Kentucky Spirit still plans to leave state July 5; judge rules that state can't require company to stay for two-month transition

In the latest development in the saga of the state Cabinet for Health and Family Services and Medicaid managed-care firm Kentucky Spirit, the company appears to be the victor, at least for now, because a Franklin circuit judge this week that the state can't require it to keep serving Medicaid beneficiaries two months beyond its July 5 exit. Cabinet officials have appealed the decision, saying that if the company darts out of the state without a two-month transition plan, it will “jeopardize the health” of 125,000 people.

A May ruling said Kentucky Spirit could face fines if it terminates its three-year contract before expiration in July 2014. The company appealed. On Wednesday, it said it intends to leave Kentucky July 5, just as it made clear last year. The state appealed Thursday, and unless the court's decision is reversed next week in the Kentucky Court of Appeals, Kentucky Spirit will be able to bolt out of Kentucky on July 5, despite the damages it may face, reports Tom Loftus of The Courier-Journal.

The state's appeal aims to keep the company in Kentucky until August to grant the cabinet enough time to switch the 125,000 people covered by Kentucky Spirit to the other two managed-care firms. Cabinet officials say this transition time is vital, especially for a more vulnerable population, because transferring Medicaid recipients to Coventry Cares or WellCare will take time.

“A sudden cessation of services by Kentucky Spirit would jeopardize the health of its approximately 125,000 members, particularly those who require uninterrupted treatment or care which their new MCO would be unable to coordinate without advance notice,” said the emergency motion filed by the cabinet on Thursday, reports Ryan Alessi of cn|2's "Pure Politics."

Kentucky Spirit says the state has refused to work with it to ensure an “effective” transition, and it's now the state's responsibility to do so. Franklin Circuit Judge Thomas Wingate, who no longer has jurisdiction on the matter since Kentucky Spirit appealed, said the state has “been repeatedly cautioned by this Court to prepare for this contingency, and a lack of preparation at this junction does not warrant a grant of the extraordinary remedy of injunctive relief” requested by the state.

Regardless of what happens, Medicaid beneficiaries assigned to Kentucky Spirit shouldn't worry because their coverage will be honored by providers, cabinet spokeswoman Jill Midkiff told Alessi. In an earlier report, Midkiff said providers may feel the blow of this disruption, but Medicaid beneficiaries won't. “There won’t be disruption of services to members,” Midkiff told Loftus, “But there will be a disruption ... confusion with providers and paperwork and who they bill.”

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing too much money covering the 125,000 Medicaid enrollees contracted to the company. Kentucky Spirit argues in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two managed-care companies in the state.

The school health services gamble: Ky. health departments could win on the state's bet against Kentucky Spirit's appeal of ruling

By Molly Burchett
Kentucky Health News

Kentucky’s health departments may soon get money for school nurses, based on a court ruling in May that said Medicaid managed-care firm Kentucky Spirit must pay for treatments provided by the nurses. The money wouldn't be coming from Kentucky Spirit, at least immediately, but from funds the state is withholding from the company, betting the payments on a court victory.

Circuit Judge Phillip Shepherd of Frankfort ruled in May that Kentucky Spirit must pay $8 million for services provided by school nurses, and the state has been withholding payment to the managed care company until it complies with the ruling, reports Ronnie Ellis, Frankfort correspondent for Community Newspaper Holdings Inc. On Monday, Shepherd told attorneys for the Cabinet for Health and Family Services and Kentucky Spirit that he is “inclined” to order the state to pay the health departments out of those withholdings.

The cabinet wants Kentucky Spirit to post bonds to cover the disputed payments during the company's appeal process. If the state made payments directly to the health departments, it would be gambling at its own risk, reports Ellis. If Kentucky Spirit wins its appeal of Shepherd’s earlier ruling, the state would have to refund the money, and the health departments would keep the payment.

This lawsuit originally came about when Kentucky Spirit stopped providing coverage for school health services last summer. The company said its state contract didn't require payment for such services, even though the state's Medicaid program has always paid for these services and other managed care companies were providing coverage for them. The court ruled that Kentucky Spirit must pay health departments, and the company appealed the decision.

Regardless of the source of funds, health departments and school districts could find some relief if payments are made because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for school services.

Shepherd will allow attorneys for the state to respond to the motion and hear arguments on July 25, Ellis reports.

Parents should walk the walk, not just talk the talk, when it comes to healthy eating and exercise, study shows

A new study highlights the influential role parents have in shaping their children's eating and exercise habits. Children of mothers who encourage them to exercise and eat well, while doing likewise themselves, are more likely to be active and healthy eaters, says a Duke University study.

Both exercise and healthy diets are critical in fighting childhood obesity, a significant problem in Kentucky, where more than one in four kids aged 2 to 5 are already overweight or obese, says a report by the College of Public Health at the University of Kentucky.

At the same time parents are setting a good example for their children, they can keep themselves healthy; being overweight or obese greatly increases the risk of developing chronic diseases like diabetes, arthritis, heart disease and cancer.

The Duke study is a reminder that parents are influential role models in shaping their children's habits, whether that's good or bad. "It’s hard for parents to change their behaviors, but not only is this important for you and your own health; it is also important for your children because you are a role model for them,” said Marissa Stroo, a co-investigator on the study. “This might be common sense, but now we have some evidence to support this.”

To promote healthy dietary and physical behaviors in children, a healthy home environment and parental role modeling are important, the researchers say. They recommend limiting access to junk foods, providing access to fruits and vegetables at home, setting parental policies to support family meals and increased consumption of healthy foods, and encouraging children to play outside to increase their physical activity.

“Obesity is a complex phenomenon, which is influenced by individual biological factors and behaviors,” said study author Dr. Truls Østbye, professor of community and family medicine at Duke. “But there are variations in obesity from one society to another and from one environment to another, so there is clearly something in the environment that strongly influences the obesity epidemic.”

These findings are important because they show that being overweight doesn't just come from your genes, and parents can be actively involved in improving the health and well-being of Kentucky's children. In this study, Østbye and his colleagues examined the relationship between the home environment and behaviors related to obesity, such as dietary and exercise habits, among 190 preschoolers. The study was published online in the International Journal of Obesity. (Read more)

Eye doctors warn about danger from fireworks, even sparklers; optometrists provide safety tips

The Fourth of July goes hand in glove with firework displays. Most families protect parents and children against the dangers of fireworks, but thousands still visit the emergency room every year, many with eye injuries.

According to a report from the U.S. Consumer Product Safety Commission, about 9,600 people were treated for injuries due to fireworks in U.S. emergency rooms during 2011; it says 17 percent of those injuries were to the eyes, and about 45 percent of those eye injuries involve children age 15 or under. Most eye injuries were bruises, cuts and other diagnoses that included foreign objects in the eye, and one in six fireworks-related eye injuries result in permanent vision loss or blindness, says the American Academy of Opthalmology.

“Celebrating the Fourth of July with fireworks is a great tradition, but safety needs to be the top priority,” Dr. Jon Shrewsbury, an optometrist in Beaver Dam, Ky., said in a Kentucky Optometric Association release.  “Children are especially vulnerable to injury from fireworks, particularly sparklers since they are handled at such close range.”

The innocent-looking sparkler can be very dangerous, especially to children, who are most likely to play with them. They heat up to 2,000 degrees or hotter, and are the primary cause of fireworks-related visits to emergency rooms. In addition to not allowing younger children to play with sparklers or fireworks and ensuring that older children are supervised by an adult when doing so, the KOA offers these tips to help protect and preserve eyesight during firework season:

· Discuss firework safety with children and teens prior to the Fourth of July holiday.
· Never leave them unsupervised near fireworks.
· Wear protective eyewear when lighting and handling fireworks of any kind.
· Store fireworks, matches and lighters in a secure place where children won’t find them.
· Be aware of your surroundings, and only light fireworks when family, friends and children are at a safe distance.

