation box to support breast cancer research on their state income tax returns — something the first lady has encouraged taxpayers to do — the governor announced Tuesday the formation of a foundation exclusively committed to reducing the rates of several types of cancer.

Gov. Beshear, who was treated for prostate cancer in 1994, joined members of the newly-formed Kentucky Cancer Foundation to announce their plans
to reduce lung, colon, breast and cervical cancer rates. To do so, foundation members will raise private funds and pursue grants to pay for services like mammograms, pap smears, smoking cessation programs and colon cancer screenings.

The public-private collaboration would focus first on screening 4,000 uninsured Kentuckians for colon cancer. Beshear has put $1 million for the screenings in his current budget proposal.

"Our most recent information shows more than 24,000 new cases of cancer in Kentucky each year and of those, more than 9,500 Kentuckians die from these cancers," Beshear said. "This is a real problem in our state that is affecting the lives of every family. As a cancer survivor, I know firsthand that screenings and an early diagnosis will help save our citizens from this horrible disease." (Read more)

As for the tax gaff, the Lexington Herald-Leader's Jack Brammer reports the 2010 returns show the Beshears did opt to check the box to donate at least $2 of their taxes to the Kentucky Democratic Party.

Diane L. Brumback, a Northern Kentucky breast-cancer survivor and Democrat who participated in a news conference with Beshear in January to promote the state-run Breast Cancer Research and Education Trust Fund, said Monday the first lady should stop promoting the cause "if she is not going to do as she says."

A Beshear spokeswoman underscored that the governor and first lady are very charitable. "On their 2010 tax return, you'll see they donated nearly $19,000 of their gross income — that's more than 11 percent of their before-tax income," said spokeswoman Kerri Richardson. "Not only do they donate money to many worthy causes, including those that support breast-cancer research, but they give their time and energy to promoting those charities and non-profit organizations." (Read more)

Extensive series focuses on the many faces of mental illness

Mental illness in Rowan County is the subject of an eight-part series of stories written by Noelle Hunter for The Morehead News.

With Part 1 largely an introduction to the project, Part 2 gets into the facts and figures of the disorders that fall under the mental-illness umbrella. According to the Substance Abuse & Mental Health Services Administration, 45.9 million American adults — one in five — experienced some mental illness in the past year. In Kentucky, 180,000 people live with a serious mental illness, which includes schizophrenia, bipolar disorder, major depression, obsessive compulsive disorder, panic disorder and post-traumatic stress disorder.

Dr. Thomas Insell, director of the National Institute of Mental Health, described mental illnesses as "real brain disorders that result from complex genetic risks plus environmental factors." Neither prevalence nor mortality rates associated with mental illness have decreased over time. And though there have been advancements in treatments these disorders, most in the way of medication and therapy, there is still much that is unknown, Hunter reports.

That comes with larger cultural ramifications. In 2008, about 5,100 adults who have a mental illness were incarcerated in Kentucky prisons and almost 700 adults committed suicide, "almost always a result of untreated mental illness," Hunter reports.

The series is running on Tuesdays in the twice-a-week paper. Part 3 profiles a woman living with bipolar disorder; Part 4 will report on the views of clinicians and therapists; Part 5 will profile a man living with bipolar disorder; Part 6 will profile a person living with schizophrenia; Part 7 will focus on the effects on families; and Part 8 will look at treatment options and recovery. The website of the newspaper, part of Community Newspaper Holdings Inc., is here.

Avoiding immunizations on religious grounds is risky: Bill Moyers

The movie "Contagion" has veteran journalist and commentator Bill Moyers thinking about how fast a deadly disease outbreak can spread, something that can be further propagated by children whose parents have declined to get them immunized on religious grounds.

All states require children to receive some vaccinations, but almost all, including Kentucky, grant religious exemptions. "Now seven states are considering legislation to make it even easier for mothers and fathers to spare their children from vaccinations, especially on religious grounds," Moyers writes.

In some places, that is affecting vaccination rates. In Oregon, the number of children in kindergarten with religious exemptions is up from 3.7 percent to 5.6 percent in the past four years. When the number of people who are not vaccinated increases, that can affect the whole population, since "a certain number of any population group needs to have been vaccinated to maintain the ability of the whole population — 'the herd' — to resist the spread of a disease," Moyers explains. In a class of 25 students, it just takes five who are unvaccinated "for the herd immunity to break down," he writes.

Recently, several outbreaks have been linked to children who have not received their vaccinations. Reuters reported 13 cases of measles in central Indiana, including two whop attended the Super Bowl in Indianapolis. "Patriot and Giants fans back East have been alerted," writes the New York-based Moyers. "So far, no news is good news."

Moyers calls the vaccination gaps "serious business," and reminds readers about serious disease outbreaks of the past, including measles, flu, small pox, polio, and whooping cough. While it's easy to be unconcerned, he says "our human herd moves on a conveyor belt of constant mobility, so that a virus can travel as swiftly as a voice from one cell phone to another. When and if a contagion strikes, we can't count on divine intervention to spare us. That's when you want a darn good scientist in a research lab." (Read more)

"The comments from vaccination skeptics on Bill's column show there are science-deniers on the left just as there are on the right," said Al Cross, director of the Institute for Rural Journalism and Community Issues.

Monday, February 27, 2012

Kentucky ranks next to last, Fifth Congressional District dead last in national healthiness and happiness survey

(Click on images for larger versions)
Kentucky was again next to last among the states in happiness and healthiness of its residents in 2011, ranking above only West Virginia, though precise rankings are uncertain. Eastern Kentucky's Fifth Congressional District ranked at the very bottom of the 436 districts — falling in last place in the categories of life evaluation, emotional health and physical health.

The Gallup-Healthways Well-Being Index is based on a continuing national survey that asks respondents about their overall sense of well-being, physical health, happiness, job satisfaction and other factors related to quality of life.

Of the 190 cities ranked, Lexington was 95th and Louisville 152nd. Kentucky's well-being score was 63.3 out of a possible 100 points. Hawaii again ranked first, at 70.2. West Virginia's score was 62.3. Because there were fewer than 10 points between first and last place, the rankings are not precise. Kentucky ranked lowest in the country in emotional health, which is based on feelings of happiness and sadness. Respondents were also asked about "physical health (chronic health conditions, obesity); lifestyle behaviors (smoking, diet and exercise); emotional health (feelings of happiness, sadness); work environment (relationship with supervisors); basic access (health care, food); and life evaluation (how they rate their lives)," reports Nanci Hellmich of USA Today.

