Experts disagree on whether states will choose to expand Medicaid

Experts disagree on whether states will choose to expand Medicaid, a crucial, but voluntary, part of the federal health-care reform law. Yesterday, the Supreme Court ruled the federal government could not force states to expand the system for the poor and disabled, but that the expansion itself is constitutional.

Yesterday, both Gov. Steve Beshear and Senate President David Williams both indicated they are researching how Kentucky should proceed.

U.S. Sen. Lamar Alexander, R-Tenn., said "many states, maybe most, will decide that they simply cannot afford to choose to expand Medicaid." Though the federal government will pay for the newly eligible enrollees for several years after the law takes effect in 2014, states will eventually have to pay 10 percent of the cost.

Despite the expected cost, Sara Rosenbaum, a professor of health law and policy at George Washington University, predicts that "only a small number of states" will pass up the opportunity to expand, given the federal government's generous offer, reports Robert Pear for The New York Times.

The Medicaid expansion is central to the health care law, since about 17 million of the 30 million Americans who will newly qualify for health insurance will do so under Medicaid. In Kentucky, that translates to 280,000 more people enrolling in the program.

Senior administration officials said they feel sure states will choose to expand Medicaid, but Republican governors like Mitch Daniels in Indiana and Bob McDonnell in Virginia would not commit either way. Daniels said the expansion would cost Indiana $2 billion in the next 10 years.

And though U.S. Sen. Max Baucus, D-Mont., is one of the authors of the new law, he was not sure his own state would opt to expand. He did call the offer of federal assistance "a big juicy carrot." (Read more)

Useful list helps explain health care law and Supreme Court ruling

To learn more about the U.S. Supreme Court ruling on the federal health-care reform law, as well as the Affordable Care Act itself, the Detroit Free Press has put together a list of helpful websites that elucidate the issues.

The list would be helpful to reporters interested in localizing the impact of the law.

Click here for the list, compiled by reporter Pat Anstett.

Don't leave children in hot vehicles this weekend, officials warn

With extreme heat blazing over the state this weekend, the Kentucky Cabinet for Health and Family Services urges the public to avoid leaving children in vehicles.

"Extreme temperatures are cause for concern, so we advise the public to take necessary steps to keep cool and prevent harm," said Dr. Steve Davis, acting commissioner for public health. "Serious injury — particularly for children exposed to extreme levels of heat — can occur. Everyone should take steps to avoid these dangers."

Last year, 33 children died of heatstroke, also known as hyperthermia. In 2010, there were 49 deaths, according to a cabinet press release.

More than half of child heat stroke deaths happen because parents and caregivers forget the child is in the car. To prevent this from happening, drivers should place a cell phone, purse or briefcase on the floor in front of the child to trigger their awareness. They can also set an alarm to remember to drop their child off at day care.

Parents should not underestimate the risk, since vehicles can heat up very quickly even on relatively cool days. A child's body temperature increases three to five times faster than adults, making them especially vulnerable to heat.

Thirty percent of heat stroke deaths happen because a child was playing in a vehicle that was left unattended. Parents should remember to lock the vehicles to avoid the children being able to enter them.

If a bystander sees a child unattended in a car, he or she could call 911 immediately. (Read more)

New Kentucky Medicaid commissioner appointed

In the face of serious turmoil caused by the move to managed care for Kentucky's poor and disabled, a new Medicaid commissioner has been appointed. Lawrence Kissner starts his new job July 1.

Gov. Steve Beshear acknowledged the privatized system, now run by four managed-care companies, has run into some bumps and said he feels Kissner will "ensure that the Medicaid program is more cost efficient and, most importantly, more effective in providing high quality care to the Kentuckians we serve."

Kissner has nearly 30 years experience in the private insurance industry, 17 of which were specifically in managed care. Most recently he was president and CEO of Magnolia Health Plan in Jackson, Miss., a managed care company. In Kentucky, he will over see the program which serves more than 800,000 Kentuckians. He replaces acting commissioner Neville Wise, who has spent more than 22 years in various positions in the Medicaid program. He will remain with the department. (Read more)

As high court upholds health care law, Beshear orders creation of state insurance exchange; questions remain about Medicaid

Journalists wait to hear the Supreme Court's ruling.
(Associated Press photo by Evan Vucci)

By Tara Kaprowy
Kentucky Health News

Voting 5-4, the U.S. Supreme Court has upheld the federal health-care reform law, the core of which requires individuals to get health insurance or pay a fine.

The decision means about 280,000 more Kentuckians will qualify for Medicaid, and about 220,000 will qualify for insurance under a state exchange where they can choose from various policies. More than 900,000 Kentuckians who were previously denied coverage for pre-existing conditions will now also be able to get coverage.

"More people will have access to health insurance is the short answer when it comes to the impact this will have in Kentucky," said Anne Hadreas, attorney for the Kentucky Equal Justice Center. "People with low incomes and moderate-income people will not have to worry about choosing between getting a breast cancer screening and putting food on the table."

Those who are newly eligible will be able to get health insurance in two ways. Individuals with an income as much as 400 percent above the poverty level will be able to buy insurance through a state insurance exchange, an insurance marketplace where people can choose from several plans. As he said he would, Gov. Steve Beshear ordered the creation of such an exchange today, noting that "Kentucky has been systematically preparing to meet the implementation deadlines set forth in the bill as a precautionary matter." Individuals who are part of the exchange will get federal subsidies to help pay their premiums.

The other means to get coverage will be through the law's expansion of Medicaid coverage. People who have an income 133 percent above the federal poverty level will qualify for Medicaid starting in 2014.

Though the Supreme Court also upheld the the law's Medicaid expansion, it ruled the federal government could not take away existing Medicaid funding from states that decide to opt out of the expansion. If Kentucky opts to expand Medicaid, it will eventually cost the state money. For the first five years, the federal government will foot the bill for those who are newly eligible. But in 2019, states will have to start paying 10 percent of that sum. Beshear has expressed concerns over how the state will do that. Spokespersons for Beshear and Senate President David Williams both said they are researching the matter.

John Barro of Bloomberg News predicts that all states will opt for expansion because the federal government will pay for it in the early years. "That's a pretty big carrot," he writes. "States that refused to expand Medicaid will be rejecting nearly free federal money. Such a rejection would be tantamount to saying that government health insurance for low-income people is so undesirable that a state is not even willing to pay 10 cents on the dollar for it." For more on Medicaid, the states and the politics of the issue, see this post on The Rural Blog.

At the center of the Supreme Court debate was whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. Insurance companies agreed to stop denying coverage due to pre-existing conditions because of the mandate, which grows their pool of customers by 30 million people. But if the mandate had been struck down and insurance companies still couldn't refuse customers because of pre-existing conditions, premiums would have skyrocketed.

The Obama administration said the individual mandate was constitutional under the commerce clause of the Constitution, which states that Congress can use its powers to regulate interstate commerce. Chief Justice John Roberts rejected that argument but sided with the court's four liberal justices because a penalty for refusing to buy health insurance — which is part of the mandate — is the equivalent of a tax.

