Wednesday, November 27, 2013

Feds say reform law has saved Kentuckians on Medicare an average of $928 this year on prescription drugs

The federal health reform law has saved seniors and the disabled millions of dollars on their Medicare prescription-drug coverage, says the Centers for Medicare & Medicaid Services.

CMS said 65,040 Kentuckians have saved a total of $60.4 million in the first 10 months of 2013, an average of $928 per person in Medicare. CMS said Kentucky seniors have saved $180.9 million on the coverage, known as Part D, since the passage of the reform law.

Seniors will also be free to use more of their Social Security cost-of-living adjustment as they choose, because the Medicare Part B premium will not increase in 2014 as a result of the law’s cost restrictions, CMS noted. The deductible for standard Part D plans will decline by $15 in 2014, to $310.

The data also show that since the Patient Protection and Affordable Care Act took effect, more than 7.3 million seniors and people with disabilities who reached the prescription coverage gap, commonly known as the "donut hole," have saved $8.9 billion on their prescription drugs, an average of $1,209 per person.

The "donut hole" is the gap in coverage after the basic coverage and before the catastrophic coverage takes effect.  Without rebates authorized by the law, Medicare beneficiaries would have to pay out-of-pocket for the entire cost of prescription drugs once they hit the hole, until they incur enough expense to reach catastrophic coverage.

Next year, Medicare Part D participants in the donut hole will save about 53 percent on the cost of brand name drugs and 28 percent on the cost of generic drugs, CMS says. These savings and Medicare coverage are to gradually increase until 2020, when the donut hole will be closed.

Irvine hospital's Susan Starling wins American Hospital Association's award for leadership in small or rural hospitals

Susan L. Starling, president and CEO of Marcum & Wallace Memorial Hospital in Irvine, is the 2013 winner of the American Hospital Association’s Shirley Ann Munroe Leadership Award.

The award recognizes the accomplishments of small or rural hospital leaders who have improved health care delivery in their communities through innovative and progressive efforts. Starling was recognized "as a widely respected leader who fosters strong collaborative relationships that improve the health care of the rural community," says a press release from the American Hospital Association.

Serving a community of approximately 15,000 that covers several counties for the last 30 years, Starling has forged statewide partnerships, updated the Catholic Health Partners facility, provided leadership in initiatives such as Project HOME (Helpful Opportunities for Medical Care Enhancement), helped to connect uninsured and under-insured patients with preventive services, developed partnerships resulting in the first rural community lung-cancer screening and breast-cancer awareness and screening, and in 2010 provided "groundbreaking direction" for her hospital to be certified as the first Level IV trauma center in Kentucky, the release says.

Starling also received the Kentucky Rural Health Association’s Dan Martin Award for her dedication to rural health care in Kentucky in 2012, according to the release, and was recognized by the AHA's political action committee as its Most Valuable Player for her significant outreach and advocacy efforts. UPDATE, 2/23/14: Becker's Hospital Review included Starling in its initial list of "50 Rural Hospital CEOs to Know."

Humana, United and Assurant allow non-compliant policies to be extended; Anthem and Bluegrass offer sort of half a loaf

Some health-insurance companies won't give Kentucky customers the opportunity to renew polices that don't comply with the federal health-reform law, under the conditional extension granted by President Obama, state Insurance Commissioner Sharon Clark told a legislative committee yesterday.

"Humana, United Healthcare and Assurant Health say they will go along with President Barack Obama’s healthcare fix and let thousands of their customers renew their canceled insurance policies for another year," The Courier-Journal reports. "Insurers such as Bluegrass Family Health and Anthem are offering an alternative, providing some consumers an early renewal option that essentially could allow them to keep existing coverage partly into 2014."

"Melissa Metzger, an attorney for Anthem, said the company has spent more than $150 million to beef up operational systems and develop products that would meet the ACA requirements, often in markets that Anthem has served for decades," C-J reporters Mike Wynn and Chris Kenning write.

"About 280,000 Kentuckians — 130,000 in individual plans and 150,000 in group plans — have or will receive discontinuation notices from insurance companies saying their current health plans would not be offered under the federal health care law," Kevin Wheatley reports for The State Journal in Frankfort. "About a third of Anthem’s more than 100,000 individual plan members and half of its 100,000 group plan members have accepted" the company's offer, which expires Dec. 15, "to change the effective date of their current policies to Dec. 1, meaning they could carry that plan through Dec. 1, 2014."

Monday, November 25, 2013

Not only may you not get to keep your plan under Obamacare, you might not be able to keep your doctor; there are reasons

By Molly Burchett
Kentucky Health News

Part of the sales pitch for the federal health-care reform law was that people could keep their doctors, but many Americans and some Kentuckians won't because insurers are excluding some hospitals and doctors from policies in an effort to make the new, standardized plans on the insurance exchanges more affordable.

Eleven Kentucky hospitals have filed complaints with the state Department of Insurance, saying Anthem's policies on the state's exchange include only a narrow network of providers, excluding them. Limiting the number of providers on the exchanges is one seldom-mentioned way insurers are trying to reduce premiums for new policies.

The department upheld three of the complaints because the hospitals said they would be able to serve at least four of the state's eight Medicaid regions, a concern that led to their original exclusion. The department has since ordered Anthem to accept applications from those hospitals- UK Healthcare, Our Lady of Bellefonte in Ashland and Highlands Regional Medical Center in Prestonsburg, reports Mike Wynn of The Courier-Journal.

Insurance-company research shows that consumers’ highest priority when shopping for insurance is price. To compete on price, insurers contract with doctors and hospitals who charge them the lowest fees. Some prestigious and well-known academic medical schools that charge higher prices are being excluded from exchange plans, Forbes magazine reports.

These same market forces may also limit the ability for small hospitals and providers to provide care through exchange plans if their health systems lack economies of scale that enhance their negotiating power. UK has already negotiated a deal with Anthem, and the company's negotiations with Highlands and Bellefonte are ongoing.

Anthem is not the only insurance company with narrow networks. Stephen Miller, vice president of finance for the Kentucky Hospital Association, said other Kentucky insurers are also using network restrictions to "steer patients to hospitals with the best rates for the insurer," Wynn reports. Around the country, many plans have more narrow networks than previous plans in order to limit premiums, Politico reports.

This tactic lowers expenses for the insurers by bypassing higher-priced health systems but means that some patients may have to change doctors or hospitals, report Sandhya Somashekhar and Ariana Eunjung Cha in The Washington Post: "The result, some argue, is a two-tiered system of health care: Many of the people who buy health plans on the exchanges have fewer hospitals and doctors to choose from than those with coverage through their employers."

Consumer advocates say tighter networks will disrupt care and limit access for middle-and lower-income consumers, who may be sicker than the average consumer, reports Kaiser Health News: "Narrow networks present the opportunity for lower costs via discounts from select hospitals and doctors in return for patient volume. But smaller networks can require members to travel farther for care or make it hard to get appointments."

Anthem says limiting networks helps insurers save money, which is passed on to patients through reduced premiums. Critics say healthy people must pay more than their fair share to help provide coverage for sicker people. Health-reform advocates say the law's trade-offs are acceptable costs in exchange for getting health coverage to more needy people, but some wonder about that if they have to drive 30 miles to get it.

What is a narrow network?

An insurance company's health-care network is a group of physicians, hospitals and other providers that agree to provide medical services at pre-negotiated rates. The wider the insurance company's network, the more doctors and hospitals from which you can choose without paying more to see an out-of-network provider.

Anthem spokesman Tony Felts said the smaller networks are an attempt to keep exchange plans affordable and that the company worked hard to design products that would attract consumers to them. Four other companies are offering policies on Kynect, the state exchange: Humana, United Healthcare, Bluegrass Family Health and the Kentucky Health Cooperative. Anthem and the cooperative are the only two insurers offering individual plans statewide.

"Many companies have selectively entered the exchanges because they are concerned that they will be dominated by risky, high-using populations who wanted insurance and couldn't afford it" before the law took effect, Gail Wilsensky, a UnitedHealth director, told U.S. News. "They are pressed to narrow their networks to stay within the premiums."

