Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible

Medicaid managed care company Kentucky Spirit must cover preventive care services provided by local health departments in schools, a judge has ruled.

Circuit Judge Phillip Shepherd of Frankfort said the company must pay $8 million for the services already provided by school nurses, which would be only .07 percent of its estimated profit for 2013, according to the updated earnings report of Centene Corp. of St. Louis, the parent company for Kentucky Spirit. The company is the only one of the five managed care organizations in Kentucky  that had disputed the coverage of school health services.

Kentucky Spirit stopped providing coverage for school health services last summer, saying its state contract didn't require payment for such services,but Shepherd noted that the state reimbursed health departments for school services before it transitioned to managed care, reports Tom Loftus of The Courier-Journal. “Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments,” Shepherd wrote.

Health departments and school districts will now find some relief because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for services. “It’s great news because there have been dozens of districts that have had to either say they are going to cut back on nurses, or that they are going to close clinics, or that they are going to dip into their reserves to try to cover the additional costs,” Kentucky School Boards Association spokesman Brad Hughes told Loftus.

Gov. Steve Beshear said Kentucky Spirit had “sought a loophole” in its contract to avoid paying for school health services covered by Medicaid, writes Loftus. Centene released a statement later Tuesday saying that the company is reviewing options and considering an appeal.

This isn't the only payment Centene is trying to avoid. A ruling is expected soon in a lawsuit the company filed against the state last year seeking to end its contract a year early, saying the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million.

Appalachian Regional Healthcare, the largest health-care system in Eastern Kentucky, filed suit in April of this year against Kentucky Spirit for $5.9 million in unpaid claims. This suit is still pending, and was filed just before Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Sick of all the bad facts about Kentucky's health? Here's encouraging news about oral health and drug treatment

Despite the plethora of bad news about Kentucky's poor health status, there are many positive initiatives for Kentucky's oral health and substance abuse treatment, which were stories buried under health news headlines about Medicaid expansion and low health rankings.

The Kentucky Board of Dentistry recently established the position of public heath dental hygienist, permitting hygienists to go into Kentucky schools to assess teeth on the front lines, which will provide basic preventive dental care to underserved kids with tooth problems through local health departments, Al Smith, left, reports in an opinion piece for the Lexington-Herald Leader.

"These hygienists will be able to do school fluoride varnish programs, place sealants, refer kids in pain, and promote dental health programs (like brushing and better nutrition) in the schools without being supervised by a dentist," Dr. Rankin Skinner, director of the Clark County Dental Health Initiative, told Smith. "I think this is a major step in developing dental health program like ours across the state and moving our kids towards better health in general."

The initiative, comprising 17 dentists and 127 volunteers, was selected as a national model by a national association of all the health departments. "It isn't often that a private volunteer program in Kentucky sets a national standard," Skinner told Smith.

Meanwhile, in Florence, Kentucky's first lady, Jane Beshear, a Democrat, joined her Republican co-chair of Recovery Kentucky, Lexington homebuilder Don Ball, to celebrate the Brighton Recovery Center's fifth birthday and nearly 800 graduates.

Brighton is one of the 10 new homes for Recovery Kentucky, a program that is also becoming a national model, Smith writes. Since its inception during the Fletcher administration, the program has provided supportive housing and addiction recovery programs to over 10,000 men and women, writes Smith.

Beshear said the next steps are for her and Ball to create more drug-free housing and jobs for graduates of the program, Smith reports. This goal creates hope for other successful initiatives and shines a ray of light at the end of a dark and dreary tunnel.

Pikeville Medical Center joins Mayo Clinic Care Network

Pikeville Medical Center President Walter May and Dr. 
Stephen Lange, Mayo Clinic's Southeast medical director

Pikeville Medical Center joined the Mayo Clinic Care Network last week, extending the clinic's knowledge and expertise to PMC staff, which the hospital says will improve health care delivery for 420,000 Appalachians while allowing them to stay close to home.

Some of the resources that will now be available to PMC physicians and providers include its online point-of-care information system and electronic consulting that connects physicians with Mayo Clinic specialists about diagnosis, therapy or care management, says a PMC news release.

“Pikeville Medical Center is honored that we have been asked to become a member of Mayo Clinic Care Network,” says Walter E. May, president and chief executive officer of PMC. “I have admired Mayo Clinic for many years and tried to make Pikeville Medical Center more like the Mayo Clinic. This new agreement will take our hospital to the next level.”

The primary goal of the Mayo Clinic Care Network is to offer Mayo Clinic expertise close to home so that patients only travel when necessary, says the release. The network was launched in 2011 and has member organizations based in Arizona, Florida, Illinois, Kentucky, Michigan, Minnesota, Missouri, Montana, New Hampshire, North Dakota, Puerto Rico and Mexico. See details about specific hospitals in the map below.

“We are pleased to welcome Pikeville Medical Center and its more than 2,000 employees into our Mayo Clinic Care Network family,” says Stephen Lange, M.D., southeast medical director of the Mayo Clinic Care Network. “Our mission is to work collaboratively to improve the quality of health care and value for our patients. We are very excited to work together with Pikeville to find bold and innovative ways to enhance the quality of life for the patients in that region of the country.”

PMC serves 420,000 people and 15 counties in Kentucky, Virginia and West Virginia, and the hospital is currently undergoing a $150 million expansion.

Religious business owners and corporations have filed half the lawsuits over health reform mandate to cover contraception

By Molly Burchett
Kentucky Health News

Some religious business owners are filing suit against the government, saying the health-reform law violates the constitutional freedom of religion by mandating employee contraceptive and abortion-inducing drug coverage; the lawsuits are expected to land in the U.S. Supreme Court, and a case filed by Hobby Lobby is the first of this kind to be heard by a federal appeals court.

Challenges to the mandate that will require businesses with more than 50 employees to provide no-cost coverage of all contraceptives, sterilization procedures, plus education and counseling, are not just coming from Catholic entities with a religious, moral objection to contraception. About half of the cases have been filed by corporations, reports Robert Barnes of The Washington Post.

There are now 60 cases involving 190 individuals representing hospitals, universities, businesses, schools and people opposed to the mandate, says the Becket Fund for Religious Liberty. The Becket Fund maps the cases, as shown below; for the interactive version, click here.

Since the law mandates contraceptive coverage, groups such as Catholic bishops have accused the Obama administration of waging war on religious liberty, reports Barnes. In February, the administration announced an exemption for faith-based organizations from covering employees' contraception costs because the conceptions would be covered by a third party. Self-insured organizations like Catholic schools sued, arguing that the accommodation would not apply to them because there is no third-party insurer to cover contraception. But those cases have been dismissed in court because such organizations are given a one-year grace period to comply with the mandate, reports Laura Bassett of the Huffington Post.

Businesses don't qualify for faith-based exemption from mandates

Hobby Lobby's David and Barbara Green

Business do not meet the new exemption either, because they are not religious organizations. However, some businesses like Hobby Lobby, which was founded and is still owned by an evangelical Christian family that believes life begins at conception and already covers contraceptives through existing employee health coverage, are fighting the law's mandate to cover abortion-inducing drugs or devices, like morning-after and week-after pills.

