Legislature passes bill on personal-care homes but stalls on one to regulate pill mills as doctors lobby hard

By Al Cross
Kentucky Health News

The effort to quash "pill mills" that feed one of Kentucky's worst problems, prescription drug abuse, stalled on the next-to-last day of the General Assembly's session and faces cloudy prospects on April 12, when the legislature returns to conclude its business. But the legislature gave final passage to a bill aimed at limiting the admission of mental patients to personal-care homes.

The snag in the pill-mill bill stems from the Kentucky Medical Association's opposition to moving the state's electronic prescription-tracking system to the attorney general's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has been found to go easy on them, compared to other states. The bill includes several other measures, including a requirement that pain clinics must be owned by doctors.

After Sen. Carroll Gibson, R-Leitchfield, failed in a parliamentary maneuver to make the bill more difficult to pass, and Senate President Pro Tem Katie Stine, R-Southgate, ruled that his motion had lost on a voice vote, Majority Floor Leader Robert Stivers, R-Manchester, "said it might be better to consider the bill April 12, but Sen. Ray Jones, D-Pikeville, said delaying a vote on it would give its opponents more time to try to kill it," report John Cheves and Jack Brammer of the Lexington Herald-Leader. "Stivers called for party caucuses to meet to discuss the issue. After the caucus meetings, the Senate adjourned and Stivers said lawmakers would work on the bill for possible consideration April 12."

The session's final day is scheduled to give the legislature a chance to override any vetoes by Gov. Steve Beshear, so a bill passed then could be killed by a veto. That might seem unlikely, since Beshear has been among those pushing for stronger action against pill mills. However, if he were unhappy with a bill the legislature sent him, he could veto it and call a special legislative session to pass one more to his liking. That possibility, and his power to set the agenda of a special session, could make him a player in the negotiations between now and April 12.

The bill’s sponsor, House Speaker Greg Stumbo, D-Prestonsburg, downplayed the problem. He blamed it on "confusion over a provision that limits the amount of drugs that may be supplied to a patient at any one time," Mike Wynn of The Courier-Journal reports. "Some lawmakers feared that limits on prescriptions would cause more patient co-pays, but a simple fix to the bill’s language could allay those concerns, Stumbo said."

Also on Friday, the legislature sent Beshear a bill that would "require potential residents at personal-care homes to be screened for brain injuries by medical professionals," the Herald-Leader reports. "Personal care homes provide long-term care for people who do not need full-time nursing care but need some assistance."

Senate Bill 115 "stems from the death last year of Larry Lee, a brain-injured resident who disappeared from a personal care home and was found dead four weeks later on the banks of the Licking River, not far from the Falmouth Nursing Home in Pendleton County," the Herald-Leader notes. "There are about 2,500 to 3,000 people in 82 free-standing personal care homes across Kentucky," and many are mentally disabled or mentally ill. Kentucky Protection and Advocacy, a watchdog state agency, released a report last week saying that said placement of the mentally ill in personal-care homes violates federal disability laws. (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.

'Meds for meth' bill is about to become law despite heavy lobbying campaign by pharmaceutical companies

The bill to limit purchases of a popular cold medicine used to make methamphetamine passed the General Assembly today and Gov. Steve Beshear said he would sign it.

The Senate voted 29-8 to approve changes the House made in Senate Bill 3, sponsored by Senate Majority Floor Leader Robert Stivers, R-Manchester, left. The bill would require a prescription to buy more than 7.2 grams of pseudoephedrine in a month and 24 grams in a year. "A generic box of pseudoephedrine with 48 pills, each with a 30-milligram dosage, contains 1.44 grams of the medicine," Jack Brammer of the Lexington Herald-Leader reports. ""Gel caps and liquid pseudoephedrine would be excluded from the limits in SB 3 because making meth from those forms is considered more difficult."

The bill’s sponsors had wanted lower limits, and initially a prescription for any amount, "but they compromised with opponents who worried about inconveniencing cold and allergy sufferers," Brammer notes. "The pharmaceutical industry has lobbied aggressively against the state requiring prescriptions for pseudoephedrine at any level," ranking first in reported lobbying expenses without even counting its extensive advertising campaign. The industry apparently viewed Kentucky as a sort of firewall, the absence of which could make passage of similar "meds for meth" bills in other states. Only Oregon and Mississippi now have such legislation.

Makers of Sudafed, similar cold medicines again lead in legislative lobbying expenses, and that doesn't count their radio ad campaign

The Consumer Healthcare Products Association, which is fighting legislation that would limit the amount of pseudoephedrine that could be bought without a prescription, remained the leading spender among lobbying interests at the General Assembly in February, the state Legislative Ethics Commission said in its monthly newsletter.

CHPA, which represents manufacturers and distributors of over-the-counter medicines, spent $192,985 on lobbying in February, and a total of $388,000 for the first two months of the session. Those amounts do not include an extensive radio advertising campaign, which from all indications has cost more than the spending that had to be reported.

Other health-care interests were among the top spenders in February. Ranking second through 11th were the Kentucky Hospital Association ($38,422, for a two-month total of $74,543); the Kentucky Chamber of Commerce ($30,056, two-month total $63,404); Altria (Philip Morris) Client Services ($28,129, two-month $50,434); the Kentucky Farm Bureau Federation ($24,805, total $38,655); AT&T ($24,199, total $47,432); the Kentucky Medical Association ($21,958, total $42,731); the Kentucky Education Association ($21,629, total $45,249); the Kentucky Retail Federation ($21,191, total $45,452), which also opposes the meds-for-meth bill; Kentuckians for the Commonwealth ($18,317, total $34,188) and the Kentucky Optometric Association ($18,227, total unavailable).

Meds-for-meth, pain-pill bills each clear a second chamber; both probably headed to conference committee(s)

"State lawmakers gave new life Wednesday to two bills designed to tackle Kentucky's problems with methamphetamine labs and prescription drug abuse," John Cheves and Jack Brammer report for the Lexington Herald-Leader.

"On a 60-36 vote, the House approved Senate Bill 3, which would further limit the amount of cold medicines containing pseudoephedrine that consumers could buy without a prescription. Pseudoephedrine is a key ingredient used in making meth. Meanwhile, the Senate approved House Bill 4, which transfers from the state Cabinet for Health and Family Services to the attorney general's office an electronic monitoring system that keeps track of prescriptions for pain pills. The vote was 26-9. Both bills are likely to go to conference committees made up of representatives from both chambers, who will try to negotiate a compromise on differences in the House and Senate versions of the bills." (Read more)

Senate panel OKs pill-mill bill with provision moving prescription-monitoring system to attorney general's office

Over the objections of the Kentucky Medical Association, a Senate committee today approved a bill that would "transfer oversight of the state’s prescription-monitoring system from the Cabinet for Health and Family Services to the attorney general’s office," Jack Brammer reports for the Lexington Herald-Leader.

House Bill 4, an effort to fight so-called "pill mills," passed the Senate Judiciary Committee 7-2 after Chairman Tom Jensen, R-London, said last week that he trusted the attorney general's office to handle the job, now in the hands of the Kentucky Board of Medical Licensure. The bill now goes to the Senate Rules Committee, which could send it to the floor or to another committee, a move that would probably kill it since this is the last week of the legislative session.

The bill would allow no more than 20 attorney-general employees to access the monitoring system. It would also require doctors to report pain-pill prescriptions within 24 hours starting July 1, 2013, and would "not charge health care providers a fee for using the system," Brammer reports. The committee also changed the bill to allows only physicians to own pain-management clinics. (Read more)

State starting free training for dentists in pediatric dentistry

One of the many problems with Kentucky's oral health is that not enough dentists are willing to accept children as patients, or lack proficiency in treating children when they are around age 1, the recommended time for a child's first dental visit.

