Friday, August 30, 2013

In its colorful Kynect costume, Obamacare hits the streets in Kentucky and attracts national news coverage

By Molly Burchett
Kentucky Health News

When the Patient Protection and Affordable Care Act takes effect Jan. 1, many Kentuckians may have signed up for the health coverage it mandates without ever associating it with its political label, Obamacare.

This could be a planned marketing strategy or just the result of the state's effort to provide health care coverage to uninsured Kentuckians, but there's no need to anxiously await for Obamacare's arrival in Kentucky; the state's part of the health-reform law has hit the airwaves with a commercial, and the streets with tote bags and flyers in hand. And national news coverage has followed.

Huffington Post’s Jason Cherkis spent a day at the Kentucky State Fair and the next day in Laurel County with workers from Kynect, the state’s online health-insurance marketplace, and while learning much about the Kynect outreach efforts, he reports little about Obamacare. That's because it's not being called Obamacare, a label Republicans devised and the White House eventually accepted.

At the reform law's core is the implementation of health-insurance exchanges and subsidies in each state, which is provided through Kynect in Kentucky, "but little or none of these operations will have the words 'Affordable Care Act,' much less 'Obamacare,' attached to them," writes Jonathan Bernstein of The American Prospect. 

The Kynect website, where Kentuckians can go to sign up for insurance coverage and determine their eligibility for it, doesn't mention the federal government, reports Kevin Drum of Mother Jones in an article titled "Here's Hoping That Obamacare Is Better Than That Appalling Obamacare."

The state site describes the long-awaited (for some) and highly controversial (for more) law: without referring to it directly: "Starting next year, most Americans will be required to have health insurance. By using Kynect, you may receive payment assistance, special discounts or tax credits to help cover the costs of coverage for you, your family or your employees,"it says.

Most Kentuckians probably don't know that the insurance exchange exists, let alone that the exchanges are part of Obamacare. In an August Kaiser Family Foundation health reform poll, only 22 percent of respondents nationwide said they’ve heard “a lot” or “some” about the state-by-state exchanges, which are set to begin selling policies and signing up people for expanded Medicaid on Oct. 1.

Half of those polled (51 percent) said they didn’t know enough about Obamacare to understand how it will affect them and their family, and the number was even higher (62 percent) among the uninsured, the reform law's target population.

The uninsured and newly eligible Medicaid recipients, an estimated 600,000 Kentuckians, are also the target of Kynect's outreach efforts, although they may not be the ones receiving the tote bags at fairs and community events.

Furthermore, the Kaiser survey results show a vast majority of Americans don't know that the health law is actually a law; about 44 percent said they were “unaware” of the current status of the law, with 31 percent of that number  (14 percent of the total) saying they simply didn’t know if the Affordable Care Act was law or not.

This all suggests the possibility that, even as people start signing up for Obamacare in a few weeks, public opinion about the health law won't change, writes Sarah Kliff of The Washington Post. Thus, while public opinion of Obamacare leans to the negative, that may not keep some of its ostensible opponents from becoming users of it.

Kliff writes that the following three paragraphs written by Cherkis say everything you need to know about Obamacare:
Reina Diaz-Dempsey
A middle-aged man in a red golf shirt shuffles up to a small folding table with gold trim, in a booth adorned with a flotilla of helium balloons, where government workers at the Kentucky State Fair are hawking the virtues of Kynect, the state’s health benefit exchange established by Obamacare.
The man is impressed. “This beats Obamacare I hope,” he mutters to one of the workers.
“Do I burst his bubble?” wonders Reina Diaz-Dempsey, overseeing the operation. She doesn’t. If he signs up, it’s a win-win, whether he knows he’s been ensnared by Obamacare or not.
With millions of dollars from the federal government, the state conducted "market research that included holding a dozen focus groups in Louisville, Paducah and London, according to Gwenda Bond, assistant communications director with the Cabinet for Health and Family Services," Cherkis reports. The tote bags are popular, but Diaz-Dempsey doesn't hand one over until the would-be recipient hears her simple pitch, which does mention the law, but without its political label:
We are Kynect -- part of the new health care law.
Do you know anyone who doesn’t have health insurance?
You may qualify for Medicaid or a tax credit based on your income.

"The crush of people don't greet Diaz-Dempsey with tea party dogma or amateur constitutional scholarship," Cherkins writes. "No one is there to complain about the individual mandate or heckle about death panels. They have questions. They wonder if they could get coverage despite having a pre-existing medical condition, how much it will cost them. . . . Could they just enroll their child? They talk about their sons and daughters, neighbors going without health care, and ask about the subsidies. The vast majority are relieved to learn about the health exchange."

Erin Hoben
But the next day in London, in a heavily Republican area, Cherkis encountered many skeptics and outright opponents of Obamacare. He reports that Erin Hoben, an outreach worker with Kentucky Voices for Health, an association of pro-Obamacare groups, told him that a Hazard woman she had been working with "called her recently to tell her that the Tea Party had urged her not to enroll because the exchange wasn’t happening."

Democratic Gov. Steve Beshear, who expanded Medicaid and defended Obamacare in a speech to the fair's Kentucky Farm Bureau Country Ham Breakfast, told Cherkis, “Most people don’t really understand it yet. I do not find that most people have any kind of negative feeling about it. It’s just that most people don’t quite understand the act or what they’re supposed to do yet.”