"They ought to be able — just like a church, just like a charity — to have the right to opt out of a provision that infringes on their religious beliefs," said Kyle Duncan, who argued the case Thursday before the 10th Circuit Court of Appeals on behalf of the Green family, and a sister company, Christian booksellers Mardel Inc, reports The Associated Press.

Other suits have been filed by religious business owners of diverse enterprises, from a company that makes wooden cabinets to owners of Panera Bread restaurants, reports Barnes, but all the cases base their arguments on the First Amendment guarantee of free exercise of religion and on the Religious Freedom Restoration Act of 1993. The Hobby Lobby case also specifies that the mandate violates freedom of speech and the Administrative Procedure Act because it was imposed without prior notice or sufficient time for public comment.

In the early stages of litigation, lower courts have split on the issue. Some have rejected Hobby Lobby's request for an exemption to the mandate, and requests by other businesses for a temporary injunction, saying for-profit businesses aren't covered by the faith-based exemption. However, courts in St. Louis and the Seventh Circuit have granted temporary injunctions. (Read more)

Website eases application process for SNAP, formerly food stamps, and promotes healthy food

With a federal grant, the state Department for Community Based Services has launched a customer service website to promote healthy foods by assisting the families receiving food benefits through the Supplemental Nutrition Assistance Program, formerly called food stamps.

The portal allows people to check their eligibility for SNAP and apply for benefits with a shorter application that will be followed by a DCBS interview. They can also check their benefit status, report changes and receive electronic notices.

The agency says an online application eliminates any transportation issues a family may have with visiting a DCBS office, and encourages applications. “Modern improvements like this make it easier for families to apply for benefits and ultimately increase access to healthy food,” said Audrey Haynes, secretary of the Cabinet for Health and Family Services, which houses DCBS.

“SNAP helps people of all ages afford healthy food,” said DCBS Commissioner Teresa James. “For some of our DCBS customers, it means the difference between having a family meal or nothing at all. This website makes applying for benefits, making updates or accessing information even easier since customers don’t have to make an office appointment or even pick up the phone to get help.”

Since the portal’s launch on March 11, DCBS has received more than 1,000 electronic applications. Click here to learn more about SNAP. 

Health insurers could exclude one in four Americans from coverage because they don't have bank accounts

By Molly Burchett
Kentucky Health News

Federal Deposit Insurance Corp. graphic

A new study says if corrective action isn't taken, health-insurance companies could exclude 27 percent of qualifying Americans now eligible for premium-assistance tax credits under the health-reform law because they plan to require customers to pay premiums automatically through a bank account. More than 1 in 4 of these people do not have a bank account.

If insurance companies won't do business with them, that will undermine efforts to expand health coverage and equalize access to health care, denying coverage to the more than 8 million "unbanked" Americans, says the report from tax firm Jackson Hewitt.

Unbanked households are those that lack any kind of deposit account, checking or savings, at an insured depository institution, so requiring a checking account for coverage could also worsen the existing disparities in both health-care access and health status of minority groups. African Americans and Hispanics are over 40 percent more likely than whites to be "unbanked," says the report.

Most health plans accept a credit card for the first month’s premium payment and thereafter require monthly payment from a checking account. An estimated 30 percent of U.S. households are "unbanked" or underbanked, with the highest rates among non-Asian minorities and lower-income, younger and unemployed households; underbanked households hold a bank account but also rely on alternative financial services, and one in five households use such check-cashing stores and money lenders instead of a traditional bank, says the Federal Deposit Insurance Corp.

This all goes against the basic ideals behind the health care law's "comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care," says the White House website.

Law doesn't protect Americans from discrimination

Federal officials are wary taking action that may discourage insurance companies from participating in the exchanges, current and former state health officers who have pressed the U.S Department of Health and Human Services for a ruling told Varney.

“I think there is a dawning awareness that this is a large problem,” Brian Haile told Varney; Haile is senior vice president for health policy at Jackson Hewitt Tax Service and has called on federal official to set a uniform standard requiring all insurers to accept all forms of payment.

Neither the health law nor other laws require insurance companies to accept all forms of payment, says Sarah Varney of Kaiser Health News. Alternative forms of payment include credit cards or pre-paid debit cards that people without bank accounts often use, and although health insurance companies are evaluating these options, they are not required to do so, reports Varney.

“I’ve not seen any specific guidance that says you have to be able to accept these types of payments,” Ray Smithberger, Cigna’s general manager of individual and family plans, told Sarah Kliff of The Washington Post.

Insurance carriers take a risk by accepting credit cards and pre-paid debit cards because transaction fees can run as high as 4 percent and pre-paid cards are popular among low-wage workers, Haile told Varney. 

“If you accept re-loadable debit cards, are you in fact getting folks with lower health status?” Haile told Varney. “That’s a real risk when you’re in the insurance business. So you can’t be the only one picking up those risks.”

The Jackson Hewitt report calls for immediate action by federal policy makers to ensure insurers cannot discriminate against the 'unbanked' through their payment acceptance policies by creating a system-wide rule requiring all forms of payment must be accepted.

"Given the dilemma presented to insurance companies by the strong financial incentives to discourage non-bank payment mechanisms, insurers are unlikely to resolve this issue without federal action," says the report.

Fort Campbell works to address post-traumatic stress disorder, common ailment of Afghanistan-Iraq veterans

Research shows almost 14 percent of veterans returning home from Iraq and Afganistan suffer from post-traumatic stress disorder (PTSD), and as an estimated 2 million veterans are coming home, Fort Campbell has quickly acted by reaching out to the medical community in Kentucky to help address the challenges of PTSD.

Top behavioral health and brain injury research experts came to Ft. Campbell on Tuesday to teach civilian behavioral health professionals about the military's current PTSD and brain injury research and treatments, reports Kristin Hall of The Associated Press.

PTSD can be one of war's ugly side effect, and it is an anxiety disorder that can develop after exposure to a terrifying event in which ther's potential for grave physical harm, such as "violent personal assaults, natural or human-caused disasters, accidents, and military combat," says the National Institute of Mental Health. Not properly treating PTSD symptoms can lead to alcohol or drug use, spouse or child abuse, depression or suicide

The clinics at Ft. Campbell will focus on PTSD and brain trauma treatment and will each have 13 mental health professionals to offer more personalized, focused care, which is expected to reduce "cases of psychiatric problems, spouse or child abuse, sexually transmitted diseases, suicides and drug use," like the pilot program at Fort Carson in Colorado, reports Adam Ghassemi of News Channel 5.

Some Kentucky veterans, like Mike Jeffrey who spoke about his physical and mental battles after his two tours in Iraq at a Veteran's Recognition Program, are addressing other problems associated with PTSD, which are that many veterans won't talk about it, and they both families and veterans lack awareness about treatment options. Jeffrey talked about the struggles he had when returning home and his "baby steps" toward normalcy.