Next week, the state Department of Public Health will start to offer free continuing education for dentists and other oral-health professionals who need or want training in pediatric dentistry, funded by a federal grant.

The Access for Babies and Children to Dentistry (ABCD) program will have one-day training sessions in Lexington on Friday, April 6, at the Embassy Suites on Newtown Pike next to the interstate, and in Somerset on Wednesday, April 11, at the Hampton Inn on US 27. Both sessions will start at 8:30 a.m. The sessions offer 8 continuing education units out of a possible 20 in the program.

For more information about the training, and to register for it, contact Meghan Towle at Meghan.Towle@ky.gov or 502-564-2154.

Obama finally embraces the Republican term 'Obamacare'

“The Obama administration made a decision on Friday to own the term‘ObamaCare’,” NBC News reports in its First Read blog, adding a capital letter not often used. “It had been used as a pejorative by Republicans, but the White House has made the decision to embrace it and not let opponents have a word that they only drive as a negative. White House senior adviser David Plouffe noted on ‘Meet the Press’ Sunday that, in 10 years, health care will be a positive and cited polling that people don’t want to re-litigate it. We can report that last part came from Democratic polling Plouffe has seen; he was not citing any public polling on this specific issue.”

The NBC item is also based on a story yesterday from The New York Times, which reported that Democrats are “launching a Twitter campaign that seeks to build positive associations for it.” The Twitter post read, “If you’re proud of Obamacare and tired of the other side using it as a dirty word, complete this sentence: #ILikeObamacare because ...”

The story noted that “Obamacare” has been used “primarily by Republicans, as a term of disdain. Democrats have tried to limit the term’s use to reshape perceptions, but that has been a tough sell.” The Times quotes Grant Barrett, a vice president for the American Dialect Society, who said that once a word becomes political, it is very difficult to quash it: “It’s an invitation to have your heart broken. You forbid it, and they start writing it on the bathroom stalls.”

For the Times story and a nice graphic showing the history of the term, and examples of its use, by Amanda Cox, Alicia DeSantis, Alicia Parlapiano and Jeremy White, click here.

More foreign-born doctors practice in rural areas, come from poor nations; Kentucky is about average, West Virginia is high

More than 15 percent of physicians in the U.S. received training in lower-income countries, including India, Pakistan and the Phillippines, a new study has found, reports Lori Kersey of The Charleston Gazette. The study was a joint effort by the National Research Council and the Stanley Medical Research Institute, and was published online on PLoS ONE.

Most doctors from low-income countries practice in low-income areas of the U.S., where most U.S.-trained doctors don't usually want to go. West Virginia has the most such doctors, at 29 percent all of physicians in the state. Kentucky has 16 percent, just above the national average of 15.4 percent. Montana, Idaho and Alaska all have less than 2 percent.

The authors of the study said low-income countries that send most of their doctors to the U.S. lost more money training them than they receive in U.S. foreign aid. In 2010, the Phillippines spent $1.7 billion training more than 20,000 doctors who then came to the U.S., but was only given $33 million in U.S. foreign aid. The authors suggest the U.S. should pay those countries back in some way. (Read more)

Rural newspapers don't write a lot of health stories — but they should, expert says

“If a newspaper can’t stand for better health and better health care, then what in the world can it stand for?” This was the galvanizing statement of a talk today by Al Cross, director of the Institute for Rural Journalism and Community Issues, who keynoted the third annual Kentucky Health Literacy Summit. Cross discussed ways newspapers are — and aren’t — publishing health-related stories on their pages.

A research paper Cross presented with University of Kentucky graduate student Sarah Vos yesterday showed that with a few exceptions, rural newspapers in the state are not publishing many articles about health care and health. The vast majority of articles — 71 percent — run on the inside of the paper rather than on the front page. In large part, stories are institutionally oriented, Cross said, often pertaining to promoting the local hospital or reporting on problems with it.

Interviews with rural publishers and editors in Kentucky and Mississippi showed “while many of them believe health coverage is important, they are reluctant to be seen as crusading in the news columns for a cause, even if it is one that usually has no countervailing interest,” Cross said. He said Kentucky editors are specifically reluctant to point out health disparities comparing their community to neighbors, the state or nation, because they want to build up the community “rather than going out of their way to point out local problems that have no easy solutions.”

Another issue is that most of Kentucky’s 150 newspapers serve very small markets, which “mean less revenue, small staffs and low pay, so most of these newspapers lack the resources to do what we journalists call enterprise reporting,” Cross said. And with all but two Kentucky dailies owned by corporate chains, that can mean “less news space, fewer staff members, more focus on number of stories rather than quality, less focus on community service, more on bottom line,” he said.

However, rural newspapers continue to have considerable influence over their readership, with 60 percent of adults saying their local paper is their primary source of news. Their content is almost entirely local. Thus, Cross said, there are opportunities — and ones that don’t require a lot of legwork. A story about someone's life being saved because she got a cancer screening can make a big impact, he said, and sometimes an article written by an outside source, such as a local extension agent, “doesn’t need to be put on page 12.” Cross said. Newspapers can use social media, such as Facebook, to promote their stories and find local people willing to talk about a health issue.

Cross also recommended Kentucky Health News as a service editors can rely on for stories that can be used verbatim or be easily localized. Cross noted newspapers are using the service, and “We think we are moving the needle.”

Rural newspapers have power to influence people's health, but few health articles are being published in Kentucky, study finds

By Tara Kaprowy

Kentucky Health News

Though studies suggest that newspapers can influence people's decisions about their health and can even lead to public-policy changes, for the most part Kentucky's rural newspaper editors are publishing very few health-related stories, a report compiled at the University of Kentucky concluded.

The six-month study found more than 1,200 articles  primarily about health were published in 131 rural Kentucky newspapers, including opinion pieces, reprints, press releases, briefs and letters to the editor. That averaged to nine stories per newspaper in six months, though daily papers tended to run far more articles than non-dailies (52 percent of dailies ran health articles 1 to 2 times per week while 68 percent of non-dailies ran health articles less than once a month).

Speaking at the third-annual Kentucky Health Literacy Summit, study co-author Al Cross said he wasn't surprised by the findings, sensing "there wasn't a great deal of coverage out there to help people live healthier lives." But Cross said his goal as director of UK's Institute for Rural Journalism and Community Issues "is to help rural newspapers help define the public agenda."

"In Kentucky," he said, "that needs to be about health."

The topic of health-care funding and policy accounted for 35 percent of the articles published, though co-author Sarah Vos said that number is likely skewed because the time period analyzed included a legislative session during which there was extensive discussion about Medicaid.

Stories on drugs and alcohol accounted for 12 percent of the total, followed by tobacco/smoking (9.5 percent) and exercise, food, diet or obesity (8.6 percent). Vos also found stories that did run were often incomplete, with 40 percent failing to contextualize the problem for the reader. Only 20 percent mentioned health disparities, the differences in health between geographic areas and demographic sectors.

While there is a dearth of health reporting in rural newspapers — all newspapers but those that serve the Lexington, Louisville and Cincinnati areas were included in the study — they could have considerable pull in the health decisions people make. Vos cited one study showing media coverage can influence individual health decisions and preventive behaviors, and one that showed coverage of health issues can lead to both changes in public policy and public perception.