Results were based on telephone interviews conducted between Jan. 2 and Dec. 29, 2011, producing a random sample of 353,492 adults. The margin of sampling error for most states is plus or minus 1 to 2 percentage points, but as high as plus or minus 4 points for states with small populations such as Wyoming, North Dakota, South Dakota, Delaware and Hawaii. (Read more)

Will birth-control mandate cost more or less? Yet to be seen

Will requiring insurance companies to provide contraception be cost-neutral, as the Obama administration claims? It is unclear, and so is whether insurance companies will make Catholic institutions pay more. These were the findings of, a nonpartisan, nonprofit, consumer-advocate project funded by the Annenberg Public Policy Center of the University of Pennsylvania.

In support of its claim, the administration cites data from Hawaii's birth-control mandate, which shows health insurance premiums "did not appear" to increase. The study also found the number of pregnancies increased after contraception coverage was required.

But when Pennsylvania considered imposing a similar mandate, a state agency found "the amount of possible savings relative to the cost of the legislation is unclear." Findings were also unclear in Connecticut when officials there looked at whether or not insurance plans saved enough because there were fewer pregnancies to offset the cost of providing coverage. A Texas study found insurance companies would not save enough because women would buy contraception on their own.

A recent survey of 15 insurance companies found six thought costs would increase and another three felt the move would be neutral in cost. None felt they would save money because of the mandate.

"Until better data are available, we're unable to conclude whether the Obama birth-control mandate is likely to result in a net cost increase or not," FactCheck reports.

ER at Louisville's University Hospital says it is pushed to brink; many other hospitals seeing more emergency patients

Louisville's University Hospital is straining to meet the vastly increased demand of patients coming to the emergency room. Last year, there were 58,010 visits to the ER to the facility, which is meant to act as a safety net for indigent care. That's way up from 33,058 in 2006.

"The safety net is frayed and getting ready to break completely," said Bill Wagner, executive director of Family Health Centers and ex-officio member of the Louisville Metro Board of Health. "The current situation isn't sustainable ... The system is broken and it's gonna get worse."

"The rising number of uninsured patients is a major driver" of the exploding ER volume, reports Laura Ungar of The Courier-Journal. Between 2008 and 2010, 663,000 Kentuckians — or 15.5 percent of the population — lacked health insurance. In 2010, University Hospital received almost $69 million from federal, state and local governments to pay for indigent care, but it fell short by $20 million of the actual cost.

The strain has strapped the facility for cash to make improvements such as adding beds — to deal with overflow, 12 have been installed in the facility's hallways — or upgrading technology. Recently, University tried to merge with Jewish Hospital & St. Mary's HealthCare and Catholic Health Initiatives to gain an influx of funds, but Gov. Steve Beshear blocked the move, since it would mean losing University as a public asset. University is now looking for other merger options.

Some of the increase in visits is due to the fact that fewer people are leaving the ER without being treated because of long waits. In 2009, 15 percent left for that reason, but "That's down to 1.7 percent this year, after a push to attend to patients immediately and get physicians to see them more quickly," Ungar reports.

But there's evidence there are just more patients coming to the hospital for treatment, as is the case in a program called First Care, meant for patients with less serious ailments, such as tooth abscesses. "Two-thirds or more of First Care patients are uninsured, and in recent years increased demand has led the hospitals to expand its beds from six to 13, become a 24-7 facility and hire a handful of new nurse practitioners," Ungar reports. "First Care cases, which are not included in the hospital's ER volume totals, rose from 8,353 in 2006 to 20,546 last year." Of those patients two-thirds or more were uninsured.

Other area hospitals have also seen increases in ER visits. From 2006 to 2010, visits increased from 45,377 to 49,462 at Kosair Children's Hospital; from 27,836 to 29,357 at Norton Hospital; and from 29,779 to 33,508 at Jewish Hospital. Some hospitals have seen slight declines, such as Baptist Hospital East, but that may be due in part to its retail clinics in Walmart and increased numbers of urgent-care centers. (Read more)

Friday, February 24, 2012

Convenience, not expense, is making us avoid eating fruits, vegetables and other non-processed foods

A lack of convenience, not a high price, is the major obstacle to getting people to eat more fruit and vegetables, a study published in the journal Public Health Nutrition has found. The study analyzed the fruit and vegetable consumption in six low-income, mostly minority neighborhoods in Chicago.

"Participants who agreed that they had 'convenient access to quality' produce were more than twice as likely to eat the FDA-recommended amounts of fruits and vegetables," Sarah Kliff reports for The Washington Post. "Those who reported high cost as a barrier to the consumption of produce ended up eating just as much as those who didn't." (Post photo above by Barbara Damrosch)

The study seems to support New York Times columnist Mark Bittman's assertion that Americans are skipping nutritious food because it takes much more work to prepare, not because it's too expensive. "It's cooking that's the real challenge," he writes in a September 2011 column. "The core problem is that cooking is defined as work, and fast food is both a pleasure and a crutch." (Times photo by Daniel Borris)

Contributing to the problem, Bittman argues, is the addictive qualities of fast food and processed food: physically addictive, as a study by the Scripps Research Institute shows, and mentally addictive. Bittman cites David A. Kessler, former commissioner of the Food and Drug Administration and author of The End of Overeating, who said manufacturers created food that was "energy-dense, highly stimulating and went down easy. They put it on every street corner and made it mobile, and they made it socially acceptable to eat anytime and anyplace. They created a food carnival, and that's where we live. And if you're used to self-stimulation every 15 minutes, well, you can't run into the kitchen to satisfy that urge."