Aside from more Kentuckians being eligible for health insurance, the law will mean:
• Children will be able to stay on their parents' insurance up to the age of 26.
• The Medicare "doughnut hole" in prescription drug coverage will be eliminated, something that will impact 129,000 Kentuckians.
• Health plans will be required to cover preventive services like screenings.

And, though "today's ruling is no way going to diminish the toxicity and politicking on both sides," most people agree children will benefit, said Terry Brooks, executive director of Kentucky Youth Advocates. He said the law provides additional oral health coverage, allows foster children to keep health insurance coverage until the age of 25; and provides "a dedicated stream of revenue for school-based health services."

But Sen. Mitch McConnell, R-Ky., issued a statement calling the law "terrible," saying it has "limited choices," "increased health care costs" and "made it harder for American businesses to hire." He said Congress must act to repeal what he called a misguided law.

Williams called the ruling a victory for President Obama and Beshear but not for Kentucky's small- or medium-size businesses owners.

Whether Kentucky has the medical infrastructure for 500,000 more people having health insurance is uncertain. In Jefferson County alone, 455 primary-care doctors will be needed by 2020 — almost as many who work in medical practices now, Patrick Howington reported for The Courier-Journal this year. "I think the provider shortage is definitely a concern," said Jodi Mitchell, executive director of Kentucky Voices for Health. "That's something to be looking at."

As for how individuals should proceed, Mitchell said Kentuckians "need to stay informed during implementation and stay engaged."

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.

Swine flu killed nearly 300,000 worldwide, study finds

The swine flu of 2009, often referred to as H1NI, killed an estimated 284,500 people, making it 15 times more deadly than it was thought at the time of the pandemic, a new study has found. The report, published Tuesday in the journal Lancet Infectious Diseases, said the numbers might be eventually be  as high as 579,000 people. The original count, tabulated by the World Health Organization, was a mere 18,500.

Those nearly 300,000 deaths were confirmed by lab testing, which the WHO warned vastly underestimated the situation "because the deaths of people without access to the health system go uncounted, and because the virus is not always detectable after a victim dies," reports Sharon Begley for Reuters. In Kentucky, the Department for Public Health reported there were 41 confirmed H1N1-related deaths, said spokeswoman Beth Fisher.

More than 50 percent of swine flu deaths were in Africa and southeast Asia, though they only account for 38 percent of the world's population. Because vital statistics data are either non-existent or incomplete in poorer countries, researchers had to rely on estimates and assumptions but did start with hard data, including the number of health workers who went door-to-door to ask about flu-like symptoms in rural areas and obtained nasal and throat swab samples. They used these numbers to get an estimate on the proportion of a country's population infected with H1N1. Results show the flu killed two to three times more people in Africa than elsewhere. It infected children most, adults moderately and the elderly hardly at all. (Read more)

Expert: Health care landscape already changed, despite what Supreme Court decision is this week

Whether or not the federal health-care reform law is upheld by the U.S. Supreme Court tomorrow, initiatives are already in place that will change the way health care is delivered, an expert said at a Lexington conference Tuesday. Gregg Nunziata, senior director at research and consulting firm The Advisory Board in Washington, D.C., "said the burgeoning number of baby boomers entering retirement, the ever-accelerating advances in technology and the increasing public health crisis that finds more and more Americans with chronic illness such as diabetes, are fundamentally changing how health care works in America," reports Mary Meehan for the Lexington Herald-Leader. As people age, they are "demanding a different kind of care, and they will be living long into their golden years," he said. When they become seniors, who already tend to cast their vote, they will become a powerful voting bloc.

Health officials are looking at ways to cut down on costs, which is necessary because "the government is the major funding source, and the major funding source is broke," Nunziata said. To cut costs, the government and insurers are looking at new ways to pay for health care. One example is the Centers for Medicaid and Medicare scoring hospitals based on their performance and paying them accordingly. "A low score could reduce payments by only 1 percent or 2 percent," Meehan reports, but that can translate to a multi-million dollar loss. "Every hospital is being judged and Washington is keeping score," he said.
Bundling payments is another method being tried, in which one flat fee covers all of the care that is provided in a procedure. "The idea would be to force more efficient and cost-effective care by encouraging cooperation," Meehan reports. (Read more)

Pharmacies to offer free HIV tests as part of pilot program; no Ky. locations chosen yet

Getting tested for HIV may soon be as easy as going to the pharmacy to get a flu shot or blood pressure check. Pharmacies in 24 cities and rural communities will offer rapid HIV tests free of charge as part of a $1.2 million program. Testing is already available in Washington, D.C., Oakland, Calif., and an Indian health service clinic in Montana. The remaining 17 locations will soon be chosen by the Centers for Disease Control and Prevention.

The test involves swabbing the inside of a person's mouth and preliminary results take about 20 minutes. Makers of the test say it is accurate 99 percent of the time. "If the test is positive for the AIDS virus, pharmacy employees will refer customers to a local health department or other health care providers for a lab blood test to confirm results, counseling and treatment," The Associated Press reports. "The workers are expected to deliver the news face-to-face and give customers privacy."

According to the CDC, there are about 1.1 million Americans who are infected with HIV, but up to 20 percent of them don't know they have it. Since 2006, the CDC has recommended all Americans ages 13 to 64 get tested at least once, but fewer than half of adults under the age of 65 have done so. (Read more)

50,000 students to get more fruit, vegetables during the school day

More than 50,000 students in 125 Kentucky elementary schools will be able to eat fresh fruit and vegetables in the coming school year. The nutritious snacks will be provided as part of the U.S. Department of Agriculture's Fresh Fruit and Vegetable Program.

To see which schools were selected, click here.

The goal of the program is to create healthier school environments, introduce children to fresh fruit and vegetables and expand their consumption.

Schools chosen have at least 50 percent of their students who qualify for free or reduced-price meals. Priority was given to the schools with the highest percentages. Kentucky received $2.7 million for the upcoming school year from the program, which translates to about $53 per student. (Read more)

UK hospital chosen to national program to improve breastfeeding rates

Photo courtesy of University of Kentucky Chandler Hospital

University of Kentucky Albert B. Chandler Hospital has been chosen to participate in Best Fed Beginnings, a national effort to improve breast feeding rates.

Improvement is badly needed, with half of babies born in the United States given formula the first week of their lives. By nine months, just 31 percent of babies are breastfeeding at all, reports Allison Perry for UKnow.

The program will involve the hospital implementing then steps to successful breastfeeding, which are endorsed by the American Academy of Pedicatrics. Some of those steps include informing all pregnant women about the benefits of breastfeeding; helping mothers breastfeed within one hour of birth; showing mothers how to breastfeed and how to maintain lactation; allowing mothers and infants to stay together 24 hours a day; and giving no pacifiers or artificial nipples to breastfeeding infants.

UK is one of 90 hospitals nationwide selected to participate in the program. Earlier this year, UK became the first hospital in Lexington to participate in "Kangaroo Care," a training program that promotes skin-to-skin contact between mothers and infants to help with breastfeeding and bonding.