Rural newspapers are well read by their readership, with the average reader spending about 39 minutes reading their local paper. Sixty percent of adults say their rural paper is their main source of news, Vos said. "Rural newspapers have a special relationship with readers," she said. "It's intimate. One researcher even called them an extended member of the family."

For a copy of the paper, click here.

Book about Appalachian health reveals region and culture-specific issues for researchers, region's residents

Editors of a new book hope it will shed light on the health problems facing Appalachia while debunking myths about the culture. Robert Ludke and Phillip Obermiller, both of the University of Cincinnati, compiled work for Appalachian Health and Well-Being from researchers "who present data addressing health disparities affecting urban and rural Appalachians and offers possible solutions," the Cincinnati Enquirer reports. Obermiller said most of the book's 40 contributors are from the region. The book will be officially debuted at the Appalachian Studies Association Conference this weekend in Indiana, Pa.

Ludke said the book is intended to be a resource to Appalachians or people studying public health. He said politicians and the general public need the information to better address Appalachians' health issues. The editors said they also wanted to draw attention to "urban Appalachians," or people of Appalachian heritage living in metropolitan areas. Ludke said the Appalachian population living in Cincinnati has assimilated less than in other metro areas. (Read more)

Norton and UK HealthCare formalize the collaboration they announced almost a year and a half ago

UK HealthCare and Norton Healthcare have formalized the collaboration they announced almost a year and a half ago and will "focus on creating collaborations with hospitals across the state in stroke, cardiovascular and cancer care," Dr. Michael Karpf, executive vice president for health affairs at the University of Kentucky, announced today.

Said Steve Williams, president and CEO of Norton: "Our intent is to bring our combined health care expertise and resources into communities across the commonwealth to improve health-care outcomes."

The partnership will be in the form of a non-profit organization. The board of the Norton-UK HealthCare Partnership for Quality has already approved a budget of $595,000 to grow stroke outreach and education and launch programs to fight heart attacks and cancer, a press release says.

In late 2010, the two systems joined forces to create a statewide collaboration that addresses Kentucky's major health issues, including cancer, stroke and heart disease that stem from high obesity and smoking rates. Some of the accomplishments since the agreement include a transplant program, an effort to increase the number of obstetricians statewide; pharmacy education; and cancer care.

A competing collaboration, between the University of Louisville, Jewish Hospital and the Lexington-based St. Joseph Health System, is again trying to formalize its arrangement following rejection of a merger by state officials on grounds that University Hospital was a public institution that could not be bound by the Catholic system's restrictions on reproductive care.

Conflicting interpretations abound regarding CBO's report about cost, coverage of Affordable Care Act

By Tara Kaprowy
Kentucky Health News

Since the Congressional Budget Office released a report with revised estimates about how many people the Affordable Care Act will cover and how much it will cost, it has spawned a whirlwind of op-ed pieces with vastly opposing interpretations.

According to Julian Pecquet in The Hill, the estimate showed the federal health-care reform law will allow 30 million more people to get insurance coverage by 2016, down from the previous estimate of 32 million. Thus, the law's coverage provisions are now estimated to cost $1.083 trillion over the next 10 years, $50 billion less than last year's projection.

The CBO also estimates that 4 million Americans will lose their employer-sponsored health insurance by 2016, not the mere 1 million figure projected last year. It also estimates that 1 to 2 million fewer people will qualify for state health-insurance exchanges than initially thought, but an additional 1 million will qualify for Medicaid or the Children's Health Insurance Provision, known in Kentucky as K-CHIP.

"CBO faults a slower than anticipated recovery for the soft numbers, along with technical changes to CBO's estimating procedures and legislative changes adopted over the past year," Pecquet reports. The changes in cost estimates are "due in part to slower growth in health-care spending resulting in an 8 percent drop in premiums, as well as taxes and penalties paid by employers and their workers as struggling businesses cut down on employer-sponsored coverage," Pecquet writes.

Conn Carroll, senior editorial writer for The Washington Examiner, has an entirely different view, saying the cost has doubled. "The gross cost of President Obama's health care law has risen from $940 billion when the bill was passed, to $1.76 trillion today. This did not sit well with Obamacare's leftist apologists," he writes. Carroll uses gross figures to arrive at his calculations.

Carroll is comparing apples to oranges, and the estimate hasn't doubled, writes Ezra Klein of The Washington Post. "The disparity in the cost estimates only comes when you take a different sample of years, in which the law is doing different things, in an economy of a different size. And even then, costs went up only if you take "gross" costs rather than "net" costs, which is a rather unusual way to think about the budget."

Paul Krugman of The New York Times weighs in too, but not on the numbers. He does say, "For all its imperfections, this reform would do an enormous amount of good. And one indicator of just how good it is comes from the apparent inability of its opponents to make an honest case against it."

Krugman said "most of the disinformation" about the reform is about costs. "Each new report from the Congressional Budget Office is touted as proof that the true cost of Obamacare is exploding, even when — as was the case with the latest report — the document says on its very first page that projected costs have actually fallen slightly."

CBO Director Douglas Elmendorf defended in his blog the changes in estimates. "We will continue to update our estimates regarding health insurance coverage as new information becomes available about the implementation of the ACA, underlying trends in the health-care and health financial systems, and the probable responses to the legislation by businesses, families and others."

Affordable Care Act helping families, seniors in rural areas, agriculture secretary says on its second anniversary

The Patient Protection and Affordable Care Act is already making an impact, including for people who live in rural America. That was the message from Agriculture Secretary Tom Vilsack today on the second anniversary of the enactment of the federal health-care reform law.

In a teleconference, Vilsack noted several pieces of the law that are benefitting people, including the 2.5 million young adults who have insurance coverage because parents can keep them on their plan up to age 26. "That's providing a degree of comfort to moms and dads," he said.

The law has also helped 3.6 million seniors on Medicare, who saved $2.1 billion on their prescription drugs in 2011 because the law allowed them to get a 50 percent discount on brand-name drugs. Vilsack said seniors saved an average of $600 last year and were also "able to get a number of services, including preventive services like mammograms, for free."

Under the law, insurance companies are now required to spend 80 percent of their premium dollars on "actual health care, not overhead," Vilsack said, and they are not allowed to increase their premiums by more than 10 percent without an explanation. Children who were previously denied coverage because of pre-existing conditions can no longer denied, as per the law's mandate, and "in a couple of years that will extend to all people," Vilsack said. And thousands of new primary-care doctors and nurses are being encouraged to practice in rural areas and will receive higher payments.

Vilsack said his Department of Agriculture is working to improve the rural health-care landscape, through a joint effort with the USDA Rural Development division and the Department for Health and Human Services. In the past three years, Vilsack said 730 counties have received grants so they can "embrace telemedicine." Nearly 600 health-care facilities in rural communities have received money to fund equipment like CT scans, MRIs, ultrasound and lab equipment, Vilsack said. And rural citizens can now get care from a hospital outside their health plan's network when there is no time to get to a hospital that is farther away.

"No one should have to go without health care because of where they live, and for too long, rural Americans have been getting the short end of the health-care stick," he said. "The Affordable Care Act is helping millions of young people access health care, strengthening Medicare, and training thousands of new doctors to serve rural areas to give middle-class families the health security they deserve." (Read more)

Reform act good for kids, Kentucky Youth Advocates head says

This week marks the second anniversary of the Affordable Care Act and debate about its cost and benefits continues to be vigorous. But one thing that can't be denied "is that the ACA, on a most basic level, benefits vulnerable kids in Kentucky," writes Terry Brooks, right, executive director of Kentucky Youth Advocates, in an op-ed piece in the Lexington Herald-Leader.