“If a firework-related eye injury does occur, always follow up with a full optometric eye exam,” Shrewsbury said. “An optometrist will help ensure that the injury heals correctly and will continue to monitor for future vision problems.” To find an optometrist in your area, click here.

Kids Count report shows where children in your county and school district rank, in a huge number of measures

Conditions have improved slightly for Kentucky children, especially in education and health, and the state's overall well-being ranking has gone up one spot, from 35th to 34th in the nation. But economic conditions for young Kentuckians have slipped since last year, says the Kids Count report released Monday by the Annie E. Casey Foundation.

The annual report measures how the country and its 50 states are doing according to four measures of child well-being – education, health, economic well-being, and family and community. How well Kentucky's children score in each domain paints a picture of Kentucky's future.

One of the many data sets available by county and school district

The report includes a wide range of data for every county and school district. The data include current and five-year rates of child poverty; median family income and median household income; infant mortality rate; child death rate; teen death rate; child abuse and neglect cases; foster care cases; births to mothers who are teenagers, who smoke, who are not high-school graduates, and who get early and regular prenatal care; pre-term births; low-weight births; newborns breastfed when they leave the hospital; early childhood obesity, number and percentage of child-support collections; asthma hospitalizations; recreational facilities; number and percentage of children receiving food stamps, Medicaid, child-care subsidies, Supplemental Security Income, and benefits from the Women, Infants and Children nutrition program; the number and percentage eligible for reduced-price meals at school; the number and percentage in publicly funded preschool; the hourly wage needed to pay fair-market rent and the percentage of renters unable to afford such rent; juvenile justice data; percentage of students ready for college and careers; and the six-year college graduation rate.

Statewide, the report shows that Kentucky has made gains in education, and the state ranks 28th on this measure. Since 2005, more children are attending preschool, more fourth-graders are proficient in reading and more eighth-graders are proficient in math, says the report.

Kentucky has also improved in many health measures. There are fewer low birth-weight babies, fewer children without health insurance and fewer teens who abuse alcohol or drugs. Medical coverage should only continue to improve as the state expands Medicaid coverage to households at 138 percent of the poverty line. However, youth advocates say gains in education and health may not be maintained if more children continue to live in poverty.

Unfortunately, Kentucky children continue to struggle economically, weighing in at 32nd in the nation. The report says 37 percent of Kentucky children have parents who lack stable employment, up from 33 percent last year, and 32 percent of children live in households that are burdened by housing costs, up from 27 percent.

The state's lowest ranking is 38th, on the family and community measure. Its constituents: More than 27 percent of children live below the poverty line, compared to the national average of 23 percent, and the number of children in single-parent families has increased from 31 percent in 2006 to 36 percent in 2011. On the bright side, teen births declined during that period.

With the hard work of child advocates, community agencies, educators and policymakers, the report shows progress has been made to improve children's well-being, but there is still much to be done. Click here for Kentucky's profile or here to go to the data center.

New York Times starts series that will study Affordable Care Act's implementation and impact in Louisville area

It's the calm before the health-care storm, and amid the uncertainty of how the health-care reform law will be implemented, health-care conditions in Louisville, Ky., seem to make it a good environment for a New York Times series that will study the process and its impact.

Reporter Abby Goodnough writes that Louisville, a city with four hospitals, a medical school and one of the nation's largest health insurers, "embodies both the triumphs and the shortcomings of the medical system in the United States." She notes that despite such resources, Kentucky continues to have dismal health outcomes, including some of the nation’s highest rates of smoking, prescription-drug abuse, and deaths due to cancer, diabetes and heart disease.

To watch the six-minute New York Times video, click here.

The health law is intended to address some of those shortcomings, and the potential health benefits to the state are huge. About 90,000 people could get Medicaid coverage in Louisville alone, and the law could also "create thousands of jobs in Kentucky and, if its aspirations are realized, provide better care at lower cost," notes Goodnough.

However, there are many concerns about the law's implementation among health-care providers and Americans in general, both insured and uninsured. Republican Sen. Mitch McConnell says the 2,700-page bill and more than 20,000 pages of regulation is "a massive bureaucracy" not understood by doctors, hospitals, states, small business and most Americans. Regardless, in January the law will require most Americans to have health insurance, or they or their employers will pay a penalty.

Providers and patients: Challenges to providing and receiving care on the front line

For providers, "This is a period of fevered preparation for the far-reaching changes," and many clinics, practices, and health systems are hiring coaches and consultants to meet the demands of the federal health care overhaul, writes Goodnough.

She focuses on the challenges ahead of one such coach, Danny DuBosque. He was hired by Family Health Centers, one of the many clinics and practices across the state that must prepare to treat thousands more newly insured individuals as a result of the law, while simultaneously converting paper charts to electronic medical records to avoid federal penalties. Many practices, particularly in Kentucky's rural areas, are already struggling to stay open, due partly to resources required for this conversion process and problems associated with Medicaid payments from managed care  companies.

Clinics like Family Health Centers, which provide services to patients regardless of their ability to pay, are at a front line of the health law's changes, writes Goodnough. They represent many obstacles now faced by primary-care providers in Kentucky: They serve Kentuckians who are often unhealthy and tend to put off preventive care; they earn less than most physicians; and they are worried about having the staff and money to treat newly insured patients.

Front-line providers like Alaina Brohm, a nurse practitioner in Louisville's West End, treat "a diverse and challenging population: the unemployed, the chronically depressed, the obese, patients with advanced diabetes and feeble hearts," reports Goodnough. She describes the heartfelt stories about patients trapped in the health care system and investigates anticipation of medical coverage from the patients' perspective. (Click here for more details.)

Brohm's patients are often unable to pay for necessary treatments and medications, and they have a hard time even finding transportation to the clinic. One such diabetic patient, identified only as Ms. Edwards, cannot afford medicine to control her blood sugar, and she is depressed by that and her lack of insurance, writes Goodnough. But she will qualify for Medicaid under expansion next year.

Yet, patients like Ms. Edwards and Mr. Elson, who is unable make health insurance premium payments because his diabetic condition led to a 400 percent cost increase, are still skeptical or fearful of the health care law, writes Goodnough. "I don't see it helping anybody, just making everybody get insurance," he told her. Family Health Centers' providers are worried too. Brohm told Goodnough she is concerned that poor, newly-eligible Kentuckians will be required to pay part of their medical costs and she knows of a business that may be sold because it cannot afford employee insurance. (Many businesses don't know about subsidies available for that.)

On the other hand, Gov. Steve Beshear's decision to expand Medicaid with the law is a historic, long-awaited one for Bill Wagner, director of Family Health Centers, reports Goodnough. It will allow about 308,000 Kentuckians to gain insurance coverage, which is almost half of the state's uninsured population, and it may solve the $3 million budget shortfall faced by the center, she writes. As a Federally Qualified Health Center, it has already received $5.4 million to expand its facilities.

Placing waterproof boots on the ground while Louisville prepares for the storm, Goodnough sets the stage for an interesting and highly complex view of the health law's impact that, rather than focusing on the political debate surrounding the health care law, tells tales of patients and providers in the eye of the storm of change. Stay tuned for more alerts.

Health care providers, employers and patients can click here to contribute to Goodnough's reporting by telling about expectations for the health law and their previous experiences with health care in the Louisville area.

Republican lawmaker says state should switch to block-grant system for Medicaid

Democratic Gov. Steve Beshear has argued that his expansion of Medicaid under federal health reform will improve Kentucky's health, but a freshman Republican legislator with experience in state health policy says a whole new approach would do much more for less money, providing funds that could be used to help Kentucky's mental-health agencies or to provide education, public protection and other services.