“I woke up and had kicked down my apartment doors overnight without knowing it,” he said. “It was hell just living with myself,” reported Tracy Harris of The News Democrat. Jeffrey started counseling for his PTSD and is now using a service dog trained specifically for veterans, Seal Team.

“Seal Team is his security blanket,” said Jeffrey's wife, Shelly, who contacted four service dog organizations before finding K-9 trainer Mike Halley, a Vietnam veteran living in Florida, reports Harris. In addition to suggesting use of a service dog, Jeffrey said veterans shouldn't bury their own experience with PTSD, which many are reluctant to talk about.

“We all grew up in the suck-it-up-and-drive Army,” he said. “But you can only suck it up for so long,” said Jeffrey.

Efforts like the ones made by Ft. Campbell and Mike Jeffrey represent progress in treatment of mental health issues. And while these efforts alone won't address the problem, work within local communities can make a world of difference for struggling veterans.

Retired Maj. Gen. Mark Graham said "there is no quick way to eliminate the stigma often attached to seeking out mental health care, but the key is partnerships with the communities," writes Hall.

The story of returning veteran's is a big one that may be hard to cover, so click here for journalism tips. Click here to learn more about PTSD programs in Kentucky, or click the link below to watch news coverage about the behavioral health clinics in Ft. Campbell.

Ft. Campbell Opens Behavioral Health Clinics To Fight PTSD - NewsChannel5.com | Nashville News, Weather & Sports

Ky. is already short of doctors, dentists; how will its health-care system handle expansion of Medicaid and private insurance?

By Molly Burchett and Al Cross
Kentucky Health News

In the wake of Gov. Steve Beshear’s recent decision to expand Medicaid under federal health reform, there is concern that Kentucky's health-care system will not be able to care for the newly insured.

Health reform means that an estimated 308,000 new Kentuckians will qualify for Medicaid, and 332,000 more will qualify for subsidies to buy private insurance through the state insurance exchange that will start taking enrollments Oct. 1.

But Kentucky already has a health care provider shortage, especially in rural areas. A study for the state estimates that it needs 3,790 more doctors just to meet current demand, to say nothing of what will be needed to care for those who haven't been a regular part of the health-care system, reports Laura Ungar of The Courier-Journal.

The report by Deloitte Consulting made 11 recommendations, including authority for nurse practitioners to prescribe less risky drugs without a written agreement with a doctor, and one that would be even more controversial, putting limits on medical malpractice awards, said Ungar.

The report also recommended expanding and increasing Medicaid reimbursements in rural areas, to encourage more physicians to take Medicaid patients.

It did not mention complaints by health-care  providers about getting paid by the managed-care Medicaid system that the state began in November 2011; Gov. Steve Beshear said when he announced Medicaid expansion that those problems are being worked out.

"Consultants said 61 percent of the 3,790 'full-time equivalent' physicians needed (which includes primary care doctors and specialists) were in rural counties," reports Ungar. Jonathan Felix of Deloitte said, “Primary care, dental care and behavioral health are all big needs in the state.”

The report said the state needed 183 more primary-care doctors, even before Medicaid expansion, but a 2012 Kentucky Physician Workforce Needs Assessment report by the University of Kentucky said the state needs 557 more primary-care physicians and 1,655 more total physicians to meet the national ratios for physicians to population.

The consultants said the state already needs 612 more dentists. It now has 1,711.

Complicated provider shortage problem, no easy answer

About 192 federally identified areas in Kentucky — including 47 counties — have shortages of health professionals, Ungar reports. Kentucky counties who will have the most non-elderly residents eligible for Medicaid often have fewer primary-care doctors per person, according to data analyzed by The Courier-Journal. Ungar notes that Casey County, for example, ranks in the bottom third for doctors per capita, but it has the highest portion of newly eligible residents at 13.5 percent.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” Susan Zepeda, president and chief executive officer for the Foundation for a Healthy Kentucky, told Ungar.

Nationally, there is a primary-care shortage, partly because such doctors make less money than most, and low reimbursement rates exacerbate that. A 2012 study in the journal Health Affairs said 21 percent of office-based physicians in Kentucky did not accept new Medicaid patients in 2011, Ungar notes.

The health reform law will raise the Medicaid fees to match what Medicare pays primary-care doctors, but only for two years. Kentucky's Medicare rates are about 72 percent of the Medicare rates, compared to a national average of 59 percent, says an Urban Institute study. But the time limit leaves some practitioners wary.

“If I choose to increase the number of Medicaid patients, and two years down the road that payment drops back to two-thirds, all of a sudden I’m going to have an awful lot of trouble keeping my doors open,” Reid Blackwelder, a family practitioner and incoming president of the American Academy of Family Physicians, told Michael Ollove of Stateline. 

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness, particularly in Kentucky and other states that are expecting the largest percentage increases in Medicaid enrollees and that have low numbers of primary-care physicians.

“I’m not sure who’s going to pick up all those patients into their practices,” Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, told Ungar. Legislation to let nurse practitioners prescribe non-scheduled drugs without a doctor agreement failed in the state Senate this year.

While some policy analysts have touted nurse practitioners as a solution to the rural primary-care shortage because they often provide primary care in rural and isolated areas that do not have doctors nearby, they would not be covered by the two-year reimbursement increase. Ewen said the reimbursement is only $23 for a lower-level visit by an established patient.

A possible long-term solution includes greater reliance on community health centers, some say. And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, said her system is looking to open new primary care offices and hire more staff.

Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from its new partner, KentuckyOne, to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agree that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it. The state estimates that 188,000 of the 308,000 newly eligible will enroll, but some think that estimate is low.

Don't get burned, bitten or bamboozled this summer; here are safety tips for dealing with the sun, insects and sales pitches

By Molly Burchett
Kentucky Health News

Summer is finally here, and after one of the coldest Kentucky springs, who doesn't want to be outside swimming, skiing, fishing, barbecuing or soaking up rays on the beach? While summer may bring much-anticipated fun in the sun, it's important to take some  safety precautions to make sure you and your family are not getting too much of a good thing.

Sunscreen can protect you from cancer, but don't spray it

The sun is bad for your skin, and exposure to its harmful ultraviolet (UV) rays can increase your risk for skin cancer, which is the most common cancer in the U.S., says the federal Centers for Disease Control and Prevention. It's critical to protect yourself and your children from sun damage because just one blistering sunburn in childhood more than doubles the odds of developing skin cancer later in life, says the Mayo Clinic.

Fortunately, it’s never too late or too early to lessen your risk of sun damage by using sunscreen, and the Environmental Working Group has recently released its 2013 Guide to Sunscreens, which rates more than 1,400 sunscreens, lip balms, and SPF moisturizers and cosmetics for safety and effectiveness.

This year, EWG says 184 sunscreens, 25 percent of those on the market, met its criteria of offering adequate UV protection and posing few safety concerns. You can click here to view that product list, or here to check out the EWG findings for moisturizers, lip balm and makeup.

