Consumer Reports rates hospitals on safety, puts Somerset hospital last in Kentucky; hospital blames its incomplete data

Consumer Reports magazine recently released safety rankings for hospitals across the country, compiled from government data. Miles Memorial Hospital in Damariscotta, Maine, received the best safety rating in the U.S., a 78 on a scale of 100. That was 12 points higher than the hospital labeled Kentucky's safest, Georgetown Community Hospital.

Lake Cumberland Regional Hospital in Somerset received by far the lowest rating in Kentucky, a 20. That was eight points below the next-lowest Kentucky hospital and nine points above Bolivar Medical Center in Cleveland, Miss., which was rated the nation's least safe hospital.

According to a message to the community prepared by Lake Cumberland Regional Hospital officials, "The information used to calculate the Consumer Reports scores does not provide an accurate picture of our hospital's quality and safety performance," because "We learned several years ago that we had not been submitting complete clinical information to Medicare." The hospital employed a clinical documentation improvement program that helped quality scores back into the expected ranges. Because the report featured data from 2009-2012, these improvements were not represented in the results, according to the message. Mark Brenzel, CEO of the hospital, said current information "reflects a much better score for the various quality indicators that they used." The hospital is owned by LifePoint Hospitals of Brentwood, Tenn.

The safety ratings are based on data gathered from the federal Center for Medicare and Medicaid Services. The five categories are occurrences of hospital acquired infections, unnecessary readmissions, mortality, communication about new medications, and appropriate use of scanning. Each categories counts for up to 20 points. Rankings by city, state, and county are available here. Some hospitals have not been rated because they did not have all the valid data measures needed to calculate the score.

"The average score for hospitals is just 51, and 43 hospitals got a score below 30," Consumer Reports said. John Santa, M.D., medical director of Consumer Reports Health, said "It is unacceptable that so many hospitals are doing so poorly. Especially since our ratings show that some hospitals can do a good job at keeping patients safe."

Unfortunately, approximately "440,000 hospital patients a year die at least in part because of preventable medical errors," Consumer Reports said. This figure is based on a comprehensive analysis published in the Journal of Patient Safety, a peer-reviewed medical journal. "What matter is that too many people are dying in hospitals because of medical mistakes, not enough is being done to stop it, and patients need more information," author John James said.

UPDATE, April 4: There are many forms of hospital rankings, some done with questionable business practices such as "licensing fees" they get from hospitals, notes Pia Christensen of the Association of Health Care Journalists.

Kentucky hospitals list their community benefits

Kentucky hospitals estimated that they contributed nearly $2.18 billion to their communities in 2012, up from $1.96 billion the previous year, says a report compiled from information provided by the hospitals to the Kentucky Hospital Association.

The report focuses on how Kentucky's 131 hospitals meet their community needs.

The largest community contribution reported by Kentucky hospitals in 2012 was the $658.8 million they absorbed for bad debt, or money that is owed by patients, but is not paid. Bad debt often occurs when uninsured patients make too much money to qualify for financial assistance or charity care, but still cannot afford the cost of their care, or when uninsured patients can't afford co-pays and deductibles. This amount has almost doubled since 2008, the first year Kentucky Hospital Association did this survey, and the year that the Great Recession began.

The second largest contribution reported for 2012 was $452 million in financial assistance and charity care, which includes caring for patients regardless of the their ability to pay. This amount has more than doubled in the last three years.

KHA cited Julie Lumberg of Louisa is an example of charity care contribution. She had a health condition that doctors were having a hard time diagnosing, and became virtually unable to see and couldn't drive. She was unable to work, lost her health insurance, couldn't afford to pay for COBRA coverage, and was still sick. Because of charity care, Julie was able to go to King's Daughters Medical Center in Ashland for an MRI. She was diagnosed with a brain tumor and was able to have surgery without paying. Julie was up and driving within 14 days.

Kentucky hospitals, which treat an average of 55 percent Medicare patients, said they absorbed a $177.2 million shortfall from the federal program in 2012. Hospitals also reported a $300 shortfall in Medicaid, the federal-state program that covered approximately 830,000 Kentuckians in 2012. A shortfall is the difference in what the treatment cost and what the program paid. The report suggests that under federal health care reform, the Medicare shortfall will rise to $852 million in 2019.

Some hospital contributions to the community fall in the area of community health improvement services such as health education, treatment and/or prevention like health fairs, screening programs and immunization clinics. Kentucky hospitals said they contributed $58.5 million to these types of programs in 2012, up from $43.7 million in 2011.