But the feds like what Kentucky is doing, and the state's only Democratic congressman, John Yarmuth of Louisville, told Cherkis: “I know that the administration believes that Kentucky and Vermont are the two best exchanges that were created, that are models for the country. They’ve said that numerous times to the Democratic caucus.” (Read more)

So, as the Kynect website says, "It’s a new day for health-care coverage in Kentucky. Thanks to Kynect, the power to manage your own care is finally in your hands," regardless if you know it or not.

Click here to view a Kynect factsheet to learn more about the health-insurance exchange.

Kentucky nursing homes rank 40th in the nation in new survey; reformers ask governor to create special task force for action

Kentucky got a D grade and a rank of 40th among the states in a new national survey of nursing-home care, and reform advocates are calling on Gov. Steve Beshear and other policymakers to take corrective action.

The state ranks lowest in the Southeast, the lowest ranked region, in nursing home care quality; one in five Kentucky nursing homes were cited as having a severe deficiency, "indicating widespread abuse, neglect and mistreatment of residents," says the report of the survey, created by a Florida-based advocacy group Families for Better Care.

"The results of this first-ever survey sadly represent real people, human beings being abused and neglected every day," writes Bernie Vonderheide, president of the Kentuckians for Nursing Home Reform, the lobby that spearheaded the call for action. A representative of the Kentucky Association of Healthcare Facilities, the lobby for for-profit nursing homes in the state, was unavailable for comment.

The survey analyzed eight federal measures gauging nursing home care, and the state's nursing homes scored below average in five of the eight categories. For example, only a third of Kentucky facilities reported health inspections above average. Click here for more information or to see survey results.

In the letter to the governor, Vonderheide requested the creation of a special task force to address the issues, which they say affect thousands of Kentuckians, many who cannot speak up for themselves: "It’s time to stop this growing crisis in our state before it gets so big that we cannot manage it."

Thursday, August 29, 2013

Donor who helped Monroe schools take over, expand wellness center pledges more for improvements, upkeep, scholarships

The Monroe County Schools are getting a $1 million-plus donation for a family wellness center and scholarships for graduates of the county's only high school from businessman George Eagle Bushong of Bradenton, Fla., who grew up in a prominent Monroe County family.

George Bushong and daughter Isabelle
School Supt. Lewis Darrell Carter told Shelley Smith of the Glasgow Daily Times that Bushong had mentioned his intent to donate $50,000 a year for 10 years for the  Monroe County Family Wellness Center, and surprised him two weeks ago by adding an extra $55,000 for the next decade for various scholarships.

The schools took ownership in November 2011 of the center, "which was built on property owned by the school district," Smith reports. "Since then, Carter said the wellness center membership has gone up from 340 members to 1,200." The annual donations will pay for an indoor digital golf machine, a swimming scoreboard and maintenance of the George and Isabelle Bushong Foundation Aquatic Center, which Bushing helped build to hold swim meets and was named for his daughter.

Asst. Supt. Amy Thompson told Smith the wellness center is heavily used by student athletes for training, physical education classes and afterschool fitness classes. “It gives the kids something to do to include fitness in their lives,” she said. " Carter said he’s even seen families meet at the wellness center to work out together," Smith reports. "He said the funding to help support this facility will be great service to community. . . . To pay homage to Bushong’s generous donations, Carter said they will change the name of the wellness center to the George and Isabelle Bushong Foundation Monroe County Family Wellness Center."

Wednesday, August 28, 2013

Some parents complain about healthier school lunches, but USDA says it's on course to improve public health

A few school districts in other states are opting out of a federal-funded school lunch program that was touted by first lady Michelle Obama to provide healthier options to students, and some parents in Harlan County are complaining about the new menus. But the U.S. Department of Agriculture, which runs the National School Lunch Program, says the naysayers are in a small minority and the healthier fare will become more popular and improve public health.

That is backed up in a study forUSDA's Economic Research Service of 2005, showing that "Students in schools that offered greater quantities of fruits and vegetables consumed more of these foods by most measures." During the 2012-13 school year the lunch program increased servings of fruits, vegetables, whole grains and fat-free or low-fat milk, while setting standards for calorie content and reducing intakes of sodium and trans fat. Students are allowed to eat as much fruit and vegetables as they want. The full report can be read here. (USDA graphic)

Districts from Kentucky to Illinois to New York have complained that students aren't interested in the healthier foods, leading students to buy fewer school meals, which costs the school districts who rely on federal reimbursements. But the number of districts opting out could be minimal. The School Nutrition Association "found that 1 percent of 521 district nutrition directors surveyed over the summer planned to drop out of the program in the 2013-14 school year and about 3 percent were considering the move," Carolyn Thompson reports for The Associated Press. There were 31 million students in the program in 2011.

So many students and parents have complained in Harlan County that the school board held a special meeting to address the issues, Mark Bell reports for the Harlan Daily Enterprise. "Complaints ranged from not being fed enough to food received not being good enough. While fruits and vegetables are offered freely and students can take their fill of those, meats and carbohydrates will continue to be served in limited portions only, so students complain of not getting enough food."