EWG also created a somewhat surprising list of things NOT to bring on vacation because they are unsafe or do not provide adequate UV protection:

• Spray sunscreen: These sprays may pose serious inhalation risks, and they make it too easy to not apply enough sunscreen or to miss a spot.
• High-SPF sunscreens: These products may tempt people to stay in the sun too long, which can increase the risk of other kinds of skin damage, and EWG recommends that consumers avoid products labeled higher than SPF 50.
• Oxybenzone: Used in half of sunscreen products, this chemical penetrates the skin and can adversely impact health in several ways; in the body, it acts like the female hormone estrogen and can cause allregic reactions.
• Loose powder sunscreen: Tiny zinc particles in these products can also end up in your lungs when you breathe them in during application, which irritates the lungs.
• Retinyl palmitate: Some sunscreens contain this chemical, which is a form of vitamin A, but when applied to sun-exposed skin, it may speed development of skin tumors and lesions.
• Combined sunscreen/bug repellents: Studies show this combination leads to increased skin absorption of the repellent ingredients.
• Sunscreen towelettes: Whether they really work is unknown.
• Tanning oils: They are simply a bad idea and can ultimately lead to behavior that increases risk of developing skin cancer.

So, check the ingredients for your sunscreen, avoid high-SPF's or sprays and make it a habit to wear sunscreen during sports or whenever you're outside. Be sure to reapply often to ensure UV protection, particularly if you get wet or sweaty. Click here to read EWG's "Nine Surprising Facts about Sunscreen."

Hats and clothing: Choose the right kind

Children are more vulnerable to sun damage, so in addition to actual sunscreen, the best sun protections for them are a hat and shirt (which also protect adults). The CDC recommends avoiding straw hats that let sun through the holes, and to wear a hat with UV protection or a wide brim to shield the face, head, ear and neck. If you do chose to wear a baseball cap, protect your ears and neck with clothing, sunscreen (with at least SPF 15) or spend lots of time in shade.

Wear clothing to protect exposed skin. The CDC says loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best UV protection. Darker colors may offer more protection than lighter colors, and a wet t-shirt offers much less UV protection that a dry one.

Sunburn treatment: People with fair skin or light-colored hair are more likely to be sunburned. If you get sunburned, remember that "The skin heals but is forever damaged," writes University of Kentucky nursing Professor Mollie Aheshire. "The more frequent and more severe the burns, the more damage there is," along with risk for cancer and premature aging. "If a sunburn is blistering and covers a large portion of your body; is accompanied by a high fever, extreme pain, confusion, nausea or chills; or does not respond to at-home treatment within a few days . . . see a health-care provider." Mild sunburns can be treated with over-the-counter pain relievers, cold compresses and moisturizing creams — aloe vera or hydrocortisone lotions. "If blisters form, do not break them," Aheshire writes. "Drink plenty of fluids to prevent dehydration. Treat peeling skin gently. Stay out of the sun until redness and pain resolve." (Read more)

Sunglasses: Not just to help you see now, but to keep you seeing longer

Besides being dangerous for your skin, UV rays are dangerous to your eyes and can cause vision disorders, premature aging of the eyes or even blindness. It is important to wear sunglasses to protect eyes from sun damage, although a new survey from the American Optometric Association shows that only 40 percent of consumers cite this protection as the primary reason for wearing sunglasses, says a Kentucky Optometric Association press release.

To help reduce the risks of harmful UV exposure on the eyes, children and adults should start wearing protective sunglasses as as early as possible, and parents should ensure that babies are protected by sunglasses too, says the release. When choosing sunglasses or protective contact lenses, make sure that they block more than 95 percent of UV-A and more than 99 percent of UV-B radiation, says the KOA, and sunglasses should have a frame that fits close to the eyes so the UV rays can't sneak around the sides.

Insect repellent: Bugs can bug you, but don't over-react to them

Although nothing can ruin a relaxing summer picnic faster than bugs, take precautions to ensure you're using the right type of bug repellent-- one that's been approved by the Environmental Protection Agency -- and that you're using it wisely.

Not only are bugs annoying, they can also carry dangerous diseases, and for the safe and effective use bug repellents, always read the product label before using the product, EPA says. It says to follow these bug-repellent safety tips:

• Repellents should be applied only to exposed skin and/or clothing. Do not use them under clothing.
• Store insect repellents safely out of the reach of children.
• Do not apply near eyes and mouth, and be use sparingly around the ears.
• When using sprays, spray on the hands first and then apply to the face, not directly to the face.
• Never use repellents over cuts, wounds or irritated skin.
• Do not spray in enclosed areas and avoid spraying near food.
• After returning indoors, wash treated skin and clothes with soap and water.
• Do not use any product on pets or other animals
• Most insect repellents do not work on lice or fleas. 
• Click here to search for a repellent that's right for you.

Beware if you want to use a wearable repellent that's not sticky and has to be continuously resprayed, such as Off!'s clip-on mosquito repellent. It works once the cloud of mosquito protection is built around the wearer, says Brighid Moret of The Washington Times, but it's not a good option for an active or young child. The manufacturer warns on the label that a chemical on the product's enclosed disk is harmful if swallowed, directly inhaled or absorbed through the skin, and young children should not wear it.

Whether you're going on vacation or a "stay-cation," these tips can help protect you and your family from the sun and bugs in order to safely make the most of your summer. Click here for more sun safety tips from EWG.

U of L's Trover medical campus ranked among best for rural medicine education and addresing rural physician shortage

The University of Louisville School of Medicine Trover Rural Campus in Madisonville was rated third best in the nation for preparing medical students to practice in rural areas, which is critical to the state since most of Kentucky's rural counties are considered to be short of health professionals.

“From the president and the deans to the individual faculty and staff, our team has proven the value of a collaboration of a rural campus and an urban university. The beneficiaries are our students and the rural Kentucky communities who receive these new doctors who are well prepared to care for them,” Dr. Bill Crump, right, associate dean for the Trover campus, said in a UofL press release.
  
The study by researchers at the University of Colorado, which will be published in Academic Medicine in August, ranked 35 programs across the nation and found that 62 percent of Trover graduates practice medicine in rural areas, says the release.

“This national recognition is the fulfillment of Dr. Loman Trover’s vision outlined almost 60 years ago of providing first class medical education in a small town with the goal of producing more physicians for rural Kentucky, and is a testament to the strong support we’ve had from the Louisville Campus over the past 15 years,” said Crump.

Nationally, there is a physician shortage in rural areas because only 3 percent of medical students report want to practice rural medicine, while 16 percent of Americans live in rural areas. This problem is especially large in Kentucky, says the release, since a majority of the state's 59 counties classified as rural are considered to be short of medical professionals..

“Our Trover campus is vital to fulfilling this mission and especially critical now because our state faces such a significant shortage of physicians, especially in rural areas. Dr. Crump’s leadership of the program is one of the reasons for its success. We view the program as a model that has the potential to be implemented in other areas of Kentucky,” said School of Medicine Dean Dr. Toni Ganzel.