Rep. Robert Benvenuti

Rep. Robert Benvenuti of Lexington, former inspector general of the state Cabinet for Health and Family Services, told Ryan Alessi of cn|2 that the state could improve Medicaid with a block-grant system, which  could be implemented through a federal waiver. It would effectively end the open-ended approach to Medicaid, meaning that rather than paying a set amount per enrollee, states would be provided with annual lump sums and be free to run the program as they wanted, reports Kaiser Health News.

Republican governors have long lobbied for this flexibility, saying that it would result in a cheaper, more effective program, but the Democratic governor of New York, the independent governor of Rhode Island (who will run for re-election as a Democrat) and the Republican governor of Indiana have been granted waivers to implement a block-grant system, and their results suggest such system could improve Medicaid. Indiana used its waiver to introduce subsidized health savings accounts, which increased satisfaction rates for Medicaid enrollees to 94 percent by granting them more control over their own health dollars, reports Avik Roy of Forbes magazine, writing that Rhode Island saved $1.34 billion from 2008 to 2010, "an astounding figure for such a small state."

Benvenuti said Kentucky's current blanket-coverage system "doesn't provide any incentive with co-pays and deductibles to get the person with diabetes to be more careful about their weight, to manage their diabetic condition better. . . . The more we say we are simply going to blanket our commonwealth with Medicaid recipients, then the less we'll have to target what ultimate will be the solutions: education and true management of health."

A block-grant system provides flexibility to address Kentucky's specific needs, says Benvenuti. “You would then have money to say ‘In Kentucky, what are our health issues?’ And we could drive centers of excellence in cardiac care, in drug addiction and mental health much deeper into our commonwealth, much more at a grassroots level and provide that care,” he told Alessi. The cabinet declined to comment.

Throughout his career as a health-care attorney and work with numerous health systems, Benvenuti has focused on fraud and abuse as well as other operational and regulatory issues facing health-care providers. As the cabinet's inspector general, he led "investigations involving more than 3,000 health care facilities and services" across the state, says his website. Here's his interview with Alessi:

Kentucky and online audiences hear discussion of proposed system for patients to report medical errors; comments due July 8

By Molly Burchett
Kentucky Health News

The Obama administration is creating a new system for patients to report medical mistakes because existing systems fail to do so, and if all goes as planned, the pilot program will launch this fall, a federal official told a Health Watch USA meeting in Kentucky and online Wednesday night.

Research suggests that many adverse medical events go unreported in current systems that don't allow patients to provide input about their care, said James Battles, Ph.D., of the Agency for Healthcare Research and Quality. To fix this problem, AHRQ has funded the development of a prototype patient reporting system through a contract with RAND Corp.

Called the Consumer Reporting System for Patient Safety, the project is designed to collect information from patients "about medical errors that resulted or nearly resulted in harm or injury” and can also secure reports from family members, said Battles. The data will be available for use by providers and health systems that wish to create or enhance their own local reporting systems.

Here's how the system will work: When a patient recognizes a medical error, an intake form will ask what happened, including questions about the details of the event and the health care provider(s). Providers and patient safety officers are expected to follow up with the patient, which AHRQ estimates would add 28 hours to the provider's annual work load. The collected data will be analyzed to produce estimates about the patient safety events, which will be shared with health institutions.

There is concern about how the project findings will be used and that "frivolous" patient reports may lead to increased medical malpractice liability for providers. Despite apprehension that findings could possibly be linked to financial or legal penalties for poor performance, hospitals say they are receptive to the idea, Robert Pear of the New York Times reported last fall when project was first posted in the Federal Register.

"The question then would become, frivolous to whom?" Battles said when asked what he would say to concerned providers. Patient input is critical to gaining a full understanding of an adverse event, he said, and the overall project will include public awareness campaigns to let patients know their care experience is valued: "The purpose of the system is to improve patient safety, develop ways to prevent future harm and inform policy."

Patients, physicians, hospitals and other health care providers have until July 8 to comment on revisions to the government proposal, says the notice published in the Federal Register. (Click here for more information.) Battles said AHRQ has made substantial changes to the proposed reporting system's data collection tools, based on comments received last fall when the project was originally outlined.

After approval from the federal Office of Management and Budget, Battles said, a pilot program will be launched this fall near Philadelphia, then the system will be tested on a regional basis while considering reports from providers and patients.

Health Watch USA, based in Somerset, was founded by Dr. Kevin Kavanagh to promote health care transparency and patient advocacy, says its website. The organization's next meeting will be held July 31 at 5 p.m. and will feature Dr. Patrick Conway, chief medical officer for the federal Center for Medicare and Medicaid Services.

AMA calls obesity a disease; could spur coverage for treatment

The American Medical Association now recognizes obesity as a disease, which may make it easier for Kentuckians to fight the state's obesity epidemic by gaining insurance coverage for necessary medical treatment. Under the leadership of newly elected President Ardis Hoven of Lexington, the physicians' group voted to approve this new obesity policy June 18 during its annual meeting in Chicago. Click here to read the report by the AMA’s Council on Science and Public Health.

Kentucky ranks 10th highest in the U.S. for adult obesity, and the state's obesity rate is predicted to jump from 30 percent in 2011 to more than 60 percent in 2030. This year, $2.3 million is expected to be spent on medical costs linked to obesity, and that number is estimated to rise to $6 billion in 2018, says a report by the College of Public Health at the University of Kentucky.

Read more here: http://www.kentucky.com/2012/09/24/2349167/recent-report-on-kys-obese-future.html#storylink=cpy

Being overweight or obese greatly increases the risk of developing other chronic diseases like diabetes, stroke, arthritis, sleep apnea, asthma, heart attack and certain cancers or other complications like asthma, joint problems and psychological issues, says the report. Kentucky children also suffer from high rates of obesity, and if the current trend continues, one in every three American children will develop Type 2 diabetes.

"Recognizing obesity as a disease will help change the way the medical community tackles this complex issue," AMA board member Dr. Patrice Harris said in a statement. Although Medicare and Medicaid do cover obesity treatment associated with another disease or disorder, they do not cover interventions and counseling about lifestyle changes necessary to fight obesity. The AMA declaration could lead to coverage and help increase funding for obesity research, reports Jacque Wilson of CNN. With the AMA now calling obesity a disease, "insurers can stop ducking their responsibility" in paying for obesity treatments, Dr. Virginia Hall, an obstetrician from Hershey, Pa., said in a Forbes magazine report by Bruce Japsen.

Also, identifying obesity as a disease help reduce the stigma often associated with being overweight, Joe Nadglowski, president of the Obesity Action Coalition, told Wilson. "Obesity has been considered for a long time to be a failure of personal responsibility -- a simple problem of eating too much and exercising too little," he said. "But it's a complex disease. . . . We're hoping attitudes will change."

Mayors and AMA say food stamps shouldn't pay for soft drinks

Louisville's Greg Fischer is among 18 mayors asking Congress to ban sugary drinks from purchase under the Supplemental Nutrition Assistance Program, commonly called food stamps.  One day after their June 18 letter, the American Medical Association adopted a policy supporting the removal of sugar-sweetened drinks from SNAP.

In a the letter sent to congressional leaders, the mayors said it is "time to test and evaluate approaches limiting" the use of the subsidies for sugar-laden beverages to fight obesity and diseases linked to obesity, reports Jennifer Peltz of The Associated Press.

At its annual meeting, the AMA took several steps toward controlling the country's increasing obesity problem, including calling obesity a disease, an action that may prompt insurers to cover medical treatments aimed against obesity. “The AMA is working to improve the nation’s health care outcomes, particularly cardiovascular disease and diabetes, which are often linked to obesity,” said AMA President Dr. Ardis Hoven of Lexington. “Removing sugar-sweetened beverages from the Supplemental Nutrition Assistance Program will help encourage healthier beverage choices.”