Kentucky's breast-feeding rates are among the lowest in the country, with about 59 percent of new mothers breast feeding. The national rate is 75 percent. (Read more)

Schools have big role to play in battling childhood obesity

Schools can make a powerful impact on battling the childhood obesity epidemic, but only when health and nutrition are seen as a way to improve student learning rather than take away from it.

But there can be push-back in making this transition, said John Skretta, a health advocate and superintendent of Norris School District in Firth, Ky. At the Coordinated School Health Symposium in Lexington Monday, he talked about his efforts to introduce tuna salad in the school lunch menu, with food service directors saying students wouldn't eat it. Finally, the district's head of nutrition made some herself using low-fat mayonnaise and pickles and it was a hit with kids.

To get kids more physically active, Skretta said kids in his elementary schools now take two 10-minute walks a day, which have improved test scores and gets children closer to the goal of making long-lasting choices about their health.

To help with the process, school staff are encouraged to model healthy behavior and avoid eating or drinking items that have low nutritional standards in front of students.

"If schools don't take the lead on this, who will?" Skretta asked. (Read more)

Health care law ruling expected Thursday by Supreme Court

Associated Press photo by Alex Brandon

The U.S. Supreme Court will issue its ruling on the constitutionality of the federal health-care reform law Thursday. 

As for the outcomes, Politico's Jennifer Haberkorn sees four possible scenarios: 

• Strike down the individual mandate as well as insurance reforms

• Strike down the mandate but keep insurance reforms intact

• Strike down the majority of the law

• Let the law stand in its entirety

At the heart of the debate is whether the government can force people to buy health insurance, which is often referred to as the individual mandate. If the mandate is axed but insurance reforms stay intact, insurance companies "could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn writes.

The Supreme Court did issue two key rulings today, "throwing out much of Arizona's new immigration law and deciding that juveniles to life in prison without possibility of parole qualified as a 'cruel and unusual' punishment," The Associated Press reports. (Read more)

Kentucky first state to require license for diabetes educator; Beshear signed bill into law last week

Kentucky is the first state to require diabetes educators to be licensed, a move Gov. Steve Beshear that said will "raise the standards for diabetes management and care."

Beshear signed Senate Bill 198, which establishes the licensure requirements, last week. "For years, our certified diabetes educators have worked diligently to assist patients with diabetes. By adding the licensure requirement, we are taking an important step forward in terms of recognition for the diabetes educator."

The law defines the scope of practice for a qualified diabetes educator; establishes minimum quality standards for providing service; and offers more protection for the patient.

"This is truly a step forward in the field of diabetes management and care," said Dr. Steve Davis, acting commissioner of the Kentucky Department for Public Health. "Not only are we raising professional standards and heightening recognition for those working in the field, we are improving standards for patients." (Read more)

Despite problems, managed care saved state $190 million in six months, official says

Though there have been plenty of bumps in the state's move to  managed care for 820,000 Kentuckians on Medicaid, Health and Family Services Cabinet Secretary Audrey Haynes told lawmakers Wednesday it has saved the state $190 million in just six months.

Payments have cost $190 million less than if the state had not contracted with three managed-care organizations, reports Nick Storm for cn|2's "Pure Politics." The companies are paid on a per-month, per-patient basis, considered less expensive than the fee-for-service model.

Haynes, who replaced Janie Miller in the spring, said her immediate goals for the cabinet are implementing the state's prescription drug monitoring system within the cabinet; hiring additional social workers; and continuing to smooth the bumps caused by managed care. Overall, she said she wants to improve transparency within the cabinet; improve coordination between departments; and shore up service gaps, especially within managed care.

Sen. Julie Denton, R-Louisville, asked Haynes about concerns she has over management in the Louisville office of the Department for Community Based Services, but Haynes said she could not comment on an ongoing investigation. (Read more)

134,000 Kentucky families will split $15.3 million in health insurance rebates

About 134,000 families in Kentucky will get money back from their health insurance companies this summer. The families, representing about 249,000 people, will get a total of $15.3 million in rebates, which averages out to about $114 for each family. The returns are the result of the Patient Protection and Affordable Care Act.

"As part of the controversial 2010 health insurance overhaul pushed by President Barack Obama, insurance companies must spend 80 percent of all premiums they collect to pay claims or improve health outcomes," reports Beth Musgrave for the Lexington Herald-Leader. "The remaining 20 percent may be spent on administrative costs, such as salaries and advertising."

Insurance companies that did not meet that standard must return the money by Aug. 1. How much each family gets depends on their health insurance policy. (Read more)

KET program will focus on children's health this Sunday

A discussion about the problems Kentucky families and children face on a daily basis will be at the heart of this week's "One to One" with Bill Goodman on KET.

Dr. Terry Brooks, executive director of Kentucky Youth Advocates, will be speaking about the 2012 legislative session. The program airs Sunday at 1 p.m. EST and Tuesday at 7:30 p.m. EST.

KYA has been busy as of late, holding KIDS COUNT conversations in different parts of the state. A recent conversation in Hardin County painted a picture of the health status in the area as well as pointed out which public policies are in place to improve children's health. The conversation turned to topics like childhood obesity, oral health, health insurance, physical activity and birth-related indicators and outcomes like smoking during pregnancy and low-weight births.

The conversations are held in different counties about four times a year. Last week, there was another KIDS COUNT conversation in Jefferson County.

"We try to cover topics across the child's lifespan," said Amy Swann, KIDS COUNT coordinator. "We're touching on infants, touching on issues when they're still in utero, we're touching on school-age stuff, touching on teens."

New report lists contaminant, treatment violations at Kentucky's 461 public water systems

Reporters can now find out if their local public water systems were recently cited with violations related to contaminants in the water or inadequate treatment.

The Kentucky Division of Water's annual compliance report was released last week. Statewide, it shows that maximum contaminant level and treatment violations decreased from 116 in 2010 to 96 in 2011. "The majority of violations at Kentucky's public water systems last year involved administrative infractions rather than problems with water treatment," said Julie Roney, coordinator of the DOW Drinking Water Program. "These results are encouraging."

There are 461 public water systems in Kentucky, which are tested on a regular basis for bacteria, nitrate and other inorganic chemicals, radiological elements and more than 100 industrial chemicals and pesticides.

The report is detailed and quite dense. Reporters can call Natalie Bruner at 502-564-3410, ext. 4987 for help interpreting the results for their water systems. (Read more)

Large percentage of patients with dementia given drugs they don't need; see how your nursing home is doing

Kentucky reporters can now see how the nursing homes in their area are treating patients with dementia. The Boston Globe has published a list of all the nursing homes in the country that shows the percentage of residents without psychosis or a related condition but who are being given antipsychotic drugs. The data came from the federal Centers for Medicare & Medicaid Services.

Almost 40 percent of nursing home residents with dementia are on powerful antipsychotic drugs though they don't have psychosis or a related condition, federal regulators announced at the end of May. Their aim is to cut the use of these drugs on these patients by 15 percent by the end of this year.

The median use nationwide for patients being given antipsychotic drugs but who don't have psychosis is 16.7 percent. In Kentucky, 161 of 280 nursing homes surveyed were over the median number, according to the nonprofit advocacy group Kentuckians for Nursing Home Reform.