"Today, because of the ACA, kids with pre-existing conditions like diabetes and asthma can't be denied the care they need," he writes. "And children across Kentucky are receiving preventive care like immunizations without their parents having to pay out-of-pocket costs so they can avoid illness and we can avoid unnecessary health care costs for preventable problems."

Brooks also notes that the ACA allows children to be covered under parents' insurance up to age 26.

If provisions of the ACA are not revoked, children can continue to benefit into their adulthood, Brooks writes: "They'll be protected from their insurance companies placing lifetime caps on their coverage and benefits, so if a child beats leukemia at age eight, she will still be able to get the care she needs if she relapses at age 20." That will translates to 360,000 children in Kentucky being protected. "And more than 180,000 Kentucky children will be able to receive preventative care such as well-child visits and other screenings with no out-of-pocket costs," he writes.

"So, yes, let's debate the pros and cons," he said. "But let's not deny the simple fact that the ACA is good for kids, and kids should be spared from the politics and animosity of this debate." (Read more)

Knox County Hospital bounces employees' checks; blames old, bad debt and late Medicaid payments

Debt inherited from previous management and late Medicaid payments caused some Knox County Hospital checks to bounce. Most of the facility's employees could not cash their checks last Friday afternoon.

"It was more of an accounting issue than anything and had we known that this was going to happen, we would have put personal money into it and this wouldn't have happened," said Dr. Satya Chatterjee, a management owner. Hospital CEO Craig Morgan said, "That money is starting to come; it's just not coming fast enough, so hopefully we're past the worst of it." Morgan said he "takes the blame for the billing issue and actually had all people in administration hold their checks so other employees were paid as soon as possible,"  Jerrika Insco reports for WYMT-TV.

It is not the first time the hospital has bounced checks, . "Ever since Medicaid was implemented, the CEO says the hospital has struggled financially," Insco reports.

Presumably, she means managed care for Medicaid, which has prompted many complaints from health-care providers. Since the legislative session began, lawmakers have heard gripes about the state's three new managed-care companies, who took over Kentucky's Medicaid program outside the Louisville region Nov. 1. The companies have been too slow to reimburse providers and require burdensome pre-authorizations before treatment can be provided, critics say. State Auditor Adam Edelen said the companies are sitting on "north of a quarter billion dollars of taxpayer dollars. That's something that requires an explanation to the people of Kentucky." (Read more)

Legislation to fight pill mills will need to strike balance between law enforcement and medicine, panelists on TV show make clear

By Tara Kaprowy
Kentucky Health News

The legislation meant to crack down on so-called "pill mills" will turn on striking a balance between thwarting prescription drug abuse and making sure doctors and patients don't feel their hands are tied, it became clear on statewide television Monday night.

On KET's "Kentucky Tonight," Attorney General Jack Conway argued strongly for the legislation, as did state Rep. John Tilley, D-Hopkinsville, chair of the House Judiciary Committee. Dr. Shawn Jones, president of the Kentucky Medical Association, said physicians are interested in fixing the problem but don't want legislation to be overly burdensome. State Sen. Tom Jensen, R-London, chair of the Senate Judiciary Committee, would not commit to either side, but did voice some concerns.

Conway said 90 Kentuckians a month die from prescription-pill overdoses, and Kentucky is the fourth most medicated state in the country. And he said the problem is expected to grow, with 80 percent of middle-schoolers saying they know someone who has used prescription pills for off-label purposes.

But Jones warned legislators should not over-reach. "When we write legislation and we try to mandate medical care, it's very difficult," he said. "We think primarily our role as physicians is to protect the right of the patient to relieve suffering. . . . We think we need to address this problem. How to do that is the big issue."

Right now, all prescriptions dispensed in Kentucky are tracked through the Kentucky All Schedule Prescription Electronic Reporting, a system known as KASPER. The Cabinet for Health and Family Services is charged with tracking disturbing trends that show up in the system and conveying those anomalies to the doctor-dominated board that licenses doctors. That is not happening, Conway said. "In my first four years in office, I've never gotten a referral from the Kentucky Board of Medical Licensure," he said, adding under the current system law enforcement has no way to "get at the data" unless they already have a case file opened.

House Bill 4 would put Conway's office in charge of tracking KASPER data and allow it to track data without opening a case. It would also require pain clinics to be owned by doctors or advanced registered nurse practitioners and require doctors to use KASPER when seeing new patients and periodically thereafter. Now, only about one in four physicians have KASPER accounts, Conway said. An alternative measure, Senate Bill 98, would not shift power to Conway's office, but would require that doctors be the owners of pain clinics.

Jones said requiring doctors to use KASPER is too heavy-handed, in part because the system does not instantly respond to doctors' requests. Conway acknowledged the system is old and "needs to be updated," but said Gov. Steve Beshear set aside $4.5 million in his proposed budget to do so.

Patient privacy is another consideration, since House Bill 4 would also allow county and commonwealth's attorneys, along with law enforcement, access to KASPER data, Jones said. Jensen pointed out another concern: "You don't want to have a chilling effect on physicians to prescribing medications on a patient. I hate to think we're doing something where doctors are going to say, 'I don't want to give someone pain meds because I might be monitored and I might get in trouble.'"

Bob Talley of Bowling Green, who called in to the show and said he has chronic pain, agreed with Jensen, saying he "certainly does not want the political process to make it harder for my doctor and harder for me to get legitimate treatment."

Though Jensen pointed out potential problems, he said he is "still in the mode where I'm learning" because he hasn't been involved in the process of sculpting what has been proposed. "I think this is a broad bill, it's a big bill that we need to look at cautiously," he said.

Tilley agreed "the devil is in the details," but said something needs to be passed before the impending end of the legislative session. "This is a scourge. People are dying," he said. "It's imperative we act this session."

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.

House panel OKs "meds for meth" bill; chair predicts passage

The bill to limit purchases of the cold medicine used to make methamphetamine cleared another legislative hurdle Monday, and the chairman of the committee that approved it predicted that it will become law despite a heavy lobbying effort by over-the-counter drug makers.

By a 10-4 vote, the House Judiciary Committee approved a version of Senate Bill 3 that differs slightly from the version passed by the Senate. Rep. John Tilley, a Hopkinsville Democrat and the committee’s chairman, predicted the revised SB 3 will pass on the House floor. "Tilley said Senate leaders have signed off on the changes the House committee made," Jack Brammer reports for the Lexington Herald-Leader. The House version clarifies "language regarding prescriptions" and would ban "criminals convicted of meth-related offenses from purchasing pseudoephedrine for a five-year period," Mike Wynn of The Courier-Journal reports.

The core of the bill would allow consumers without meth records to buy 7.2 grams of medicines with pseudoephedrine each month, approximately a two-week dose, and up to 24 grams per year, without a prescription. Another 7.5 grams a month or 90 grams a year could be available with a prescription. "Experts have testified that those amounts are adequate for most cold and allergy sufferers, and more than 90 percent of all purchasers use dosages that fall below the proposed thresholds," Wynn reports. "State law already limits purchases to 9 grams per month, with a yearly cap of 108 grams, and purchasers are required to present a photo ID and sign a log at the point of sale."

The bill would not apply to gelcaps, which are more difficult to use for meth, or liquids, which are used for children. (Read more)

Amid legislative action on 'Larry's Law,' report says mentally ill and intellectually disabled don't belong in personal-care homes

By Tara Kaprowy
Kentucky Health News

As state legislators move to change the procedure for admitting mentally ill patients to personal-care homes, a new report argues those patients shouldn't be in the institutions at all — and neither should people who have intellectual disabilities.