Molly Rusk is someone who benefited from one such educational program, KHA said in its report. Molly is a 27-year-old woman who weighed too much to ride a mule through the Grand Canyon while on vacation. Upon returning to Kentucky, she attended a free seminar on medical weight loss options by Norton Healthcare in Louisville, enrolled in the program, and lost 60 pounds. She also no longer needs blood pressure or cholesterol medicine

Kentucky hospitals reported a big increase in research investment in 2012: $336.8 million, up from $270.8 million in 2011. They also contribute to education of health professionals. In 2012, they reported spending $141.7 million on health professions education, up from $127.4 million in 2011.

Pediatric care simulator

KHA cited as an example two pediatric care simulators, which are used throughout the state. They were purchased by Saint Joseph Hospital Foundation, part of KentuckyOne Health.  They have been instrumental in improving pediatric education for nurses who use them to practice assessment and intervention techniques, improving pediatric care and outcomes, KHA said.

The hospitals also contribute to their communities by subsidizing clinical services. The 24 neonatal intensive care units in Kentucky are examples of such programs that have received a portion of the reported $31.7 million spent on subsidies in 2012.

Hospitals said they contributed $12.3 million to support community and social service organization to promote health in 2012. As an example, KHA cited support for medical missions around the world by St. Elizabeth Healthcare in Northern Kentucky.

Hospitals said they contributed $3.8 million in 2012 for community building activities to protect or improve the health or safety of their communities. KHA said such programs often address the root cause of health problems, which are often not obviously health-related. One such program is the refurbished porches and ramps built for several needy families in Clay County that were provided by the Manchester Memorial Hospital.

A more obvious way that hospitals give back to their communities is through providing jobs, KHA noted. Kentucky hospitals were one of the largest employers in 2012. They paid approximately $4.1 billion in employee wages and salaries and more than $1 billion in employee benefits in 2012.

Hospitals also stimulate the economy through purchasing of supplies and services, which they said totaled more than $6.4 billion in 2012. They also said they generated an estimated $604 million in state and local taxes, through taxes paid directly or from their 82,488 full and part-time employees.

Obamacare raised woman's premium 74% but she's thankful it has extended health care to those who didn't have it

"Beneath the loud debate" about the Patient Protection and Affordable Care Act, it is "quietly starting to change the health care landscape," writes Abby Goodnough of The New York Times, in the latest installment of her series looking at the law through the lives and businesses of Kentuckians.

"In Kentucky alone, more than 350,000 people — about 8 percent of the state’s population — have signed up for coverage," Goonnough notes. "Insurers and medical providers are reporting steady demand from the newly covered for health care, ranging from basic checkups to complex surgical procedures." About 80 percent of the signups in Kentucky are for Medicaid, and that number is likely to increase, because while open enrollment in private plans for 2014 closes tonight at midnight, Medicaid accepts enrollees year-round.

Goodnough's story looks at a new Medicaid enrollee, a man who is having difficulty affording his subsidized policy, and a woman whose income is so high that she couldn't even get subsidies for a new policy through the state health-insurance exchange — but who, like the other two, came to one of the Family Health Centers in Louisville because her doctor wasn't in the network for her new policy. The centers "primary and preventive care in low-income neighborhoods where private doctors are scant," and just over half their patients last year had no coverage, Goodnough reports.

New York Times video; to play it, click on image

Donna Morse, 61, is a widow who "lost her insurance last year because it did not meet the new law’s standards. Now she has a new plan with much higher premiums, and which few doctors and hospitals will accept," Goodnough writes. "She is paying $448 a month for a new Humana plan, up from the $258 monthly premium she paid before," an increase of 74 percent. And when she took her prescription to her neighborhood Walgreens, she "discovered that the chain did not accept her new Humana policy, a so-called narrow network plan with a limited number of providers."

Nevertheless, Morse, a dental hygenist, told Goodnough that she was “very pleasantly surprised” by her experience at the clinic and “I’m really thankful that a lot of people are getting health care that couldn’t have it in the past.”

That describes David Elson, 60, "a self-employed businessman with a multitude of health problems and medical bills," and forgot to pay the first month's premium for his subsidized policy; and Tamekia Toure, 40, a diabetic and single mother who moved to Louisville from Alabama and got on Medicaid but found a job at Amazon soon after her clinic appointment. "She was elated to find work so quickly . . . but also a little scared," Goodnough writes. "Would her new income make her ineligible for Medicaid, so soon after she had signed up? With the expanded program, this so-called churning in and out of Medicaid, based on changes in income, is expected to be common, and for many, problematic." (Read more)

Public Health Week, April 1-7, puts focus on issues

The state Department for Public Health is working to promote National Public Health Week, April 1-7 this year. The week is an annual observance that focuses on critical public-health issues to raise awareness and help people live longer, healthier lives.