At least one in eight teens, and perhaps one in five, have a mental-health issue; ADHD tops, substance abuse also high

The most comprehensive report yet on mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in those aged 3-17, and the most common health issues for teenagers include addiction to drugs, alcohol and tobacco.

An estimated 13 to 20 percent of U.S. children experience a mental disorder in a given year, says a new report by the Centers for Disease Control and Prevention, and children are increasingly suffering from and being hospitalized for mood disorders like depression; that hospitalization rate has increased 80 percent from 1997 to 2010, says the report. And, while 3.5 percent of children under 18 have behavioral problems, almost 7 percent of them are diagnosed with ADHD.

About 4.7 percent of teens, or 1.7 million children aged 12–17, have disorders involving abuse and dependence upon alcohol, drugs or tobacco, says the report. Alarmingly, two-thirds of teenagers had an illicit drug use disorder, one million teenagers abused drugs or alcohol, and more than 695,000 were addicted to tobacco.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC Director Dr. Tom Frieden said. “No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

Knox County converting ambulance tax, taking 3/8 of health tax and asking library for same in order to save hospital

The Knox County Fiscal Court and the Knox County Board of Health reached a deal Monday to aid its debt-laden county hospital's recovery from bankruptcy by diverting, at least temporarily, 37.5 percent of local health tax revenue to the hospital, asking the local library to do likewise and converting an ambulance tax into a hospital tax.

The proposed agreement is "revenue neutral" and would not create any additional tax for Knox County residents while allowing the Knox County Hospital in Barbourville to stay open, writes Jeff Noble of The Times-Tribune in Corbin.

To save the hospital, the hospital board needs a tax of about 8 cents per $100 worth of property, County Judge-Executive J.M. Hall said. The deal would convert a 5-cent ambulance tax to a hospital tax, and the county health board has agreed to shift 1.5 cents of its 4-cent tax to the hospital. The library board is considering similar action, which would make up the total 8 cents, Hall told Noble.

Health Department Director Susan Liford said the two-year deal with the health board will begin in January 2014 and will be re-evaluated at the end of that period. The health department will be diverting $300,000 to $400,000 a year to the hospital, Noble reports.

"The board felt like we needed to help the hospital, and they were very adamant they did not want to put the health department in jeopardy and have no one here lose their jobs," Liford told Noble. "I think it’s the moral thing to do. And we need our hospital."

The hospital has a debt estimated at $23 million, though the Knox County Fiscal Court purchased it out of bankruptcy by in 2004 for just $7.2 million, according to documents analyzed by the Barbourville Mountain Advocate, Knox County's weekly newspaper. Last July, the fiscal court took over hospital operations of the hospital, borrowing $6 million to fund them, after the former owners filed Chapter 11 bankruptcy. (Mountain Advocate graphic; click on it for larger version)

UK HealthCare hosts 'Women, It's About You' conference June 1

On June 1 UK HealthCare will present its fifth annual "Women, It’s About You" conference, which is designed to educate women with the most up-to-date information about health topics ranging from mammograms to nutrition to financial abuse.

This year's conference will feature 15 presentations on the following women's health topics:

Menopause, presented by Dr. Kathy Dillon 

Memory and aging, presented by Dr. Gregory Jicha 

Women's heart health, presented by Dr. Susan Smyth 

Eye health, presented by Dr. Eric Higgins 

Physical fitness, presented by Richard Watson 

Gynecologic cancer, presented by Dr. Lauren Baldwin 

Financial abuse of women, presented by Susan Lawrence 

Weight loss, presented by Dr. Stephanie Rose 

Skin care and cosmetic procedures, presented by Dr. Amit Patel 

Stroke, presented by Lisa Bellamy 

Diabetes, presented by Sheri Legg and Beth Holden 

Nutrition, presented by Rachel Miller 

Mammography, presented by Dr. Margaret Szabunio

Pelvic Prolapse, presented by Drs. Rudy Tovar and Mark Hoffman.

Participants will have the opportunity to participate in a variety of health screenings, including blood pressure and stroke-risk assessment, says a UK HealthCare press release. The event, which will take place at the Embassy Suites hotel on Newtown Pike in north Lexington, costs $10 and also includes a continental breakfast, a luncheon with entertainment, giveaways and an exhibitor fair. Click here for more information or to register by the Friday, May 17 deadline.

Foundation for a Healthy Kentucky seeks nominations for its board of directors and Community Advisory Committee

The Foundation for a Healthy Kentucky is accepting nominations for qualified persons to join its board of directors and Community Advisory Committee.

The 15 directors are responsible for preserving the foundation’s endowment and upholding its charitable mission of addressing the unmet health care needs of Kentuckians. Nominations are being accepted for three seats, including one to be selected by the directors and one by the governor.

The third seat will represent Supreme Court District 6: Bath, Boone, Bracken, Campbell, Carroll, Fleming, Gallatin, Grant, Harrison, Henry, Kenton, Lewis, Mason, Nicholas, Oldham, Owen, Pendleton, Robertson, Shelby, Spencer and Trimble counties. This director will be chosen by a Community Advisory Committee subcommittee, comprising five members who help run organizations addressing the unmet health care needs of Kentuckians.

The foundation is also accepting Community Advisory Committee nominations in anticipation of electing two new committee members. The 31 members provide advice and recommendations to the board, serve as community liaisons, serve on foundation committees, take part in the annual policy forum and appoint or nominate directors.

Please complete the nomination form and attach a resume or bio. Self-nominations are allowed.  The deadline for receipt of nominations is July 15. Mail to Mary Jo Dike, Foundation for a Healthy Kentucky, 1640 Lyndon Farm Court, Suite 100, Louisville, KY 40223, or email to mdike@healthy-ky.org. For more information call 502-326-2583 (toll-free 1-877-326-2584).

Could Medicare Part D be an inadvertent enabler of prescription drug abuse?

UPDATE, Jan. 7: Medicare proposes giving itself authority to ban abusive prescribers, ProPublica reports.

By Molly Burchett
Kentucky Health News

An examination of the Medicare Part D program that Congress established a decade ago, dedicating billions of dollars to subsidizing prescription drug purchases for 35 million elderly and disabled Americans, uncovers the program's risky lack of oversight -- and suggests that it might be contributing to Kentucky's prescription-drug abuse epidemic.

An analysis of Medicare prescription records by ProPublica, an independent, nonprofit newsroom, found that the program has failed to properly monitor safety, ProPublica's Tracy Weber, Charles Ornstein and Jennifer LaFleur write in The Washington Post. And despite their findings that many providers prescribe antipsychotics, narcotics and other drugs known to be dangerous for older adults, Medicare officials told them it's not their job to monitor for unsafe prescribing or to stop doctors with criminal histories.

The largely unchecked prescribing habits of Medicare providers and the increased availability of prescription drugs suggests that Part D has inadvertently enabled prescription drug abuse, by making drugs available for abuse by Medicare patients, their friends, acquaintances and family members, particularly teenagers. A 2010 national survey by the U.S. Department of Health and Human Services found that 65 percent of teens who report that they have abused prescription medicine got them from friends, family and acquaintances rather than illegal drug dealers.