The answer is in changing mindsets, Bittman writes, and getting "people to see cooking as a joy rather than a burden, or at least as part of a normal life." That takes education and changing the environment, which, he points out, has been done with tobacco. Cultural change can happen by celebrating whole foods, he writes. Political action would mean limiting "the marketing of junk; forcing its makers to pay the true costs of production; recognizing that advertising for fast food is not the exercise of free speech but behavior manipulation of addictive substances; and making certain that real food is affordable and available to everyone. The political challenge is the more difficult one, but it cannot be ignored." (Read more)

Judge orders Cabinet for Health and Family Services to speed up its release of child-abuse records

The state Cabinet for Health and Family Services has been given 90 days to release thousands of pages pertaining to about 180 cases of children who died or were badly injured from abuse or neglect. The order was issued Thursday by Franklin Circuit Judge Phillip Shepherd, who called the cabinet's reluctance to comply with state open records laws an "utter failure," reports Deborah Yetter of The Courier-Journal.

The ruling is the latest in the cabinet's fight with the Louisville newspaper and the Lexington Herald-Leader. Shepherd's ruling replaces a previous order that told the cabinet to release 1,000 pages a week, which it started doing Jan. 27. The documents released so far — which have been "heavily redacted" at the cabinet's discretion and against Shepherd's ruling — represent 15 cases.

The cabinet argued it should not be obligated to release the records since it is appealing Shepherd's decision, but the judge rejected that argument. He also said the cabinet had to list reasons for why it was redacting some information "and be prepared to defend them in court after releasing the files," Yetter reports. (Read more)

Meds-for-meth bill sent back to committee; compromise in the works, original sponsor says

The bill that would make pseudoephedrine — the key ingredient to make methamphetamine — available only by prescription was taken off the Senate floor Thursday afternoon. The bill's original sponsor, Sen. Tom Jensen, R-London, said "he expects a compromise is near," reports Jessie Halladay for The Courier-Journal.

"We've probably reached some consensus on where we want to go," said Jensen, right, but declined to go into details about the compromise. Of a possible concession, he would only say, "It's not necessarily what I want and it's not necessarily what the industry wants," but would be a step in the right direction.

Senate Bill 50, which was narrowly approved by the Judiciary Committee last week, has been opposed by the pharmaceutical industry, which says it imposes an unnecessary burden on users who need the medicine for the relief of colds and allergies. Many law enforcement agencies, including the Kentucky Narcotics Officers Association, support the bill, saying it would made a big dent in the number of meth labs found in the state. The bill excludes pseudoephedrine that is sold gel-cap format. (Read more)

Thursday, February 23, 2012

Kentucky receives $57.9 million to set up insurance exchange

Kentucky received $57.9 million Wednesday to help set up a health insurance exchange or marketplace — though lawmakers have made no move to make that happen. Kentucky is one of 10 states to receive this latest round of federal insurance exchange establishment funds, which totals $230 million. Of these 10 states, Kentucky received the highest sum by several million.

Of the 10 latest states to receive grants, seven of them have adopted a plan or made substantial headway, reports Richardo Alonso-Zaldivar for The Associated Press. In the exchange, considered one of the cornerstones of the new health care law, individuals and employees of small businesses can choose from several plans whose benefits coverage packages have been pre-approved by the state and federal governments.

So far, 30 states and the District and Columbia have received grants. Of those, only 13 and the District of Columbia have adopted a plan for how to proceed. States have until Jan. 1, 2013.

"Kentucky has not determined whether it will establish a health benefit exchange in light of challenges to the Affordable Care Act and the lack of federal guidance and a tangible federal exchange model to consider," said Kerry Richardson, communications director for the Office of Gov. Steve Beshear, said at the end of January. "However, impending ACA deadlines require considerable planning, evaluation, design and development of systems to address exchange issues whether the state or the federal government operates the exchange, and we are engaged in those efforts."

In September 2010, the Kentucky Cabinet for Health and Family Services' Office of Health Policy received a $1 million exchange planning grant. In August, it received another $7.7 million to fund information technology systems. No bill has been introduced that would establish a state-based health insurance exchange so far. (Read more)

Lawmakers hear more complaints about managed care

Patients with mental illness are being denied medication, forced to try cheaper drugs that have already been proven not to work for the patient, or not getting them in time because of delays in approval. These were some of the complaints of the state's new Medicaid managed-care system, reports Deborah Yetter of The Courier-Journal.

"If this is how it's going to be, it is scary," Dr. Scott Haas, chief medical officer of the Bluegrass Mental Health/Mental Retardation Board, told the state Senate Health and Welfare Committee Wednesday. "It is dangerous, and it ultimately is going to cost us a lot of lives."

The testimony is the latest that highlights the weaknesses of managed care, which the state changed to on Nov. 1 to for 560,000 Medicaid recipients living outside the Louisville area. Executives of the three companies hired to provide the care — CoventryCares of Kentucky, Kentucky Spirit Health Plan and WellCare of Kentucky — last week pledged to do better.

The majority of yesterday's testimony focused on the system's problems in dealing with mental illness, but Deb McGrath, executive director of the Epilepsy Foundation of Kentuckiana, said she's been inundated with "complaints about delays or rejections in medications patients need to control seizures," Yetter reports. "Something has to be done," McGrath said. "It's just a vicious cycle." (Read more)

Wednesday, February 22, 2012

Single best thing we can do for our health is exercise

In an innovative video that draws a complete picture of the answer, Dr. Mike Evans asks the question "What is the single best thing we can do for our health?"

It turns out that whether a person wants to reduce the risk of knee arthritis, dementia, Alzheimer's, diabetes, hip fractures, anxiety, depression, fatigue and low quality of life, the key is exercise.

"The best thing you can do for your health is to spend half an hour being active," said Evans, an associate professor of family medicine and public health at the University of Toronto. "Low fitness was the strongest predictor of death."

The 9-minute video is worth a watch.

Happily, a survey shows more doctors like Evans are telling their patients to get out and exercise. Nearly 33 percent of adults who went to the doctor in the previous year said their doctor told them to be more physically active. In 2000, just 23 percent did, the survey by the Centers for Disease Control and Prevention showed.

The survey found more women were told to do so than men, reports Mike Stobbe of The Associated Press. Of patients with chronic health issues, diabetics were told the most often. Cancer patients were least likely.