To see how your nursing home is doing, click here. (Read more)

Six Kentucky community health centers receive $3.7 million in grants

Kentucky has received $3.7 million in grants to expand six community health centers, part of an effort to improve access to primary care. The federal funds were distributed through the Affordable Care Act.

Centers that will receive funds include Cumberland Family Medical Center in Burkesville ($608,333); Grace Community Health Center, Inc. in Gray ($650,000); Community Health Centers of Western Kentucky, Inc. based in Greenville ($599,055); Health Help, Inc. in McKee ($650,000); Sterling Health Solutions, Inc. in Mount Sterling ($650,000); and Mountain Comprehensive Care Center in Whitesburg ($541,667).

Nationwide, $128.6 million were handed out in 41 states, the District of Columbia, Puerto Rico and the Northern Mariana Islands. Money was awarded to 219 health centers, which will improve care for more than more 1.25 million patients and create about 5,640 jobs, according to a press release by the U.S. Department of Health & Human Services. In Kentucky, about 27,000 more patients are expected to benefit from the funds.

"Health centers serve more than 20 million patients nationwide and are an integral part of our health care system," said Mary K. Wakefiled, administrator of the Health Resources and Services Administration. "These awards demonstrate our commitment to increasing access to quality health care through the creation of new health center sites." (Read more)

Coventry must extend contract with Appalachian Regional Healthcare until Nov. 1, judge rules

Conventry Cares must continue its contract with Appalachian Regional Healthcare through Nov. 1 so the 25,000 Eastern Kentucky Medicaid patients affected don't get "thrown under the bus," a federal judge ruled yesterday.

"The health and well-being of thousands of these patients hang in the balance, and many have already suffered hardships, stress and confusion as a result of Coventry's sudden notice of termination of its contract with ARH," U.S. Senior Judge Karl Forester wrote. "ARH serves a high-risk population in an economically depressed area. If faced with a lengthy and costly trip to visit their primary care physician, many patients will simply forego preventive care, leading to worse health problems, higher risk, and more expensive treatment in the future."

ARH operates eight hospitals and other health clinics in Eastern Kentucky. Coventry, also known as Coventry Health & Life Insurance Company, is "one of three companies the state hired Nov. 1 to manage care for the 560,000 Kentuckians enrolled in the federal-state health care program for the poor and disabled," report Valarie Honeycutt Spears and Beth Musgrave for the Lexington Herald-Leader.

Coventry has since said it has lost $50 million in the first quarter of 2012 in Kentucky and is trying to make up for the losses by renegotiating its contracts across the state. When Coventry said it would terminate its contract with ARH in May, the hospital system filed a lawsuit asking for a preliminary injunction to prevent that from happening. Forester ruled the injunction "essential."

After Nov. 1 this year, Forester said Coventry could terminate its contract but "ordered Coventry to provide ARH a list of its members who have used ARH during the past five years so ARH may contact those patients." Right now, ARH only has a contract with one of the two other managed care organizations. (Read more)

Graphic warning labels help smokers remember tobacco health risks, study finds

Study participants looked at these two images while
researchers assessed how effectively they were viewed.
Graphic by Penn Medicine.

Graphic warning labels on cigarette packages can help smokers remember the message and the health risks associated with smoking, a study has found.

Researchers asked 200 smokers to look at either a text-only label advertisement — which is similar to warnings that have been on cigarette packages since 1985 — or a graphic warning label showing a hospitalized patient on a ventilator along with a written warning — which has been proposed by the U.S. Food and Drug Administration.

Researchers used eye-tracking technology to measure how the advertisement was looked at and for how long, reports research-reporting service Newswise. Then participants were asked to rewrite the message they'd seen to show how well they remembered it.

Results showed 50 percent of participants who saw the text-only ad remembered the warning label, while 83 percent of those who saw the graphic image warning remembered what they'd seen.

"In addition to showing the value of adding a graphic warning label, this research also provides insight into how the warning labels may be effective, which may serve to create more effective warning labels in the future," said Andrew A. Strasser, associate professor at the University of Pennsylvania, where the study was conducted. "We're hopeful that once the graphic warning labels are implemented, we will be able to make great strides in helping people to be better informed about their risks, and to convince them to quit smoking."

The 2009 Family Smoking Prevention and Tobacco Control Act mandated the FDA to require graphic warning labels on cigarettes packaging starting in September 2012. The mandate has since been held up in court. (Read more)

With more than 2,000 product recalls in 2011 alone, consumers may be suffering from 'recall fatigue'

Regulators, retailers and manufacturers are getting worried that the public is suffering from "recall fatigue."

Last year, there were 2,363 recalls, according to data from the U.S. Food and Drug Administration, the Department of Agriculture and the Consumer Product Safety Commission. That's a 14 percent increase over 2010 when there were 2,081 recalls. In 2007, there were 1,460.

"We have this growing concern for safety, but with there being so many recalls going on, [is the public] paying attention to them and responding to them in a manner that is necessary for the recalls to be handled effectively?" asked Mike Rozembajgier, a vice president of Stericycle ExpertRecall.

There have already been hundreds of recalls this year. Pfizer recalled birth-control pills after it was discovered they could have been packaged out of sequence, increasing chances for pregnancy. Nearly 170,000 Ikea customers were asked to return high chairs after it was found the restraint buckle opened unexpectedly. Today, Samsonite recalled suitcases because they were made with high levels of compounds linked to cancer.

Experts believe "the increase is the result of a combination of greater oversight by regulators, better testing procedures and the use of social media where consumers can quickly point out and discuss problems with other people," reports Christopher Doering of the Des Moines Register. (Read more)

University Hospital cuts contribution to U of L by half

University Hospital. Photo by Bill Luster, The Courier-Journal.

In the midst of financial woes, University Hospital gave just half of what it normally does to the University of Louisville Health Sciences Center — and is considering reducing its contribution to zero.

The hospital gave $5.5 million rather than its usual $11 million annually.

In the past, critics have asked why the hospital wasn't using the funds given to the health center to shore up its own financial problems. Dr. David Dunn, U of L's executive vice president for health affairs, said "symbiotic arrangements between teaching hospitals and health sciences centers are common across the nation, and cutting the contribution in half has meant struggles to recruit and retain physicians and nurses," Laura Ungar reported for The Courier-Journal.

University Hospital has long been looking at ways to stabilize its finances. Last year, Gov. Steve Beshear nixed plans for the hospital to merge with a Catholic health system since it would have been subject to Catholic health directives. Since, it's been looking for a new merging partner, a process that has been delayed until the end of this month. (Read more)

Facing budget shortfalls, many county and district health departments cut hours and staff

Reduced hours and staff will be the new reality for many health departments across Kentucky starting in July as they deal with funding shortages and changes.

Though the total amount of state funding to local health departments has not gone down, the way it is allocated has changed. “Part of the new formula took into account the population served and percentage of population below the poverty level,” reports Beth Musgrave for the Lexington Herald-Leader. Counties that serve more “working poor” — people who are employed but don’t have insurance — were hit the hardest by the reformulation.