In Kentucky, drug overdose, mostly from prescription drugs, is the leading cause of death, and the widespread availability of drugs and easy access to drugs are some reasons for this trend, says the 2012 combined report from the Kentucky Justice & Public Safety Cabinet. In addition to taking the lives of loved ones, drug overdose takes a huge financial toll on the state, and a recent study shows that the Medicare program bankrolls the single largest percentage of drug overdose inpatient hospitalizations.

Inpatient hospitalizations for drug overdoses by percentage of total charges,
among Kentucky residents treated in Kentucky acute-care hospitals, 2010

Medicare alone was billed for 30 percent of all inpatient hospitalizations for drug overdoses in Kentucky from 2000 through 2010, totaling over $440.7 million, says a report by the Kentucky Injury Prevention Research Center. During those 11 years, the number of unintentional drug-overdose hospitalizations of Medicare beneficiaries increased 222 percent.

The fact that almost a third of overdose hospitalizations involve Medicare patients is concerning, said Van Ingram, executive director for the Kentucky Office of Drug Control Policy. In addition to these alarming statistics, Medicare and Medicaid incurred nearly $4 million worth of charges for drug-overdose visits to emergency rooms in 2010, which represents 41 percent of the total charges, says the KIPRC report. Also, during the period from 2008 to 2010, the number of unintentional Medicare drug-overdose emergency visits increased almost 44 percent.

Among prescription drugs, opiates and similar narcotics are most likely to be abused and most likely to lead to death. Since Medicare Part D began covering prescription drugs in 2006, drug overdose deaths involving opiates have increased almost 80 percent in Kentucky, says the KIPRC report.

ProPublica's Prescriber Checkup database shows that 30 percent of Medicare Part D patients have filled at least one narcotic prescription. The most common drug provided by Part D in Kentucky is hydrocodone-aceteminophen, which is an opiate painkiller known commercially as Lortab, Lorcet or Vicodin. Part D paid more than $12.6 million on 958,933 claims for hydrocodone-aceteminophen from 2007 to 2010.

Medicare officials told ProPublica that the government isn't responsible for monitoring these types of prescriptions because that is the duty of private health plans administering the program. Yet, health plans aren't given the tools to do so, the reporters write, and no one party has been slated the task of ensuring safe medication-use. This complacent mentality suggests Medicare officials, who also say it's not the providers' duty to "prevent inappropriate prescribing for individual patients," could be passively contributing to the drug-safety issue of prescription medications covered by Part D.

In addition to indicating that providers should not industriously discourage dangerous prescription drug usage, ProPublica’s examination of Part D data showcases numerous examples of Medicare officials failing to act against providers with troubled prescribing backgrounds. Such examination initiates a worthwhile discussion about the program's role in encouraging, or well, at least not actively combating, prescription drug abuse. Click here to visit Kentucky's Medicare Part D Prescriber Checkup. Individual doctors can be looked up.

Beshear announces launch of Kynect, the state's new online shop for health insurance; open enrollment starts Oct. 1

Gov. Steve Beshear has announced the launch of Kentucky’s Healthcare Connection, which is referred to as Kynect and is Kentucky's one-stop onlineshop for the state's new health insurance exchange.

Beginning next year, most Americans will be required to have health insurance, and Kynect is designed to help an estimated 640,000 uninsured Kentuckians get coverage through private insurance plans, Medicaid or the Kentucky Children’s Health Insurance Program. The online service is also aimed to promote public education and awareness about the health benefit exchange, says a recent press release.

“When I issued an executive order last year creating a state-based health benefit exchange, I did so to ensure that our health benefit exchange would be designed to best meet the unique needs of Kentuckians,” Beshear said. “Individuals, families and small businesses will be able to use kynect for one-stop shopping to find health coverage and determine if they are eligible for payment assistance or tax credits to help cover costs.”

During open enrollment, which begins Oct. 1, Kentuckians and small businesses can compare and select health insurance plans using the Kynect website, a toll-free contact center, a mail-in application or in person, says the release. People can also use the website to find out if they qualify for payment assistance and special discounts on deductibles, co-pays and co-insurance.

For example, the website indicates that a family of four making $48,000 will receive a tax credit that can be used to pay insurance premiums, which is estimated to be $252 per month, in addition to government subsidies for medical care. A family of four making $80,000 will a receive tax credit too, and insurance premiums are estimated to be $634 per month. Small businesses can also use the website to see if they qualify for specific tax credits (Click here for a PDF fact sheet about payment assistance)

“Starting today, we are undertaking a major education and awareness campaign to ensure that all uninsured Kentuckians understand how Kynect can help them and their families find affordable health coverage,” said Audrey Haynes, secretary for the Cabinet for Health and Family Services, which will oversee Kynect along with the Kentucky Office of the Health Benefit Exchange.

Beshear created the health exchange by an executive order in July 2012. A recent lawsuit alleges this action was not authorized and should first be approved by the General Assembly. To date, Kentucky has received about $250 million in federal grants to cover the initial costs of exchange, but the state will be responsible for all funding for the exchange beginning in 2015. Kentuckians can visit the service's website or watch the video below to learn more about the program. 

New study finds texting and driving kills and injures more teens than drinking and driving, and is becoming more prevalent

A new study finds that texting while driving has become more dangerous among teenagers than drinking and driving, and it says the number of teens who are dying or being injured as a result of this habit has "skyrocketed."

Nationwide, more than 3,000 teens are killed and 300,000 are injured as a result of texting and driving, compared to 2,700 deaths and 282,000 injuries from drinking and driving, said researchers at Cohen Children's Medical Center in New Hyde Park, N.Y.

"A person who is texting can be as impaired as a driver who is legally drunk," said Dr. Andrew Adesman, chief of developmental and behavioral pediatrics at Cohen.

Adesman and his team found that the number of teens who text and drive exceed the number who drink and drive, that more boys admit to texting than girls, and that texting increases with age, writes Delthia Ricks of Newsday. While teens' texting is increasing, the CDC reports alcohol use among teen drivers has decreased by 54 percent over the past 14 years.

On Wednesday, officials from the National Highway Traffic Safety Administration described texting as among the worst of driver distractions, and Adesman says texting is as hazardous as "drinking and driving, binge drinking, drug and tobacco use, unsafe sex and tanning devices," writes Ricks.

"We have very strong taboos against drinking and driving. Kids don't drink and drive every day," Adesman said. "But some kids are out there texting and driving seven days a week -- and they admit it."

Poll shows strong support for medical marijuana in Kentucky

A statewide poll has found that 78 percent of Kentucky adults support the use of marijuana for medicinal purposes if recommended by their doctor, while only 26 percent of favor it for recreational purposes.

There were no significant differences in the poll results among the regions of the state on the medical-marijuana question, but on the recreational-use question, the Louisville area and Northern Kentucky were more likely to favor it, at about 37 percent. For geographic and demographic breakdowns of the poll results, click here.

Nationally, 17 states and the District of Columbia allow medical marijuana, and three states have recently legalized it for recreational use.