The widest margin of increase was in patients ages 85 and older. In 2000, just 15 percent were told by their doctors to exercise. In 2010, nearly 30 percent were. "It's very encouraging that doctors feel people at that age still have time to live and can make their health better," said Pat Barnes, a CDC health statistician who was the lead author of the report. (Read more)

Courier-Journal editorialists change position and join the Herald-Leader in supporting meds-for-meth legislation

The state's two biggest newspapers are in agreement: pseudoephedrine should be available by prescription only in order to curb methamphetamine production. The Courier-Journal offered its opinion in an editorial today: "Meth remains a scourge in Kentucky. It is not going to go away soon and without strong action its deadly, family-shattering impact will not diminish."

The position represents an about-face for the paper in Louisville, where the editorial board previously felt "such a restriction would create unnecessary burdens and expenses for legitimate users of pseudoephedrine."

However, with the meth problem not going away — there were a record 1,080 labs discovered in 2010 — the newspaper has changed its position, though acknowledged prescription-only will create some problems of its own: "'Pill mills' will likely dispense pseudoephedrine, just as they now illegally and unethically flood the market with pain medication, and police will have to crack down on such sales."

In December, the Lexington Herald-Leader offered its position, backing a prescription-only pills bill by Rep. Linda Belcher, D-Shepherdsville. "Methamphetamine would be a scourge if it hurt only those who ingested it. But the harm is far more widespread than that," it reads. "Highly mobile and as compact as a large soft-drink bottle, the meth-making process creates a risk of toxic exposure, respiratory injury and fire to all who come close."

The Courier-Journal backs Senate Bill 50, sponsored by Sen. Tom Jensen, R-London, and Sen. Robert Stivers, R-Manchester, which is similar to Belcher's bill. It narrowly cleared the Senate Judiciary Committee last week, but opposition to it "has hardened" in the Senate, the editorial reads. (Read more)

Kentuckians talk about health care on new video channel

Featuring stories of Kentuckians telling their stories about their experiences with the health care system, Kentucky Voices for Health has launched a video advocacy channel.

"The mission of Kentucky Voices for Health is to advocate for the needs of the Kentucky health care consumer," Executive Director Jodi Mitchell said. "That means our main priority is helping to ensure that all Kentuckians have access to the quality care they deserve. This new video advocacy effort will ensure that legislators, media and the public can always hear firsthand about the healthcare concerns facing our state."

KVH is a coalition of more than 250 health care organizations, individuals and advocates. The stories will initially focus on stories relating to the move to Medicaid managed care. For more information, click here.

New federal rules on vending machines in schools are expected in the next few weeks

With new lunch standards set to kick in by next school year, the Obama administration is looking at its next target in the school food landscape: vending machines. New guidelines are expected to be released in the coming weeks "for foods that children can buy outside the cafeteria," reports Ron Nixon of The New York Times. Kentucky already has some rules in place, may get stronger as a result of the new guidelines. (NYT photo by Kirsten Luce)

Students eat from one-fifth to one-half of their daily diet at schools, and the Centers for Disease Control and Prevention report 20 percent of American children are obese. As of 2007 in Kentucky, more than 37 percent of children were either obese or overweight, a study by the National Conference of State Legislatures shows. The administration wants to ensure that students eat what is good for them and avoid becoming overweight, Nixon reports, but there is strong pushback from the food and beverage industries.

A study by the National Academy of Sciences reports that about $2.3 billion worth of snack food and drinks are sold each year in schools nationwide. Schools have a stake in the fight as well, with candy sold in fundraisers often used to help pay for sports, music and arts programs. In Kentucky, the changeover to water, lowfat milk and fruit juices caused a downturn in revenue from the machines, but in most cases it appears to have rebounded to earlier levels.

The forthcoming guidelines are unknown, but officials predict they will be similar to the changes in the school lunch program, which reduced sugar, salt and fat. Those changes were a compromise after a fight between health advocates and the food industry. Nancy Huehnergarth, executive director of the New York State Healthy Eating and Physical Activity Alliance, said she expects another fight. "I think the food and beverage industry is going to fight tooth and nail over these rules," she said.

In Kentucky, schools are not allowed to sell food that competes with the national school lunch and breakfast programs from the minute students arrive until 30 minutes after the last lunch period. Only water, 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving are allowed to be sold in school vending machines, as per state mandate. There are no limits as to what foods or drinks that can be sold in fundraisers. (Read more)

Columnist likens pain docs to drug pushers and loan sharks

Doctors at some pain management clinics are the equivalent to modern-day drug pushers, writes Richmond business columnist Don McNay in a piece entitled, "Making money in businesses that are supposed to (and should) be illegal."

"People spend a few minutes and lots of money to get a 'physical'," he writes. "They skip insurance and pay the clinic with cash or a credit card. The 'medical staff' will then arrange for you to get a large order of the highly addictive pain medicines prescribed by the clinic doc. You can often get the prescription filled right at the clinic."

McNay points out such clinics are "perfectly legal" in Kentucky and owners do not have to have a medical background. (A bill in the legislature would change that.) "I'm not a lawyer, but would love to own a law firm," he writes. "I'd like to own a plumbing contracting firm but not be a licensed plumber. . . . None of those options are available to me. But owning a pain management clinic is."

He likens the clinics to payday lenders, which he likens to "legalized loan sharking." He also takes issue with the "Super PAC" concept, which allows corporations to make unlimited contributions to political campaigns. "With super PACs allowing corporations to give unlimited amounts to fund campaigns," he writes, "the big corporations control the political process."

McNay concludes, "As a society, it would seem logical that we would want drug pushing, loan sharking and corporate influence peddling to stop. At the very least, we could go back to making it against the law." (Read more)

National School Breakfast Week to be observed March 5-9

National School Breakfast Week, an observance meant to increase awareness of the availability of the federal School Breakfast Program, will be held from March 5 to 9 this year.

Research has shown students who eat breakfast score better on tests, have fewer health issues and are better behaved, says a press release from the Kentucky Department of Education. In Kentucky, about 190,000 students eat breakfast at school each day, which represents about 30 percent of public school enrollment, said spokeswoman Lisa Gross. The numbers are not broken down by district.

Schools are encouraged to participate in a spirit contest whose winners will be given a certificate of excellence by Kentucky Education Commissioner Terry Holliday. Schools can plan festivities and then share what they've done to celebrate the event. Winners will be recognized April 19. The deadline to enter is March 22. For more information about contest rules, click here.