In Spencer County, there were no complaints about the food, just a price increase of 10 cents for lunches, to $2.30 ($2.45 at the high school) that school officials attributed to the 2010 federal law. District Director of Operations and Transportation Brett Beaverson wrote in a school-board agenda item, "The logic behind the mandated increase is to eventually equal the difference between the reimbursement rate ($2.86) and the full-pay lunch price." Malloy Bilger reports for the Magnet, "Beaverson said failing to pass the increase would make it appear that the federal government was subsidizing full-pay lunches." (Read more)

Overall, schools are getting healthier, according to a report released Monday by the Centers for Disease Control and Prevention. Since 2006, "the percentage of districts that required schools to prohibit offering junk food in vending machines increased from 29.8 percent to 43.4 percent . . . and the percentage of districts with food procurement contracts that addressed nutritional standards for foods that can be purchased separately from the school breakfast or lunch increased from 55.1 percent to 73.5 percent." states the CDC. "Between 2000 and 2012, the percentage of districts that made information available to families on the nutrition and caloric content of foods available to students increased from 35.3 percent to 52.7 percent." (Read more)

Obamacare hearing highlights employers' worry and uncertainty; Yarmuth says repeal and defunding bids block needed changes

Three of Kentucky's congressmen agreement at a field hearing in Lexington Tuesday that the Patient Protection and Affordable Care Act needs changing, but had no a consensus on how it should be fixed.

From left, U.S. Reps. John Yarmuth, D-3rd District; Andy Barr, R-6th District; and Brett
Guthrie, R-2nd District, listen to Rep. Phil Roe, R-Tennessee, who chaired the hearing.
Business leaders at the hearing also called for a fix, saying the law creates challenges for employees, workers and the economy.

Republican Reps. Brett Guthrie of Bowling Green and Andy Barr of Lexington said the law should be repealed. Democratic Congressman John Yarmuth of Louisville said efforts to change the law are hindered by efforts to repeal or defund it, reports Ryan Alessi of cn|2's "Pure Politics."

Yarmuth supports changes to the law's definition of a full-time employee as one that averages 30 hours of work a week, which he says has led to unintended consequences. Many of the 130 hearing attendees also expressed concern about the 30-hour employees, Alessi reports.

The law includes a mandate that companies 50 or more full-time employees must provide those workers with health insurance or pay a $2,000 penalty per employee. Although this mandate has been delayed a year by the Obama administration, the employee mandate and complex regulations of the law has created "massive uncertainty" for U.S. employers, said Barr.

Several business owners complained about the looming mandate and uncertainty as well as the harmful financial consequences of Obamacare at the hearing, which was held by the U.S. House's Subcommittee on Health, Employment, Labor and Pension. Six of the eight speakers were Republicans expressing opposition to the law.

"What we know is what the administration is now admitting — that this massive piece of legislation is unworkable,” said Barr, who also said that the law should be permanently delayed, reports Alessi.

A majority of Americans (57 percent) disapprove of "defunding" Obamacare as a way to stop the law from being implemented, says an August poll from the Kaiser Family Foundation.  Almost 70 percent of respondents said defunding would be "using the budget process to stop a law is not the way our government should work."

Long-time Lexington restaurant owner Joe Bologna said he is concerned that Obamacare will impact people's ability to eat out.  To prepare for this and rising health costs faced by the business, he has reduced his staff from 54 to 47 and is closed on Mondays, reports Jack Brammer of the Lexington Herald-Leader. Other business people shared similar stories about the law's negative consequences.

On the other hand, Carrie Banahan, executive director of the Kentucky Health Benefits Exchange, the state's online insurance marketplace, said the law will improve Kentucky's health. There were many supporters of the law at the hearing, and some even hissed at critics of the law, reports Alessi.

“If we could get a bipartisan agreement to actually work on tweaks legislatively, I think we could dramatically improve the law and eliminate a lot of uncertainty,” said Yarmuth. Click here to read more about testimonies form the hearing or to watch cn|2 videos.

Kentucky expands list of permanent locations for safe disposal of unneeded or expired prescription medications

Gov. Steve Beshear announced today that Kentucky now has 149 permanent prescription drug disposal locations in 97 counties where Kentuckians can safely dispose of unused or expired medications in order to help curb the state's prescription drug abuse problem.

“The effects of prescription drug abuse are devastating to our families and our communities,” Beshear said in a news release. “Medications, once they are no longer needed for their prescribed purposes, should be disposed of properly to reduce their risk of being diverted and abused . . . "

Counties with permanent disposal boxes are shown on the map below in green. The boxes are monitored to ensure safe drug disposal and are located in law enforcement buildings. There are two pending locations, one in Ohio County and one in Franklin County, as shown in light blue. The 23 counties in white do not have permanent disposal locations.

“One in five of our Kentucky teens has abused prescription medication for an off-label purpose, and that abuse is starting in the home when children have access to their parents’ unused or expired pain medications,” Attorney General Jack Conway said in the news release.

The disposal boxes are funded by Kentucky Agency for Substance Abuse Policy, Operation Unite, Kentucky League of Cities and state and local law enforcement agencies, says the release.  Click here for a complete listing of locations and hours of operation.

Wednesday, August 21, 2013

UK, with magnet of National Cancer Institute designation, attracts 4 researchers and their $17 million in funding from U of L

"A month after the University of Kentucky announced it is home to the state’s first National Cancer Institute-designated cancer center, an internationally recognized research team studying the role metabolism plays in cancer is leaving the University of Louisville for its chief in-state rival," Laura Ungar reports for The Courier-Journal. "The four researchers . . . will bring with them more than $17 million in federal funding over five years."

UK officials told Ungar they didn't recruit the researchers, and a U of L official said the school made "a significant counter-offer." But one of the researchers told Ungar that UK offered new equipment, new laboratory space and an opportunity to work with a wider group of collaborators.