Kentucky Protection & Advocacy, an independent state agency, argues personal-care homes promote "congregate" and "segregated" living arrangements and, as such, run counter to the Americans with Disabilities Act and a court decision saying disabled patients  should live in the "most integrated setting," meaning one "that enables individuals with disabilities to interact with non-disabled persons to the fullest extent possible."

The report is based on data collected from 218 people in 20 of Kentucky's more than 80 free-standing personal-care homes. Of the facilities visited, 85 percent of the residents living there either had a mental-health diagnosis or an intellectual disability. The visits were unannounced, and individuals were asked at random if they wanted to participate in the survey.

The report found residents in personal-care homes are often restricted from their community either because of lack of transportation — nearly 43 percent said they had to walk in order to go anywhere — or because the home is geographically isolated from most of the community. Staff also rarely plan outings, with one in three respondents saying it never occurs. Another 14 percent said it happens "a couple times a year" and 14 percent said it happens weekly.

Though community mental health centers have programs for counseling and rehabilitation, only 13 percent of personal-care home residents said they go. "Many residents expressed interest in attending the therapeutic rehabilitative programs and the community mental health center for counseling or case management services; however, the staff at PCH would not arrange it," the report reads.

Adding to the argument that residents live in a congregate arrangement, the report points out residents are "subjected to regimented meal times, often with assigned seating, medication, smoke breaks, curfews and bedtimes;" have roommates but are not able to choose them; are not always allowed to refuse to take their medication; and have limited visiting hours.

Still, when asked if they have any complaints about living in a personal-care home, 51.2 percent said they didn't. Nearly 46 percent said they did, and 3.2 said they were unsure. Being lonely or having nothing to do was the single biggest complaint. To download the report in PDF form, click here.

Two bills have been filed to change the way people with mental illness or intellectual disability would be admitted to personal-care homes. Senate Bill 115, which the Senate Health and Welfare Committee approved today, would require that a potential resident receive a medical exam that includes a medical history, physical exam and diagnosis before being admitted. The same would be required by House Bill 307, which would also require more assessment for a person with an acquired brain injury. It hasn't seen action since it was posted in committee Feb. 6. 

The bills are dubbed "Larry's Law," after Larry Lee, who disappeared in August from Falmouth Nursing Home. Lee, who had a brain injury from childhood, had been diagnosed with schizophrenia, bipolar disorder and diabetes. He was found dead four weeks after his disappearance on the banks of the Licking River, which flows through Falmouth. (Read more)

"Larry Lee is not the first person to walk away from a personal care home and die," Beth Musgrave and Valarie Honeycutt Spears write for the Lexington Herald-Leader, citing cases from Grant and Letcher counties. (Read more)

Kentucky hospitals say they gave back $1.67 billion to their communities in 2010, mostly by absorbing losses and bad debts

By Tara Kaprowy
Kentucky Health News

With the downturn in the economy part of the reason, Kentucky's hospitals say they gave back a whopping $1.67 billion to their communities in 2010, mainly by providing care for which they were never paid.

That's 13 percent more than the hospitals reported last year, and just one of many figures in the latest annual report from the Kentucky Hospital Association, which runs a little over a year behind because it takes a long time to compile the data from more than 100 hospitals.

KHA's 2010 Community Benefits Report shows hospitals absorbed $435.5 million in bad debt in 2010, which accrued when patients came to the hospital and were treated but did not pay their bills.

Shortfalls in Medicare and Medicaid payments cost even more — $456.2 million — because the federal government reimburses Kentucky hospitals for about 85 percent of the cost of Medicaid patients and 95 percent for those on Medicare. That's big, because 71 percent of patient days in Kentucky are covered by one of these programs, said Pam Mullaney, KHA's director of membership services. Hospitals also gave $274 million to charity-care programs that are set up to include free or discounted care to people who are unable to pay. Those three categories of losses increased by more than $158 million over 2009. KHAcalls them community benefits because "you're not getting any type of margin," Mullaney said.

A 2009 Thomson Reuters study showed the average U.S hospital reported an operating profit margin of 3.7 percent. The average operating margin at Kentucky hospitals was 2.44 percent in 2009. Forty percent of hospitals lost revenue from patient services that year, Mullaney said. Still, reported community benefits increased by 13 percent, a total of $190 million.

This is the third year of the report, which was based on a voluntary survey to which 104 of 123 hospitals responded (Eight hospitals were not surveyed because they treat limited types of patients, such as veterans, children or psychiatric cases.) Mullaney said the number of hospitals turning in figures "has grown a little bit each year, but it’s not consequential."

Hospitals are asked to describe and put a value on the programs and activities they provide at or below cost that help their community. Though community benefits are "the greatest single affirmation of not-for-profit hospitals' tax-exempt status," Mullaney said data show Kentucky's 26 for-profit hospitals "do every bit as much as the not-for profits."

In the past two years, Pikeville Medical Center has absorbed $70 million in charitable care and bad debt. The Murray-Calloway County Hospital is in the ninth healthiest county in Kentucky, but has felt the crunch too. From 2010 to 2011, bad debt increased from $7 million to $7.8 million and charity care increased from $5.1 million to $6.2 million.

T.J. Samson Community Hospital in Glasgow has also seen bad debt increase and business decrease when the economy crashed and then stagnated. "Our elective procedure volumes have come down. Patients often wait until they're sicker before they come in," said Laura Belcher, director of planning, marketing and development. The hospital has responded by cutting costs, adopting the "lean philosophy" of eliminating waste and streamlining processes.

Interestingly, the hospital is also pushing for more preventive care since the economy went south. "People ask us, 'Aren't you putting yourself out of business?' But we really want people to be proactive about their health. We've done a lot more health fairs, more screenings," Belcher said.

Indeed, the report shows Kentucky hospitals spent $500 million in 2010 to actively help their communities, through such activities as health screenings, support groups, research, training of nurses and doctors, addiction recovery and neonatal intensive care, or simply donating money to community functions. Many of these programs "are provided at no cost or at a financial loss and would not be provided if the decision was based on monetary decisions," Mullaney said.

Realizing there was a need in the area for children with special needs, the Glasgow hospital set up C.A.M.P. T.J. Kids, a weeklong day camp in the summer for children with special needs. "These children often receive services through school and during school," Belcher said. "But we found many of the families could not afford or handle the transportation to get here during the summer. This is almost like a summer booster."

The camp falls under the umbrella of the Discovery Academy, funded by the hospital and money raised by volunteers. The academy also hosts an annual overnight camp for children with autism. While the children swim in the hotel pool or interact with each other, parents are "in a conference setting to learn about ways they can learn to be better parents" to kids with autism, Belcher said. "In the evening, while children are being supervised, the parents get to go for a quiet, romantic dinner."

When tornadoes struck Kentucky March 2, Pikeville Medical Center kicked into high gear and co-hosted a radio-a-thon that raised $200,000. "We allowed our employees to donate their vacation time, which we converted to actual dollars based on their rate of pay, and we offered employees the ability to do payroll deductions to contribute to the cause," said Cindy Johnson, director of public relations and the Medical Leader, the hospital's community newspaper.

The Murray hospital has increased its community outreach efforts and adopted a mission to provide the local school system with athletic trainers, whose salaries are paid entirely by the hospital, as well as school nurses, which are partly hospital funded. The goal is to promote health and wellness, said marketing director Melony Bray.