“In some way, public health touches everyone, every day in Kentucky,” said Health Commissioner Stephanie Mayfield, M.D., said in a news release. She noted efforts to expand public health’s influence in Kentucky, including health departments' work to obtain national accreditation and find opportunities for improvement within existing programs at a time of continuing budget cuts.

“We know that investing in prevention and public health can make an enormous difference and it’s the right direction for Kentucky to move in to address poor health outcomes,” Mayfield said. “Many premature deaths could be prevented by making healthy choices like not smoking, maintaining a healthy weight, eating right, staying active, and the getting recommended immunizations and screening tests.”

The state health department, the Kentucky Health Department Association, the Kentucky Public Health Association and local health departments will be sponsoring community events that promote taking the simple preventive steps that lead to better health and lead to a healthier Kentucky. For more information about National Public Health Week, visit http://www.nphw.org/about. More information about Kentucky public health can be found at. http://chfs.ky.gov/dph/.

Kynect enrollment accelerates as Monday deadline nears; call center to be open form 8 to 4:30 Saturday and Sunday

Enrollment in coverage through the state's Kynect health-insurance exchange is accelerating as Monday's deadline for open enrollment approached.

State officials reported Friday that the rate has surpassed 4,000 per day, bringing the total to more than 350,000, or one of every 12 Kentuckians. Four-fifths of the enrollees are in Medicaid, which is open to adults with incomes at or below 138 percent of the federal poverty threshold and to children in households up to double the threshold.

Medicaid, funded mainly by the federal government, is free to beneficiaries. The insurance exchange offers private insurance plans with premium subsidies to people earning up to 400 percent of the poverty threshhold, about $96,000 for a family of four. A preliminary analysis has found that about three-fourths of enrollees report that they did not have insurance before signing up through Kynect.

Thousands of people have been found eligible for a subsidy to purchase a qualified health plan but have yet to select a plan. People who remain uninsured as of Tuesday, April 1, could face a financial penalty of $95 or 1 percent of income, whichever is greater, under the federal health-reform law. The penalty applies to every uninsured member of a household and will increase each year.

“In these final days of open enrollment, we strongly encourage folks to complete their applications and choose a plan,” said Carrie Banahan, executive director of Kynect. “After March 31, the subsidies to help cover the cost of a private health plan won’t be available again until the fall enrollment period – and by that point, being without insurance may cost you on your taxes, not to mention keep you at risk for big bills from sickness or injury.”

Individuals can sign up online 24 hours a day at kynect.ky.gov. If someone has started or filed an application by March 31 and has not been able to complete it through no fault of their own, Kynect says it will work with them to make sure they get enrolled. Individuals who have applied by March 31, but have not yet chosen a plan will have until April 15 to do so, with coverage beginning May 1.

The Kynect call center will be open through the weekend to help people navigate the exchange. For assistance, call 1-855-4kynect (1-855-459-6328) Saturday and Sunday from 8 a.m. to 4:30 p.m. ET.

County Health Rankings officials are coming to Kentucky Tuesday to spotlight local projects to improve community health

State officials and health leaders will gather April 2 at the Kentucky History Center in Frankfort to celebrate Kentucky’s successes in implementing strategies for improving health at the community level, as reflected by the latest edition of County Health Rankings by the Robert Wood Johnson Foundation and the University of Wisconsin Population Health Institute.

Representatives of the foundation and the university will be at the Frankfort event, arranged by the state Department of Public Health, the Foundation for a Healthy Kentucky and the Friedell Committee for Health System Transformation, which is planning a statewide campaign to improve Kentucky's health status, community by community.

The event will highlight promising local health projects and initiatives to improve community health. It will feature four Kentucky counties – Grant, Todd, Floyd and Franklin counties – that have used the County Health Rankings to help their communities begin to show signs of progress.  Lt. Gov. Jerry Abramson will highlight Gov. Steve Beshear’s "Kyhealthnow" initiative to significantly improve Kentucky’s dismal health rankings and habits.

The County Health Rankings allow counties to see how well they are doing on 29 factors that influence health, including smoking, high school graduation rates, employment, physical inactivity and access to healthy foods. This year’s rankings include several new measures including housing, transportation and access to mental health providers.

“The County Health Rankings are a starting point for change, helping communities come together, identify priorities, and create solutions that will help all in our diverse society live healthier lives, now and for generations to come.”said Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation.

Nationally, this year’s Rankings show that people living in the least healthy counties are twice as likely to have shorter lives as people living in the healthiest counties. For a story on the rankings in Kentucky, click here.