"One area the scientists have been researching is lung cancer, which strikes and kills Kentuckians at the nation’s highest rate," Ungar writes. "Their work includes a newly funded project from the National Cancer Institute on biochemistry in lung cancer." (Read more)

Monday, August 19, 2013

National magazine looks at drug companies' efforts to stop anti-methamphetamine bills, especially in Kentucky

In a strong piece of investigative reporting for Mother Jones magazine, largely about Kentucky, freelancer Jonah Engle delves into the history of how making methamphetamine became a simple task via over-the-counter cold medications, and how drug makers have warded off most state laws intended to make the decongestant pseudoephedrine more difficult to purchase. (Photo by Stacy Kranitz: Cleaning up a meth lab found on school property in London.)

Engle's well-rounded story examines the issue from the viewpoints of politics, law enforcement, drug users and the effects of their habits on their children, while looking at how small-town life -- especially in Kentucky, where meth-related cleanup and law enforcement cost the state $30 million in 2009 -- has been hit hard by the drug. When a bill in 2011 to require a prescription for pseudoephedrine, a Washington-based group representing the makers and distributors of over-the-counter medicines and dietary supplements, reportedly spent more than $303,000 in three weeks, with most of the money spent on "robocalls," or automated telephone messages. The bill failed, but in 2012 the legislature passed a law with a tighter limit on the amount of pseudoephedrine anyone can buy in a month, after a strong radio advertising campaign by the Consumer Healthcare Products Association. The drug is kept behind counters so purchases can be tracked but does not require a prescription.

Engle tells a tragic story of meth in many states, ever since 2007, when the process called "shake-and-bake" or "one-pot" method, became commonplace. "The number of clandestine meth sites discovered by police has increased 63 percent nationwide," Engel writes. "As law enforcement agencies scramble to clean up and dispose of toxic labs, prosecute cooks, and find foster homes for their children, they are waging two battles: one against destitute, strung-out addicts, the other against some of the world's wealthiest and most politically connected drug manufacturers. In the past several years, lawmakers in 25 states have sought to make pseudoephedrine—the one irreplaceable ingredient in a shake-and-bake lab—a prescription drug. In all but two—Oregon and Mississippi—they have failed as the industry has deployed all-star lobbying teams and campaign-trail tactics such as robocalls and advertising blitzes."

In Oregon, the number of meth labs found by police dropped 96 percent since the bill was passed, while in Mississippi the number dropped 74 percent, Engle writes. "Children are no longer being pulled from homes with meth labs, and police officers have been freed up to pursue leads instead of cleaning up labs and chasing smurfers. In 2008, Oregon experienced the largest drop in violent-crime rates in the country. By 2009, property crime rates fell to their lowest in 43 years. That year, overall crime in Oregon reached a 40-year low. The state's Criminal Justice Commission credited the pseudoephedrine prescription bill, along with declining meth use, as key factors."

"Everywhere else, industry has prevailed," Engle reports. "Many states have very limited laws on what lobbyists must report, and they don't monitor spending on robocalls or ads. But news reports and my interviews with legislators in Southeastern and Midwestern states where meth labs are most concentrated—and where CHPA had the biggest fight on its hands—show that the pharmaceutical industry deployed a mix of robocalls, print and radio ads, as well as a Facebook page and a website, These states include Alabama, Kansas, Missouri, North Carolina, Oklahoma, and Tennessee." (Read more)

Laurel True, longtime advocate for health, education and human services, dies suddenly at 80

Laurel W. True, who continued his public service for health and other causes long after leaving state government, died suddenly Saturday at his home near Waddy in Shelby County. He was 80.

"For the past five decades, Mr. True worked tirelessly to improve the health and welfare of Kentuckians," The Courier-Journal said in an editorial. In the 1970s True was the first secretary of the old Cabinet for Human Resources and executive director of Kentucky Health Systems Agency-West, a state health-planning organization, and was an assistant superintendent of public instruction. Earlier, he helped start Medicaid in Kentucky and the conversion of United Mine Workers hospitals into Appalachian Regional Hospitals.

In retirement he continued as an advocate for health, education and human services as a member of the National Policy Council of AARP, vice chairman of the board of Seven Counties Services, secretary of Kentucky Voices for Health, a member of the Friedell Committee for Health System Transformation and as a trustee of Georgetown College, his alma mater. Under the aegis of the Freidell Committee in 2009, True conducted a study of the Kentucky Children's Health Insurance Program in Anderson County, which helped lead to policy changes designed to ease and encourage enrollment in KCHIP.

“He was a wonderful champion all of his life,” Sheila Schuster, a longtime mental health advocate, told The Courier-Journal. “He was never boastful or self-serving.”

Visitation will be from 3 to 8 p.m. Tuesday and 9 to 10 a.m. Wednesday at Immanuel Baptist Church in Frankfort, where True was a deacon and Sunday School teacher. The funeral will follow at 10 a.m., with internment in Frankfort Cemetery and arrangements by LeCompte-Johnson-Taylor Funeral Home. Donations are suggested to the Infant Resource Center at Immanuel Baptist Church, 1075 Collins Lane, Frankfort KY 40601. (Read more)

Friday, August 16, 2013

Agreement will move at least 600 from personal-care homes to community mental health facilities

At least 600 people now in personal-care homes will be moved to community-based settings under "an agreement that advocates say will systematically change the way community mental health services are delivered in Kentucky, improving the lives of hundreds of people with mental illnesses and disabilities," Beth Musgrave reports for the Lexington Herald-Leader.