The reform law requires insurers to provide enough doctors and hospitals to ensure quality care, but the federal government offers little guidance on how this is defined. The Kentucky Heath Benefit Exchange says at least 20 percent of available essential community providers in an exchange service area must be in its network, and insurers must contract with at least one of these providers in each county in the service area. However, these regulations don't specify a penalty for not adhering to the recommendation, and there is no guarantee that the network includes your doctor.

Consider a plan's network, premiums and out-of-pocket amounts

Patients may not realize whether or not their doctor is in a plan's network until January, when the new policies take effect. Therefore, consumers should be careful to check the details about an exchange plan's network. Consumers should also be aware of the plan's out-of-pocket costs; the cheapest exchange plans have high deductibles.

On Kynect, insurance shoppers can filter plans to see if a specific provider is included. Insurance Department spokeswoman Gwenda Bond said the agency relies on insurance companies to provide network information to be posted on the exchange. She said the department has experienced some minor issues with this process due to insurers using different names for the same provider.

To address this problem, Kynect also provides a link to each issuer’s web site for their provider directory, said Bond. "The issuer’s provider directory web site should contain the most current list of providers available in the issuer’s network. We continue to work with insurance companies to improve the lists," she said.

"Under Obamacare’s exchanges, people who really want to keep their doctor, at any price, will often have to pay higher premiums for the privilege. And people who prefer lower premiums, above all, might need to choose a different doctor," writes Avik Roy of Forbes.

As Medicaid enrollment grows, fewer providers accept it

At the same time some providers are being excluded by insurance companies or are choosing to exclude themselves, some providers are opting out of the exchanges and are not accepting Medicaid patients. A recent survey by the Medical Group Management Association found that 40 percent of its members are still deciding if they are going to accept insurance offered on the Obamacare marketplaces, CNN reports.

About 56,000 Kentuckians have enrolled in Kynect plans as of Nov. 22, and 82 percent of those are Medicaid plans. According to the Centers for Medicare and Medicaid Services, which administers the Medicaid program, three times more doctors are refusing Medicare patients than three years ago.

Doctors cite Medicare's increasing rules and lowered payment rates as reasons for not accepting Medicaid, and those who will see some Medicaid patients are limiting the number, reports The Wall Street Journal. Doctors also say administrative hassles and delays in getting paid also discourage them from accepting Medicaid, says the Center for Studying Health System Change.

Hospitals across the state have expressed concern about delayed payments from Kentucky's managed care companies as a result of the state's quick transition to a managed care model, and state officials are working to address this problem. Still, Kentucky's Medicaid payment rates are about 72 percent of Medicare rates. The reform law raised Medicaid fees to match what Medicare pays primary-care doctors, but only for two years and after much administrative hassle.

Humana allows policyholders to keep old plans without paying more; Anthem is still deciding

Humana, one of the three insurance companies offering individual health policies on the state's insurance exchange, will allow Kentuckians to keep their insurance coverage for another year without charging them more for it.

The other two companies on the individual market are Anthem and the Kentucky Health Cooperative. Anthem hasn't responded to recent inquiries about the old policies; it said last week that it was still deciding whether or not it would extend policies that don't comply with federal health reform. Since the non-profit cooperative is a new insurance organization, it is only offering policies that comply with the law.

A Humana spokeswoman told Kentucky Health News Monday that the company communicated premium amounts to individual policyholders in October when presenting policy owners with coverage options for 2014, including the option to continue their current plan. Those premium amounts for individual policies have not changed since the most recent changes to the Affordable Care Act, she said.

Some insurance experts have warned that consumers renewing noncompliant plans will be predominantly younger and healthier, while older and sicker people will migrate to the subsidized marketplaces, which could drive up costs for plans. Some states aren't allowing insurers to renew policies. For example, Washington Insurance Commissioner Mike Kreidler said he would not allow insurers to extend the policies “in the interest of keeping the consumer protections we have enacted,” reports Kaiser Health News.

In Kentucky, at least for Humana policyholders, this is not the case. President Obama said people whose policies were being canceled because they didn't comply with the law could renew them for another year if state regulators allow it. Gov. Steve Beshear gave insurers the green light to decide whether or not to renew these policies. Humana has decided to do so without charging additional premiums short-term.

Meanwhile, Anthem is deciding what to do and some existing policy owners in other states face as much as a 24 percent increase in their premiums. Obama's extension allows non-compliant policies to stay in place only for a year. This time next year, the transition must be made to plans that are qualified under the law.

Beshear to study nursing-home staffing minimums, suggests homes' high liability costs are related to poorly ranked care

Responding to a letter from Kentuckians for Nursing Home Reform, which cited a low ranking for the state's nursing homes, Gov. Steve Beshear said he is "committed to taking steps toward improving the quality of care in Kentucky nursing homes," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

Beshear said he would call for forums across the state to allow the public and nursing-home residents to discuss their ideas for improvement, and would research the impacts of increased staffing in nursing homes. The reform group wants minimum staffing requirements, which the nursing-home industry opposes.

"I take this challenge very seriously and will be working with my staff and the state's Elder Abuse Committee over the coming months to explore ways in which we can improve the quality of care," the governor said in a Nov. 5 letter to Bernie Vonderheide, founder of the nursing-home reform group.

Vonderheide wrote Beshear in August after Kentucky was ranked 40th in nursing-home care by Families for Better Care, a Florida-based advocacy group for nursing-home residents. On a grade scale of A to F, the group gave Kentucky a D. The grade was determined by analyzing eight federal measures of nursing home quality, according to the group's release.

Beshear suggested in his letter that the low ranking of Kentucky's nursing homes might be related to another of their lobbying concerns — liability costs that are well above national norms. The homes want to limit those costs by subjecting lawsuits against them to medical review panels, which couldn't block the suits but would give the homes leverage in settlement negotiations.

The governor said "a trend emerges" when the low ranking is matched with an actuarial report showing that a typical 100-bed nursing home in Kentucky has annual liability costs of $535,000, while the national average is $154,000. Kentucky was among the states with high liability costs that received a below average or failing grade on the Families for Better Care report, Beshear noted.

Vonderheide said the letter marked "the first time . . . that a Kentucky governor has embraced nursing home staffing standards." Actually, as Spears reports, Beshear "said he would ask program leaders from the Cabinet for Health and Family Services to research the impact that increasing nursing home staffing could have in Kentucky." (Read more)

The Herald-Leader said in an editorial on the issue, "Listening, exploring, collecting information and ideas must lead — quickly — to action."

Life Lessons from Cancer encourages those with cancer to build a network of support

By Melissa Patrick
Kentucky Health News

The fight against cancer requires not only a personal commitment to mind, body and soul; it also requires the support and physical help of family and friends.

That's one of the key messages in Life Lessons from Cancer, a book written by cancer patient Keen Babbage and his sister-in-law and caretaker, Laura Babbage.

Keen, a teacher and native Lexingtonian who has written 17 books about education, said at the first promotional event for the book in October, that he hopes the lessons in this book will be an inspiration and guidance for other patients with cancer as well as a resource for health-care providers.

Kentucky has both the highest rate of new cancers as well as the highest death rate for all cancers in the U.S., according to a report from the Kentucky Cancer Consortium. With a 2013 census report saying 27 percent of Americans live in one-person households, many cancer patients are likely fighting this battle largely alone.

Keen was one of those.

Two days after he was diagnosed with a rare form of nasal cancer, in October 2010, he began an aggressive, three-month regime of radiation and chemotherapy at the University of Kentucky Markey Cancer Center.

His mother died of widespread abdominal cancer after his first round of chemotherapy. As she lay dying, Laura promised her that she would look after Keen.

Here's a video clip of the authors talking about the book at UK:
With great insight, Keen knew he couldn't battle cancer by himself and immediately set about building a network of people who could support him both physically and emotionally. He even enlisted the love and affection of Laura's family dog. "Cancer, we have learned, declares war," Keen said at the promotional event. "It's not a battle, it's a war."