King-size Snickers and Twix will be things of the past by 2014

King-size versions of Snickers and Twix bars will no longer be on store shelves in 2014, as their maker tries to improve the nutritional value of its products. (Photo by Candy Warehouse)

Mars Inc. will no longer sell chocolate products with more than 250 calories, Reuters reports. The giant Snickers and Twix contain a whopping 540 calories.

It's not the first time the Virginia-based maker has tried to improve its image. In 2007, "It said it would stop buying advertising time or space if more than a quarter of the audience was likely to be under 12 years old," Reuters reports.

Mars also makes M&Ms, Skittles and Juicy Fruit chewing gum, along with Uncle Ben's rice and Dove ice cream bars. (Read more)

Tuesday, February 21, 2012

Group fighting meds-for-meth bill says it spent nearly $200,000 in January on lobbying, and that apparently omits radio buys

The group fighting a bill that would make the key ingredient for making methamphetamine available only by prescription spent more than $194,000 last month alone to lobby lawmakers, far more than any other lobbying interest at the General Assembly.

The Consumer Healthcare Products Association "reported spending more on Frankfort lobbying for the month than the next eight largest groups combined," reports Tom Loftus of The Courier-Journal. "That's almost an obscene amount of money to be spending on one month on one issue," said Senate Majority Leader Robert Stivers, R-Manchester. Stivers is sponsoring the bill, which would require a prescription for cold and allergy medicine that contains pseudoephedrine.

The group with the second highest spending was the Kentucky Hospital Association, at $36,120.

CHPA "is a group of manufacturers and distributors of over-the-counter medicines whose members include Bayer Healthcare, GlaxoSmithKline and Johnson & Johnson," Loftus reports. In a statement Monday, the group said it is again "efforts by some legislators to deny law-abiding citizens nonprescription access to certain cold and allergy medicines they depend on."

The $194,957.76 spent on lobbying apparently does not include what the CHPA spent on broadcast advertising, which it does not have to report. As of Feb. 3, the group had spent more than $82,000 running ads on Louisville, Lexington and Somerset radio stations owned by Clear Channel Communications Inc., the nation's largest radio operator, according to public-inspection files at those stations, the only ones that have been checked by Kentucky Health News and its journalistic partner, Jonah Engle. In 2011, CHPA paid the Kentucky Association of Radio and Television more than $93,000 to run ads, according to public-inspection files from Cumulus Broadcasting, another major owner of stations in Kentucky.

As for lobbying expenses, more than $12,000 was spent on salaries for three lobbyists, plus nearly $4,000 for food, lodging, beverage and transportation expenses. More than $150,000 was spent "for professional and technical research and assistance," plus nearly $27,000 for "educational and promotional items."

"I'm not surprised they reported so much for lobbying because it's obvious they're doing a pretty good job of getting their message out ... which I believe is a misleading scare campaign," said Sen. Ray Jones, D-Pikeville, who is co-sponsoring the meds-for-meth bill. (Read more)

Dean of U of L medical school resigns to take New York job

The dean of the University of Louisville School of Medicine, Edward C. Halperin, is stepping down from his post to become chief executive officer and chancellor for health affairs of New York Medical College and provost for biomedical affairs at Touro College and University System.

His new job starts May 1. During his tenure at U of L, which started in 2006, he recruited nine department chairs; applications for admissions rose 67 percent; research funding in the school of medicine increased 28.3 percent to $111.4 million; a post-baccalaureate program was established; and three dual-degree programs were created.

"Dr. Halperin has been instrumental in moving our School of Medicine to a different level in terms of our missions of education, research and clinical care," said Dr. James R. Ramsey, U of L president. "He has raised the standards we now hold ourselves to in terms of the students we accept and graduate from the School of Medicine, as well as the faculty we recruit."

U of L said it will name an interim dean and start a national search to replace Halperin in the coming weeks. (Read more)

Replacing cigarettes with smokeless tobacco reduces disease risk, says U of L prof who's received tobacco-industry funding

Smokers can greatly reduce their risk of disease if they replace their cigarettes with spit-free smokeless tobacco or electronic cigarettes, University of Louisville professor Brad Rodu, right, said in a presentation at the annual meeting of the American Association for the Advancement of Science last week. It's the same message residents of Owensboro heard in an advertising campaign with which Rodu was involved late last year, one partly funded with grants from the tobacco industry.

"Quit or die: That's been the brutal message delivered to 45 million American smokers, and it has helped contribute to 443,000 deaths per year," Rodu said in a U of L press release. "The truth, however, is that total nicotine and tobacco abstinence is unattainable and unnecessary for many smokers."

Rodu's 20 years of research has reportedly shown that e-cigs and smokeless tobacco are relatively safe alternatives for smokers who can't or are unwilling to quit nicotine. "Nicotine is addictive, but it is not the cause of any smoking-related disease," he said. "Like caffeine, nicotine can be used safely by consumers."

Research has shown smokeless products are 98 percent safer than cigarettes, the press release states. A 2002 study in the United Kingdom found smokeless tobacco to be up to 1,000 times less hazardous than smoking.

As for whether smokeless tobacco can contribute to mouth cancer, Rodu said the risk "is extremely low." "The annual mortality rate among long-term dry snuff users is 12 deaths per 100,000 and the rate among users of more popular snus, moist snuff and chewing tobacco is much lower. For perspective, the death rate among automobile users is 11 per 100,000 according to the 2009 report from the National Highway Traffic Safety Administration. Compare those to the rate among smokers: more than 600 deaths per 100,000 per year." (Read more)

The Oral Cancer Foundation's website says about 37,000 Americans will be diagnosed with oral or pharyngeal cancer this year and cause about 8,000 deaths. The foundation does not support the contention that smokeless tobacco is "safe." "Promoted by some as a safer alternative to smoking, it has in actuality not proven to be any safer to those who use it when referring to oral cancers," the website reads. "Campaigns to promote the safety of smokeless are being initiated, but it is clear that while it may reduce lung cancers, it has a negative effect on the rates of oral cancers."

Michelle Obama announces nationwide contest to fight childhood obesity; $500,000 in prizes

As part of her Let's Move initiative to fight childhood obesity, First Lady Michelle Obama announced a contest today that will give away $500,000 in prizes. The Active Schools Acceleration Project will reward the most "creative, impactful and scalable school-based programs and technological innovations that promote physical activity for children," a press release reads.