Stories by the Herald-Leader and investigations by Protection and Advocacy, a state agency for the disabled and mentally ill, "found that personal care homes often are an ill-equipped last resort for people with complex problems such as substance abuse, mental illness or a mental disability," Musgrave writes. "Past problems at personal care homes have included criminal arrests of operators for stealing money from residents, lack of food, poor medical care and deaths" when residents walked away from homes in Letcher and Pendleton counties.

The state Cabinet for Health and Family Services estimates that the changes will cost $19 million over the next three years, and it said the money would come from the budget for housing people in mental hospitals. "Under the agreement, people can use their state supplement of $520 a month for services that will keep them out of a personal care home. Under the current system, a person can receive the supplement only if they live in a personal care home," Musgrave writes. "That change will affect anyone who is eligible for personal care home services, not just the 600 people who will get additional services under the agreement." The cabinet will have until October 2014 to move the first 100 personal-care-home residents. (Read more)

Read more here:

Ashland hospital lays off another 4 percent, citing lower revenue

King's Daughters Medical Center in Ashland is laying off another 4 percent of its payroll and closing satellite centers in Pikeville and Russell, citing lower numbers of patients and reduced federal and state reimbursements.

"It is the most recent in a series of layoffs for the medical center, which saw layoffs and shift reductions for more than 100 employees in 2010 and an undisclosed number of layoffs in 2012," reports Beth Hendricks of The Herald-Dispatch in Huntington, W.Va. "Most affected positions are in support, administration and supervisory areas, according to KDMC spokesman Tom Dearing. Staffing levels for direct patient care remain unchanged. Physicians at the closing family-care offices will be relocated to other centers."

Mike James of The Independent in Ashland reports, "Some workers had their hours cut from full time to part time, Dearing said. . . . CEO Fred Jackson ... said the cuts were part of a national slump in the health care business. . . . Jackson’s email blamed 'a perfect storm of a shifting business model, changing federal and state reimbursements, increasing demand for charity care, and a weak economy' and said the hospital would look to outpatient services and its community outreach centers for future growth."

Jackson has been under fire from the Service Employees International Union for his total compensation of $1.37 million in 2010, the figure reported on the not-for-profit hospital's most recent IRS Form 990. "By comparison, a CEO at a Huntington-based hospital earned $725,744," Hendricks reports. "Five additional KDMC senior management officials saw a combined $300,000 in increased wages over the same period."

Hendricks writes, "Ashland City Commissioner Kevin Gunderson said the layoffs Thursday, coupled by layoffs in recent years, raises questions about whether the board and management at King's Daughters have overspent on various outreach clinics, some of which are closing. 'They should have focused on their core medical center instead of building outreach centers in Pikeville, Prestonsburg, Flatwoods, Cannonsburg, Russell and South Shore and Jackson, Ironton, Burlington and a large one in Portsmouth,' Gunderson said. 'I just drove by there today, and they had people out planting shrubbery.' . . . This week's layoffs are the latest in a string of woes for the hospital, which lost its contract with Medicaid managed-care organization CoventryCares in late 2012. King's Daughters is also under a Department of Justice investigation into its cardiac program."

Effort for kids' dental health in Clark, started by volunteers and continued by health department with tax, earns national award

"A community effort to fight tooth decay in children in Clark County has been named a model for the nation," veteran journalist Al Smith reports in an op-ed for the Lexington Herald-Leader. The Clark County Dental Health Initiative received the award for model practice last month at the annual conference of the National Association of City and County Health Officials, and the county health board recently raised taxes to pay for it.

"Its five-year campaign for change by volunteer dentists, hygienists and engaged citizens should inspire all Kentuckians in a state further scandalized by its own Diane Sawyer in her '20/20' program on ABC in 2009 when she showed 11 million viewers shocking scenes of Appalachian kids with disfigured teeth called Mountain Dew Mouth," writes Smith, former federal co-chair of the Appalachian Regional Commission and co-founder of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News.

The Clark County program was inspired by Winchester dentist Rankin Skinner, after he and his wife, Ruthi, had started a preventive program for poor children in Ecuador, Smith writes: "He developed a similar plan for Clark County, became its unpaid director and persuaded all 16 other Winchester dentists and 116 volunteers to apply dental fluoride varnish to children in preschool through fifth grade. Every Winchester dentist donated service and staff to take the initiative inside the schools.
Five years later the decay rate in sixth graders has dropped to 11 percent, a decline of 78 percent since 2008 when Kentucky's decay rate for children was reported in national media to be a shameful 50 percent, the country's worst."

Smith notes that the effort was boosted by "a local banker who raised money with help from the Clark County Community Foundation and First Lady Jane Beshear, who urged Gov. Steve Beshear to use the Clark initiative as an example in organizing treatment for underserved children in Eastern Kentucky." The Beshears' permanent home is in Clark County.

Volunteerism only lasts so long, but the Clark County Health Department is now funding the program with a tax increase that will let it hire the state's first public-health dental hygienist. "With continued help from the local dentists and citizen volunteers, [it hopes to] eventually extend the program to students through high school," Smith reports.

The Clark County Board of Health voted this month to raise its tax rate to 4.6 cents per $100 of assessed property value from last year's 4 cents, to generate about $150,000 in additional revenue for the program. Public Health Director Scott Lockard "estimated that funding the program would take $127,531 per year, but the board wanted a cushion in the budget to help pay for dental care for students not covered by Medicaid, KCHIP or private insurance," Rachel Gilliam reports for The Winchester Sun. Lockard told the board, “I can think of nothing better to invest in other than our children.”