This isn't the first attempt to ban soda from SNAP. The Department of Agriculture, where the program is housed, turned down such a request from New York City's Mayor Michael Bloomberg in 2010. The city had proposed a two-year experiment to see if a sugary beverage ban would reduce obesity among food-stamp recipients. But, the department rejected the plan and said a soda ban would “perpetuate the myth” that food stamp users make poor shopping decisions, The New York Times reported. Read about Kentucky's SNAP program here.

The soda lobby, the American Beverage Association, said sugary drinks shouldn't be singled out as a cause of obesity. It called obesity "a complex health condition that affects Americans of all income levels." Last year, more than 47 million low-income Americans used food stamps.

Read more here: http://www.kentucky.com/2013/06/18/2683656/18-mayors-limit-use-of-food-stamps.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/06/18/2683656/18-mayors-limit-use-of-food-stamps.html#storylink=cpy

U.S. adult smoking rate dips to 18 percent; when state rates come out, will Kentucky still have the country's highest?

CDC chart; confidence interval (or error margin) means that
 95 percent of the time, the result for the entire U.S. population
would be within the range indicated at the tops of the bars.

The smoking rate for U.S. adults dropped to 18 percent last year, continuing a steady decline since 2009, when it was 20.6 percent, says an early release report of the 2012 National Health Interview Survey by the federal Centers for Disease Control and Prevention.

While state numbers will be released later, Kentucky's 2011 smoking rate was 29 percent, higher than any other state, says the CDC's Tobacco Control State Highlights 2012 report. (For county-by-county figures, click here.) State leaders and other observers have cited the high rate as the largest single reason for the state's health problems.

A recent editorial in the Kentucky New Era of Hopkinsville, a tobacco town that recently enacted a smoking ban, says this about the state's smoking statistics: "Medical expenses related to smoking are $1.5 billion annually and smoking is the cause of approximately 7,800 deaths each year."

The editorial says the state's tobacco use hurts its economy and quality of life. In addition to health-care costs, smoking-caused productivity losses in Kentucky total $2.3 billion a year. These amounts do not include health costs caused by exposure to secondhand smoke or other tobacco use, and does not include the money spent to purchase cigarettes.

"At the very least, Kentucky’s political, health and business leaders should know the rates of smoking and what it costs the state in medical care and diminished earning potential," says the editorial.

Dr. Stephanie Mayfield, commissioner for Kentucky's Department of Public Health, recently told a legislative committee that a typical smoker in the state spent $2,237 last year on cigarettes, says the editorial. And, despite Kentucky’s continuous efforts to discourage youth smoking, about 6,100 minors begin smoking each year, reports The Associated Press.

Overall, the U.S. survey found smoking rates were lower among adults ages 65 and over (8.9 percent) than among those ages 45 to 64 (19.5 percent) and those ages 18 to 44 (20.3 percent). Additionally, the percentage of current smokers was higher for men (20.4 percent) than for women (15.8 percent). The report doesn't include smoking rates for children. Click here to read about all CDC early-release measures.

Lexington internist, Dr. Ardis Hoven, becomes president of the AMA, the nation's largest physician organization

Ardis Dee Hoven, M.D., an internal medicine and infectious disease specialist in Lexington, was installed as president of the American Medical Association at its annual meeting Tuesday night in Chicago. The AMA is the nation's largest physician organization.

Dr. Hoven is a graduate of the University of Kentucky medical school, and she has served in numerous leadership position for the AMA, including her first presidential term in 1993-94. Hoven has also served at the UK’s Bluegrass Care Clinic, which treats infectious diseases including HIV/AIDS, reports Business Lexington.

The AMA is headquartered in Chicago, and since 1847 it has aimed "to promote the art and science of medicine and the betterment of public health," says its website. Furthermore, the organization's strategic focus is aligned with many of the health care issues now facing Kentucky, which are improving health outcomes, accelerating change in medical education and enhancing the sustainability of medical practice.

As Medicaid eligibility expands in Kentucky, so will subsidy of undocumented immigrants' health care

As Washington lawmakers struggle to find consensus on immigration reform, U.S. taxpayers continue to shell out money to subsidize health care for illegal, undocumented immigrants. Those expenses will probably increase, with the full effect of the Affordable Care Act and Medicaid expansion in Kentucky.

Although rarely talked about, There is an "emergency Medicaid" that reimburses a hospital for emergency care to an immigrant who is in the country illegally, reports Sandhya Somashekhar of The Washington Post. The program defines "emergency" a "sudden-onset conditions that threaten life or could cause serious impairment." It reimburses hospitals for emergency and maternity care given to people who, based on their income and other factors, would be eligible for regular Medicaid if they were legal citizens.

So, if an undocumented immigrant meets Kentucky's requirements for Medicaid, which will soon be expanded to 138 percent of the federal poverty line, he or she qualifies for the emergency program.

In 2011 alone, the federal government paid out $1.3 billion under the program, reports Somashekhar. A large percentage of those illegal immigrants receiving care are pregnant women, and so the care that's being provided is labor and delivery for children that will become U.S. citizens. "From the perspective of our health-care system, when people show up and they’re sick, the health-care system is obligated to take care of them,” Diane Rowland, executive vice president for the nonpartisan Kaiser Family Foundation, told Somashekhar.

Kentucky Spirit appeals court ruling that it can't quit Kentucky early

By Molly Burchett
Kentucky Health News

Centene Corp. announced Monday that it has appealed the Franklin Circuit Court ruling in May that said its managed care subsidiary, Kentucky Spirit, cannot terminate its contract with the state a year early. The company said it plans to be out of the state by September. Click here to view the appeal.

This move represents the continuation of a long, tumultuous relationship between Kentucky's Cabinet for Health and Family Services and Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients.

First, Kentucky Spirit announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, and the company also filed a formal dispute with the cabinet for damages incurred under the contract. Centene said in its annual report that Medicaid beneficiaries were retroactively assigned to the plan and non-inpatient claims receipts were higher than anticipated, leading to a $38.8 million loss in the second quarter of 2012.

"Since the inception of the contract, we have been in discussions with the cabinet about our concerns with the Medicaid managed care program but have been unable to resolve our differences," Jesse Hunter, Centene’s executive vice president of operations, told St. Louis Business Journal in October of last year. In response CHFS Secretary Audrey Haynes said, “I am deeply frustrated that this publicly traded, Fortune 500 company has chosen to put profits above people and will not honor the terms of its contract."

Next, Franklin Circuit Judge Thomas Wingate ruled that the company could face fines if it terminates its three-year contract before expiration in July 2014, and Centene said it would consider an appeal. Now, as Michael Neirdorff told investors on Monday, Centene is appealing that decision, reports Samantha Liss of St. Louis Business Journal.

“After a few months of operations, it became clear that our financial performance was much different than our projections based upon the data provided by the Commonwealth during the bid process. Our analysis concluded that inaccurate and incomplete data led to actuarially unsound rates for our health plan,” said Nerdorff at Monday's Investor Day event.

All managed-care companies received the same information, and Centene made the lowest bid. Kentucky originally signed a three-year contract with Centene in the summer of 2011, and the company was estimated to service about 180,000 Medicaid beneficiaries, generating an annual revenue of $700 million. Instead, it serves 140,000 recipients and lost $38.8 in one quarter.

However, Centene's $38.8 million quarterly loss in 2012 came alongside $2.2 billion in revenue, and the company's publicly-traded shares surged 11 percent after it announced that it was leaving the state. In April of this year, Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Study shows a 15-minute, moderate-speed walk a half-hour after eating can control older folks' spikes in blood sugar

It's no news that walking is good for your health or for preventing diabetes, but a new study published in Diabetes Care says a 15-minute, moderate-speed walk about 30 minutes after eating, which is when blood sugar spikes, is most beneficial for older individuals needing to control blood-sugar levels.