"We know there's so much good work going on all across this country to get our kids up and moving every single day," Obama said. "So we want to find the best school programs and technology ideas that increase physical activity for kids — and then help them reach even more children throughout America."

The competition features two categories: school programs and technology innovation. Teachers, schools or entire districts can submit their in-school activity programs, which could include a curriculum, activity, environmental modification, event or other initiative. The technology innovation category can include devices, tracking and measurement systems, software applications, social media, gaming and smart phones that encourage kids to be physically active.

Applications will be accepted through April 2. For more information, click here.

Growing up on farm helps immune system, study of pigs shows

For the first time, there is conclusive evidence that growing up on a farm is good for the immune system. Researchers from the University of Bristol's veterinary sciences school have published a study showing that "spending early life in a complex farm environment" increases the number of T-cells one has, reports Sarah Muirhead of Feedstuffs. T-cells have been identified as universal regulators of immune systems, with low numbers increasing risk of developing allergies, autoimmune and inflammatory diseases. Researcher Marie Lewis said it wasn't previously known whether farm life increased immunity to allergies, or if people more prone to allergies weren't living on farms.

Piglets were used in the study since they share many aspects of human physiology, metabolism, genetics and immunity. Some of the piglets were nursed by their mother on the farm, while the others were kept in an isolator unit under hygenic conditions and fed formula milk to reflect the "extremes of environment" in which many humans are raised. Farm-raised piglets had increased levels of T-cells compared to those raised in the isolator. Lewis said it's not clear yet exactly what caused the increase in T-cells in farm-reared piglets, but said previous work shows that intestinal bacteria "plays a pivotal role." (Read more)

Monday, February 20, 2012

Sen. Rand Paul puts holds on federal synthetic drug bans

U.S. Sen. Rand Paul, left, has put a hold on several Senate bills aimed at banning chemicals used in synthetic drugs because he feels "enforcement of most drug laws can and should be local and state issues," said his spokeswoman Moira Bagley. The move has been criticized by other lawmakers, law enforcement and a woman from his home city whose daughter had a bad reaction to synthetic marijuana. (Photo by Matt Goins)

"When Ashley Stillwell, 19, bowed to peer pressure last August and smoked a substance called 7H, it quickly immobilized her," reports Bill Estep for the Lexington Herald-Leader. "Ashley's frightened friends poured water on her and shook her. When they couldn't rouse her, Ashley heard the others discuss dumping her body in the Barren River."

The teen recovered after she was taken to the hospital, but her mother Amy, of Bowling Green, is frustrated by Paul's move to block the legislation. Three Senate measures passed committee last summer, and the House voted 371-98 in December to approve a ban on synthetic drug chemicals. Senate rules allow one member to place a hold on a bill. "That doesn't mean it can't be voted on, but it slows the process and raises some hurdles," Estep reports.

Bagley said Paul is concerned about banning the substances before research can be done on them. Sen. Charles Grassley, an Iowan Republican who sponsored one of the bills, said reclassifying the chemicals as controlled substances would not prevent research from being conducted. "We cannot let the will of just one senator obstruct the will of many," Grassley said.

One in nine high-school seniors had used a substance known as K2 or Spice in the past year, the National Institute on Drug Abuse reported in December. That makes synthetic marijuana the second most-abused drug in that age group. Calls to poison-control centers about synthetic drugs have risen from 3,200 in 2010 to 13,000 last year, Estep reports.

White House drug chief Gil Kerlikowske said his office is "urging the Senate to pass that legislation." (Read more)

Jury tells nursing home: Pay $8 million to estate of man whose legs employees broke; homes seek legislative insulation from suits

A Louisville nursing home was ordered to pay $8 million in damages last week to the estate of a retired surgeon whose legs were broken while he was being transferred from a chair to his bed at Treyton Oak Towers. He died less than two months later.

The incident happened to Dr. David Griffin in September 2008. Griffin, who had suffered a stroke, was put back in bed "like it didn't happen," attorney Matt Minner said. Employees reportedly were told to change medical records and cover up the act. Because of his condition from the stroke, Griffin couldn't tell anyone "about the agony he was in," Minner told The Courier-Journal.

Treyton Oak Towers plans to appeal the ruling. Its attorney, Scott Whonsetler, told newspaper that "Griffin had severe osteoporosis and doctors failed to inform nursing home employees of the diagnosis," Andrew Wolfson and Jason Riley report . "We categorically deny that there was any coverup whatsoever" after the incident, Whonsetler said.

The verdict, returned after about two hours of deliberation, includes $2 million for pain and suffering, $1 million for violating the state nursing home statute and $5 million in punitive damages. (Read more)

The verdict comes after the introduction of House Bill 361, which would establish medical review panels. Under the proposal, panel members would consider whether civil litigation against a nursing home is warranted before it is sent to court. The purpose of the panel would be to prevent frivolous lawsuits, but "could deny nursing home residents access to the courts of law," reads a press release by Kentuckians for Nursing Home Reform, a nonprofit organization that advocates for nursing home residents. The bill was introduced Feb. 1 but has not been posted for consideration by the House Health and Welfare Committee.

Same Catholic health system considering University Hospital's request for proposals

Though Gov. Steve Beshear twice rejected a proposal that would have merged it with a Catholic health system, University Hospital's expected release of a request for proposals is drawing attention from the same Catholic health system, reports Laura Ungar of The Courier-Journal. (C-J photo by John Rott)

"We still believe that a close working relationship with the University of Louisville School of Medicine and University Medical Center is important to our vision as an organization, to this community and citizens across the commonwealth," wrote Ruth Brinkley, chief executive officer of KentuckyOne Health, the company created after St. Joseph Health System, owned by Catholic Health Initiatives, and Jewish Hospital & St. Mary's HealthCare merged earlier this year.

If the deal had gone through as planned, University Hospital would also have been part of that merger. But since University Hospital would have been subject to Catholic health directives — which includes forbidding sterilization and in-vitro fertilization — under the merger, Beshear rejected the deal; University Hospital has been ruled a public entity. The New York Times notes the episode in a story today saying the expansion of Catholic hospitals could limit reproductive health care.