Thursday, August 15, 2013

Aug. 28 webinar will help journalists understand health reform

Jennifer Tolbert
After The Rural Blog published an item (see below) yesterday that said 80 percent of people who could benefit from insurance exchanges being established under the Patient Protection and Affordable Care Act knew nothing about it, a reporter immediately emailed to say she and and a co-worker were trying to decipher the act for readers, and "I'm personally terrified."

So, how do reporters go about covering the changes? The Kaiser Family Foundation hopes to help, through a series of webinars for journalists that will "address key aspects of the law, the implications for consumers, and strategies for connecting the dots for different audiences," according to the foundation.

The first webinar is scheduled for 12:30 to 1:30 p.m. ET on Wednesday, Aug. 28, and "will be an overview of how health reform’s impact will vary for people in different circumstances, including those currently with employer coverage, those who buy their own insurance and those who are currently uninsured," the foundation says.

Karen Pollitz
The webinar will be hosted by the foundation's state health policy director, Jennifer Tolbert, and senior fellow Karen Pollitz, who will "explain the law’s individual mandate requiring most Americans to obtain coverage, as well as the law’s new coverage options, including new state insurance marketplaces, subsidies for people with low- and moderate incomes, and new rules prohibiting insurers from discriminating based on pre-existing conditions." They will also answer questions. For more information or to register click here.

Most who would benefit from insurance exchanges under health reform knew nothing about them last fall

The Patient Protection and Affordable Care Act will affect millions of Americans, especially those in rural areas. But many are not prepared for the coming changes, according to a survey by Enroll America, a non-profit group that calls itself "a nonpartisan organization whose mission is to maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act" through online insurance marketplaces known as exchanges.

The survey "shows that nearly 80 percent of those who stand to benefit have no idea what an exchange is or how to get the health insurance subsidies they will offer," Christine Vestal reports for Stateline. There's no reason to think the percentage in Kentucky would have been much different at the time of the survey, taken early last fall. State government, which will open its exchange Oct. 1, has been using advertising and other means to inform people who could benefit from the exchange.

"When the exchanges open, anyone who does not already have employer-sponsored insurance will be able to comparison shop for coverage and find out whether they qualify for federal subsidies to help pay for their policies," Vestal notes. "Visitors to federally funded websites and call centers will also find out whether they qualify for Medicaid or the Children’s Health Insurance Program, and they’ll be able to sign up for that coverage immediately. Policies purchased on the exchange will take effect Jan. 1, 2014. The Obama administration is scheduled to announce Thursday how it will dole out $54 million in federal money to hire so-called 'navigators' who will help people actually sign up." (Read more)

Clearly, this subject needs more news coverage to inform people about it. To help reporters do that, the Kaiser Family Foundation is holding a series of free, one-hour webinars, beginning Wednesday, Aug. 28, from 12:30 to 1:30 p.m. ET. For details and registration, click here.

Federal report says many hospitals wouldn't keep critical-access designation if distance rules were strictly enforced

More than two dozen Kentucky communities still have hospitals because of the critical-access hospital program, in which small, isolated hospitals get higher Medicare and Medicaid reimbursements in return for limiting their size and services. Now federal officials appear to be considering a move that could cost the hospitals money and perhaps put them at risk of closing.

Most of the hospitals would not meet current location requirements if required to re-enroll to get reimbursements from Medicare, and the Centers for Medicare and Medicaid Services could realize substantial savings by revoking certification to some of these hospitals and reimbursing them at lower rates set by prospective payment systems and fee schedules rather than at 101 percent of costs, according to a report by the Department of Health and Human Services.

The agency found that "the program costs the government and Medicare beneficiaries up to a billion dollars a year more than the original parameters of the law allowed," Jenny Gold reports for Kaiser Health News. If forced to re-enroll, 849 of the 1,329 hospitals in the program would not meet the requirements -- having 25 or fewer beds and being at least 35 miles away from another facility (15 miles in mountainous terrain) in communities that would otherwise have limited access to health services.

"Until 2006, states were allowed to waive the distance requirement and designate small hospitals considered 'necessary providers' as critical access hospitals as well, even if they were close to other facilities," Gold reports. "The program grew quickly and now nearly one in four acute care hospitals are getting the extra payments. Congress got rid of the loophole in 2006, but hospitals that already had the exemption were grandfathered." (Read more)

Critical-access hospitals are located in Barbourville, Berea, Burkesville, Cadiz, Carlisle, Carrollton, Franklin, Greensburg, Hardinsburg, Hartford, Harrodsburg, Horse Cave, Irvine, Liberty, Martin, McDowell, Monticello, Morganfield, Owenton, Princeton, Russell Springs, Salem, Scottsville, Stanford, Versailles and Williamstown. For a detailed list, click here.

Friday, August 9, 2013

Smokers, take note: Chinese meditation technique offers hope

In 2010, Kentucky had the second highest rate of adult smokers in the U.S., with 24.8 percent of the adult population -- or 1.1 million adults -- smoking, according to statistics from the Cabinet for Health and Family Services. Only West Virginia, at 26.8 percent, had a higher percentage of adult smokers.

So, what can Kentuckians do to cut the cigarette habit?  A Chinese meditation technique may contain the answer. And the kicker is, smokers don't even need to focus on quitting smoking to be successful.