Kentucky’s move to managed care for its Medicaid recipients also affected funding because reimbursement rates went down. Meanwhile, retirement and health insurance costs continue to go up.

There are 59 county and district health departments in Kentucky, all of which are funded partly by local property taxes, ranging from 1.8 cents to 4 cents per $100 worth of property. With the recession, local tax revenues have decreased, contributing to funding shortfalls.

Musgrave reports of furloughs, staff cuts and program cuts in various counties surrounding Lexington. Local news outlets should look at what is happening to health departments in their areas. (Read more) 

Black lung affects Kentucky surface miners more than those in other states, CDC study finds and Courier-Journal reports

Photo by Getty Images.

Nearly 4 percent of surface coal miners who work in Central Appalachia who were tested for a study by the Centers for Disease Control and Prevention have black lung disease, compared to 2 percent of all U.S. surface miners and 3.2 percent of underground coal miners.

Though the study didn't test Kentucky separately from the 14 other states assessed, Laura Ungar of The Courier-Journal in Louisville asked about it and found that "13 of 230 Kentucky surface miners tested — or 5.7 percent — had black lung," she reports, quoting Cara Halldin, a CDC epidemic intelligence service officer, as calling that number " a disproportionate burden."

It's not clear why the incidence is higher in Central Appalachia than other parts of the country, but Halldin suspects it has to do with "more years spent mining, area geology or the safety culture at mines," Ungar reports. One study showed miners who work in Central Appalachia typically work 28 years in the mines while non-Appalachian miners work average 20 years.

Black-lung disease, or coal workers' pneumoconiosis, is the result of miners repeatedly inhaling the dust that comes from extracting coal. That dust occurs whether the miner is under- or above-ground. "Coal mining is really, really dusty. Don't matter what you do, you're in the dust," said John Bud Ritchie, a retired surface miner who has black lung disease. "It's real rough. You can't hardly keep the dust down on hot days."

The federal exposure limit for "respirable dust" in underground and surface mines is 2 milligrams of coal dust per cubic meter of air. That limit was set in 1969, along with a law that set up "a surveillance system for assessing prevalence of black lung among underground coal miners," Ungar reports. "But the requirement for surveillance doesn't extend to surface miners." Haldin said, "Industry should recognize this is a problem and their workers are at risk and bring down the levels." (Read more)

Almost half of Americans did not receive routine preventive care before 2010, study finds

Los Angeles Times graphic by Mel Melcon

Though preventive medicine is considered a cornerstone in improving health, nearly half of Americans did not receive routine preventive care before 2010, a report by the Centers for Disease Control and Prevention has found.

The findings show “there are large disparities by demographics, geography, and health care coverage and access” when it comes to receiving preventive clinical services, said CDC Director Dr. Thomas Frieden.

The analysis looked at “how many people with vascular heart disease were prescribed aspirin or antiplatelet therapy to prevent heart disease (just 46 percent) and how many adults with hypertension had their blood pressure under control (just 43 percent). Only 28 percent of adults between 18 and 64 had received the seasonal influenza vaccine. Only 7.6 percent of tobacco users were prescribed tobacco cessation medication,” reports Eryn Brown for the Los Angeles Times.

When it came to cholesterol testing the results were more positive, with 70 percent of men and women considered at risk receiving screening in the last five years. Preventive care to manage diabetes was also more readily accessible.

The goal of the study was to establish a baseline of preventive care before the implementation of the Affordable Care Act, which “gave 54 million Americans at least one new free preventive service through private health insurance plans,” Brown reports. (Read more)

States with helmet laws have far fewer motorcycle-related deaths; Kentucky doesn't require bikers to wear protective headgear

Petersburg (Tex.) Volunteer Fire Dept. photo

“Fewer motorcyclists die in states that require helmets, and the costs to society are lower too,” reports Mike Stobbe for The Associated Press. About five times as many no-helmet biker deaths occur in states with less restrictive laws.

Kentucky once had a helmet law for motorcyclists, but repealed it several years ago. Nationwide, 20 states had universal motorcycle helmet laws in 2010, but Michigan has since reversed course and allowed helmets to be optional for riders over 21.

The study, conducted by the Centers for Disease Control and Prevention, looked at 14,283 motorcycle-related deaths from 2008 to 2010. Of those, 6,027 bikers did not wear a helmet. “Only about 12 percent of those deaths occurred in the 20 states that required everyone on motorbikes to wear helmets,” Stobbe reports.

The study also found that helmet use saved $3 billion in U.S. medical expenses. Another $1.4 billion could have been saved if all states had helmet laws, the CDC concluded. Motorcycles account for about 3 percent of vehicles on the road, but 14 percent of deaths caused by traffic accidents. (Read more)

Lexington physician will lead American Medical Association

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A Kentucky physician has been chosen to head the American Medical Association.

Dr. Ardis Hoven of Lexington, an infectious-disease specialist, ran unopposed and will be the AMA's 168th president and the third woman to hold the position.

"The honor here is that I've been given a large responsibility, of which I'm very aware," she said. "We have the opportunity to take medicine, to take health care, to a better place."

Hoven was at the forefront in battling the first wave of the AIDS epidemic, reports Cheryl Truman of the Lexington Herald-Leader.

Hoven, a Cincinnati native, was president of the Kentucky Medical Association from 1993-94 and was elected to the AMA Board of Trustees in 2005. (Read more)

New resource guide and school curriculum aimed at expanding farm-to-school programs in Kentucky

A resource guide and school curriculum are the latest efforts to expand farm-to-school programs in Kentucky. With fewer than 30 percent of Kentuckians consuming the recommended amounts of fruits and vegetables every day, farm to school is a “win-win for students, school food service, farmers and local economies,” said Elaine Russell, coordinator for Kentucky Obesity Prevention Program and chairwoman of the Kentucky Farm-to-School Task Force.

The guide includes advice from Kentuckians who have already participated in projects; resources to connect farmers and school food service directors, how to follow procurement rules; recipes; a produce calculator; funding sources; and how to get kids to eat their vegetables.

The curriculum helps students recognize the sources of the food they eat and explains how eating locally-grown food can improve their diet and nutrition.

The undertaking is a joint effort between the Kentucky Department for Public Health the state Department of Agriculture the state Department of Education and the University of Kentucky. The new resources will be presented to school food service personnel June 19 at the Kentucky School Nutrition Association’s conference at the Northern Kentucky Convention Center in Covington. (Read more)

Rural health care is a notch below care in urban areas, but its costs are lower and its emergency rooms are faster, study finds

A national study has found a narrow gap between the quality of health care in rural and urban settings, but it does recognize the "significant differences" differences between urban and rural care.

The report is an update to "Rural Relevance Under Healthcare Reform: A Tracking Study," by iVantage Health Analytics, and evaluates performance measures across physician, outpatient, hospital and emergency room settings. According to a press release, the report reveals that in Medicare could save about $7.2 billion if costs per patient were the same in rural and urban settings. The report also finds that for rural patients, physician payments are 18 percent lower and hospital payments are 2 percent lower than in urban areas, but outpatient payments are 14 percent higher. The overall cost per Medicare patient is 3.7 percent lower for rural patients.