“Our Kentucky Health Issues Poll is designed to be informative to Kentucky policymakers,” said Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. “Over the past several years, bills dealing with legalization of marijuana have been filed in the Kentucky General Assembly. This research gives policymakers a snapshot of Kentuckians’ views on this issue and should be helpful as lawmakers consider issues for the 2014 legislative session.”

For years, Sen. Perry Clark, D-Louisville, has introduced bills in the Kentucky Senate aimed to legalize medical marijuana. Although the bills, referred to as The Gatewood Galbraith Medical Marijuana Memorial Act, gained media coverage in the 2012 and 2013 legislative sessions, they have not received a committee hearing and have not passed.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati and was conducted last year from Sept. 20 to Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones, and the poll has a margin of error of plus or minus 2.5 percentage points.

Medicaid expansion could change Kentucky's course, big time

NEWS ANALYSIS

By Al Cross

Kentucky Health News

"Today we change the course of Kentucky's history."

It is not often that a public official can say such a thing with a large measure of credibility, but Gov. Steve Beshear legitimately raised that hope Thursday, as he announced that he would expand Kentucky's Medicaid program under federal health reform.

Beshear with graph predicting positive impact on budget

If Beshear's vision is fulfilled, Kentucky will no longer have one of the unhealthiest populations of any state, a change that will make it more attractive to employers, and any Kentuckian who wants health insurance will be able to get it.

It is in large measure the realization, in the state where all President Harry Truman's grandparents were born, of his 68-year-old dream of national health insurance. The statue of Truman's vice president, Alben Barkley of Paducah, seemed to shine a little more brightly than usual in the Capitol rotunda as the press-conference crowd dispersed.

But this is a project with many moving parts -- billions of dollars, thousands of health-care providers, hundreds of thousands of Medicaid beneficiaries, and scores of political and bureaucratic decisions -- and much could go wrong.

Skeptics point to the problems with the managed-care Medicaid system that Beshear implemented too hurriedly, apparently to avoid complicating his November 2011 re-election, and argue that the program needs fixing before adding 300,000 new enrollees to the 825,000 already on the rolls. Beshear says he's tackling the problems, the program is "working pretty well" and the managed-care companies can handle the influx.

The skeptics also question whether the state can afford the match for the federal funds. "Broad and vague anxieties," Beshear called them, and he came armed with two studies concluding that expansion would actually gain the state money -- mainly because of the billions it will send to the state's health-care providers, creating more jobs, but also because many of the 300,000 or so newly eligible people are not expected to enroll, based on a Price Waterhouse Coopers study drawing on research by the Congressional Budget Office.

University of Louisville research

Preliminary estimates were that expansion would add 400,000 Kentuckians to the Medicaid rolls. However, the study estimated that only 308,000 will become eligible and that only 188,000 will enroll, thus costing the state much less than some expected when it has to match federal funds beginning in January 2017. The initial match will be 5 percent, rising to 10 percent in 2020. The estimated cost for the newly eligible in fiscal 2020-21 is $151 million, in a state budget that is likely to exceed $10 billion. (The state's current share of Medicaid costs, 29.5 percent, is about $1.5 billion a year.)

Those are just estimates. "I believe reality will dwarf those numbers on the spending side," Tea Party activist David Adams, who says he plans to challenge the plan in court, told reporters. But for the time being at least, Beshear has the numbers on his side, and he said they are "very conservative."

The governor said opponents of the plan "fall back on national politics" and say expansion means that Kentucky, a state that President Obama lost big both times, will be "supporting Obamacare. To them I say, 'Get over it.' . . . I'm going to do what's best for Kentucky's people, period." Asked why so many governors have rejected expansion, he said it was mostly "partisan politics."

Conservative columnist John David Dyche cites an Oregon study saying Medicaid is ineffective, but a Harvard School of Public Health study in three other states showed that expansion of Medicaid improves health and saves lives.

Beshear said the expansion, along with health insurance and subsidies available through a state-run exchange that is also part of health reform, would give the state a healthier workforce because studies show that people with health insurance are less likely to skip exams and let health conditions worsen and become costlier and more difficult to treat. "The lack of early care is one reason that Kentucky's health picture is so horrendous," he said.

Kentucky's workforce is one of the nation's least healthy, and the state has a disproportionate number of working-age people who are not in the workforce because of health problems. The state ranks first in smoking, cancer deaths and preventable hospitalizations; second in heart disease and poor physical-health days; third in heart attacks and poor mental-health days; and in the top 10 in diabetes,  cholesterol and sedentary lifestyles. That hurts the state's image as well as its economy, Beshear said. "There will be a huge economic effect for a healthier Kentucky."

He said most of the newly eligible people are not "freeloaders asking for a handout," but people who are working at jobs without health insurance. He said another 332,000 Kentuckians will get insurance through the state exchange, 276,000 of them with subsidies available to people with incomes up to 400 percent of the poverty level. Without Medicaid expansion, he said, 206,000 would not be eligible for Medicaid or a subsidy, and "We cannot leave those people stranded."

The health-reform law tried to force states into expanding Medicaid, but the U.S. Supreme Court ruled that the states should make the choice without fear of financial penalties. The law calls for expansion to cover people under 65 in households up to 138 percent of the federal poverty level -- currently $15,856 for an individual or $32,499 for a family of four.

Republicans can do little to stop the expansion. They control the state Senate, but Medicaid eligibility and benefit decisions belong to the executive branch, and even if a bipartisan legislative committee were to block the implementing regulations, Beshear could override it.

Or perhaps we should say he would override it. Emotional at times, Beshear called the move "the single most important decision of our lifetime for improving the health of Kentuckians" but said it was easy to make. As a governor who has failed to win his main campaign promise, expanded gambling, and has had relatively little money to spend because of the Great Recession, this is likely to be his largest legacy.

For details and background from the governor's office, click here. For Beshear's YouTube commentary on the issue, click here.

Beshear looks likely to announce that he will expand Medicaid

Gov. Steve Beshear appears likely to announce tomorrow that he will expand Kentucky's Medicaid program to people in households with incomes up to 138 percent of the federal poverty level, under federal health-care reform.

The notice of the governor's news conference about "Decision regarding Medicaid expansion" says it will be held in the ornate State Reception Room on the second floor of the state Capitol, an unlikely venue for an announcement that would disappoint so many of his natural allies in the Democratic Party. And Rep. Tom Burch, D-Louisville, chairman of the House Health and Welfare Committee, reiterated his February prediction that Beshear would expand Medicaid, cn|2 reports.

Under health reform, the federal government would pay all the cost of the estimated 400,000 newly eligible Kentuckians in Medicaid in 2014, 2015 and 2016. The state would pay 3 percent of the added cost in 2017, rising to 10 percent in 2020. Beshear has said the state should expand Medicaid if it can afford it.

Some Republicans have said the state can't afford it, but national research has estimated that the state's cost for Medicaid would increase only 5 to 6 percent over the amount it would pay if the program were not expanded. The federal government now pays more than 70 percent of the program's cost in Kentucky.