Group overseeing effort to make state healthier hears of 'dire need,' tools for improvement

Kentucky's health is "in dire need of improvement," but the state has some tools to do that, including health-care reform and the insurance program for its own employees, the group of officials charged with improving the state's health heard at its first meeting Thursday.

Mayfield

Dr. Stephanie Mayfield, commissioner of the Department of Public Health, told the group overseeing "Kyhealthnow" that the state is near the bottom of national rankings on nearly every goal set for the effort, but "is poised to make strong progress through school-based programs and the fact that federal health reform has made preventive services free," a state press release said.

The goals are that by 2019, Kentucky will reduce its smoking, obesity and uninsured rates by 10 percent; cut its death rates from cancer and cardiovascular disease by 10 percent; reduce deaths from drug overdoses and the average number of poor mental health days by 25 percent; reduce the percentage of children with untreated dental decay by 25 percent, and increase adult dental visits by 10 percent.

The effort is overseen by state cabinet secretaries, other key state officials, Mayfield as co-chair and Lt. Gov. Jerry Abramson as chair, by appointment from Gov. Steve Beshear. They are to meet quarterly.

The oversight group also heard from Department of Employee Insurance Commissioner Joe Cowles, whose agency provides health insurance coverage for 266,000 members, including employees of state agencies, school boards and local government, as well as retirees under age 65 and their dependents.

Cowles talked about the two insurance plans that contain a wellness component designed to encourage plan members to lead healthier lifestyles. "These plans provide lower coinsurance, deductibles and out-of-pocket maximums," Cowles said. "But more importantly, those who choose a LivingWell plan are required to complete an online health assessment. This helps them become more aware of their current well-being and understand their health risks. And, they get a personalized plan of action so they can get or stay healthy."

The department also offers a diabetes prevention program at no cost, and it has shown encouraging results, as participants are improving their physical activity and overall health, Cowles said. And it has anti-fraud measures that track the distance members drive to fill prescriptions, what drugs they are buying, how often, and so on.

The officials also heard from Dave Adkisson, president and CEO of the Kentucky Chamber of Commerce, which has made the health and wellness of Kentuckians one of its top three priorities because health-insurance costs have increased and an increasing share of companies’ tax dollars go to pay for health care. He said the state's health problems have reached “epidemic proportions.”

“We commend Governor Beshear for engaging his entire administration in a comprehensive effort to improve Kentucky’s health problems,” Adkisson told Kentucky Health News. “Health costs are a major issue among Kentucky businesses. But containing those costs can be like turning an aircraft carrier around in open water. We are glad state government as a huge employer has stepped up its efforts to encourage wellness among state employees and their family members who are covered by the state’s health insurance program. By being aggressive on wellness, prevention and disease management, tens of thousands of lives will be improved and health care costs paid by taxpayers will be contained.”

Telemedicine can help delay Alzheimer's, especially in rural areas, where it starts sooner, Appalachian health conference is told

By Melissa Landon
Kentucky Health News

Telemedicine is a strategy that can be used to help prevent and treat Alzheimer's disease, especially in rural areas, where the disease comes sooner in life, Dr. Gregory Jicha, clinical-core director of the University of Kentucky's Disease Center, said today at the fourth annual Appalachian Translational Research Network Summit in Lexington.

Dr. Gregory Jicha

While mortality rates for prostate cancer, breast cancer, heart disease and HIV are going down, the rates for Alzheimer's are going up, and by 2020, it is estimated that 5.6 million Americans could be affected by it. Rural areas have higher incidents of the condition, and the onset of dementia averages four years younger in rural areas than in urban areas, Jicha said.

The university's Telemedicine Cognition Clinic offers appointments that involve video interaction with patients and caregivers in remote areas. In rural areas in general, telemedicine can be particularly helpful for patients who live great distances from the nearest specialist. "I cannot drive to Paducah and fill an entire clinic every week," Jicha said. But he explained that he can "travel" to a different city every hour and provide care to patients. "Telemedicine really is the wave of the future," he said. 

During telemedicine appointments, medical experts can talk about the patients' history, administer cognitive tests, and even observe patients walking or performing tasks to diagnose them. The goal of the program is to provide high level care and cognitive evaluations in rural areas by partnering with primary care physicians and clinics in rural areas, Jicha said.

Another important aspect of the growing program is education, both for patients and for physicians. Alzheimer's disease has no sure, but some risk factors associated with it—such as hypertension, alcohol use and depression—are treatable. If rural residents had better access to specialists who can detect the early symptoms of the disease, its onset could be delayed.