Rural emergency care is faster overall than urban emergency room care, with rural patients seeing a doctor 30 percent faster (once the patient gets to the hospital, we should add). This results in fewer hospital admissions. The full report can be accessed here.

State takes Medicaid contractor Coventry's side at hearing over dispute with Appalachian Regional Healthcare

"Appalachian Regional Healthcare argued for a federal injunction against Medicaid contractor Coventry Cares on Tuesday as negotiations for a new agreement between the two have stalled," reports Mike Wynn of The Courier-Journal.

At a hearing before District Judge Karl Forester, "Witnesses for ARH testified that Coventry will no longer provide an adequate network of hospitals and doctors if a contract is not renewed with ARH, which operates eight hospitals and additional clinics in the area. But Coventry and the state Cabinet for Health and Family Services dispute those claims and called witnesses to defend Coventry’s network of health care providers." (Read more)

Forester asked ARH and Coventry to submit proposed findings by tomorrow, reports Valarie Honeycutt Spears of the Lexington Herald-Leader, giving the case background: "After Coventry said it would sever its contract with ARH, the hospital company filed a lawsuit in U.S. District Court in Lexington. Coventry agreed to continue its contract until June 30 while renegotiating for long-term coverage." (Read more)

New law will allow officers to make arrests in emergency-room assaults that they do not witness

Emergency-room workers who treat individuals under the influence of drugs or alcohol will have greater legal protection, and those who misbehave in ERs will have less protection, under a law that will take effect next month.

The measure, sponsored by Sen. John Schickel, R-Union, will allow peace officers to make an arrest or issue a citation for a fourth-degree assault that occurs in a hospital emergency room, even if the officer didn’t witness the crime, as long as the officer has probable cause to believe the offense occurred.

“Hospital emergency personnel treat individuals in the worst of conditions – and sometimes that means putting themselves at risk, if a patient comes in intoxicated or high,” Gov. Steve Beshear said at a ceremonial signing of the bill today.  “This law gives medical staff the security of knowing that an offender will be held accountable for an assault that takes place when they’re brought in for care.”

Under current law, a hospital worker has to swear out a warrant alleging assault. Fourth-degree assault is a Class A misdemeanor, punishable by up to a year in jail.

143 groups in state working to improve health, directory lists

A directory that lists all the local groups working on health-related issues in the state has been released by the Foundation for a Healthy Kentucky. It identifies 143 groups — at least one impacting each county — and lists the primary contact person at each location.

"These are local residents working on solutions to health issues in their cities and towns," said Susan Zepeda, CEO of the foundation. "As these groups work to make their community a healthier place to live, work, study and play, they are improving the overall health of our state."

Whether in the form of coalitions, collectives, consortia, associations or networks, the groups are working to improve the health of their communities. Some are looking at ways to increase access to healthy food and physical activity, others are planning screenings and education for people with chronic diseases like diabetes, and others are working toward getting smoke-free ordinances passed.

The directory can be viewed by clicking here. It will be updated periodically.

Bipartisan report from ex-secretaries of health and agriculture makes 26 recommendations for fighting obesity epidemic

Four former secretaries of heath and agriculture and the Bipartisan Policy Center have released a lengthy report aimed at the nation's obesity epidemic. With 26 recommendations, the report promotes public and private sectors working together to create healthy families, schools, workplaces and communities.

The report, called "Lots to Lose," recommends extending federal guidelines for diet and physical activity to all children under 6 years old, along with offering more support to promote breastfeeding. "Learning to be active and staying active is a critical piece of the puzzle," said Republican Mike Leavitt, former secretary of health and human services and former governor of Utah. "Government has a role to play, but it is not the answer."

"If you think this is fluffy stuff about diet and exercise or about creating a nanny state you are wrong," said Dan Glickman, who was a Democratic congressman from Kansas and agriculture secretary under Bill Clinton. "Americans like silver bullets to solve problems. This one requires silver buckshot."

Former agriculture secretary Ann Veneman, a Republican who served under George W. Bush, spoke of the importance of good nutrition during the first 1,000 days of a child's life. "Improving health outcomes early in life is a critical element in helping to shift our current health care system toward prevention," she said.

Democrat Donna Shalala, president of the University of Miami and health secretary under Clinton, also participated. While The Washington Post's Janice D'Arcy called the report "an earnest and comprehensive effort," she asked, "Haven't we been down this road before?" For the report, click here.

Free dental, health, vision clinic to help hundreds this weekend

This weekend, about 1,000 people will get free dental, medical and vision care in Pike County. The effort is sponsored by Kentucky's Remote Area Medical Volunteer Corps, which hosts a free clinic that provides free treatment to those who come from all over the state to receive it. (University of Louisville video)

Last year, 882 patients received services from volunteer health-care professionals. That meant 455 pairs of eyeglasses were given to 407 people who needed them; 386 patients received free dental services, including 974 extractions, 348 fillings and 264 cleanings; and 303 patients got free medical services.

This is the fourth year of the effort. The clinic opens at 6 a.m. Saturday and closes Sunday afternoon at Pike County Central High School. Patients are seen on a first-come, first-served basis. Numbers will be handed out starting at 3:30 a.m. each day. For the best chance of being seen, patients should plan to arrive by 3:30 a.m. on the day they wish to be treated.

RAM-KY, modeled after a national organization with a similar name, was founded by Dr. Bill Collins in 2008. Since then, the Kentucky General Assembly has passed a law that allows licensed dental practitioners from other states to apply for and received charitable licenses so they can participate in events like Saturday's.

For more information about RAM-KY, click here.

Herald-Leader dislikes mental health agency's 'clubby glow'

In an editorial today, the Lexington Herald-Leader criticized the "clubby glow emanating from the inner circle" of the Bluegrass Regional Mental Health-Mental Retardation Board, whose financial status was featured in Sunday's issue of the newspaper.

Though the paper didn't take issue with top executives earning large salaries, it did have a problem with the makeup of the board and its staff. First, the current CEO, Shannon Ware, is married to the former CEO, Joseph Troy. Troy's son-in-law is director of information technology. And at least eight of the 25 members of the board have served since the 1980s. Another three have served since the 1990s.

"Collectively, these offer the potential for an organization where the status quo is rarely challenged," the editorial reads. The editorial board took particular issue with the nepotism in place: "While it is theoretically possible that a supervisor might treat a family member exactly the same as an unrelated employee, in reality it is hard to imagine. Regardless, the very appearance of favoritism can be damaging to an organization." (Read more)

To help curb childhood obesity, Disney will ban ads for products that don't fit federal nutrition guidelines for kids

The Mickey Check logo will be
placed on Disney-licensed products
that meet nutrition guidelines.

By 2015, the Walt Disney Co. will require advertising that targets kids and families to be in line with federal nutrition guidelines that promote eating fruit and vegetables; limiting calories; and reducing fat, sodium and sugar.

The Disney Channel, its sisters (Disney XD, Disney Junior, Radio Disney) and Disney-owned online sites will follow suit. 