As you age, the process in which insulin converts sugar and glucose from your food into muscle cells, and the liver where it's stored for energy, doesn't work as well as it did when you were younger. Leaving too much glucose in the blood can lead to Type 2 diabetes and cardiovascular damage.

Exercise has long been known to helps prevent these effects. And while many individuals may not be able to get the recommended 45 minutes of exercise most days of the week, the study shows how you can be smart and get the most out of your exercising time. Compared to 45-minute walks in the morning and afternoon, the study says that only the 15-minute, post-meal walks managed to significantly reduce blood sugar spikes during the important three-hour post-meal window, reports Brian Alexander of NBC News.

This is the first controlled experiments of its kind and could be useful for pregnant women at risk for gestational diabetes who may not be able to exercise for 45 minutes,” the study’s leader, Loretta DiPietro of the Department of Exercise Science at The George Washington University, told NBC.

“This is not for weight loss, and it’s not going to increase your cardiovascular fitness very much,” DiPietro said. “It’s very specifically for glycemic control with older age.” But the study's findings benefit everyone because we all experience glucose spikes after eating, said DiPietro.

Remember to take precautions when walking at night, especially considering less than half of Kentucky adults live in communities with elements such as sidewalks or shoulders that allow for safe walking or bicycling.

Free HIV testing available from health departments and community-based health groups in June; key to AIDS prevention

In honor of National HIV Testing Day on June 27, community-based organizations and local health departments are hosting free HIV testing throughout the month of June. HIV is an infection that can lead to AIDS, and early screening and detection of HIV are critical to fighting the disease, avoiding further health complications and ensuring it isn't unknowingly transmitted to others.

“Routine testing ensures HIV-positive individuals are made aware of their status early before the disease progresses to AIDS,” said Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, which is promoting the HIV testing and awareness events through mini-grants. “Testing remains one of the most critical and effective strategies for preventing transmission, ensuring good health outcomes, keeping service costs low and keeping infected individuals healthy.”

About 20 percent of people with HIV don't even know they are infected, which is very problematic because these individuals are believed to transmit HIV to more than half of the people who become newly infected each year, and one-third of the people is diagnosed so late that they develop AIDS within one year, says the federal Centers for Disease Control and Prevention.

In 2010, 32 percent of Kentucky's 7,751 HIV cases led to an AIDS diagnosis within 30 days of the initial infection, says a Cabinet for Health and Family Services release. This highlights the importance of routine testing, which the CDC recommends for everyone, regardless of risk factors, especially for all people age 13 to 64.

"A delay in diagnosing HIV is a life and death issue, with many individuals receiving a concurrent diagnosis of HIV/AIDS upon initial testing. Early intervention and linkage to care is critical to enhance the quality of life and reduce costs for treatment,” said Gayle Yocum, HIV/AIDS prevention section supervisor, in the CHFS release.

In Kentucky, HIV disproportionately affects racial minorities, particularly the African-American and Hispanic populations. Although African-Americans represent 7 percent of the state’s population, they account for 34 percent (2,884) of new HIV infections. Individuals who are at a higher risk for infection should be tested at least annually, including those with multiple sex partners, injection drug-users and their sex partners, people who exchange sex for money or drugs, men who have sex with men and sex partners of someone with HIV, says the CDC.

Kentucky testing sites

The Department of Public Health's statewide network of HIV testing sites provide risk reduction counseling and helps individuals develop a behavior-change plan to reduce the risk of getting or spreading HIV. Here's a list of the statewide events providing free HIV rapid testing in the next two weeks:

◾ June 17, free testing and education, 10:30 a.m. to 2 p.m., Salvation Army of Bowling Green, 400 W. Main Ave., Bowling Green.
◾ June 20, afternoon gospel fest, noon to 5 p.m., New Beginnings Church, 4127 Flintlock Drive, Louisville.
◾ June 22, church health fair, 10 a.m. to 5 p.m., Faith Fellowship, 727 S. 15th Street, Louisville.
◾ June 25, free testing, 11 a.m. to 3 p.m., 2106 St. Louis Ave., Louisville.
◾ June 28, free testing and education, 10 a.m. to 3 p.m., Housing Authority of Bowling Green, 247 Double Springs Road, Bowling Green.
◾ June 28, neighborhood test fest, 10 a.m. to 4 p.m., Nia Center, 2900 W. Broadway, Louisville.
◾ June 29, free testing, 11 a.m. to 1 p.m., Walgreens, 110 Town Center Dr., Lexington.
◾ June 29, free testing, 11 a.m. to 1 p.m., Crossings, 117 N. Limestone, Lexington.
◾ July 3, free testing, 8 p.m. to midnight, The Bar Complex, 224 E. Main Street, Lexington.

Click here for more information about HIV and AIDS, about the National HIV Testing Day/Month Campaign or other programs and services.

Foundation breaks down poll by region to show differences among Kentuckians' views on health topics and issues

The Foundation for a Healthy Kentucky has released regional breakdowns of the Kentucky Health Issues Poll, conducted for it and the Health Foundation of Greater Cincinnati last fall. Each breakdown outlines respondents’ answers to various KHIP questions and then compares regional responses to statewide findings.

Statewide KHIP results showed that most Kentucky adults do not have dental insurance, view health-care costs as a financial burden, favor a statewide smoke-free law, support integration of mental-health and medical services, and say they need more information about how the Patient Protection and Affordable Care Act will impact them personally. The Foundation for a Healthy Kentucky offered these snippets from the regional breakdowns, available by clicking each link:

Western Kentucky: Residents were less likely to have dental insurance and less likely to know someone who had experienced problems as a result of abusing prescription pain relievers.

Greater Louisville: Adults were more likely to have dental insurance, support the legalization of marijuana under any circumstance and be concerned with air quality.

Greater Lexington: Adults were less likely to have been prescribed a pain reliever that could not be purchased over the counter and less likely to change or limit their activities when they hear of an air quality alert being issued.

Northern Kentucky: Adults were less likely to have visited a dentist in the past year and less likely to have a favorable view of the Patient and Affordable Care Act.

Eastern Kentucky: Adults were more likely to rely on home remedies or over the counter drugs instead of going to the doctor and recognize that drug poisonings/overdoses were the leading cause of unintentional death in Kentucky.

“Local health issue data can be extremely useful for policymakers and health officials, especially those working on local initiatives to improve the health of their community,” said Susan Zepeda, president and CEO of the foundation.

The poll was conducted Sept. 20 through 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.  The poll has a margin of error of plus or 5.3 percentage points. The poll is available online, under the “Data and Reports” tab on the foundation's website.

Working with a local, regional or state health coalition? A simple step can help make healthy changes in Kentucky

The Foundation for a Healthy Kentucky is asking you to help update last year's Kentucky Health Coalitions Directory, a list of local groups working to better Kentucky's health, so that additional coalitions can be identified and groups can work together toward their shared goal of bettering the state.

“These are local residents working on solutions to health issues in their cities and towns,” said Susan Zepeda, CEO and president of the foundation. “These groups have differing levels of organization and are pursuing various goals. The Coalitions Directory is a resource for them and allows them to connect with other groups working to make their community a healthier place to live, work, and play.”

Now, across the state's 120 counties, there are 143 coalitions with varying health interests: some are increasing access to healthy food and physical activity, others focus on education about risk-factors for serious health problems like diabetes and other chronic diseases and others are improving working conditions through smoke-free ordinances.

All groups are working to positively change Kentucky's health, and an updated directory will help the foundation raise awareness of the coalitions' local efforts, foster collaboration, build local capacity and provide assistance to groups. Follow this link to submit new or revised information to the Coalitions Directory.

Doctor shortage news: Residencies are filling the pond with primary care doctors, but U.S. and Ky. need an ocean of them

Despite a critical shortage of primary care in the country, only 25 percent of newly educated doctors go into this field, and even worse for the mostly-rural Kentucky, less than 5 percent go on to practice in rural areas, says a study by researchers at the George Washington University School of Public Health and Health Services (SPHHS).