This cancer-fighting network, according to Keen, must not only include family, but also friends and your faith community if you have one. "Put together a network and never let it go, " Keen said at the promotional event.

When building this network, Keen advises in his book that "this is the time to abolish, delete, overlook and eliminate any animosities or disagreements."

Cancer patients' needs are many. Physically, they need help with shopping and food preparation, caring for pets, laundry, cleaning, transportation, making appointments and keeping up with insurance to name a few. Emotionally, they need support that comes with companionship and encouragement.

There are times cancer patients can't leave home or the hospital for long periods; it is in these times that life must come to the patient, Keen writes.  It is only with the help and support of others that this can happen.

You must fight with every possible resource available to you, including prayer. "When someone is praying for you, it means you are not alone," Keen writes.

In response to a question about how to battle depression at the promotional event Keen said, "Small victories.  Hold onto what you believe, hold onto the people you love, eliminate every limit, find something to look forward to that can be done and then realize that it is done with a multitude of people. An individual might feel discouraged, depressed, regret. Surround yourself whenever possible with a lot of people."

Keen and Laura at Bluegrass
10,000 race, July 2011
Laura Babbage is a registered nurse who has worked as a health-care executive and is a chaplain for both UK HealthCare and St. Joseph Hospital.

Laura maintained a website on during Keen's treatment to keep family and friends informed of his condition, care and needs. The entries are included in the book and are both forthcoming and explicit. They also offer insight into the role of the caretaker.

"The caretaker needs care as well," Laura said at the promotional event. "Caretakers need to recognize their limits" and put systems in place to make sure the patient is being cared for while also taking care of themselves, she said.

Life Lessons from Cancer offers insight and encouragement to those battling cancer as well as the caregiver. It is full of lessons that not only apply to those who have cancer, but can also be applied to life.

One of the sayings for which Keen is known is his message to his students at Henry Clay High School: "Read. Read More. Keep Reading."

His motto while battling cancer came to him in a card from one of his students: "Fight. Fight more. Keep fighting."

Friday, November 22, 2013

Doctors give nurse practitioners more leeway on prescriptions; senator says tort-reform lobbies should play hardball with money

"Concerns about a growing doctor shortage, especially in rural Kentucky, is fueling the urgency for lawmakers and medical groups to agree on an approach to allow nurse practitioners to be able to prescribe certain medicines without physician supervision," Ryan Alessi reports for cn|2's "Pure Politics."

Advanced-practice registered nurses want the legislature to free them of the requirement that they have an agreement with a physician in order to prescribe non-narcotic drugs. The House passed a bill to do that this year, but it stalled in the Senate. Now, "I believe that they have a resolution to that," Senate President Robert Stivers said at the Kentucky Hospital Association's annual health leadership conference Thursday in Louisville.

Stivers, a Republican from Manchester, said Sen. John Schickel, R-Union, has been negotiating with the nurse practitioners and the doctors' lobby, the Kentucky Medical Association. He indicated that the compromise would include an initial four-year period in which an agreement would be required, but with measures to help nurse practitioners and doctors reach such agreements. Schickel didn't immediately return a call seeking comment.

Stivers said he favored the bill that failed. "In rural areas, I believe nurse practitioners are part of the solution for lack of access" to medical care, he said. The access problem is expected to grow as thousands of Kentuckians gain health insurance or Medicaid coverage under federal health reform.

Also at the KHA meeting, Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee, said the hospital, doctor and nursing-home lobbies should refuse to give campaign contributions to any legislators who won't support their efforts for tort reform -- the latest attempt at which would create review panels for medical-malpractice lawsuits. The panels could not block the suits, but their findings could give defendants more advantage in settlement negotiations.

Denton's co-panelist, Rep. Jimmie Lee, D-Elizabethtown, chairman of the House budget subcommittee for health, took umbrage at the idea of such a policy for the lobbies' political action committees.

"It's very scary to me, that if you don't give me a PAC check, I'm not going to vote with you, or if you give me one, I'm going to vote with you," Lee said. "That's scary, folks, that your PAC check is going to determine how Jimmie Lee votes."

Denton said it was unfortunate that Lee portrayed campaign money as "influencing your vote or buying your vote. I don't consider you giving a PAC check as trying to buy somebody's vote or influencing it." Lee smiled gapingly in disbelief, and said in rebuttal, "You're saying, don't give 'em any money because they didn't vote with you."

House Speaker Greg Stumbo said on the earlier panel that there is no proof that such measures reduce malpractice and insurance costs, but Stivers, also a lawyer, said the fear of lawsuits results in many unnecessary diagnostic procedures. "I've tried a lot of these cases, and I've seen it," he said. "C.Y.A."

First diabetes educator license is issued in Kentucky

Kim DeCoste (photo via AADE)
Kentucky is the first state to issue a diabetes educator license, according to a press release from the Kentucky Board of Licensed Diabetes Educators.

Kim DeCoste of Richmond, a registered nurse and chair of the Kentucky Diabetes Educators Licensure Board, is the licensee.

"I am proud to represent diabetes educators throughout Kentucky as the first person to receive a license,” DeCoste said. “Kentucky’s legislation assures that the qualifications of diabetes educators have been thoroughly reviewed and that individuals are appropriately credentialed. Improved consumer safety is vital as diabetes care becomes increasingly complex.”

The release said Kentucky passed laws in 2011 to require licensing of diabetes educators in an effort to improve the quality of health care in the state, which has a high rate of diabetes. Ten percent of Kentucky adults, or approximately 370,000, had been diagnosed with diabetes in 2010, according to the latest Kentucky Diabetes Report. An additional 233,000 Kentucky adults have been diagnosed with pre-diabetes, and research from the federal Centers for Disease Control and Prevention has indicated that approximately 27 percent of people with diabetes have not been tested or diagnosed.

Because diabetes is controllable if diagnosed early and managed well, diabetes educators play a vital role in working with people who have or are at risk of developing diabetes and developing a plan of care, the report says.

The American Association of Diabetes Educators define a diabetes educator as “health care professionals—registered nurses, registered dietitians and pharmacists, among others—who specialize in helping people with diabetes understand how to best manage their health.”

Thursday, November 21, 2013

Haynes asks hospitals for a truce as they and state work through problems with managed-care Medicaid

Health and Family Services Secretary Audrey Haynes won a smattering of applause from Kentucky hospital officials Thursday as she called for "not a surrender, but a truce" as her cabinet continues to address the hospitals' complaints about the state's managed-care system for Medicaid, which recently entered its third year.

Haynes drew the ire of hospitals last month when she said some needed to change their business models to emphasize prevention and wellness, not cashing in on Medicaid payments for emergency-room care. Thursday, she said in a speech to the Kentucky Hospital Association in Louisville that she wants "to work more closely together, not only to improve your business practices," but to improve the health of Kentucky.

Haynes also called on the hospitals to join Appalachian Regional Healthcare and the University of Kentucky hospital in contacting past patients who lacked insurance and urge them to sign up for expanded Medicaid or private insurance on the state's Kynect website, under federal health reform. "I need your help," she said. "we're very excited about the opportunity for dramatic improvements in Kentucky's health status."

Also at the meeting, state Rep. Jimmie Lee, D-Elizabethtown, the House's health-care budget subcommittee chair, said he thought Haynes and the administration of Gov. Steve Beshear had largely resolved the "prompt pay" problems of hospitals not getting money they are owed by insurance companies. But Senate Health and Welfare Committee Chair Julie Denton, R-Louisville, called for more action on the subject, such as an independent review panel to review disputed claims.

Ky. Hospital Association defends 'critical access' designation that gives small, rural hospitals a federal financial boost

The Kentucky Hospital Association came out strongly for continued federal support of small, rural hospitals Thursday, objecting to a proposal that the "critical access hospital" designation be based entirely on distance from other hospitals. Kentucky has 29 such hospitals, which get slightly higher Medicare and Medicaid reimbursements in return for limiting their size and services.