"Under the new rules, products like Capri Sun drinks and Kraft Lunchables meals — both current Disney advertisers — along with a wide range of candy, sugared cereal and fast food, will no longer be acceptable advertising material," reports Brooks Barnes for The New York Times. (Read more)

"This new initiative is truly a game changer for the health of our children," said First Lady Michelle Obama, who helped make today's announcement. "This is a major American company — a global brand — that is literally changing the way it does business so that our kids can lead healthier lives. With this new initiative, Disney is doing what no major media company has ever done before in the U.S. — and what I hope every company will do going forward. When it comes to the ads they show and the food they sell, they are asking themselves one simple question: Is this good for our kids?"

American children see about $1.6 billion a year worth of food and beverage marketing, much of which are ads that sell food that is high in calories and sugar and low in nutrition. The effort is meant to curb childhood obesity, which is a growing problem in Kentucky and nationwide. In 2007, 37 percent of Kentucky children were either obese or overweight, National Conference of State Legislatures numbers show.

NYC deeply split on Bloomberg plan to ban supersize sodas

Bloomberg with Linda I. Gibbs, deputy mayor for health.
(New York Times photo by Chang W. Lee)

In a bold move to curb obesity, New York City Mayor Michael Bloomberg wants to ban the sale of supersize sodas and other sugary drinks by restaurants, movie theaters and street carts.

"The sale of any cup or bottle of sweetened drink larger than 16 fluid ounces — about the size of a medium coffee, and smaller than a common soda bottle — would be prohibited under the first-of-the-nation plan, which could take effect as soon as next March," reports Michael Grynbaum for The New York Times.

Exempt from the measure are diet sodas, fruit juice, dairy-based drinks and alcoholic drinks. The ban would include drinks sold in grocery or convenience stores.

"New York City is not about wringing your hands; it's about doing something," Bloomberg said. "I think that's what the public wants the mayor to do." In NYC, more than half of adults are obese or overweight.

A poll conducted Sunday showed about half of New Yorkers feel Bloomberg is going too far, while 42 percent said it would be good health policy, reports Samantha Gross for The Associated Press. The idea has been harshly criticized, with an editorial in the Times calling the plan "overreaching" and saying "Too much nannying with a ban might well cause people to tune out."

But conservative David Frum, a contributing editor for Newsweek and The Daily Beast, said "good for Bloomberg," pointing out: "Sugary drinks now provide 7 percent of the calories in the American diet, the largest single national source of calories. Teen boys average more than a quart of sugary soda per day. Even adults who say they are trying to lose weight still drink more two 12-ounces cans per day, on average."

"The campaign against obesity will have to look a lot less like the campaign against smoking (which involves just one decision, to smoke or not to smoke) and much more like the generation-long campaign against highway fatalities, which required the redesign of cars, the redesign of highways, and changes in personal behavior like seat-belt use and drunk driving," Frum argues.

Health-care system not ready to deal with baby boomers as they get old, expert says at seminar on aging

When it comes to dealing with aging baby boomers, the nation's health-care system isn't ready to deal with them, Dr. Gregg Warshaw, left, said at the University of Kentucky's Summer Series on Aging in Lexington yesterday. "We've made progress," he said, but "We have a lot more to do, and we are running out of time." (Photo by Jonathan Palmer)

Warshaw's figures show "patients with five or more chronic conditions account for about 68 percent of spending on Medicare," Mike Wynn reports for The Courier-Journal. "Around 141 million people suffered with chronic conditions in 2010, and that number is expected to jump by 30 million in the next two decades."

The shift from primary-care doctors to specialists is another big, expensive problem that is hurting the quality of health care for seniors, Warshaw argued. Ageism and frustrations over health networks are also challenges. "Like a lot of things in American medicine right now, we know the answers to those questions," he said. "We just don't know how to get from here to there."

Warshaw, who is the director of the Geriatric Medicine Program at the University of Cincinnati College of Medicine, was one of more than 350 professionals who attended the seminar, hosted by the UK College of Public Health. (Read more)

Prescription pill abuse 'a holocaust' in Kentucky, hitting 1 in 16; big drug firms and even well-meaning doctors are to blame

Another in-depth look at Kentucky's prescription drug abuse problem hit the pages of The Courier-Journal yesterday, this time exploring the history of OxyContin and how well-meaning doctors started over-prescribing opioids in the 1990s in response to vigorous marketing campaigns. 

The problem continues to be gargantuan, with Laura Ungar reporting about one in 16 Kentuckians misused prescription painkillers in the past year. Kentucky ranks "as the fourth-most-medicated state in a nation that fills enough painkiller prescriptions each year to keep every American adult medicated around the clock for a month," Ungar writes.

A review published in the journal Pain Physician last year found evidence is lacking for how effective opioids are in treating long-term pain. "They're not M&Ms," said Dr. Lee Tannenbaum, founder of the Bel Air Center for Addictions in Maryland. "As physicians, we need to be really, really, really careful as to when we put someone on these drugs. Cancer pain may need opioids, but someone out shoveling snow who hurt his back doesn't. We have created so many addicts."

A C-J investigation found physicians fuel the problem in three ways. First, they do not screen patients adequately. They prescribe powerful pills for moderate pain. And they do not use the state's monitoring program, Kentucky All Schedule Prescription Electronic Reporting, known as KASPER.

The problem started in the 1990s when "medical organizations, concerned that pain wasn't being treated adequately, encouraged doctors to do more to relieve suffering," Ungar reports. OxyContin was approved by the Federal Food and Drug Administration in 1995, with OxyContin prescriptions for noncancer pain increasing by tenfold between 1997 and 2002. A report found the drug's maker, Purdue Pharma "directed its drug representatives to focus on physicians in their sales territories who were high opioid prescribers, while also issuing OxyContin 'starter coupons' for patients and distributing promotional items, such as fishing hats and plush toys," Ungar reports.

In October 2007, Kentucky and Pike County sued Purdue Pharma for its deceptive marketing campaign, alleging it misled doctors about the potency of the drug, which is twice as powerful as morphine. U.S. Rep. Harold "Hal" Rogers, R-5th District, called OxyContin "the guilty party that got this epidemic going." In Kentucky, the retail distribution of oxycodone grew from 83,000 grams in 1997 to 950,000 grams in 2010.

Part of the problem is that doctors do not have the time they need to properly assess patients for potential abuse. "You've got an awful lot of doctors prescribing not out of ill intents. They've got a limited amount of time, and pain patients require a lot of time," said Robert Walker, assistant professor of behavioral science at University of Kentucky's Center on Drug and Alcohol Research. "The easiest solution is the opioid."

While easy, they are not necessarily effective for all pain. Evidence is "very, very mixed" on whether the drugs work in the long term on chronic pain and "the evidence is pretty scant" that they are effective against treating chronic lower back pain, said Dr. Timothy Ives of the University of North Carolina.