The KHA's Mullaney said the annual report reminds people what their hospital does. "A lot of times people think of their hospital as a place to go when they need emergency help," she said. "They don't think of the hospital as one of the big providers in the community for health fairs, health professional education, types of efforts in the community to help improvements like playgrounds and common spaces. Those are things that hospitals often get overlooked for but they do that because they are part of the community."

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.

How to help your child lose weight? Lose weight yourself

If parents want to help their children lose weight, they should lose weight themselves, a new study shows.

"Parents are the most significant people in a child's environment, serving as the first and most important teachers," said Kerri N. Boutelle, associate professor of pediatrics and psychiatry at the University of California-San Diego. "They play a signifiant role in any weight-loss program for children, and this study confirms the importance of their example in establishing healthy eating and exercise behaviors for their kids."

Researchers analyzed 80 adults who were parent to a 8- to 12-year child who was either overweight or obese for five months. Some adults participated in a parent-only treatment program, while others were in a program designed for themselves and their child.

The study looked at "the impact of three types of parenting skills taught in family-based behavioral treatment for childhood obesity, and the impact of each on the child's body weight: the parent modeling behaviors to promote their own weight loss, changes in home food environment, and parenting style and techniques (for example, a parent's ability to help limit the child's eating behavior, encouraging the child and participating in program activities)," reports research-reporting service Newswise. (Read more)

A summary of what to expect when the Supreme Court hears arguments about the health-care reform law

How big a deal will it be when the U.S. Supreme Court hears arguments about the constitutionality of the new federal health-care reform law later this month? Big, concludes Stuart Taylor Jr. for Kaiser Health News.

"It's big enough for the justices to schedule six hours of arguments — more time than given to any case since 1966," he reports. "It's also big enough to attract more briefs than any other case in history ... and, finally, it's big enough to cause the justices to postpone until October half of the 12 cases that they were ordinarily going to hear in April in order to clear time to get started on the health care opinions."

The most pressing issues deal with the individual mandate of the law, which requires people without insurance to buy some or pay fines. The question is whether the mandate "represents an unconstitutional exercise on Congress' power to regulate commerce and to levy taxes," Taylor notes. There is also the question of state sovereignty, since the law requires states "to spend more of their own money or forfeit all of the federal Medicaid money they now receive," Taylor reports.

As for the outcome, that's the million-dollar question, Taylor writes. "It's clear that the court's four more liberal members, like almost all other liberal legal experts, will find the law constitutional in all respects. It's also clear that conservative Justice Clarence Thomas will vote to strike down much or all of the law. It's less clear what swing-voting Justice Anthony Kennedy and conservative Chief Justice John Roberts as well as Justices Antonin Scalia and Samuel Alito will do."

As for the major arguments regarding Medicaid and for and against the individual mandate, Taylor provides an excellent summary that is worth reading in its entirety. (Read more)

Ky. recognized for high immunization rate; up 17% since 2007

For having childhood vaccination rates considerably higher than the national average, Kentucky's Department for Public Health was recognized by the Centers for Disease Control and Prevention this week.

Kentucky's childhood vaccination series coverage rate was about 80.6 percent in the last two quarters of 2010 and the first two quarters of 2011. Nationwide, the rate was 73.1 percent. Kentucky was also acknowledged for improving its childhood coverage from 63.3 percent in 2007. The data were collected from the annual National Immunization Survey.

Starting July 1, 2011, immunization requirements started being imposed for infants, toddlers and school-age children that were more in line with CDC recommendations and national pediatric standards.

"We have been working to increase immunization rates among Kentucky's children for several years now, including a campaign to make the public aware of the changes to the immunization schedule that took effect last July," said acting Health Commissioner Dr. Steve Davis. "The improvement in vaccine coverage helps improve the health and well-being of our fellow Kentuckians, and particularly our children." (Read more)

Switch to managed care happened too fast with too little knowledge, former Medicaid commissioner says

States like Kansas are looking at Kentucky as a precautionary tale for what not to do when transitioning to managed care, former Kentucky Medicaid commissioner Shannon Turner told Ryan Alessi on CN|2's "Pure Politics" Wednesday. Kansas Gov. Sam Brownback "was heralding Kentucky . . . in the beginning," she said. "And last week, his office released what I call a 'Kansas is not Kentucky' statement."

Turner, who was fired from Passport Health Plan after she was linked to excessive travel expenses and is now a health-policy consultant, said Kentucky rushed into managed care too quickly — rather than a few months, the state really needed a year, she said. In Turner's view, there also isn't enough expertise in the Cabinet for Health and Family Services to deal with the three new managed-care operators. "I think the managed-care companies really don't have the resources that they need at the state level to give them direction," she said. "On the state side, you have people looking at managed-care processes that they really aren't familiar with."

In other states that switched to managed care, Turner said there was a turnover in state staffing. In Kentucky, "There haven't been cuts, there haven't been layoffs . . . so what are the people who are there at Medicaid focused on, and is there adequate training?"

On Nov. 1, 560,000 Medicaid recipients were switched to managed care, which is "essentially outsourcing" to the managed-care operators, Turner said. Lawmakers have heard complaints about delayed payments and rigid pre-authorization requirements, including one instance Alessi mentioned, involving a woman in labor who was required to get pre-authorization before she could deliver her baby.

Turner said the MCOs are "excluded from the majority of the rules that apply to HMOs," including one that would prevent them from "sitting on" payments." Turner called the process a "bloodbath" for independent pharmacists because of those delayed payments, as well as community mental health centers, who were "seeking pre-authorization . . . but the managed care companies said, 'You can't send it to us electronically.' They were literally snail-mailing these things." (Read more)

Beshear names Audrey Haynes secretary of embattled Cabinet for Health and Family Services

Audrey Tayse Haynes, who is a social worker by training but knows her way around politics, government and the nonprofit world, will be the new secretary of the state Cabinet for Health and Family Services. She will replace Janie Miller, who resigned last month after controversies over Medicaid managed care and release of child-abuse records.

"Audrey brings a dynamic mix of large-scale organization management, policy development, and government experience to this position," said Gov. Steve Beshear, who made the appointment. "This cabinet is a complex organization, with a broad range of programs that serve tens of thousands of our most vulnerable Kentuckians. Audrey has the right skills and resources to make sure our citizens continue to get the care and services they need."

Haynes, who starts her new job April 16, has spent the last 10 years as senior vice president and chief government affairs officer for the YMCA of the USA in Washington, D.C. During the latter part of the Clinton administration, she was chief of staff to Tipper Gore and an assistant to Vice President Al Gore. She first went to Washington on an appointment from Gov. Paul Patton as head of the state's policy office in the nation's capital.

Earlier, she was director of human resource development in the Department of Mental Health in the former Cabinet for Human Resources, and ran a literacy program with First Lady Martha Wilkinson in the administration of Gov. Wallace Wilkinson. She has bachelor's and master's degrees in social work, respectively, from Spalding University in Louisville and the University of Kentucky.

"From my experience working with Audrey Haynes, I know her to be a consummate professional," former state auditor Crit Luallen, who worked with Haynes during the Patton administration, said in the Beshear administration's press release. "She will bring strong management skills, as well as national leadership experience to this critical cabinet post."

Haynes said in the release, "I am excited to be back in Kentucky full time. CHFS impacts every single Kentuckian — whether through birth certificates, health departments, restaurant inspections or services to the elderly. I feel that I am returning to my roots of social work and mental health services."