Last week, University Hospital's operator was given permission to make a request for proposals "aimed at attracting interest from other health care entities that could stabilize the finances of the area's main safety-net hospital," reports The Associated Press. Finding such a partner is "very" critical, said Dr. David Dunn, U of L's executive vice president for health affairs.(Read more)

But after The C-J reported permission for the RFP had been granted, Brinkley sent out a note to physicians and administrators of KentuckyOne Health. "As we more closely examine the RFP and begin our planning process, we will share additional information with you," she wrote.

Merger critics said pairing up with KentuckyOne Health would lead to the same problems as the first proposal. "It's still the same pig. They're still trying to make it into a silk purse," said Honi Goldman of Louisville. "It's a dangerous road to go down ... Why are they stuck on this one suitor?" (Read more)

2009 U.S. suicide rate highest in 15 years; 600 Ky. teens in 2010

The year 2009 had the highest number of suicides in 15 years, data collected by the Centers for Disease Control and Prevention indicate.

Between 2008 and 2009, the suicide rate increased 2.4 percent, with 36,909 suicide deaths nationwide. In 2008, 13.4 percent of people who committed suicide had either job or money issues, reports research-reporting service Newswise. Numbers are expected to rise, with the National Suicide Prevention Lifeline reporting a 14 percent increase in call volume between 2010 and 2011.

Between 2008 and 2009 about 8.3 million adults (nearly 4 percent of the U.S. adult population) said they had serious thoughts about suicide in the past year, CDC data show. More than 2.2 million adults reported making plans for suicide in the past year and more than 1 million adults said they attempted suicide in the past year. (Read more)

About 600 Kentucky teens died by suicide last year, reports Jennifer Hewlett for the Lexington Herald-Leader.

Brains of autistic children develop differently, study finds

MRI image of young brain in study
Researchers have found significant differences in brain development starting at age 6 months in high-risk infants who develop autism compared to those who don't. The finding suggests the disorder develops over time and doesn't have a sudden onset, which is often believed to be the case.

"It's a preliminary, albeit great, first step towards thinking about developing a biomarker for risk in advance of our current ability to diagnose autism," said Jason J. Wolff, lead author of the study.

The study may be useful for journalists writing new stories about autistic children and their parents; April is National Autism Awareness Month. It raises the possibility "that we may be able to interrupt that process with targeted intervention," Wolff said.

Participants in the study, which was published online in the Advance section of the American Journal of Psychiatry, included 92 infants who have older siblings with autism and so were considered at high risk for developing the disorder. They were tested using a type of MRI at 6 months of age and had behavioral assessments done at 24 months. Most of the infants also had more brain-imaging scans at either or both 12 and 24 months of age, reports research-reporting service Newswise.

At 24 months, 28 infants — 30 percent — fell into the autism disorder spectrum, while 64 did not. "The two groups differed in white matter fiber tract development — pathways that connect brain regions — as measured by fractional anisotropy," Newswise reports.

Based on the way water molecules move through brain issue, fractional anisotrophy measures the way white matter is organized and develops. In 12 of the 15 tracts of children who did develop autism, there were significant FA trajectories. "This evidence, which implicates multiple fiber pathways, suggests that autism is a whole-brain phenomenon not isolated to any particular brain region," Wolff said. (Read more)

41 Kentucky high schools receive grants for nutrition, exercise, tobacco prevention to be planned by students

More than 40 Kentucky high schools will receive grants to improve student nutrition, increase physical activity or prevent tobacco use. The "Students Taking Charge" program will have students assessing their school environment and coming up with and implementing an action plan to create healthy changes.

"We have to create programs that get our young people involved in the process and on the path to lifelong health and wellness," said Victoria Greenwell, administrator for the state Department of Public Health's Coordinated School Health program and co-chair of Kentucky Action for Healthy Kids. "If we wait until children are grown to introduce them to healthy environments or sensible eating and exercise plans, it's often too late. We have to act now to instill the values of leading a healthy lifestyle."

Just 16.7 percent of Kentucky students reported eating five servings of fruit and vegetables every day and under 40 percent of students said they had been active for an hour on five days during a week, the 2011 Youth Risk Behavior Survey found. The survey also found nearly 1 in 3 students said they'd used a tobacco product in the past 30 days.

To see which schools received a grant and for more information, click here.

Friday, February 17, 2012

Board suspends license of doctor at raided Lexington pain clinic

DEA agent enters building housing clinic
(Herald-Leader photo by Charles Bertram)

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The Kentucky Board of Medical Licensure imposed an emergency suspension yesterday on the license of the doctor at a Lexington pain clinic that was raided by the Drug Enforcement Administration on Wednesday.

Dr. Najam Azmat "had little formal training in pain management or primary care, yet he was paid $7,500 a week to write prescriptions for powerful narcotic painkillers" at Lexington Algiatry, a pain clinic on Alexandria Drive, the Lexington Herald-Leader reports, drawing on board documents. The board's order said, "Azmat organized his practice at the Lexington Algiatry Clinic to maximize fraud and abuse, and it appears to be intentional."

The board "acted on an investigation that's been going on for some time," President Preston Nunnelley told the Herald-Leader. Azmat referred the newspaper to his lawyer, Fox DeMoisey of Louisville, who said he could not respond because he had not seen the board's allegations or the DEA's search warrant. "He intends to defend the matter vigorously," DeMoisey told the paper.

Azmat told a board investigator that he was employed by Warren Gold of Tampa, Fla., who owns Lexington Algiatry, for $7,500 a week. Valarie Honeycutt Spears and Josh Kegley of the Herald-Leader report, "Gold provided him with an apartment in Lexington, and Azmat traveled between Lexington and Georgia, where his family lives, organizing his work schedule around his flight schedule, the documents said." (Read more)

UPDATE, Feb. 18: A representative of the clinic "filed to do business under a new name," Kegley reports.

His latest story has more background on Gold, left, who pleaded no contest in Tampa to operating a pain clinic without a license, which at the time (2010) was required only by a local ordinance. His probation ended Dec. 23. He does not have a medical license in Florida or Kentucky, Kegley reports.

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Thursday, February 16, 2012

Senate committee narrowly passes meds-for-meth bill as advocates start their own radio advertising campaign

In the face of a strong lobbying effort by makers of over-the-counter cold medicines, a state Senate committee narrowly approved a bill today that would require a prescription for most products containing pseudoephedrine, a key ingredient used to make methamphetamine.