Though the problem is never expected to be solved completely, there are steps being taken to combat the issue. In 2010, the FDA approved a reformulation of OxyContin which makes it more resistant to being cut, chewed, crushed or dissolved — methods that make the drug more powerful. The Kentucky Board of Medical Licensure has spelled out "the steps physicians need to take as they seek to help patients control pain unrelated to terminal illness," Ungar reports. And the Kentucky General Assembly passed a comprehensive bill that requires doctors to use KASPER when prescribing certain drugs and take a full medical history of patients to whom they are considering prescribing drugs. (Read more)

To fight meds-for-meth bill, Consumer Healthcare Products Association spent almost $500,000 in last session, a record

The biggest spender to lobby the Kentucky legislature in the 2012 session was the Consumer Healthcare Products Association, which represents the over-the-counter drug industry. Of the $8.8 million spent in 2012 overall, the group spent nearly $500,000, breaking the record it set in 2010 by spending $311,000.

The group was fighting a bill that would have made cold medicines that contain pseudoephedrine, the key ingredient to make methamphetamine, available only by prescription. Its report did not include several hundred thousand dollars spent on advertising to the general public, asking citizens to contact legislators. That does not fall under the state's legal definition of lobbying, which does include other methods CHPA used, such as phone banks, social media and other Internet activities.

The Senate and House ultimately passed a compromise bill that lowers the amount of pseudoephedrine a person can buy in a month from 9 grams to 7.2 grams. The maximum a person can buy in a year without a prescription is 24 grams. For a story from the Lexington Herald-Leader, click here. Gor one from The Courier-Journal, go here.

Coventry offers to keep paying ARH, but less, for treating Medicaid patients; asks Danville chain to renegotiate

Coventry Cares has offered to pay for treatments at Appalachian Regional Healthcare as a "non-contracted provider," which would mean ARH would be paid far less than it is now, but coverage for ARH's 25,000 Medicaid patient members would not be interrupted.

"Medicaid's rates pay 75 percent of the cost of treating patients on an in-patient basis," reports Valarie Honeycutt Spears for the Lexington Herald-Leader. "Coventry has asked for a further reduction."

"The ultimate issue is whether patients in that region are going to have access to care or not. ARH needs to be paid if they are going to treat these patients," said Steve Price, an attorney for ARH.

Stephen Amato, Coventry's attorney, said Coventry's offer is a sign the company "remains committed to the best interest of its members in hopes that its willingness to preserve its members' access to ARH takes its members out of the middle of the contract dispute."

Coventry is one of four companies chosen by the state to provide care to Medicaid recipients. ARH sued Coventry, and another managed-care company, saying they owed the hospital chain more than $18 million for services. But Coventry says the state allowed another managed-care company not to include ARH in its network, which means a lot of higher-risk, higher-cost patients covered by Coventry.

Meanwhile, Coventry has given notice to the Ephraim McDowell Health System, which has facilities in six counties including hospitals in Danville and Stanford, that it wants to renegotiate its contract. (Read more)

Bluegrass mental-health nonprofit flush with cash, despite cuts in public health; spends big on executive pay and lobbying

The new Eastern State Hospital being built in Lexington. The
Bluegrass Regional MH-MR Board runs the existing facility
and wants to run the new one. (Pablo Alcla, Herald-Leader)

Despite deep cuts in state public-health funding, the non-profit Bluegrass Regional Mental Health-Mental Retardation Board, which serves 17 counties in central Kentucky, is flush with cash, making some critics question whether it is transparent enough with its finances.

"In 2011, it reported having $33.7 million in cash reserves and similar assets — more money than 10 of the state's 13 other regional mental health boards had in their entire budgets," reports John Cheeves for the Lexington Herald-Leader.

The board spends freely in executive pay (four top executives collected nearly $2 million in 2010 for compensation), political lobbying (since 2008 it has spent nearly $500,000 to pay four lobbyists in Frankfort) and real estate (it bought a $295,000 home near Lake Cumberland for its senior management team to use when in Somerset).

"We have received some concerns regarding the Bluegrass board in the last few days, and we're going to be looking into those," state auditor spokeswoman Stephenie Steitzer told Cheves.

Scott Gould, who chairs the 25-member Bluegrass MH-MR Board, said "there has been no inappropriate practice or action taken by any board member, CEO or staff member."

But one former employee, Eleisha Kiefer, said the company cuts costs in unfair ways, saying there was a weekly lunch budget of $100 at a therapeutic rehabilitation program for about 20 mentally handicapped adults in Harrison County. "We had a lot of soup beans and corn bread," she said.

Gould disputed the allegation, saying there has "never, ever" been a weekly budget placed on client meals.

Mental health experts praise the work Bluegrass does. "I'd have to put them high up on the star chart in terms of what they provide their consumers and their family members," said Sheila Schuster, executive director of the Kentucky Mental Health Coalition. "It's one thing to deliver quality care, but I feel that Bluegrass goes the extra mile."

Though is it chiefly funded by the Cabinet for Health and Family Services, Bluegrass considers itself part of the private sector. Its executive pay reflects that approach. In 2010, its current and previous chief executive officers — who are married to each other —"took home more than $1 million in total compensation," Cheeves reports.

Comparatively, Howard Bracco, the recently retired CEO of the mental health board in Louisville, Seven Counties Services, made $179,868. "We had different cultures," Bracco said. "They operate on a business model, a corporate model, versus the social model. I think, frankly, they were better business people than many of us. They lobbied hard to win contracts, they fulfilled those contracts, and they've been very successful." (Read more)

With crackdown on pill abuse, will legitimate patients be able to get the prescriptions they need?

The crackdown on prescription-pill abuse has some patients worried they won't be able to get the medicine they need because doctors are fearful of over-prescribing. "It's a huge concern in a nation where chronic pain afflicts 116 million American adults and is associated with up to $635 billion in health care costs," reports Laura Ungar in an ongoing series for The Courier-Journal.

"Pain patients feel ashamed or weak that they have to take these medications ... (and) shy away from being treated," said Dr. James Murphy, a pain specialist in Louisville. 

But there is little evidence that pain patients who really need medicine are unable to find treatment. Ungar reports: "It may take longer for them to find a doctor, experts said, and they may be subjected to urine tests and pill counts to ensure they're not abusing their medicines. But most eventually are able to get the medication they need."

"I don't see any decrease in the amount of opioid prescribing in any jurisdiction," Dr. Nathaniel Katz, president and chief executive officer of the Masschusetts-based consulting firm Analgesic Solutions, told Ungar. "So it's difficult to justify a position that legitimate opioid prescribing is being chilled."

Some worry that making physicians use the state's prescription drug monitoring system — commonly known as KASPER — for new patients could create that chilling effect. A survey of controlled-substance prescribers made to use KASPER found about half didn't change their prescribing habits and about 13 percent said they actually prescribed more opioids. But 35 percent, or 190 prescribers, said they had decreased the amount of controlled substance they subscribed because of "media coverage of abuse, increased law enforcement activity related to prescription-drug abuse and fear of investigations by law enforcement or the medical board," Ungar reports.

Some are concerned that "if more doctors make that choice, desperate pain patients may feel forced to seek relief at unscrupulous pain clinics," Ungar reports. (Read more)