A study by Texas Tech University and the University of Oregon "looked at the effect of the mindfulness meditation known as Integrative Body-Mind Training on the pathways in the brain related to addiction and self-control, discovered that by practicing the meditation exercise, smokers curtailed their habit by 60 percent. The control group that received a relaxation regimen instead showed no reduction in their smoking," reports Newswise, a research-reporting service.

Yi-Yuan Tang, a co-author and director of Texas Tech’s Neuroimaging Institute, told Newswise, “We found that participants who received IBMT training also experienced a significant decrease in their craving for cigarettes. Because mindfulness meditation promotes personal control and has been shown to positively affect attention and an openness to internal and external experiences, we believe that meditation may be helpful for coping with symptoms of addiction.”

The study group consisted of 27 young-adult smokers who averaged 10 cigarettes a day. Fifteen participants received the meditation training over a two-week period. "After two and four weeks, five of the responding smokers whose smoking had been significantly reduced after IBMT reported that they were continuing to maintain the improvement," Newswise reports.

Researchers wrote that "the apparent ability to enhance self-control and reduce stress could make the practice useful in reducing smoking and craving 'even in those who have no intention to quit smoking'" as well as treating individuals with other addictions," Newswise reports. "The meditation regime, they wrote, 'does not force participants to resist craving or quit smoking; instead it focuses on improving self-control capacity to handle craving and smoking behavior.'” (Read more)

Congressman visits Telehealth Primary Care Clinic in Campton

U.S. Rep. Andy Barr
U.S. Rep. Andy Barr, a freshman Republican from the Sixth District, recently visited the Telehealth Primary Care Clinic in Campton. The clinic, one of two in Kentucky funded by federal telehealth grants, opened in August 2012, and "provides access to primary and specialty care for the community through network established by KentuckyOne Health, the largest health system in the Commonwealth," reports KyForward.

Shelley Neal of KentuckyOne told KyForward, “We established these clinics to make quality health care accessible to the communities in and surrounding Powell and Wolfe counties. If we are to be successful in our mission to create a healthier Kentucky, we must continue to implement new technologies and services to reach our state’s medically underserved communities.”

The clinics minimize "the need to travel to see a specialist therefore reducing the costs of care," KyForward writes. The newest addition is a social worker, who serves both clinics. Through the first six months of this year the social worker "helped 185 patients complete financial assistance paperwork to obtain drug assistance for 1,804 medication orders." During that same span, the clinic saw 1,417 patients from 34 counties. The clinics, which have specialists in cardiology and pulmonology, plan to add specialists in urology, obstetrics and gynecology, endocrinology, neurology and psychiatry. (Read more)

Tuesday, August 6, 2013

Free medical screenings, dental work for teens and adults available in Mayfield through Tuesday

West Kentuckians in need of health care can get free medical, dental and optical screenings through Tuesday, Aug. 13 at the old Morgan Haugh Clinic building at 220 W. Walnut St. in Mayfield from 9 a.m. to 7 p.m., including Saturday and Sunday.

The screenings are a program of the Delta Regional Authority and the Department of Defense. Anyone is eligible to receive the free services, which do not include emergency or obstetrical treatments. For adults and children age two and up, medical screenings, non-emergency medical treatment, minor lab tests, prescription assistance and optometry exams are available. For adults and children 13 and up, dental exams, extractions and fillings are also available.

Services will be provided by 152 medical personnel from the U.S. Army Reserve and the Army National Guard. Other current clinic sites are in Blytheville, Ark., Hayti, Mo., and Dyersburg, Tenn. Earlier clinics were held in Martin, Tenn., Helena-West Helena, Ark., and four communities in western Mississippi.

Petition drive from parents asks UK Healthcare to release mortality rates for cardiothoracic surgeries on children

More than 250 people have signed a petition asking the University of Kentucky hospital "to make public the mortality rates for pediatric cardiothoracic surgery patients from 2010, 2011 and 2012," Linda Blackford reports for the Lexington Herald-Leader. "All pediatric cardiothoracic surgeries were suspended at UK last fall amid an internal review." UK spokesman Jay Blanton said Monday the investigation is not complete.

"In May, the state attorney general's office issued an opinion that said UK must release mortality rates and other data about the cardiothoracic surgery program to WUKY, the university-owned radio station," Blackford reports. "UK has acknowledged that it calculated mortality rates for the program as part of its investigation, but has refused to release them, citing patient confidentiality laws." The Herald-Leader also requested the information under the Kentucky Open Records Act.

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The three-year span includes the tenure of ardiothoracic surgeon Dr. Mark Plunkett, who no longer works at UK. Jennifer Allen, whose one-year-old daughter died after having three surgeries performed by Dr. Plunkett, wrote on the petition, "We deserve to know this information, we CAN understand and comprehend this information. It is our right to know and the right of the public!" Allen's daughter suffered from hypoplastic left heart syndrome, where the left side of the heart is underdeveloped and can't pump blood properly. Allen told Blackford she finds it "very suspicious" that UK won't release the information. UK says there were so few surgeries at times that patients' identities could be deduced.

Tabitha Rainey, whose son survived cardiothoracic surgery at UK, before being moved to another hospital, started the petition after being interviewed by CNN, which reported on the issue over the weekend and updated its story today with news of the petition. She said she doesn't accept UK's response that publicly releasing mortality rates would somehow harm patient confidentiality, telling Blackford, "There are no names and no dates, just the data on how many have passed on." (Read more)

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Thursday morning webinar will explain health reform law

UPDATE: The webinar is archived here.