The conference was a forum for hundreds of research efforts. Among the topics discussed during the conference were the connection between physical fitness and academic performance in children, and environmental enrichment to promote healthy aging brains.

Todd Gress, a professor at Marshall University in Huntington, W.Va., presented a study about a pilot test of a text-message reminder system to advance diabetes awareness, compliance, and education—particularly in remote areas where cell phone service might be unreliable.

The advancing telemedicine strategy and these other research agendas should serve as a reminder that gifted researchers are searching for ways to improve rural health.

Such conferences "represent the best of what's happening out there in the world of universities and the world of communities," UK Provost Christine Rirodan told one session. She said the Appalachian gathering "represents the passion of people who are dedicated to solving these problems" in the region, "which require a great deal of collaboration to solve. . . . They're not small problems."

One of every three Kentucky adults didn't see a dentist last year; key factors are overall health, insurance and income

More than a third of Kentucky adults say they didn't go to a dentist last year, and one in six said they hadn't in five years or more, according to the latest Kentucky Health Issues Poll.

The results show the challenges Kentucky adults who are lower income, uninsured or living in rural areas face in getting dental care, said the Foundation for a Healthy Kentucky, which sponsors the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati. “Oral health is critical to overall health,” said Dr. Susan Zepeda, president of the foundation.

The poll, taken Oct. 25 through Nov. 26, found that 64.4 percent of Kentucky adults went to the dentist in the past year. Another 8.5 percent said they had been in the previous year, 10.4 percent said their last visit was three to five years ago, and 14.6 percent said it has been more than five years. Two percent of Kentuckians polled said they had never been to a dentist.

Among those who defines their overall health as very good or excellent, 73 percent had a dental visit in the previous year while only half of those who said their overall health is fair or poor said they did.

Only 24 percent said their physician has asked about their oral or dental health. Those whose physicians did ask about their oral health (73%) were more likely to visit a dentist than those who were not asked (62%).

Dental insurance is relatively rare, so income is a major factor in seeing after oral health. Among Kentucky adults with incomes at or below 138 percent of the federal poverty threshold, making them eligible for Medicaid, 48 percent reported seeing a dentist in the past year. Among those with incomes more than double the threshold, the figure was 81 percent. Among those who said they had insurance, 70 percent reported a dental visit, while only 43 percent of the uninsured said they did.

Just over half (51%) of adults who live in Appalachian Kentucky visited a dentist in the past year compared to seven in ten (71%) of adults living outside Appalachia.

The poll surveyed a random sample of 1,551 adults from throughout Kentucky by telephone, including landlines and cell phones. The poll has a margin of error of plus or minus 2.5 percentage points.

Children 8-12 can submit a healthy lunch recipe by April 5 to get chance for trip to Kids' 'State Dinner' at White House

First Lady Michelle Obama is again teaming up with the Education and Agriculture departments to run a nationwide recipe contest to promote cooking and healthy eating by young people.

"Teaching kids to cook is a great way to ensure our children learn healthy habits early in life," a white House press release said. "Research shows that children who help with cooking and meal preparation are more likely to consume fruits and vegetables, and they are more aware of the importance of making healthier food choices.'

The third annual Healthy Lunchtime Challenge & Kids' “State Dinner” encourages students across the country to come up with healthy, original creations. It invites parents or guardians and their children, ages 8 through 12, to create and submit an original lunch recipe that is healthy, affordable and tasty.

The recipe must follow the guidance that supports USDA’s MyPlate to ensure that the criteria of a healthy meal are met. Entries must include each major food group, either in one dish or as parts of a lunch meal, including fruits, vegetables, whole grains, lean proteins and low-fat dairy foods, with fruits and veggies making up roughly half of the plate or recipe.

Recipes can be submitted through April 5, online at www.recipechallenge.epicurious.com, or via mail to The Healthy Lunchtime Challenge c/o Epicurious.com, 1166 Ave. of the Americas, 15th Floor, New York NY 10036.

This summer, Delta Air Lines will fly 56 children and their parent/guardian (one pair from each of the 50 states, plus the U.S. territories, D.C., and Puerto Rico) to the nation’s capital where they will have the opportunity to attend a Kids’ “State Dinner” at the White House hosted by Mrs. Obama. A selection of the winning healthy recipes will be served. Winners will be notified in May. For more information and contest rules visit www.recipechallenge.epicurious.com.

UK hospital tells 1,079 former patients that a laptop computer with their medical records was stolen in early February

The University of Kentucky reported Wednesday that personal health information of 1,079 people who had been patients at its hospital was on a laptop computer that was stolen in early February.