One of her first areas of focus will likely be monitoring the new Medicaid system, which brought managed care to 560,000 recipients in November. During the current legislative session, lawmakers have heard complaints about the transition, including the manner in which those with mental illnesses are being treated. "Now that Secretary Haynes is in place, we can continue to make progress on major initiatives such as managed care and ensure that our citizens get the services they deserve," said Rep. Jimmie Lee, D-Elizabethtown, chairman of the subcommittee that writes the cabinet's budget. (Read more)

Board of Dentistry's relaxation of limits on hygienists is the latest sign of hope in Kentucky's all-too-grim story of oral health

By Al Smith
Kentucky Health News

With nearly a fourth of Kentucky’s 1 million children living in poverty and suffering some of the worst oral health in America, the state Board of Dentistry voted Saturday to develop regulations to permit hygienists to treat children in a public health setting perhaps stemming a near epidemic of tooth decay in the very young.

Hygienists will still be responsible to dentists when working in public-health settings such as schools, where they can apply preventive treatments on their own if the new regulation wins legislative committee approval. It isn’t as far as we want to go in confronting our horrific problems, but it may remove stones in our path that have kept a tight control on the use of hygienists.

In the past, organized dentistry in Kentucky, fearing competition from hygienists, has opposed expanding their scope of practice, but as Kentucky remains stalled near the bottom of state rankings of oral health, younger dentists are accepting the need for change, says Dr. James Cecil, a retired dentistry professor at the University of Kentucky.

Saturday’s action by the Board of Dentistry partly may have been “from desperation, over recent bad publicity as the popular press portrays the profession as unresponsive to the needs of our poor citizens,” Cecil said in an interview. “While dentistry still remains where medicine was 20 years ago,” when many doctors opposed licensing physician assistants and nurse practitioners, Cecil said dentists “will learn they can make more money when their services become more available through greater use of auxiliaries such as the hygienists.”

Cecil, former chief dental officer for the U.S. Navy and distinguished as a national leader in public health, earlier last week participated with Kentucky Youth Advocates in the organization of a new Kentucky Oral Health Coalition, whose startup is funded by a foundation grant to KYA.

This coalition of various organizations, including public health departments, nurses, physicians, insurers, and some dentists, will be independent of dental associations or the state’s two dental colleges, and it will campaign for better programs for general as well as oral health.

In the early months of a year when the Kentucky General Assembly, like the U.S. Congress, has reached little agreement on public issues, the state Department of Public Health, actively supported by Gov. Steve Beshear, seems to be gaining traction on oral-health needs.

Grants from the Appalachian Regional Commission are expected to go to two of 13 new local health coalitions in Eastern Kentucky. The grants will pay for one mobile dental van and equipment to reach out to an area with children whose teeth are so decayed they were one focus of an ABC "20/20" documentary viewed by 11 million people in 2009.

Through funding by the federal government, the oral health program will begin training general dentists in more pediatric care. And with additional funding from ARC, this project focuses on dentists in the ARC counties for participation.

Meanwhile, Dr. Cecil and KYA hope to organize more local dental coalitions in rural Western Kentucky. Coalitions may decide to include ‘senior days’ to help older citizens with appalling dental health needs.

There are now 25 such coalitions in the state. As more are established, the challenge is to expand the reach of the state’s 3,000 hygienists, to assist and encourage the state’s 2,400 active dentists to become more pro-active about solving problems that drag down oral health in Kentucky, and to educate parents to care for their children’s teeth, beginning in their first year of life.

Historically, in a culture with so much poverty, Kentuckians have stoically accepted being toothless in old age as part of the price. First, though, there are awful workforce problems. What starts with neglect in childhood evolves into a workforce of adults with severe tooth loss and poor self-image, plus illnesses associated with dental disease (obesity, diabetes, strokes, heart disease and Alzheimer’s) and last, a distressing cohort of toothless elderly poor, sadly, among the highest in the country.

It's a grim story, but Cecil sees determination in the profession to address the problems. With a new added role for hygienists, he says, “The dam may be broken.”

Journalist Al Smith, Lexington, a former federal cochairman of the ARC, and co-founder of the Institute for Rural Journalism and Community Issues at UK, is the retired host of KET’s "Comment on Kentucky."

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.

Meds-for-meth bill stalls in state House committee

A measure aimed at curbing methamphetamine production failed to come to vote in the House Judiciary Committee Tuesday. Rep. John Tilley, a Hopkinsville Democrat who chairs the committee, said he hopes Senate Bill 3 will be voted on later this week.

The bill, which was passed by the Senate March 2, "would allow consumers to buy 7.2 grams per month of medications containing pseudoephedrine and up to 24 grams annually, an amount adequate for most cold or allergy sufferers, according to testimony," reports Deborah Yetter for The Courier-Journal. "A doctor's prescription would be required for an additional 7.5 grams per month or an additional 90 grams per year." The bill would exempt liquid or gel-cap formulations of the drug.

Right now, Kentuckians can buy 9 grams of the medicines per month and 120 grams per year.

Some committee members said they are concerned people could be breaking the law if they get or own too much of the drug. Rep. Joe Fischer, R-Fort Thomas, said his wife takes Claritin D, which contains pseudoephedrine, for allergies on a regular basis and asked if the bill would make it too hard for people like her to get the drugs without going to the doctor first. (Read more)

What health reform changes to expect in 2012 — assuming the Supreme Court doesn't strike down the entire law

The U.S. Supreme Court is set to hear arguments later this month about the federal health care-reform law, and is expected to decide the law's future this summer. While the court mulls the constitutionality of an individual mandate to buy health insurance, "implementation marches on, and a number of notable changes will take effect for consumers this year," writes Michelle Andrews for Kaiser Health News.

If the high court strikes down the Patient Protection and Affordable Care Act, "all bets are off," Andrews writes. Popular provisions, such as allowing children to stay on their parents' insurance until age 26 and the 50 percent discount on brand-name drugs for seniors under the prescription drug doughnut hole, could be eliminated — and provisions set to take effect this year could be cancelled. But, if the Supreme Court does not invalidate the entire law, here's a list of new provisions consumers can expect this year:

Free contraception coverage: "Women in a new health plan or in an existing one that has changed its benefits enough to not be considered grandfathered under the law will be able to receive contraceptives without an out-of-pocket charge," Andrews writes. Insurance plans will also have to provide basic health services for women, including screening for gestational diabetes; HPV testing; STD counseling; screening and testing for HIV; and screening and counseling for interpersonal and domestic violence. Religious employers such as churches are exempt from the new regulation, but colleges, hospitals and other employers that are religiously affiliated are not — though they do have a one-year grace period to implement it. Employees of those institutions will receive their free benefit from their employer's insurance.

Consumer rebates: Under the law, insurance companies have to spend at least 80 to 85 of their premium revenues on medical claims and quality improvement. If they don't, they have to pay the difference to policyholders, which, in most plans, means the employer. If the provision had been in place in 2010, an analysis by the National Association of Insurance Commissioners estimated that would have meant $2 billion going to consumers. In December, the Obama administration said that about 9 million Americans could receive rebates that added up to $1.4 billion.

Clearer descriptions: Starting in September, all health plans will have to give consumers benefits information that is easy to understand. "Every plan will be required to give people a short summary of coverage and a uniform glossary of terms," Andrews reports. "It will also have to provide examples of how much the plan would cover if someone had a baby or was managing Type 2 diabetes — two common situations that should make it easier for people to compare plans."