Senate Bill 50, approved 6-5 by the Judiciary Committee, is sponsored by Senate Majority Floor Leader Robert Stivers, R-Manchester, left, but he said he isn't sure of its chances in the full Senate, reports Jack Brammer of the Lexington Herald-Leader. A similar bill got out of committee last year but never came to a vote on the Senate floor because it lacked the votes to pass. This year's bill would not apply to gelcaps, which are more difficult to use in meth making.

The Kentucky State Police recorded about 1,200 meth labs last year, and former meth addict Melanda Adams, from Stivers' home Clay County, told the committee she believed the bill would "cut the burgeoning number of dangerous home-made meth labs in the state." The Consumer Healthcare Products Association, a non-profit that represents the over-the-counter medicine industry, argues that requiring a prescription would "create a hardship for legitimate consumers," reports Jessie Halladay of The Courier-Journal.

Only Oregon and Mississippi have passed such laws, so Kentucky has become a firewall for the drug makers' lobby, which has bought many radio commercials urging people to contact senators in opposition to the bill, contending it would "punish Kentucky families" and pushing an alternative measure that would bar people convicted of meth making from buying the medicines. Opponents of that bill say meth makers would continue to use surrogates to buy the medicines for them. Sen. Ray Jones, D-Pikeville, who voted for SB 50, called the radio ads "scare tactics." UPDATE: For more on the lawmakers' complaints about the ads, from cn|2 Politics, click here.

As of Feb. 3, the group had spent more than $82,000 running ads on Louisville, Lexington and Somerset radio stations owned by Clear Channel Communications Inc., the nation's largest radio operator, according to public-inspection files at those stations. In 2011, CHPA paid the Kentucky Association of Radio and Television more than $93,000 to run ads, according to public-inspection files from Cummulus Broadcasting, another major owner of stations in Kentucky.

UPDATE, Feb. 17: The drug makers have a 60-second ad from Pat Davis, who identifies herself as "a Kentucky resident for over 20 years" and the mother of six children who all "battle allergies." She is not identified as the wife of 4th District U.S. Rep. Geoff Davis, who is not seeking re-election. She testified against last year's bill. Here is the ad, via Page One Kentucky, a popular blog that has been critical of the legislation.

The drug makers' ads have been running uncontested for two months, but this week a group headed by Knox and Laurel County's Commonwealth's Attorney Jackie Steele, Real Facts About Meth, offered a counter-ad, describing the impact of meth on communities. The group does not appear to be well funded; its website solicits contributions.

Managed-care executives acknowledge problems, say they're trying to fix them

Executives of three managed-care companies who run most of the state's Medicaid program told a legislative committee yesterday that they are aware of "significant problems" with their management since they took over in November, and they are "committed to fixing them," reports Deborah Yetter of The Courier-Journal. Health-care providers have complained to lawmakers for months about late payments, claims processing and battles over new rules requiring "pre-authorization" to guarantee payment. The executives said they're meeting with providers to solve the problems.

Health care providers implied last week during testimony that the companies were withholding payments to "maximize their profits," Yetter notes. All three executives denied the claim, saying they have to pay interest on payments delayed more than 30 days. They said some late payments "weren't getting past billing clearinghouses" that many health-care providers use to process Medicaid claims. Claims have been delayed in those facilities for a number of reasons, the executives said, including new billing requirements under managed care. They said they are working to identify and pay those claims. (Read more)

Tuesday, February 14, 2012

Legislators hear from new managed-care firms; lawmaker rates their performance with a show of hands from pharmacists

Kentucky Health News

The three companies recently hired to manage Kentucky's Medicaid program outside the Louisville region defended themselves yesterday against complaints that they are squeezing independent pharmacies to the breaking point. One of the three firms, Kentucky Spirit, fared better in a hearing held by a House-Senate committee before a crowd that included many pharmacists.

When Sen. Vernie McGaha, R-Russell Springs, "asked for a show of hands from pharmacists in the audience to learn which of the three pharmacy-benefits companies they think underpay on generic drugs, nearly everyone raised their hands for Medco Health Solutions, which is Coventry [Cares]'s partner, and Catalyst Rx, which is WellCare [of Kentucky]'s. No one seemed to object to US Script, which is Kentucky Spirit's partner," reports John Cheves of the Lexington Herald-Leader.

Kentucky Spirit is the only firm that continues to pay pharmacists a dispensing fee of $4.50 to $5 per prescription, the rate that had been paid by the state. WellCare pays $3, and CoventryCares $1 to $1.50, the pharmacists told Deborah Yetter of The Courier-Journal. "Pharmacists have told lawmakers at previous hearings that pharmacy-benefits companies sometimes pay less for generic drugs than it costs pharmacies to acquire them," Cheves notes.

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Rep. John Will Stacy, D-West Liberty, left, whose business interests include co-ownership of at least two pharmacies, got into it with G. William Strein, Medco's vice president for provider relations. "Stacy cut off Strein several times while he was attempting to answer," Cheves reports.

“Why is it fair that you can reimburse us below costs?” Stacy asked Strein, who "disputed Stacy’s assertion and said managed care attempts to strike a balance between its estimated cost of the drug and the costs of the pharmacy to buy and dispense it," Yetter reports. "But that claim was disputed by some of the roughly 30 pharmacists at the hearing who operate independent drugstores. Though the hearing ended before they got a chance to testify, several said afterward that they intended to keep making their case before lawmakers."

Jason Wallace, owner of Grant County Drugs, told Yetter, “It’s a real burden for Kentucky pharmacists. That’s why I’m here.” All the companies told members of the Joint Program Review and Investigations Subcommittee that they are committed to resolving the problems.

"Much of Monday’s testimony was devoted to the complex pricing formula known as the maximum allowable cost, or MAC, that managed care companies consider proprietary," Yetter writes. "Under the Medicaid plan before managed care, the formula was provided to pharmacists, who said they knew what they would be paid. Now, they said, they don’t find out what a company will pay for a specific drug until they file claims. And too often, they say, it’s less than they paid to buy the drug.

“How would you like to go to a gas station and fill your car up with gas and then be told what the charge is?” Breckinridge County pharmacist Jonathan Van Lahr asked after the hearing. (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.