The report, which was just released in the “Published Ahead-of-Print” section in Academic Medicine,  suggests that not only are we facing a primary care shortage, but also that the problem is not likely to be solved soon. There's been a lot of talk about the need to get primary care doctors to practice in Kentucky, specifically in the state's rural areas, without mention of the underlying issue that the study makes clear: there are not even close to enough doctors being trained as primary care physicians in the first place.

In addition to finding that just 4.8 percent of the graduate medical education system practiced in rural areas, 198 institutions (26 percent) produced no rural physicians and 283 institutions (37 percent) produced no Federally Qualified Health Center or Rural Health Clinic physicians, which were created to enhance the provision of primary care services in underserved communities.

“If residency programs do not ramp up the training of these physicians the shortage in primary care, especially in remote areas, will get worse,” said lead study author Dr. Candice Chen, a professor at SPHHS. “The study’s findings raise questions about whether federally funded graduate medical education institutions are meeting the nation’s need for more primary care physicians.”

Currently, the U.S. is producing primary care physicians at rates that are “abysmally low” and unless changes are made to the system, the nation will have an even greater shortfall of primary care doctors just as the Affordable Care Act ramps up demand for these services, said Chen in a Newswise release. And in Kentucky, the additional need for primary care doctors as a result Medicaid expansion is piled onto the heap of issues.

The study's authors said policymakers should take a hard look at the skewed incentives and other factors that have led to the current primary care crisis and develop a more accountable graduate medical education system. It is critical to find a better balance in medical specialties and more primary care physicians to build an effective, affordable health system.

Covington schools show 'Fitness Rocks' by lowering body mass, lifting the bars of nutrition, wellness and academic achievement

Sparks are flying in Covington Independent Schools. The schools' Fitness Rocks program, which combines fitness and wellness activities in an after-school program four or five days a week to create a healthier community for students, is the reported cause of fire.

The district's after-school student activities are based on the SPARK (Sports, Play and Active Recreation for Kids) curriculum for out-of-school-time, and the district reports great success since the program launched three years ago.

Since then, students' body mass has shrunk 4 percent, and there has been a 6 percent increase in the number of students who engage in at least an hour of daily physical activity and the number of students eating fruits two or more times a day, and vegetables three or more times a day, reports Julie Wohlleb of the Kentucky School Boards Association.

Students in Fitness Rocks also saw a greater increase in their math and science MAP (Measure of Academic Progress) scores than students not participating. “It’s been demonstrated how students who are active 60 minutes or more a day have increased academic success,” Haggard told Wohlleb.  

The program is also being used for professional development for physical education teachers, and "The SPARK curriculum has been really helpful in giving our fitness coaches and PE teachers ways to get all kids engaged no matter their skill level,” Haggard told Wohlleb.

The district started Fitness Rocks three years ago at each of its seven schools through a Carol M. White Physical Education grant from the U. S. Department of Education. The program encourages a range of activities to keep students active, from playing flag football to video games, and so far, 55 percent of elementary students and 19 percent of high school students across the district have participated in the program this year.

In addition to after-school activities, Fitness Rocks provides healthy snacks and sponsors family nights at every school that focus on fitness, wellness and nutrition, and program coordinators are witnessing changes in health behaviors across the district. “We’ve been really working hard, especially this year, at finding a sustainability model because it has been so impactful for the community and parents and students alike; they just love it,” Haggard said. (Read more)

Leaders in Mayfield, a town with a rich tobacco heritage, approve smoking ban

UPDATE, July 9: The ban passed 5-4 on second reading. It will take effect in 2014 and "excludes spaces used primarily for sleeping such as hotels, hospices or nursing homes, rooms designated for social functions and separate smoke-proof enclosures with a heating and air conditioning system," WPSD-TV reports.

In a Western Kentucky county speckled with tobacco farms, the only sizeable town may extinguish smoking in public, enclosed spaces. By a 6-4 vote this week, the Mayfield City Council approved first reading of a smoke-free ordinance that would punish violators with fines.

The ordinance has to pass a second reading on July 8 to go into full effect. Mayor Teresa Cantrell said she wants to add her city to the list of cities with bans, even though she would not have agreed with a ban in the past, reports Jason Hibbs of WPSD-TV in Paducah.

"What has changed my mind is the realization of the public-health hazard and mainly as it pertains to the workers in the restaurants," Cantrell said. Many residents think the smoking ban is long overdue, despite Graves County's rich tobacco heritage.

"I have a little one and I don't want her to be around smoking if she doesn't have to be," restaurant customer Britanee Handley told Hibbs. Handlee doesn't smoke, avoids smoky places for her baby's sake and can't wait to see all the ashtrays in the town disappear, reports Hibbs. 

Cantrell told Hibbs that she visited three Mayfield restaurants during lunch hour and their smoking sections were completely empty, and one restaurant manager discussed removing the smoking section from his restaurant because most customers don't want to smoke.

Council members who voted against the ban said business owners should be able to decide smoking policy on their own, reports The Paducah Sun.

Cantrell told Hibbs said the Mayfield ordinance is modeled after a well-received ordinance passed in Paducah in 2006. It requires ashtrays to be stowed away and prohibits smoking within 15 feet of public places, but it does grant exceptions for hotels, nursing homes, rooms designated for private social functions, tobacco retailers and designated indoor smoking areas.

If the ban is passed in July, violators of the ordinance will be assessed a $50 fine for a first violation, $100 for a second and $250 for a third, and after that could face a restraining order or permanent injunction. To read the proposed ordinance, click here.

UK Board of Trustees OKs $31 million plan to outfit another floor of new hospital with eye toward federal certification for heart work

The University of Kentucky Board of Trustees has given UK HealthCare the green light for its $31 million plan to outfit the eighth floor of Pavilion A at UK Chandler Hospital over the next few months to make room for a growing cardiovascular program and to clear the way for a federal "Center of Excellence" certification.

After the project is complete, the floor will hold 64 beds, including 24 intensive-care beds for the cardiovascular program that offers heart transplantation, artificial hearts and ventricular devices, reflecting UK's focus on receiving the federal certification.

In the near future, such a designation will be necessary to get enough referrals from doctors and smaller hospitals to maintain important services, including cardiovascular services, and to guarantee that Kentuckians can get the care they need inside the state, Dr. Michael Karpf, executive vice president for health affairs, said in an interview with Kentucky Health News this spring.

Karpf and other UK HealthCare officials are also recommending a $30 million cost-reduction program for their system because Medicare and Medicaid reimbursements are expected to decline as competition stiffens over the next few years, reports Linda Blackford of the Lexington Herald-Leader.

In response to these forces, UK has a goal to secure half the available business from out-of-state competitive areas over the next 10 years to remain viable in a highly competitive market. And, focusing on complex care should drive revenue for the hospital because UK makes money on the complex stuff, Karpf told KHN.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cpy

The $592 million, 12-floor patient tower has remained half-empty since 2010, and when the estimated $530 million project to fully occupy the tower is added to the initial cost of constructing Pavilion A, the total price tag will top $1 billion over 20 years, reports Blackford.

The overall construction and expansion is expected to support patient care for the next 100 years, says a recent UK press release. Once it's fully occupied, the the 1.2 million-square-foot facility will include 512 private patient rooms.

Read more here: http://www.kentucky.com/2013/06/10/2673382/uk-healthcare-using-30-million.html#storylink=cp

Floyd County newspaper editor calls on readers to make lifestyle changes to address area's diabetes health crisis

The editor of an Eastern Kentucky newspaper has joined an advocacy group's call for residents in his county to make simple, healthy lifestyle changes, serving as an example of how local newspapers and community members can engage the public to confront poor health status of the area, which is often put on the back-burner despite alarming warning signs.