Until 2006, states were allowed to make the designation based on a community's health status, poverty rate, rural nature and other factors. So many were designated that they became the majority of critical access hospitals. That is also the case in Kentucky.

The Office of Inspector General of the U.S. Department for Health and Human Services said in August that the government could save up to $1 billion a year if the designation were limited to the original criterion, being at least 35 miles from another acute-care facility, or 15 miles in mountainous areas. KHA's initial repsonse is here.

"The OIG report seeks to eradicate rural health care by shutting down rural hospitals," said Charles Lovell, CEO of Caldwell Medical Center, a critical access hospital in Princeton. "People call us Band-Aid stations," but he could provide a long list of lives saved at his hospital, he said. Other speakers cited hospitals' important role in providing jobs and recruiting doctors for small towns. Cutting the list "would only hurt our communities' physical and economic health," said Susan Starling, CEO of Marcum and Wallace Hospital in Irvine.

Fran Feltner, director of the University of Kentucky Center of Excellence in Rural Health, noted that it was National Rural Health Day and said, "I believe every Kentuckian should have access to the right care at the right time, and close to home."

Critical access hospitals make up only 22 percent of Kentucky hospitals, but maintaining their extra reimbursement would also help the chains that own some of them, because costs of the chain can be allocated to individual hospitals. Here are the critical access hospitals in Kentucky, by county:
Allen: The Medical Center at Scottsville
Breckinridge Memorial Hospital, Hardinsburg
Caldwell County Hospital, Princeton
Carroll County Hospital, Carrollton
Casey County Hospital, Liberty
Cumberland County Hospital, Burkesville
Estill: Marcum and Wallace Hospital, Irvine
Floyd: McDowell Appalachian Regional Hospital; Saint Joseph Martin
Grant: St. Elizabeth Medical Center Grant County, Williamstown
Green: Jane Todd Crawford Hospital, Greensburg
Hart: Caverna Memorial Hospital, Horse Cave
Knox County Hospital, Barbourville
Leslie: Mary Breckinridge Hospital, Hyden
Lincoln: Ephraim McDowell Fort Logan Hospital, Stanford
Livingston Hospital and Healthcare, Salem
Madison: Saint Joseph Berea
Marshall County Hospital, Benton
Mercer: James B. Haggin Memorial Hospital, Harrodsburg
Morgan County Appalachian Regional Hospital, West Liberty
Nicholas County Hospital, Carlisle
Ohio County Hospital, Hartford
Owen: New Horizons Medical Center, Owenton
Russell County Hospital, Russell Springs
Simpson: The Medical Center at Franklin
Trigg County Hospital, Cadiz
Union: Methodist Hospital Union County, Morganfield
Wayne County Hospital, Monticello
Woodford: Bluegrass Community Hospital, Versailles

Tuesday, November 19, 2013

Beshear and two other Democratic governors say Obamacare is working in their states, and cite examples

Gov. Steve Beshear continues to be a major national cheerleader for the federal health-reform law, citing Kentucky examples in an op-ed piece he and the Democratic governors of Connecticut and Washington circulated to newspapers this week.

"People keep asking us why our states have been successful," they write. "Here’s a hint: It’s not about our websites. Sure, having functioning websites for our health-care exchanges makes the job of meeting the enormous demand for affordable coverage much easier, but each of our state websites has had its share of technical glitches. As we have demonstrated on a near-daily basis, Web sites can continually be improved to meet consumers’ needs. The [Patient Protection and] Affordable Care Act has been successful in our states because our political and community leaders grasped the importance of expanding health-care coverage and have avoided the temptation to use health-care reform as a political football."

All three governors expanded the Medicaid program to include people with incomes up to 138 percent of the federal poverty line. Beshear cites two independent studies that showed Kentucky "couldn’t afford not to expand Medicaid. Expansion offered huge savings in the state budget and is expected to create 17,000 jobs." The state will have to start helping pay for the expansion in 2017, but Beshear has argued that the economic activity from more health care will cover that bill.

At least one of Beshear's co-authors, Washington Gov. Jay Inslee, is not allowing insurance companies to renew policies that don't comply with the law, as President Obama allowed last week. But they wrote, "What we all agree with completely, though, is the president’s insistence that our country cannot go back to the dark days before health-care reform, when people were regularly dropped from coverage, and those with 'bare bones' plans ended up in medical bankruptcy when serious illness struck, many times because their insurance didn’t cover much of anything.
Thanks to health-care reform and the robust exchanges in our states, people are getting better coverage at a better price."

As an example, Beshear cited Howard Stovall, whose sign and graphics business in Lexington "has paid half the cost of health insurance for his eight employees" since it opened in 1998. "With the help of Stovall’s longtime insurance agent and Kentucky’s health exchange, Kynect, Stovall’s employees are saving 5 percent to 40 percent each on new health insurance plans with better benefits. Stovall can afford to provide additional employee benefits, including full disability coverage and part of the cost of vision and dental plans, while still saving the business 50 percent compared with the old plans." (Read more)

Monday, November 18, 2013

Most Kentucky hospitals will pay Medicare penalties under health reform, one the country's largest; look them up here

More Kentucky hospitals are receiving penalties than bonuses in the second year of Medicare’s quality incentive programs, one of the federal health reform law’s changes designed to create financial rewards for doctors and hospitals to provide better care. Pineville Community Hospital is being assessed the highest penalty in the country for its readmission rates.

Medicare has two quality-care incentive programs for hospitals. Value-based purchasing gives bonuses and penalties based on 24 quality measures, and the other program levies penalties for readmissions. Thirty-one Kentucky hospitals were assessed a penalty while 26 were given a bonus for improved performance, says an analysis by Kaiser Health News. Here's a screen shot of the beginning of the list:
The law allows the federal government to withhold a portion of a hospital's Medicare reimbursement money, up to a 1.25 percent penalty or bonus for every bill paid between October 2013 and September 2014, based on assessments of these quality standards.

"The incentives are among the law’s few cost-control provisions that have kicked in, but it is too early to tell how effective they will be in making hospitals operate more efficiently," reports Kaiser's Jordan Rau.

Large value-based bonuses are going to some major teaching hospitals and smaller institutions, such as Pikeville Medical Center. The state's average bonus is 0.25 percent, compared to the national average of 0.24 percent; Kentucky's penalties averaged minus 0.20 percent, for a total average of zero. It won't be known how much hospitals will receive or pay in dollar figures until next October since this depends on how much the hospital ends up billing Medicare, Kaiser reports.

However, as a result of the readmission program, Pineville Community Hospital is losing 2.57 percent of its reimbursements,the largest penalty in the country. Considering the impact of both the value-based program and readmissions program, Kaiser reports, two out of three hospitals are losing money starting last month.

Here's how the value-based score was figured: 45 percent on hospitals' use of clinical processes of care; 30 percent on patient experiences; and 25 percent on death rates. Hospitals were are also assessed by how they compared to other hospitals and how much they improved from two years ago, says

Researchers are unsure whether the penalties are significant enough to trigger major improvements, writes Rau. And, some hospitals that have made improvements are still losing money because they haven't improved as much as other hospitals. On the other hand, some hospitals with subpar quality rankings are still getting more money because they showed improvement.

Nationwide, Medicare has raised payment rates to 1,231 hospitals and reduced payments to 1,451. Hospitals that are designated as critical access facilities and certain cancer hospitals were excluded from the program. But these facilities aren't immune to other portions of the health law, such as cuts in Disproportionate Share Hospital (DSH) program payments,for having a high percentage of Medicare and Medicaid patients.

New quality measures will be added to the value-based program for 2015, including comparisons of how much patients cost Medicare at different hospitals and rates of medical mishaps. In addition, the maximum readmission penalties grow to 3 percent next year, and a third incentive program will take an additional 1 percent of payments away from hospitals that have the most injuries or infections during patients' stays.