UK HealthCare said the computer, which was password-protected, belonged to one of its pharmacy billing management vendors. The computer contained dates of birth, medical records and perhaps some patients' insurance carriers and ID numbers, but not Social Security numbers or bank information, UK said.

"We have no reason to believe at this time that any data has been compromised, but under federal privacy regulations we are required to notify people whose information was on the computer in question," UK spokesman Jay Blanton said. "We are also notifying those individuals directly about what has occurred. In that communication, we provide information about where people can contact UK HealthCare for further information." For coverage from WKYT-TV, click here.

New County Health Rankings report shows same counties at top and bottom, but many have shown moves in the rankings this year

By Melissa Patrick
Kentucky Health News

The fifth annual County Health Rankings report shows that some Kentucky counties have made great improvements in their rankings over the last five years, while others have significantly dropped or remained stuck at the bottom.

The report estimates each county's overall health outcomes (length and quality of life) and its overall health factors (determinants of health). These categories are broken down into eight different areas that are measured and calculated to rank each county relative to the other counties in the same state.

Local communities can use the data "to see how they compare to other Kentucky counties on several health dimensions," said Susan Zepeda, president/CEO of the Foundation for a Healthy Kentucky. "We hope local leaders will use this information to identify both health challenges and policy opportunities." The foundation operates a complementary data website, kentuckyhealthfacts.org, with detailed information on each county's health status.

The last five years have shown some great improvements in the health outcomes and health factors in some of Kentucky's counties. The factors used in the rankings have changed somewhat over the years, some statistical modeling is involved, and statistical differences among closely ranked counties are so small that they may not be significant.

Thus, the rankings should be viewed more as a general categorization of a county's health status than be used to make specific comparisons with counties that are relatively close in the rankings. To emphasize that, the University of Wisconsin's Population Health Institute, which compiles the data, groups counties in quartiles, or fourths of the whole. Kentucky has 120 counties, in quartiles of 30.

McLean County (ML on the map, southwest of Owensboro) is the only one that showed major improvement in both measures, moving up to 45th now from 85th in health outcomes, and up to 51st now from 79th in health factors.

Other counties that showed the most improvement in health outcomes are Hickman, moving up to 56th from 95th; Grant, moving up to 58th from 89th; Elliott, moving up to 66th from 93rd; and Simpson, moving up to 27th from 54th.

A video on Grant County is part of this year's national presentation, also funded by the Robert Wood Johnson Foundation. To watch it, click here.

Grant County was spotlighted because community members used its low ranking as a motivation for improvement. One goal of the project is to provide specific health information to counties that can be evaluated and used to improve their health status.

The counties that showed the most improvement in health factors are Bracken, moving up to 40th from 74th; Meade, moving up to 49th from 83rd; Hart, moving up to 62nd from 91st; and Graves, moving up to 42nd from 73rd. Four other counties, besides McLean, moved up 28 spots in this category: Union (to 43rd from 71st), Marion (to 36th from 64th), Christian (to 66th from 94th) and Carlisle (to 21st from 49th).

Because the rankings are relative, within the state, as many counties must move down as move up, and some counties have shown significant drops in the last five years.

Morgan and Carlisle counties both plummeted 48 spots in the rankings for health outcomes over the five-year period. Morgan fell from 14th to 62nd and Carlisle dropped from 25th to 73rd. These counties were followed by Bath, moving from 67th to 99th; Harrison, from 47th to 77th; and two that dropped 29 spots: Union, which fell from 45th to 74th, and and Robertson, which went from 57th to 86th.

Larger drops were seen in health factors. Fulton County showed a whopping 61-place decline in the last five years, from 48th to 109th. Robertson dropped to 91st from 37th; Lincoln dropped to 95th from 45th; Harrison dropped to 50th from 16th; and Clinton dropped to 89th from 60th.

The top and bottom counties in the rankings have showed very little variation over the last five years. This year the top five counties for health outcomes are: Oldham, Boone, Shelby, Calloway and Scott. The top five for health factors are Oldham, Woodford, Boone, Fayette and Scott.

All five are some of the state's wealthiest and most educated counties, and the five at the bottom are some of the poorest and least educated.

The bottom five counties for health outcomes this year are Lee, Breathitt, Wolfe, Floyd and Perry, at 120th. The bottom five for health factors are Leslie, Magoffin, Wolfe, Martin and Clay, at 120th. These overlapping groups of counties form a contiguous area in the middle of Eastern Kentucky.

Year-to-year changes are subject to more statistical doubt, but some counties showed big movements in their rankings form last year. Carlisle County showed the single greatest drop in health outcomes, dropping 29 spots, from 44th to 73rd. Adjoining Harrison County dropped 22 spots in health outcomes, moving from 55th to 77th. Trimble County dropped 26 spots in health factors, moving from 21st to 47th.