More background on Mediaid in Kentucky is available from a PowerPoint presentation that Deputy Medicaid Commissioner Lisa Lee gave yesterday at a meeting sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association. It can be downloaded here.

Medicaid expansion would have 'a big health impact,' and critical-access hospitals need to change, rural-health expert says

Expansion of the Medicaid program under federal health-care reform would have a major beneficial impact on the health of Kentucky, a doctor who ran the state and national rural-health agencies told a rural-health meeting in Louisville Tuesday.

"Medicaid expansion has a big health impact," Dr. Wayne Myers, left, told those at "Doing Care Differently in Rural Kentucky," a seminar sponsored by the Foundation for a Healthy Kentucky and the Kentucky Rural Health Association in Louisville, just before the opening of the National Rural Health Association's three-day conference in the city.

Myers said that in the three states that expanded Medicaid eligibility since 2000, one life was saved for every 176  people added to the program, according to a study by the Harvard University School of Public Health, published in the New England Journal of Medicine. If that figure were extrapolated to the entire nation, the number of lives saved would be greater than if breast, prostate and stomach cancer were eliminated, Myers said.

Skeptics argue that Kentucky can't afford the estimated 6.3 percent annual cost increase for expanding Medicaid eligibility up to 138 percent of the federal poverty level, but Myers said, "It would be nice to shift that argument from dollars to health impact." He said that if the three cancers were curable with a certain amount of money, and you argued that the nation should not spend it because of the cost, "You'd have an uphill argument."


Myers also said Eastern Kentucky would be an ideal place for Medicaid and Medicare to start rewarding small, rural hospitals for increasing their role in health promotion and disease prevention.

The federal designation of "critical access hospital" has kept open many rural hospitals, which get greater Medicare and Medicaid reimbursements in return for limiting beds, procedures and patient stays, but President Obama's proposed budget calls for revoking the CAH status of some hospitals, and rural political clout has declined with the rural share of the nation's population, Myers noted.

"The old models aren't working too well," Myers argued, saying "What people don't realize is that [critical-access] hospitals get three-fourths of their money from the outpatient department" and have relatively few traditional admissions. He said half of them have fewer than four acute-care patients per day, and fewer than two patients who are recuperating or getting skilled-nursing care.

Then he displayed maps showing that life expectancies of rural Americans are not keeping pace with the rest of the country, and in some areas, including Eastern Kentucky, are declining. "That's really scary," he said.

Myers said those trends mean that CAHs should add health promotion and disease prevention to their job description, and Medicare and Medicaid -- which provide 85 percent of their revenue -- should pay them for performing that function.

He said hospitals have space, expertise and equipment to serve as exercise and medical-education centers, while most rural health departments are "overwhelmed" with a wide array of duties.

The federal payments for disease prevention and health promotion could be limited to hospitals in counties that have a certain percentage of their population on government-subsidized insurance, he said.

"If it makes sense anywhere, does it not make sense in Kentucky?" Myers asked, reiterating the question to focus on the state's Fifth Congressional District, which he said has the nation's lowest life expectancy. When a questioner mentioned the district's congressman, House Appropriations Committee Chairman Hal Rogers, Myers suggested the program could be named for the Somerset Republican.

Other speakers at the seminar called for new approaches in rural health, despite obstacles.

"Change is not easy. . . . Almost all federal policy tends to shortchange rural, at least initially," said Craig Blakely, dean of the University of Louisville's School of Public Health and Information Sciences.

He said two important targets for prevention activities in rural America are smoking and obesity, which he said is exacerbated by high soft-drink consumption. Soft drinks are a $57-billion-a-year industry, jhe said, "so there's a lot of pushback we're going to be facing if we want to take that on."

Blakely added that much of rural America is poor, and that is associated with poor health, so rural health providers also need to focus on education and employment opportunities for their communities.

Half-day seminars on health reform's impact on business Wed. and Thur.; journalists invited

Experts on the impact of federal health-care reform on business will give advice to Kentucky companies at half-day seminars in Lexington and Louisville on Wednesday and Thursday of this week. Presentations about the Patient Protection and Affordable Care Act will include discussions of expected cost increases and tax implications for businesses.

The Kentucky Health Care Reform Seminar will be presented by The Iasis Group, The Lane Report and the Kentucky Chamber of Commerce. The seminar is part of a statewide partnership that includes Commerce Lexington, Greater Louisville Inc., the Kentucky Society for Human Resource Management and the Northern Kentucky Chamber of Commerce.

The Lexington seminar will be held Wednesday, May 8, at the Griffin Gate Marriott Resort, with registration starting at 12:30 p.m. The Louisville seminar will be held Thursday, May 9, at the Louisville Marriott Downtown, with registration beginning at 8 a.m.

Members of the news media are invited to attend the seminars at no cost. For more information or details about covering the event, contact the Kentucky Chamber's Jessica Fletcher at 502-848-8731.

Oral health care for the poor in Kentucky suffers under managed care as dentists leave Medicaid; how about your county?

Kentucky's serious oral-health problems are getting worse because fewer dentists are participating in the Medicaid program -- a result of "new paperwork issues compounding Medicaid's reputation" for low payments to providers, Laura Ungar reports for The Courier-Journal.

Ungar's source for that is Dr. Raynor Mullins of the College of Dentistry at the University of Kentucky, who told her that only 700 to 800 of the state's nearly 2,500 dentists, about 30 percent, accept Medicaid patients.

That makes now seem like a good time for journalists to ask their local dentists if they accept Medicaid -- and if not, why not; and if so, whether they are considering dropping it.

Ungar notes that 28 of Kentucky's 120 counties are deemed not to have enough dentists to serve the local population. Most if not all of them are rural. You can find out which counties are under-served by physical, dental or mental health providers at this federal Health Resources and Services Administration website.

Weekly paper in Hazard says Beshear should expand Medicaid

Gov. Steve Beshear should expand the Medicaid program for the poor under federal health reform to improve the health and welfare of Kentuckians, The Hazard Herald said in its editorial this week.

"We’re tired of reading report after report listing the health of Kentucky’s people at the bottom nationally," the weekly newspaper said. "That is especially the case in Eastern Kentucky, where here in Perry County we ranked as the 119th unhealthiest county out of 120, according to a recent study. In fact, the vast majority of the bottom 20 counties are here in Eastern Kentucky. There are many dire needs in our region of the state, from jobs to education to better access to health care. Here is one instance where our government, which the people fund, can opt to very possibly improve the lives of its citizens."

The federal government would pay the costs of expanding Medicaid to people in households with incomes up to 138 percent of the poverty level from 2014 through 2016. The state would pay 3 percent in 2017, rising to 10 percent in 2020. The editorial noted critics' warnings about costs, and a study predicting that expansion would increase the state's total Medicaid costs only 6.3 percent. "But, in truth, this is simply a monetary argument from interests on both sides of the debate," the paper said. "We feel the greatest interest belongs to the people of Kentucky. We feel the greatest priority should be placed on improving the health and welfare of our people." (Read more)