"Combined, these three quality programs have the potential to strip away as much as 5.5 percent of Medicare payments from the worst performing hospitals starting next October," reports Rau.

Dr. Patrick Conway, Medicare’s chief medical officer, says "We're moving away from volume and toward quality." Yet, to remain viable, some hospitals are being forced to make up for payment cuts by seeing more patients. Click here for the interactive chart.

At least one insurance company will let Kentuckians keep their health insurance plan for another year if they like it

By Molly Burchett
Kentucky Health News

At least one insurance company, Humana, will be allowing Kentuckians to keep their insurance coverage for another year if they like it, even if the policies aren't compliant with the Patient Protection and Affordable Care Act.

Partially owning up to his reforms' rocky rollout last week, President Obama said people whose policies were being cancelled because they didn't comply with the law could renew their policies for another year -- if insurance companies are willing to do so and state regulators allow it. Kentucky is among the states allowing them to do so, and Humana is going along.

Humana -- and Anthem Blue Cross, if it follows suit -- will be required to tell such policyholders "what protections these renewed plans don't include" and that they have alternatives that may be better and cheaper on insurance exchanges, Obama said.

“Humana has been educating people about the full range of options, including the ability to retain their current coverage, in accordance and coordination with state law," a Humana spokesperson told Kentucky Health News. An Anthem spokesperson said the company is still reviewing its options.

About 280,000 Kentuckians -- almost all those in individual and small-group insurance market -- faced policy discontinuation, requiring them to get different insurance coverage.

Experts say there are a number of obstacles that could keep insurers from letting customers renew old policies, including the concern that the risk pools of the state's health-insurance exchange will be skewed. And, insurers will have to calculate how much they plan to charge for policies that were going to be discontinued.

“Changing the rules after health plans have already met the requirements of the law could destabilize the market and result in higher premiums for consumers,” Karen Ignagni, the president of America’s Health Insurance Plans, a lobbying group, told The New York Times.

Some insurers say the president's move is adding to the confusion that surrounds the health-care law and adding uncertainty to the insurance market. This may discourage participation from a key group, young and healthy people who are needed to make insurance exchanges sustainable, reports The Washington Post.

There is doubt that insurance companies can do all of this in less than a month to ensure coverage is in place by Jan. 1. It is unclear how, as a practical matter, the changes proposed by the president can be put into effect, National Association of Insurance Commissioners President Jim Donelon said last week. And, even if they do, the proposed changes only last a year.

UK is first in U.S. to conduct clinical trial for new Parkinson's treatment that shows improvement in all five patients so far

A new treatment strategy for Parkinson's disease at the University of Kentucky could change the way the ailment is treated, manage symptoms better and halt or reverse the progressive degeneration of the brain that comes with the disease, the university announced Monday.

Dr. Craig van Horne demonstrated a deep-brain stimulation
remote control unit on Parkinson's patient Rodney Parsons.
(Lexington Herald-Leader photo by Charles Bertram)

Read more here:
UK is the first U.S. university to conduct a clinical trial of the strategy, led by principal investigator Dr. Craig van Horne, associate professor of neurosurgery in the College of Medicine, according to a news release from the university.

Parkinson's, a progressive and degenerative disease, affects around 1 million Americans and 10 million people worldwide, according to the release. Symptoms include both motor and non-motor symptoms including tremor, rigidity, slow movement and unstable posture. No cure exists.

The first course of treatment is medication, but any medication loses its effectiveness over time.The second line of treatment is deep brain stimulation, a surgical procedure that works like a "brain pacemaker." Electrodes are surgically implanted into the malfunctioning part of the brain where cells have died to emit electrical impulses to regulate the brain's abnormal impulses, according to the release.

Deep brain stimulation has improved the quality of life for many people with Parkinson's, but while it manages symptoms, it does not change the course or outcome of the disease, according to the release. UK's clinical trial explores an additional treatment option, and possibly a way to alter the course of the disease.

"They are conducting an innovative clinical trial that builds upon the established deep brain stimulation procedure by supplementing it with a nerve graft of patients’ own peripheral nerves," the release says. "The nerves in the brain do not regenerate when they are damaged, but peripheral nerves—nerves outside of the brain and spinal cord—can regenerate." The trial will "aim to use the regenerative capacity of peripheral nerves to allow the brain to heal itself."

The procedure will implant a small piece of a patient's peripheral nerve from just above an ankle. This can be done at the same time as deep brain stimulation, so the patient will get the benefit from both procedures, the release says. The effect of the implant will be tested by simply turning off the deep brain stimulator. The hope is that the peripheral nerve will "stimulate regeneration in the parts of the brain that have been damaged by Parkinson's disease."

So far, five Parkinson’s patients have undergone the combined procedure. The trial calls for six. All five have shown consistent improvement in symptoms and "were able to entirely go off the medication one month later, relying on the deep brain stimulation device to manage their symptoms," the release says. Normally, deep-brain stimulation patients are able to reduce their medication but not eliminate it.

"The patients can have more consistent 'on' times—fewer ups and downs with their symptoms," Van Horne said. "They’re not fluctuating due to meds if they’re just using the stimulation."

The trial has progressed quickly because it uses the patient's own tissue, with no risk of rejection or need for immuno-suppressant drugs, and takes only 30 minutes longer than standard deep brain stimulation.  If successful, this procedure could significantly change the treatment of Parkinson’s disease, the release says, and could have an impact on other neuro-degenerative disorders. To learn more click here.

New guidelines for cholesterol management spark controversy; faulty risk calculator could lead to over-prescribing statins

The American College of Cardiology and the American Heart Association released new guidelines for cholesterol management, a new formula to assess heart attack and stroke risk, and guidelines for lifestyle modifications and weight management to reduce heart attack and stroke risk.

“These guidelines will be helpful to all physicians and their patients, but they will be particularly relevant in Kentucky, where nearly 70 percent of Kentuckians are overweight or obese, we are the third highest state in rates of high blood pressure, five Kentucky counties are among the least active in the U.S. and the incidence of diabetes is above the national average,” Dr. Susan Smyth, director of the Gill Heart Institute at the University of Kentucky, said in an e-mail.

However, some experts have questioned the new guidelines, and the new formula for calculating cardiovascular risk appears to overstate the risk value used to determine who should receive cholesterol-lowering statin drugs.

"There may be no single perfect score that we can use to give statins the 'thumbs up' or 'thumbs down' for our patients without established cardiovascular disease," Smyth said. "Ultimately, physicians have many different tools at their disposal to evaluate CV risk in their patients, and they will review all of the available evidence to make a determination about who may be likely to benefit from statin therapy."

The new guidelines also change how statins should be prescribed. The drugs have been given to lower cholesterol to a specific numerical value, but now it is suggested that moderate to high doses of statins be given to patients who fall within four identified groups of patients who have been determined to get the most benefit from the drug:
  • already diagnosed with heart disease or stroke
  • with an LDL {"bad" cholesterol) of 190 mg/dL or higher, who may have genetic risk
  • aged between 40 and 75, with Type 2 diabetes and high LDL levels, but without heart disease or stroke
  • with an estimated 10-year risk of cardiovascular disease of 7.5 percent or higher who are between 40 and 75, without heart disease or stroke, but with high LDL levels.  
Instead of focusing strictly on patients' LDL and total cholesterol, the new guidelines suggest physicians treat patients based on their overall risk of heart disease or stroke, of which cholesterol levels are just one part, according to the report.

The guidelines in the report also call for lifestyle modification, including adhering to a heart-healthy diet, which includes vegetables, fruits, whole grains, low-fat dairy, poultry, fish, beans and healthy oils and nuts; 30 to 40 minutes of exercise three to four times a week; avoidance of tobacco products, and maintenance of healthy weight.

The guidelines use a cardiovascular risk calculator that considers age, race, sex, diabetes, smoking habits, blood pressure and low HDL, or "good" cholesterol levels, among other considerations.