Recently, the Tri-County Diabetes Partnership declared the rate of diabetes in Floyd, Johnson and Magoffin counties (map) "a crisis of epidemic proportions." The rate in 2002-10, the latest available, was 14 percent.

If the federal Centers for Disease Control and Prevention "saw a similar increase in any other illness, they would probably declare a national emergency,” said J.D. Miller, vice president of medical affairs for Appalachian Regional Healthcare, who chaired the meeting.

The group's statement was an appropriate response to direct public's attention to the imperative of addressing the area's skyrocketing rate of the disease, Ralph Davis of The Floyd County Times wrote in an editorial.

Diabetes will remain a crisis unless we do something about it, said Davis, and "if you have been waiting for a crisis before making healthy lifestyle changes, we’ve got one for you. In fact, we have several," Davis said.

The Central Appalachian region suffers from disproportionate rates of diabetes, cancer and heart disease, and Floyd, Magoffin and Johnson counties have much higher rates of obesity than state and national averages, Davis notes. Floyd County ranks last among the state’s 120 counties in overall health measures, and Johnson and Magoffin counties are ranked 108th and 104th, respectively.

To do something about this problem, Davis calls for concentrated attention by health care providers and government officials, but the problem won't be solved without action from the community and individuals, he says. Simple, healthy lifestyle changes are needed.

"It’s going to require the conscious decision by everyone in the region to do what they can to improve their diet and exercise habits, and to encourage their friends and family to do the same," said Davis.

Calls like Davis's are needed even more in most of the counties that surround the three counties, based on data from the CDC's Behavioral Risk Surveillance System. The counties in dark blue had rates above 14 percent; the highest was Greenup, at 17 percent.

Veteran journalist offers advice on covering mental health issues: Be careful, creative, and balanced, not discriminatory

The term 'mental health' has been tossed around a lot lately in stories about Kentucky's mental health funding and mental health coverage through Medicaid expansion. It's important to use precise language when writing about the topic, because a fourth of Americans are affected by mental-health issues each year, and many  don't seek treatment due to its stigma.

"Fair, accurate and balanced portrayals of mental health in the news media are so important," says Melissa McCoy of the California Newspaper Publishers Association. She notes that studies show coverage of mental health is mostly reactive, responding to a school shooting or n act of violence, which could skew public perceptions about mental illness. She says journalists should "provide accurate coverage of mental health without adding to its stigma" or to the discrimination faced by those with mental illness.

Journalists can seek balance by asking themselves about the relevance of mental health to the story and making sure to use the right type of language, says McCoy; be creative about mental health coverage by integrating it into stories about general health, veterans returning from war, substance abuse recovery, unemployment or even stress among students. 

Pike County settles its part of Oxycontin lawsuit against Purdue Pharma for $4 million; state remains a plaintiff

Officials of Pike County, Kentucky, announced this week that Purdue Pharma, the maker of OxyContin, will pay $4 million to settle the county's part of a lawsuit the county and state filed in 2007 seeking damages for the addiction OxyContin caused "after the company aggressively marketed it to doctors as a safe option for pain relief," Russ Cassady reports for the Appalachian News-Express in Pikeville.

The state remains a plaintiff in the suit, which  is largely based on admissions of guilt made by the company and several top-ranking company officials in a May 2007 Virginia federal court settlement. Purdue Pharma, its president, chief legal counsel and former medical director pleaded guilty to misleading doctors, regulators and patients about OxyContin during that case.

The nation's prescription-drug epidemic apparently began in Central Appalachia, largely because of the introduction and high rate of prescription of OxyContin. The lawsuit sought reimbursement for drug-abuse programs, law-enforcement actions and prescription payments through Medicaid and the Kentucky Pharmaceutical Alliance Program. The local officials indicated the settlement could increase the size of a planned rehabilitation facility for people convicted of drug charges.

Rural cancer survivors are less healthy than urban counterparts; 25 percent of rural cancer survivors smoke

A quarter of rural cancer survivors smoke.

Cancer survivors from rural areas live less healthier lives than survivors from urban areas. That's the diagnosis of a study by the Wake Forest Baptist Medical Center in Winston-Salem, N.C., which asked a random sample of rural and urban survivors their body weight, and if they smoked, drank alcohol, and exercised.

The study found that 25 percent of rural cancer survivors smoked, compared to 16 percent from urban areas. It didn't have state-by-state figures, but Kentucky has high rates of both cancer and smoking.

Fifty-one percent of rural survivors didn't participate in any physical activities at all, compared to 39 percent for urban survivors, and 66 percent of rural survivors were obese, while 63 percent of urban ones were. Fewer rural survivors drank alcohol, a difference of 46 percent to 59 percent, and 18 percent of them were more likely to be unemployed because of health reasons, compared to 11 percent for urban survivors.

"Rural cancer survivors may not be receiving messages from their health-care providers about how important quitting smoking and being physical active are after cancer," said Kathryn E. Weaver, assistant professor of social sciences and health policy at Wake Forest Baptist. "It is concerning that we found higher rates of health-compromising behaviors among rural survivors, when we know cancer survivors who smoke, are overweight, or are inactive are at higher risk for poor outcomes, including cancer recurrence and second cancers." (Read more)

Fewer families report having trouble paying medical bills; near-poor struggle more than poor families

Fewer American families are having problems paying medical bills, but 20 percent of them, particularly those without insurance and those that are "near poor" but not :poor," still struggle with health costs, says a study released Tuesday by the National Center for Health Statistics.

The report says 54.2 million people, or 20.3 percent of families headed by someone under the age of 65, had difficulty covering medical expenses in the first half of 2012. During the first half of 2011, 21.7 percent of families, or 57.8 million people, found it difficult to pay medical bills.

Hispanics (25.2 percent) and blacks (27.9 percent) were more likely than whites (20.1 percent) or Asians (10.3 percent) to report trouble paying their medical bills, says the report. It says families with incomes from 100 to 199 percent of the poverty line were most likely to have difficulty paying medical bills, probably because those below the poverty line qualify for Medicaid. State income limits vary; in Kentucky, income-based Medicaid is available to those with incomes less than 70 percent of the poverty line.

'Poor' are below the poverty line. 'Near poor' had incomes of 100 to 199 percent of the poverty line. 

Among families with insurance, 14 percent of those with private insurance and 25.6 percent  with Medicaid or other public insurance had similar problems paying bills in the first half of 2012, which represents a 1.7 percent and 2.5 percent decrease from 2011, respectively. For a report on the study, click here.

Study finds that daily use of sunscreen prevents aging of skin

Sunscreen doesn't just prevent sun burns and skin cancer; using it daily can slow down your skin's aging too, says a study published in the Annals of Internal Medicine. 

Australian researchers found that when adults regularly used broad-spectrum sunscreen, they were less likely to show increased wrinkling over a four-and-a-half-year period compared to adults who used sunscreen every once and a while, reports Barbara Mantel of NBC News.

This is the first study showing that sunscreen prevents skin aging, and the results show year-round use of sunscreen significantly slows the aging of skin caused by the sun's ultraviolet rays, Dr. Adele Green of Royal Brisbane Hospital in Queensland told the Gupta Guide.

"Previous research has shown that skin aging is associated with an increased risk of actinic keratoses and melanoma, and now we have the first randomized trial to show that sunscreen retards skin aging," Green said.

The sunscreen used in the study had a SPF of 15, which blocks about 94 percent of ultraviolet B rays. Stronger preparations have only a small additional effect; one with an SPF of 40 filters about 97.5 percent, Green told Mantel.

"The more important issue is applying the sunscreen well and reapplying it often," and you should make sure that sunscreen is broad spectrum, he said. The study also found that daily beta-carotene supplementation had no effect on skin aging.