It will be interesting to watch Bracken County, whose improvement of 30 spots to 40th from 70th this year might reflect in better health outcomes in the future.

Morgan County is also one to watch. Its dismal health factors scores over the last five years, ranging from 96th to 111th, may have contributed to a drop in health outcomes, from 14th in 2010, to 23rd 2011, to 29th in 2012, to 69th in 2013 and to 62nd in 2014.

The downward trend in Nelson County's health-factor ranking, from 25th in 2013 to 46th in 2014, is also worth watching to see if this will reduce its consistently high ranking in health outcomes, ranging from 17th to 25th over the last five years.

The report uses data from the federal Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, which constantly surveys Americans about their health. Because of small sample sizes for small counties, their figures are calculated through statistical modeling and comparison with counties of similar demographics.

Feds, state will allow mid-April enrollment for people who start but don't complete Obamacare applications by March 31

"The Obama administration has decided to give extra time to Americans who say that they are unable to enroll in health-care plans through the federal insurance marketplace by the March 31 deadline," The Washington Post reports. "Federal officials confirmed Tuesday evening that all consumers who have begun to apply for coverage on www.HealthCare.gov, but who do not finish by Monday, will have until about mid-April to ask for an extension."

The announcement will not change the policies and procedures of the Kentucky Health Benefits Exchange (branded as Kynect), said its executive director, Carrie Banahan. She said the exchange was already planning to enroll by April 15 people who had filed an application but not selected a plan by March 31, and will also enroll people who can show they tried to apply by March 31 but were prevented from doing so by a technical difficulty.

Here is more background from the Post.

FDA reviews alternatives to colonoscopies to screen for colorectal cancer, including mail-in, stool-sampling kits

The Food and Drug Administration is examining the possibility of two alternatives to colonoscopies for identifying tumors and growths in the large intestine. Kentucky ranks high in deaths from colon cancer, partly because people resist having colonoscopies.

According to briefing documents posted online Monday, scientists are evaluating the precision of mail-in, stool-sampling kits from Epigenomics and Exact Sciences, which if approved could be on the market this summer, Matthew Perrone writes for the Minneapolis Star Tribune.

Stool tests have long been employed to help detect precancerous tumors, and colon cancer is often treatable if found early enough. So far, the two tests are more accurate than traditional blood stool tests, but they also more often reported growths when there were none.

"Colorectal cancer is the second leading cause of cancer death in the U.S., with over 50,000 deaths expected this year, according to the American Cancer Society," Perrone reports. Last year Kentucky had the fourth highest death rate for colon cancer in the nation, Dr. Amy Tiu noted in a March 15 article for the Lexington Herald-Leader.

Though colonoscopy is the most accurate screening, many people shun it because they think it will be uncomfortable or invasive, and a liquid compounds must be used to clean out the colon before the procedure. The blood-in-stool tests, though thought to be less accurate, may work just as well if employed each year, according to a federally appointed panel.

The new screenings are expected to be more expensive than traditional tests, and it is so far unclear how often people would need to be tested, Perrone reports.

"Only through a better understanding of other key factors, such as the screening interval, adherence, cost and diagnostic evaluation of positive results, can we determine the appropriate place for stool DNA testing on the screening menu," Drs. Douglas Robertson Dr. Jason Dominitz said in the briefing documents.

One of the proposed tests, Cologuard, detected colorectal cancer in 92 percent of patients who had cancerous tumors, while the traditional blood stool test only has 74 percent accuracy. "In patients with precancerous polyps the test was accurate 42 percent of the time, compared with 24 percent for the blood test," Perrone reports.

Epigenomics' Epi proColon test, however, did not meet all of the study goals. This test discovered cancer in 68 percent of patients who had cancerous tumors, but it only recognized healthy patients in 79 percent of cases. FDA scientists warned that "lower specificity could lead to an increase in the number of avoidable colonoscopies" and "adverse events associated with such invasive procedures," Perrone writes.

Smoking persists or even increases in poor, rural, working-class counties; New York Times cites Clay County as an example

Clay County has a dubious distinction. It has the highest rate of smoking for any U.S. county with a population under 15,000. Researchers at the University of Washington pointed that out, and The New York Times focused on it in reporting the larger finding: Some poor, rural and working-class counties have increasingly high rates of smoking, while the smoking rates in wealthy counties continue to decline.