But a problem has been identified with the risk calculator, so worrisome that a past president of the College of Cardiology called for a halt to the implementation of the new guidelines, reports Gina Kolata of The New York Times. The calculator appears to overestimate the risk group so greatly, Kolata reports, that it could mistakenly suggest that millions more people should be candidates for statin drugs.

"It's stunning," the cardiologist, Dr. Steven Nissen, chief of cardiovascular medicine of the Cleveland Clinic, told Kolata. "We need a pause to further evaluate this approach before it is implemented on a widespread basis."

After an emergency, closed-door meeting on Saturday night, the two organizations that published the guidelines said "that while the calculator was not perfect, it was a major step forward, and that the guidelines already say patients and doctors should discuss treatment options rather than blindly follow a calculator," Kolata reports.

Dr Sidney Smith, the executive chairman of the guideline committee, told Kolata that "the association would examine the flaws found in the calculator and determine if changes were needed."

Two Harvard Medical School professors, Dr. Paul M. Ridker and Dr. Nancy Cook, had pointed out the calculator was not working among the populations it was tested on by the guideline makers a year earlier, during an independent review for the National Institutes of Health's National Heart, Lung, and Blood Institute, which originally developed the guidelines, Kolata reports.

Dr. Donald Lloyd-Jones, co-chairman of the guidelines task force and chairman of the department of preventive medicine at Northwestern University, told Kolata that "the committee thought the researchers had been given these results."

Ridker and Cook evaluated the calculator again after they saw the guidelines and found that it over- predicted risk by 75 to 150 percent, depending on the population, Kolata reports. They wrote in The Lancet, a British medical journal, that the miscalibration be "reconciled and addressed" before implementation, saying: "If real, such systematic overestimation of risk will lead to considerable over-prescription."

Some doctors are concerned that because many people are already "leery of statins, the public would lose its trust in the guidelines or the heart associations," Kolata reports. Currently, it is only obvious that those in the highest risk groups, such as those who have heart attacks, strokes or have diabetes, should take statins, she reports.

Community paramedics program could help provide primary-care services, help address state's provider shortage

Next spring, the Kentucky Board of Emergency Medical Services could establish a community paramedics pilot program that has the potential to ease the state's shortage pf primary-care health providers.

The idea was prompted by the likelihood that the state's expansion of the Medicaid program would lead to a shortage of primary-care personnel. It would add community paramedics to a local health care delivery system, reports Chuck Mason of the Bowling Green Daily News.

“We’re in the first stages of looking into this,” Michael Poynter, executive director of the EMS board, told Mason. “Vulnerable populations with new health insurance plans will not have access to a provider because of the increase in demand.” The provider shortage, particularly in rural areas, especially affects those without to transportation, said Poynter.

Under the program, a primary-care partner could refer a patient to EMS personnel to provide services such as fall prevention, blood draws or medication administration, in the patient’s home. The paramedic would provide documentation to the patient’s primary care physician.

The program has the potential to allow paramedics to play a more active role in care delivery, changing the face of emergency medical services, writes Mason. "The big question at this point is how health care providers would receive reimbursement from the government for expenses related to community paramedics and how the concept would integrate into the health care systems already in place in Kentucky," Poynter told Mason.

Some say such a program could reduce overall health care costs, reports Mason. It could even help reduce hospital re-admissions, potentially saving them millions of dollars because federal health reform penalizes them for re-admissions.

EMS personnel "have the training, expertise and scope of practice to provide essential primary care services," Poynter told Mason. He said such programs have been successful in Colorado, Minnesota and Pennsylvania, where paramedics are practicing community medicine after completing a training program.

Kentucky's training could be provided by colleges and universities, Mason writes. Western Kentucky University is exploring coursework for emerging jobs in the health care field. "Patient education, teaching about healthy best practices and health care screening could be some of the roles filled by the community paramedic," Poynter told Mason. "The idea is not to replace home health or physician office visits, but rather to augment the health care." (Read more)

Great American Smokeout is Thursday, Nov. 21, featuring supportive characters to share on social media and a Twitter chat

The American Cancer Society's annual Great American Smokeout will be held Thursday, Nov. 21. The event encourages smokers to quit smoking, or make a plan to quit smoking, that day.

Quitting, even for one day, according to the Cancer Society, is an important step toward a healthier life, one that can lead to reducing cancer risk.

In Kentucky, according to the Centers for Disease Control and Prevention, 25.2 percent of adults are cigarette smokers, second highest in the nation. The Kentucky Tobacco and Cessation Program reports that each year more than 8,000 Kentuckians die of illnesses caused by tobacco use.

"Tobacco use remains the single largest preventable cause of disease and premature death in the U.S., yet nearly one in every five adults smoke," the Cancer Society says. It also notes that there are 13.2 million cigar smokers in the U.S. and 2.2 million who smoke tobacco in pipes, which are also dangerous and addictive forms of tobacco.

To celebrate quitters and their supporters, the American Cancer Society has designed a series of characters available to share on social networks. (See characters.)

They are also hosting, with Sharecare, a Great American Smokeout Twitter Chat on Wed., Nov. 20. This event allows you to post questions on Twitter to  @Sharecarenow  about how to quit smoking, smoking legislation or anything on your mind related to smoking.  You can also submit questions on Sharecare’s Facebook page.  The answers from the Cancer Society and other experts will roll out on Twitter at #quitforgood on Thurs., Nov. 21, between 11 a.m. and 4 p.m.

The health benefits of quitting are greater if you quit when you are young, but quitting at any age is beneficial. The Cancer Society lists the benefits chronologically:
  • In 20 minutes: your heart rate and blood pressure drop
  • In 12 hours: the carbon monoxide level in your blood drops to normal
  • 2 weeks to 3 months: your circulation improves and your lung function increases
  • 1-9 months: coughing and shortness of breath decrease
  • 1 year: your risk of coronary heart disease is cut to half that of a continuing smoker
  • 5 years: risk of certain cancers is cut in half, and stroke risk can fall to that of a non-smoker
  • 10 years: the risk of dying from lung cancer is about half that of a person who still smokes and other cancer risk decrease
  • 15 years: the risk of coronary heart disease is that of a non-smoker
The American Cancer Society is available to offer steps to quit smoking and to provide quit-smoking programs. To learn about the available tools, call 1-800-227-2345.

Thursday, November 14, 2013

Ky., high in childhood obesity, fights it with better school meals, increased activity requirements and maybe help from Big Bird

By Melissa Patrick
Kentucky Health News

Kentucky children are some of the nation's fattest.

In 2011, the last year for which data are complete, Kentucky ranked sixth in the U.S. in the percentage of obese 2-to 4-year-olds from low-income families (15.5%), eighth for percentage of obese 10-17 year-olds (19.7%), and third in percentage of obese students in high school (16.5%), according to a project of the Trust for America's Health and the Robert Wood Johnson Foundation. (Read more

Kentucky has several programs in place to fight childhood obesity, such as improving food choices in schools with farm-to-school mini-grants and improved school nutritional guidelines. Efforts are also being made to increase the standard expectations of physical activity, according to the federal 
Centers for Disease Control and Prevention website.  

Laws that require Kentucky school districts to develop local wellness policies for grades K-5 that includes moderate to vigorous physical activity each day and encourages healthy choices among students are a step in the right direction toward decreasing childhood obesity. This legislation also requires assessment tools to measure each child's level of physical activity on an annual level, according to the National Association of State Boards of Education website. There is also a push to increase the activity requirements in child care facilities, according to the CDC website.

The frequency at which children eat fast food, and its nutritional value, are also challenges in decreasing childhood obesity. Kids and teens consume up to 300 calories more per trip to a fast-food or full service restaurant compared to days they eat at home, Ryan Jaslow reports for CBS News. (Read more)

Although fast-food restaurants have made some improvements with healthier sides and beverage choices in most children's meals, "there is room for improvement," researchers say in the "Fast Food Facts 2013" report, issued by Yale University's Rudd Center for Food Policy & Obesity.