The study shows that just 15 minutes of sun on any part of your body can age the skin, and it is never too late to start using sunscreen, said Dr. Nancy Snyderman of NBC News. Even in middle age, if you start using sunscreen, you can role back the aging of your skin, she said. Here's NBC's video clip:

UK joins Eastern Ky. Healthcare Coalition, giving it five hospitals

The University of Kentucky and St. Mary’s Medical Center in Huntington, W.Va., are joining the Eastern Kentucky Healthcare Coalition, originally comprising Highlands Regional Medical Center of Prestonsburg, Our Lady of Bellefonte Hospital of Ashland and St. Claire Regional Medical Center of Morhead.

“UK HealthCare and St. Mary’s will make excellent additions to the coalition’s efforts to develop a clinically integrated network of providers to enhance the health status of our communities,”  coalition Executive Director Jim Fuzy said in a UK press release.

Although each medical center remains autonomous, the coalition promotes integration Dr. Michael Karpfto help coordinate for collective efficiencies, adapt to health reform, deal with vendor contracts and have combined health events, while increasing patient access to quality care, said the release.

"As Kentucky’s largest academic medical center, focused on providing advanced sub-specialty patient care, we at UK HealthCare are committed to improving the health of the people of Eastern Kentucky and through our collaboration with other members of the Eastern Kentucky Healthcare Coalition, we will be able to impact and improve the access and quality of care for Kentuckians,” said Dr. Michael Karpf, UK's executive vice president for health affairs.

State officials tell health-care providers to meet with managed-care companies to get paid, say new system is improving health

By Molly Burchett and Al Cross
Kentucky Health News

At the latest in a series of forums on Medicaid managed care, state officials said the new system has improved the quality of care, but you could cut the tension with a scalpel in the packed auditorium at the University of Kentucky as they fielded complaints and questions and urged the providers to work out the problems with managed-care companies themselves.

Gov. Steve Beshear and the Cabinet for Health and Family Services say the forums are designed to improve relations between providers and the managed-care organizations, but reactions from capacity crowd of health care providers and staff -- reactions that included a roomful of laughter about the MCOs' low count of transferred phone calls from providers -- suggested that the state’s solutions to providers' problems with the companies aren’t quite the solutions sought by providers.

Kentucky's transition to Medicaid managed care

In 2011, Kentucky was faced by spiraling Medicaid costs that gave the state two options: cut reimbursement rates to providers by a third or moving from a fee-for-service model to a managed- care system, in which MCOs get a specified fee for each patient they manage and use the money to pay providers, said Lawrence Kissner, commissioner of the Department for Medicaid Services.

The change is driving improvements in health for Medicaid clients while saving the state money, said Kissner: It has increased well-child visits for children aged 3-6 from 2 percent to 53 percent, has increased diabetes testing from 6 percent to 59 percent, and has improved adult access to preventative and ambulatory health services.

MCOs also have numerous quality initiatives underway, said Kissner, including one in improving anti-depressant medication management and compliance.  One company, Wellcare, has worked to improve oral health through a campaign that offered $10 gift cards for dental visits, but no one hears about this, he said.

What we've heard are complaints from physicians, hospitals, pharmacies and other health-care providers who aren’t getting some claims paid in a timely manner, or at all. Providers say manage care's complicated pre-approval process, designed to limit costs, delays critical treatment for patients and adds unsustainable administrative burdens.

Read more here: http://www.kentucky.com/2012/02/08/2061060/health-care-providers-say-medicaid.html#storylink=cpy

State officials' response: meet with the MCOs

Kissner said the new system denies 6 percent of providers' requests for pre-authorization, compared to the fee-for-service model that only denied 1 percent of such requests, but he says that's about the same as other states that use managed care.

About 20 percent of providers' claims have either been denied or suspended. In the first 14 months of managed care, 22 million of the 28.3 million claims, or 78 percent, were paid within 30 days. Kissner said 4.9 million (17 percent) were denied in 30 days and 1.2 million (4 percent) were suspended; he did not mention  the monetary amount of the denied or suspended claims.

Kissner speaks to crowd at UK; Cabinet Secretary Audrey Haynes looks on from first front-row seat.

When an audience member questioned the lack of payment for hospice services, Cabinet Secretary Audrey Haynes replied, “There are some providers around the state that have been quite vocal about how much we owe them, but when there’s been an attempt to sit down and work it out with them, they will not make an appointment.” She said it is a provider’s responsibility to reach out to MCOs about the payments they are owed.

“It is about you going to each one of them and setting an appointment for them to work out with them you’re accounts receivable," Haynes said. “If you really want to get paid and if you are really owed, and I believe most of you are, then let’s get an appointment set” with the MCO.

“We want this worked out,” said Haynes. “The time has come and gone for us to still be having problem getting payment if your contract says you deserve payment. These folks know they are on the hook. Let's all work together to get it fixed.”

Meetings with MCOs are part of the plan Beshear outlined after vetoing House Bill 5, which the last session of the General Assembly passed to help providers receive prompt payments from MCOs. The plan also requires the state Department of Insurance to investigate payment complaints and to conduct audits of this process. The department began this work in April and says it does not yet have statistics about 'clean claim' approval rates.

However, audits by the state's managed-care branch have shown Kentucky Spirit and Coventry Cares to be deficient in their financial management, and the state has implemented "corrective action plans" to address those deficiencies, said Kissner.
  
Providers' response to dispute-resolution plan

It may be an unwelcome change for providers as they now may have to set up consultations with MCOs to receive the money owed to them. They may ask: How many other business-to-business contracts require the service provider to meet face-to-face with the payor in order for the provider to be paid for contracted services that have already been provided? They argue that delayed payments and fee cuts could stretch medical practices and hospitals so thin that those needing care might be at more risk.

One provider in the audience addressed this concern, asking how general dentists are supposed to continue giving high-quality care to all patients if their fees are getting cut, but our expenses are going up? None of the officials on the panel answered the question.

Another audience member asked about provider fee cuts, and after the microphone was passed around to Kissner, he said the reductions are a part of the transition process to managed care, which was initiated to avoid a 35 percent Medicaid rate cut.

"When managed care enters into a a fee-for service environment, there's savings in a variety of pockets," Kissner said. "How do they control costs and try to make a profit in the system?"

The forum wrapped up with question from another skeptical audience member: Will this really make a difference?

"Well, you tell me, said Haynes. "And I'm sorry for those of you that feel like it will not make a difference because everyone in this room would have seen a 35 percent cuts in your rate, in all rates, had we not gone to managed care.  Not only that, our folks were not getting healthier, and we have proof of that." In her opening remarks, she said the state has spent billions of dollars on health care for the poor without seeing an improvement in the state's health status, so a different approach was needed.

Future forums

Kissner said the forums between the MCOs and providers are expected to resolve disputes by January, the deadline given to the cabinet by Rep. Bob Damron, D-Nicholasville, during a meeting of the joint Administrative Regulations Review Subcommittee. Damron and other legislators have "vowed to lead a legislative revolt" if the administration doesn't fix these late payment issues between providers and MCOs by then, reports Ronnie Ellis of CNHI News Service.

All the managed-care forums follow the same agenda, which can be found along with additional information at the Medicaid website. The dates and locations of the remaining forums are:

• Region 2, June 20: Main Lodge, Pennyrile Forest State Resort Park (20781 Pennyrile Lodge   Road., Dawson Springs) 
• Region 3, June 24: Kent School of Social Work, University of Louisville Shelby Campus (312 N. Whittington Pkwy., Louisville) 
• Region 4, June 26: VP Henry Auditorium, Lindsey Wilson College (210 Lindsey Wilson St., Columbia) 
• Region 6, June 27: Student Union Building, Northern Kentucky University (20 Kenton Drive, Highland Heights) 
• Region 1, July 15: Curris Center, Murray State University (102 Curris Center, Murray)