Smaller doughnut hole: "This is the break in Medicare prescription drug benefits that, in a standard plan, begins after total drug spending by the beneficiary and the health plan exceeds $2,930 and continues until the beneficiary has hit the $4,700 out-of-pocket limit," Andrews reports. Last year, people on Medicare with high drug costs got a 50 percent discount on brand-name drugs once they reached the doughnut hole. This year, they'll also get a 14 percent discount on generic drugs. (Read more)

Jewish Hospital of Louisville becomes national leader in removing heart pumps from patients with heart failure

Eleven patients with advanced heart failure were able to have their heart pumps removed thanks to a combination of medication administered at Louisville's Jewish Hospital.

Texas Heart Institute is the only other institution that has removed heart pumps, also known as left ventricular assist devices. Twenty of the devices have been removed in 10 years there. At Jewish, all 11 have been taken away in the past 18 months, Laura Ungar reports for The Courier-Journal.

The program at Jewish uses a cocktail of medicines, including ACE inhibitors, beta blockers and others, in combination with the heart pump. The medication helps strengthen the heart, allowing the pump to be eventually removed. "These patients have a very good quality of life, much better, in fact, than if they continued with the LVAD alone or received a heart transplant," said Dr. Emma Birks, director of the Jewish Hospital Heart Failure, Transplant and Mechanical Support Program.

The treatment could mean "some patients with advanced heart failure may be able to forgo a heart transplant, while others can delay having one," Ungar reports. "That could mean a longer life for younger heart failure patients with LVADs; life expectancy after a transplant averages 10 years."

Nationwide, about 5 million Americans have heart failure, which translates to 300,000 deaths a year, National Heart, Lung and Blood Institute figures show. (Read more)

Smoking ban bill clears House committee for first time; but sponsor says she won't take it farther this session

A measure for a statewide smoking ban passed the House Health and Welfare Committee today, the first time such a bill has cleared committee in legislative history, Deborah Yetter reports for The Courier-Journal.

But House Bill 289 is not expected to be called for a vote this year, said its sponsor Rep. Susan Westrom, right, D-Lexington. "I'm not someone who wants to shove something down someone's throat," she said, adding she plans to reintroduce the measure next year.

Westrom predicts support will continue to grow as "people come to realize local smoking bans have worked well in cities, including Louisville, Lexington and Owensboro. Already, 23 states ban smoking statewide in indoor public spaces," Yetter reports.

Support for the bill was given a significant boost when the Kentucky Chamber of Commerce stepped behind it. President David Adkisson said the majority of business owners the chamber talked to support a ban. "We now feel like it needs to be statewide and not a patchwork," he said.

HB 289 passed with a 10-2 vote. Rep. Addia Wuchner, R-Burlington, a candidate for Congress in the Fourth District, was one of two Republicans to vote against the measure, calling it "well meaning" but too intrusive on people's rights. "It is not the role of the government to go this far," she said. (Read more)

Campbellsville pharmacists have mixed views about meds-for-meth bill; a good example of localizing a statewide issue

Pharmacists have mixed opinions about a bill that would require a prescription to purchase pseudoephedrine after a monthly or yearly limit has been reached, reports Calen McKinney for the Central Kentucky News Journal in Campbellsville. (Photo by McKinney)

The drug is the key ingredient used to make methamphetamine. Last week the Senate approved a bill that would limit non-prescription individuals' purchases to 7.2 grams per month and 24 grams per year.

Tresa Phillips at Nation's Medicines in Campbellsville told McKinney she feels the system in place now — an instant computer tracking system called MethCheck — is working. "I'm not sure that a new law is going to make a big difference," she said, adding that a person who is buying the drug already has to show state-issued identification.

However, Jay Eastridge at Eastridge-Phelps Pharmacy applauded the move. "It sort of restricts pseudoephedrine getting into the wrong hands," he said. "I wholeheartedly support the bill." Eastridge said pharmacists have become "gatekeepers" in the face of the meth epidemic and "it's just painful to watch" people coming in "from one drug store to the next seeing what they can get."

Ed Baise of the Medicine Centre agreed that pharmacists have "become the police" when it comes to limiting pseudoephedrine. But he said the drug should be put in a class of its own and pharmacists should be responsible for controlling purchases. Baise pointed out allergy sufferers could be inconvenienced by the bill. "This may help some," he said, "but it's not gonna solve the problem." (Read more)

Smoking ban can't get a vote due to Republican boycott over chairman's block of measure for drug tests for welfare recipients

There could have been a vote Thursday on a bill for a statewide smoking ban, but a Republican boycott of the Democratic-controlled House Health and Welfare Committee over another bill prevented that.

"Republicans were upset over the committee chairman's decision not to have a vote on House Bill 26, sponsored by Rep. Lonnie Napier, R-Lancaster, which would require the Cabinet for Health and Family Services to implement a substance-abuse screening program for recipients of public assistance," reports Greg Hall for The Courier-Journal.

Chairman Tom Burch, D-Louisville, said he didn't allow a vote because he didn't want to "embarrass" Napier. "Whether he admits it or not, you don't embarrass somebody by killing their bill in front of them," he said. "You just hear it."

Just eight of 16 committee members were present; at least nine are needed to move a bill. Six of the absentees were Republicans; two were Democrats. "Without a committee majority present, no vote was take on HB 289, the smoking ban sponsored by Rep. Susan Westrom, D-Lexington. Burch said he likely will call a special committee meeting early next week to hear the bill," Hall reports. (Read more)

Senate panel and House OK bills to tackle prescription-bill abuse

Two bills aimed at attacking the state's prescription drug abuse problem made headway yesterday, with a major difference between the House and Senate measures, reflecting possible turf battles between state agencies and doctors' desire to maintain as much control over regulation as they can.

Senate Bill 2 would keep the state drug monitoring system — known as the Kentucky All Schedule Prescription Electronic Reporting, or KASPER — the responsibility of the Cabinet for Health and Family Services. House Bill 4 would give it to the attorney general's office.

The Senate Judiciary Committee approved Senate Bill 2 on an 8-to-1 vote. House Bill 4 passed the full House 81 to 7. The bills' low numbers reflect their importance to legislative leaders in both chambers.

Lawmakers feel the issue will ultimately be taken up near the end of the session in a conference committee, whose members represent the House and Senate and come together to come to an agreement between the two chambers, reports Jack Brammer for the Lexington Herald-Leader.

SB 2 originally required that doctors use KASPER when dispensing narcotics and get a KASPER report before issuing a prescription. At the request of the Kentucky Medical Association, bill sponsor Sen. Jimmy Higdon, R-Lebanon, changed that stipulation, requiring the Kentucky Medical Licensure Board, made up mainly of doctors, to issue regulations on how doctors should use KASPER. Higdon said he made the change in order to get the bill out of committee, a move that angered Sen. Ray Jones, D-Pikeville, who accused the KMA of trying to "gut the bill." (Read more)

HB 4 would still require the use of KASPER, used by only less than a third of doctors, and "would bolster regulation on pain clinics and call on coroners to perform mandatory drug tests in cases of deaths with an unknown cause," reports Tom Loftus for The Courier-Journal. "It also would give commonwealth's and county attorneys access to the data in KASPER and would require that pain clinics be owned by a licensed physician or an advanced practice registered nurse." SB 2 would allow only doctors to own pain clinics, but Sen. Brandon Smith, R-Hazard, said clinics with non-physician owners should be grandfathered in if they have not have previous problems with the law.

As for whether the KASPER should stay in the cabinet or go to the attorney general, Sen. Tom Jensen, R-London, said he doesn't has one strong feeling over the other. "We have to make sure the enforcement is there, whoever is doing it. properly," he told Ryan Alessi on CN|2's "Pure Politics."