The report examines how 18 major restaurant chains market their foods and beverages to children and teens, and analyzes the nutritional quality of the chains' food. Significant findings included: Less than 1 percent of all children's meal combinations at such restaurants met recommended nutrition standards; McDonald's spent 2.7 times as much to advertise its products as all fruit, vegetable, bottled water and milk advertisers combined; the total amount spent on all advertising by fast-food restaurants in 2012 was $4.6 billion; preschoolers viewed 2.8 fast-food ads per day in 2012; children 6 to 11 saw 3.2 such ads per day; and teens viewed 4.8. The researchers also found that fast-food restaurants continued to target black and Hispanic youth, populations at high risk for obesity and related diseases.

Researchers called for fast-food restaurants to stop marketing unhealthy foods to children and teens, saying "Research shows that exposure to food marketing messages increases children’s obesity risk." (Read more

On the marketing front, "Sesame Street" characters have joined the Produce Marketing Association to help market fresh fruits and vegetables to children, according to a press release from the Robert Wood Johnson Foundation.

"Marketing healthy products with the same skill and vigor typically used for less healthy options could make a major difference in shaping children's food preferences," Dr. Risa Lavizzo-Mourey, the foundation's president and CEO. "I have a vision of children pestering their parents for pears and begging for broccoli."

Obama says health policies that don't comply with reforms can be renewed for another year; state will let insurance firms decide

People with insurance policies that don't measure up to the federal health-reform law will be able to renew them for another year, President Obama announced today in an effort to quell outrage about policy cancellations that made hash of his promise "If you like your plan, you can keep it."

An estimated 280,000 Kentuckians have policies that are being canceled because they do not comply with the law's coverage requirements. Obama said insurance companies will be required to tell such policyholders "what protections these renewed plans don't include" and that they have alternatives that may be better and cheaper, with the help of federal tax subsidies.

The president also said state insurance commissioners will still have the power to decide what plans can and can't be sold in their states. "Kentucky will comply with the president’s request to allow Kentucky’s insurers the option of determining whether to extend existing health insurance policies to current policyholders for one more year," Gov. Steve Beshear said in a written statement. "This will be a business decision for each insurer to make, as many of them have invested a great deal of time and money into preparing for the transition to new standards under the Affordable Care Act."

At a White House press conference, Obama was asked why he kept repeating that people could keep their plan when his own administration had said in the Federal Register that people in the individual and small-group markets, about 6 percent of Kentucky's policyholders, would lose policies.

"There's no doubt that the way I put that forward unequivocally ended up not being accurate," he said. "It was not because of my intention not to deliver on that commitment. . . . We put a grandfather clause into the law but it was insufficient." The law said people could keep policies they had in place when it was passed, but that protection disappeared if an insurance company changed the policy, which seems to have happened in most cases.

Obama said he thought that most people whose policies were canceled "could find better policies at lower costs or the same costs in the marketplaces" run by the federal government and individual states like Kentucky, and the rest would be covered by the grandfather clause. "There's a good chance they'll be able to buy better insurance at lower costs," he said.

Asked if his broken promise creates a breach in public trust and confidence in government, Obama said, "There is no doubt that people are frustrated" and think that in Washington, "'not enough is being done that helps me with my life.' They expect me to do something about it. . . . It's legitimate for them to expect me to have to win back some credibility on this health-care law in particular and on a whole range of these issues in general."

U.S. Sen. Mitch McConnell issued this statement: “President Obama’s announcement doesn’t even come close to fixing the problems that so many Americans are facing right now as a result of cancelled health care plans and skyrocketing premiums. But, it does represent the clearest acknowledgment yet that his oft-repeated pledge ‘if you like your plan, you can keep it’ was false all along. What makes this admission even worse is the fact that it was prompted not by the heartbreaking stories of millions of Americans, but by the private pleadings of a handful of endangered Democrats. Americans are becoming increasingly aware of the fact Obamacare is broken beyond repair. The only ‘fix’ is full repeal followed by step-by-step, patient-centered reforms that drive down costs and that Americans actually want.”

Obama said at the press conference that the law will work and he is not backing away from it: "We’re going to do everything we can to help the Americans who have received these cancellation notices. But I also want everybody to remember there are still 40 million Americans who don’t have health insurance at all. I’m not going to walk away from 40 million people who have the chance to get health insurance for the first time. And I’m not going to walk away from something that has helped the cost of health care grow at its slowest rate in 50 years."

Tacitly acknowledging that it makes some people pay more, he said society and governments often make decisions carrying initial costs that are outweighed by long-term benefits, such as requiring motor vehicles to have seat belts. Speaking of the law's ineffective grandfather clause, he said “It's almost like we said to folks, 'You gotta buy a new care even though you can't afford it right now.'”

Many questions at the press conference dealt with the faulty federal website, which Kentuckians to not use. Obama said, "These are two fumbles . . . on a big game, but the game's not over."

"This solution combines a clever public-relations stunt, a stalling tactic, an act of retribution, the genuine possibility of transition assistance for some, and a large political and substantive gamble," Brian Beutler writes for Salon. "It bears the hallmarks of desperation and frustration and determination, but it just might work."

Tuesday, November 12, 2013

Pike County officials urge newly eligible residents to sign up for health insurance before Dec. 15

A call to action.

That's what Pike County officials are calling their efforts to encourage citizens to sign up for health care insurance, as called for by the Patient Protection and Affordable Care Act, reports Russ Cassady of the Appalachian News-Express in Pikeville.

The act and the state's expansion of Medicaid under the law have made an estimated 9,915 people in the state's easternmost and geographically largest county eligible to receive health insurance, county Social Services Commissioner Carol Napier said at a Fiscal Court meeting last week.

“Of that number, 5,127 are now eligible for Medicaid,” she said, adding that 3,984 others are eligible to get subsidies for private health insurance.

The call to action also reminds people to apply before Dec. 15 to assure that their coverage will begin Jan. 1, Cassady reports. “There’s still yet those individuals that are under the impression that they don’t qualify,” Napier said.

Judge-Executive Wayne T. Rutherford, at the same meeting, reminded Pike County residents who apply through the state insurance exchange that they will not have to go through the national system, Cassady reports.

Kentucky's online health insurance exchange, Kynect, hailed by some as the best Obamacare website, is available to all Kentucky residents to explore their options, find out if they qualify for subsidies, and sign up for health insurance.

Cassady's story gives a list of local Kynect assistance sgencies, where people can call to ask questions or request help:
 • Pike County Health Department, (606) 437-5500
 • Mountain Comprehensive Care Center, (606) 432-3143
 • Big Sandy Area Development District, (606) 886-2374
 • Appalachian Research and Defense Fund of Kentucky, (606) 886-3876
Citizens of Pike County can also call the county Social Services office at (606) 432-6246 with questions about their eligibility for health insurance under the Patient Protection and Affordable Care Act. (Read more; subscription may be required)

Health care's culture doesn't encourage doctors to report medical errors of colleagues; article says patients should come first

By Melissa Patrick
Kentucky Health News

Doctors are often aware of their colleagues' medical errors, but fail to report them because of a culture that does not support or encourage such actions, Marshall Allen writes for ProPublica, a non-profit, non-partisan journalism organization.

Medical errors are estimated to kill 400,000 people in U.S. hospitals each year according to an online article by John T. James in the Journal of Patient Safety, causing some to say that medical errors are one of the nation's leading causes of death, Allen reports.

According to a report from the U.S. Department of Health and Human Services, most health-care providers employ a philosophy of "deny and defend" when confronted with issues related to medical errors. Providers fear full disclosure will lead to more lawsuits, higher jury awards, higher insurance premiums, and the loss of reputation or coverage for the provider, the opposite is true, the HHS report says. It says honest and open communication helps to lessen malpractice costs.

The Department of Veterans Affairs Medical Center in Lexington has led the way in the move toward health-provider transparency. It has worked under a philosophy of full transparency and disclosure since 1987, requiring prompt reporting and investigation of medical errors and near misses, full investigation, full disclosure of investigation results to the patients and families who have been injured because of accidents and medical negligence, and expressions of apology and  fair remedy, including compensation for injuries, according to the HHS report.