Amid much speculation and misinformation about the Patient Protection and Affordable Care Act, Kentucky Voices for Health will hold a webinar this week to explain it, and to help participants explain it to others.

"Get Covered Kentucky: Understanding the Affordable Care Act" will be held Thursday, Aug. 8, from 10 to 10:45 a.m. Eastern Time. The webinar is designed for health educators, health-care employees, community members, and journalists in Kentucky who want to improve their understanding of, and ability to talk to the public about, the health reform law, expansion of Medicaid and the new health benefit exchange branded as Kynect, where health insurance and subsides will be offered.

Kentucky Voices for Health, a coalition of health lobbying groups, said in its news release, "By the end of the webinar, participants should be able to:
• Explain to a lay audience the most important provisions of the Affordable Care Act;
• Understand the general timeline for implementation of the ACA, specifically when Kentucky's exchange and Medicaid expansion go into effect;
• Discuss how the ACA affects the health insurance responsibilities of employers and private individuals in Kentucky;
• Educate others about Kynect and its function;
• Inform community members about their eligibility for federal tax credits for purchasing insurance via Kynect;
• Inform community members about their eligibility for enrollment in Medicaid, as a result of its expansion;
• Debunk myths and misunderstandings about the ACA which may hamper implementation; and
• Communicate knowledge about the ACA to Kentuckians in a culturally appropriate manner."

To register for the webinar, click here.

Monday, August 5, 2013

Adair County Hospital District files Chapter 9 bankruptcy

In a move perhaps unprecedented in Kentucky, the Adair County Hospital District has voted to file for protection under Chapter 9 of the federal bankruptcy code, the same chapter used by bankrupt cities such as Detroit.

The district has a $20 million debt, creditors demanding payment, and no clear way to pay them. "The Chapter 9 filing will allow the hospital district to reorganize by extending the timeline to repay debt, refinance debt, or reduce debt by different means. It does not liquidate the taxing district nor does it close down operations" of Westlake Regional Hospital in Columbia, reports Sharon Burton of the Adair County Community Voice.

David Cantor, an attorney with Seiller Waterman LLC in Louisville, told Burton the filing is “incredibly rare” and perhaps the first in the state. “We cannot find any published cases of a Chapter 9 in the Commonwealth of Kentucky,” he said.

Farmers National Bank of Danville has sued in state court, seeking to force the  district board to levy a local property tax to pay its debt. "The federal court will, however, now likely decide the local taxation issue," Burton reports. "The hospital board voted to establish a tax but it is stalled until at least the 2014 general election after a group of citizens successfully filed a recall petition."

Only part of the Community Voice story is online, but a 7 MB PDF of its three pages with hospital news can be downloaded here.

Thursday, August 1, 2013

Auditor Edelen says Medicaid providers 8 percent fewer under managed care; cabinet says report is limited, outdated

The number of people relaying on Medicaid will increase dramatically in 2014, as Kentucky expands it to include people with incomes up to 138 percent of the federal poverty level, but there is more concern than ever about the availability of health-care providers to treat them.

A review released Wednesday said the number of Medicaid providers in Kentucky declined 8 percent in the first six months of a managed-care system that has been unpopular with providers. Roger Alford of The Associated Press reports that some hospitals in border states have already stopped accepting Kentucky Medicaid, which went to managed care in November 2011.

After the Patient Protection and Affordable Care Act goes into effect Jan. 1, an additional 300,000 Kentuckians may be added to a program that already serves nearly 800,000. State Auditor Adam Edelen raised concerns whether Kentucky's rural hospitals could continue to deal with Medicaid's slow reimbursements under managed care. He said, "Managed care is designed to save taxpayer dollars, but it can't be at the expense of the health of our citizens."

A clinic on Main Street in Frankfort recently joined Medicaid.
State Cabinet for Health and Family Services spokeswoman Jill Midkiff told Alford the auditor's review was "limited and somewhat outdated" and said it "doesn't fully and accurately reflect" the status of the managed-care system.

Edelen told Kentucky Health News that the audit ran only through May 2012 because his office typically deals with fiscal years. State fiscal years end June 30. He said he believes the trends have continued.

Midkiff said "The overall number of Medicaid providers has actually grown under the managed care program," Alford reports. "She cited a 20 percent increase in dentists, a 150 percent increase in certified nurse practitioners, and a 300 percent increase in physician assistants." She said, "The cabinet firmly supports managed care as the best way to deliver needed medical services to a vulnerable population while also providing good value to Kentucky's taxpayers."

She also said, "The move to managed care was not simple or painless, but our records show evidence of health-care providers and managed care organizations working together to adapt to the new Medicaid system and that Medicaid members are receiving prompt, effective medical services with measurable improvements in health outcomes." (Read more)

"Midkiff said Tuesday other issues cited in Edelen’s report are not the result of managed care because they existed before its implementation, including the adequacy of medical providers in Kentucky, and it does not belie the need to expand Medicaid services, Ronnie Ellis of CNHI News reports.

Edelen made several recommendations, including:
• Establishing a formal advisory panel of members and stakeholders
• Requirements for retaining claims records
• Establishment of an approval process for subcontracts with MCOs, including third party providers for dental, vision and behavioral health services
• Improved monitoring of MCO accounts payable
• Establishing a way to estimate the cost savings of managed care for the state.