Several years ago, Allen contacted a Las Vegas surgeon to follow up on hospital data that showed peers of this surgeon that had high rates of surgical injuries. Allen reported that before he could reveal the list of peers to the surgeon and request his services in the investigation, the surgeon shared stories of the many surgeries he and his partners did to "clean up" the mistakes of "the worst surgeons in town" and said "he did not need a database to tell him which surgeons made the most mistakes."

An article in the New England Journal of Medicine, “Talking With Patients About Other Clinicians’ Errors,” says that although there is a common belief that there is an ethical duty to inform patients who have been harmed by medical errors, physicians often do not.

The existing guidelines emphasize ethical duties related to self reporting when physicians make  errors, says the report, but offers little guidance about what to do when they discover someone else's mistake.

In a survey separate from the New England Journal of Medicine report, but led by the same main author, more than half of doctors said that in the previous year they had identified at least one error by a colleague.  Gallagher told Allen that the survey did not ask what the doctors did about it.

For the New England Journal report, Dr. Thomas Gallagher, an internist and professor at the University of Washington, led a team of 15 experts who identified possible reasons doctors stay silent about errors by their peers. One reason is the system of referrals on which doctors depend, Allen reports; if a physician "becomes known as a tattler" he or she will lose referrals, and thus suffer financially.

The report lists other reasons for not reporting colleagues' medical errors, such as lack of time to investigate, a culture that promotes loyalty and solidarity, concerns about harming one's institution or becoming involved in a medical malpractice case,  concerns about causing a colleague to face legal issues,risk of acquiring an unfavorable reputation with colleagues and issues related to cultural differences, gender, race and seniority.

The bottom line, Gallagher told Allen, is that "physicians are not learning from their errors and patients are not getting the information they need to receive proper treatment or compensation when the outcome is harmful."

Dr. Brant Mittler, a cardiologist who works as a medical malpractice attorney in Texas, told Allen that in almost four decades in medicine he often saw errors and stayed quiet because "there would have been hostility" if he had reported them. “There’s not a culture where people care about feedback,” Mittler said. “You figure that if you make them mad they’ll come after you in peer review and quality assurance. They’ll figure out a way to get back at you."

Gallagher told Allen, "The result of this culture is too much leniency toward mistakes."

The New England Journal article said that despite the challenges of disclosure, the patient comes first, and doctors should "explore, not ignore" a colleague's error, Allen notes.

Once an error is suspected, the report suggests, the doctor recognizing the error should find the facts, starting with a direct conversation with the physician who made the error so together they can decide how to inform the patient. The article also suggests that hospitals and other health-care institutions lead by supporting transparency.

Dr. David Mayer, vice president of quality and safety at Medstar Health, which runs 10 hospitals in Maryland and Washington, D.C., told Allen that "reporting of medical errors (and near misses) is a top priority at the organization so everyone can learn from mistakes, saying that each month there are about 1,400 reported safety events."

The safety events are analyzed for trends, Mayer told Allen.  If a patient is harmed, an investigation is conducted and the information is disclosed to the patient and family, an apology can be made and compensation can be offered.

Dr. Humayun Chaudhry, president and CEO of the Federation of State Medical Boards, which provides guidance for how state boards regulate doctors, told Allen that doctors and other providers should be more assertive about reporting errors. "Failing to tell a patient about another doctor's mistake undermines the doctor-patient relationship," Chaudhry told Allen. "It makes patients wonder if they can trust their own physicians and the profession of medicine."

Bill Clinton says Obama should keep promise on insurance, but knows that won't work, Washington Post writer says

Former president Bill Clinton's recent statement that President Obama should change the health-reform law to keep his promise that people who liked their health-insurance plans could keep them or ironic because "He's the reason Obama made the disastrous promise in the first place," Ezra Klein writes for The Washington Post.

"Veterans of the effort to pass Clinton's health-care plan believed that their core mistake was producing a plan that upended the insurance arrangements of almost every American," Klein reports. "In the aftermath of Clinton's failure, health-care reformers swung far to the other side. Rather than building a plan in which almost everyone lost their insurance, they began trying to build plans in which almost no one lost their insurance — and selling them under the promise that literally no one would."

But that promise "went too far," Klein writes, because "saying 'everyone who likes their health insurance can keep it' is very different from saying '95 percent of people who like their health insurance can keep it'." However, Clinton "knows that it's functionally impossible to reform the health-care market if you upend nothing." (Read more)

Monday, November 11, 2013

Draft plan for a statewide campaign for better health gets endorsement, much talk at Friedell Committee annual meeting

By Al Cross
Kentucky Health News

A statewide committee of volunteers is on target with its plan for a campaign to make Kentucky a healthier state, an expert in state and local health told the committee Monday.

“You guys are absolutely on the right track,” Julie Willems Van Dijk of the University of Wisconsin told the Friedell Committee for Health System Transformation at its annual meeting in Lexington.

The committee is developing a campaign that would involve many partners around the state, including health-care providers, education and business leaders, state and local health officials, and other groups and individuals interested in improving Kentucky’s poor health. The draft campaign’s working motto is “healthier, wealthier and wiser,” reflecting how education, health and economic development are related.

“Your three-legged stool of health, industry and education fits solidly within the model we’re talking about,” said Van Dijk, deputy director of the County Health Rankings and Roadmaps Program funded by the Robert Wood Johnson Foundation.

Dr. Lee T. Todd Jr.
Kentucky’s health rankings – we’re first in smoking, cancer deaths and preventable hospitalizations – prompted Dr. Lee T. Todd Jr. to dub such statistics “the Kentucky uglies” when he was president of the University of Kentucky. Now part of the group developing the campaign, he told the committee in a keynote speech Sunday night, “Those are things we need to remember and repeat.”

Noting the low life expectancy in many Kentucky counties, and the wide range of life expectancy among Louisville neighborhoods, Todd asked, “Why can’t people get excited about that, or disappointed, or just mad about it?”

Kentucky ranks 44th among the states in health, and “The bottom line is, it hurts us economically,” Audrey Haynes, secretary of the state Cabinet for Health and Family Services, told the committee Monday.

Todd noted how San Antonio reduced its obesity rate after losing a prospective employer that cited how fat the city’s sixth-graders were. He said local communities should “get mad about something and decide you’re going to change something. . . . We have just got to stop tolerating ill health.”

As examples, he cited Grant County’s successful effort to improve its health ranking, the Hopkins County oral-health program that reduced premature births, and Clark County’s effort – now funded by a small extra tax – to varnish students’ teeth to prevent cavities.

“Why can’t we get this stuff to roll across this state and make a big difference?” Todd asked. He suggested that one reason has been a shortage of leadership and courage, as demonstrated by the political dominance of traditional industries with health implications, such as coal and tobacco.

Todd said the committee needs to find “a market driver” like the state Supreme Court ruling that forced education reform in 1990 or the Russians’ launch of the first man-made satellite in 1957, which prompted national reform of science and math education.

He said the federal health-reform law could provide that spark, because it will bring many people into the health-care system and provide free preventive services. He suggested a targeted effort, such as getting the newly enrolled to check their A1C hemoglobin (a rough measure of blood sugar and an indicator of diabetes), and predicted the tests would show many of them “are diabetic but didn’t know about it.”

While the statewide campaign can focus on certain things, Todd said, it “can’t be viewed as outsiders” giving direction to local communities. He said the effort must be led by people in local communities, focusing on their local health problems. Willems said the committee could set strategic priorities from which communities could select.

As the committee met Monday, Todd and Committee Chair Jane Chiles of Lexington said the campaign needs grant money and a staff. “This subject is too important for us to nickel-and-dime it,” he said.

As Chiles adjourned the meeting, she said of the proposal, “This is a winning concept, a winning strategy.”

For a PDF copy of the committee’s draft proposal, click here.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky. Al Cross is director of the Institute and a member of the Friedell Committee.