Ed Smith Jr.
(NYT photo by Tim Harris)

In Clay County, the smoking rate was 36.7 percent in 2012. “It’s just what we do here,” Ed Smith Jr., 51, told the Times, which reports, "Several of his friends have died of lung cancer, and he has tried to quit, but so far has not succeeded." (Institute for Health and Metrics map shows adult smoking rates by county; Clay and Knox counties are the red area in southeastern Kentucky. The interactive map shows how rates have changed since 1996, overall and among men and women. To view it, click here.)

The smoking rate among adults has decreased 27 percent since 1997, but only 15 percent among poor people, and haven't changed at all for adult smokers living in deep poverty in the South and Midwest, the study found. "The findings are particularly stark for women," Sabrina Tavernise and Robert Gebeloff write. "About half of all high-income counties showed significant declines in the smoking rate for women, but only 4 percent of poor counties did." Education also plays a role. "Americans with a high-school education or less make up 40 percent of the population, but they account for 55 percent of the nation’s 42 million smokers."

Clay County is one of the nation's poorest, and only 7 percent of its people have a college degree. The county seat, Manchester, passed an indoor smoking ban in 2012, and Manchester Memorial Hospital "runs a smoking-cessation program that offers free nicotine patches and gum in an effort to reach low-income smokers," the Times reports. “Smoking cessation is our biggest uphill battle,” Jeremy Hacker, the hospital’s community outreach coordinator, told the newspaper. Smoking is no longer a normal activity in urban places, he said, but in Clay, “It’s not viewed as a problem.” (Read more)

Humana Inc. bus travels the rural roads of Mississippi, looking to enroll people in Obamacare by March 31 deadline

Insurance providers have been scared off by Mississippi, one of the poorest and unhealthiest states in the country. Only nine percent of eligible residents have signed up for insurance under federal health reform, ranking Mississippi near the bottom of all states in Obamacare, with only 25,554 residents having signed up as of early March.

Politico photo by Madeline Marshall: Humana bus

Louisville-based insurance company Humana Inc. is attempting a unique way to try to get Mississippi residents signed up. The company has a bus that travels the state, having made more than 200 stops "pulling into hospital parking lots and Wal-Mart shopping centers, parking at churches large and small and hitting other obvious targets to find and convince the uninsured that President Barack Obama’s signature health achievement will benefit them," Jennifer Haberkorn reports for Politico. "Sometimes the company’s agents see dozens of people per stop. Other times, just a few individuals climb aboard."

Mississippi is the only state where Humana has a bus, Haberkorn writes. "It’s also the only state where the company is covering the co-pay for customers’ first doctor’s visit before June, immediate cash savings that it hopes will get people to start a relationship with a primary-care physician. Officials declined to say exactly how much is being spent on the dual strategies."

Based on the dismal number of residents signing up, the bus hasn't exactly been a hit. Part of the problem is that rates in Mississippi are the third highest in the country, and that Humana is only one of two insurers in the state. "Despite all the political rhetoric about a government-run health program, Obamacare relies on private insurers to sell policies on the state and federal exchanges. If there’s no insurance company, then there’s really no Obamacare," Haberkorn writes. "And Mississippi is one of the last places the typical risk-averse health insurance company would choose to sell policies under the law. Statistically, it’s one of the unhealthiest states, topping the charts in all kinds of negatives such as obesity, diabetes, hypertension and cardiovascular disease — conditions that can be stabilized with treatment or kill without."

"But Humana has every incentive to sell as many policies as possible," Haberkorn writes. "The math involved is simple: Insurance works when there are more people enrolled, which spreads the risk of high costs across hundreds or thousands of customers. To succeed in a state like Mississippi, it had to go all out to get customers."

Humana originally offered policies in only four counties, but the state insurance commissioner persuaded it to go to 40. The company's Mississippi market director, told Haberkorn, “Back in August, when we added on an additional 36 counties, we had to act really quickly on how we would get to all of the people in those counties at such a last minute. Operating this mobile tour has allowed us to get to people, instead of waiting for them to come to us.” (Read more)

High-school health fair takes healthy messages to students

Dietitians Josie Crew and Heather Schierer staffed an exhibit on
risks of sugary drinks. (Messenger photo by Melissa Mudd)  

More than 1,000 students participated in Meade County High School's sixth annual health fair, which focused on issues specific to students' health and wellness, Melissa Mudd reported for the Meade County Messenger in Brandenburg.

More than 20 booths were set up at the March 11 fair, featuring exhibits about such topics as alcohol and drug abuse, nutrition, breast cancer, dental and physical health, stress and distracted driving. Booths offered games and prizes. The fair was hosted by the Lincoln Trail District Health Department and various community organizations.

“The health fair originally started with an idea of doing something to promote health and wellness for students. We also wanted to come up with a fun way to engage students in learning the harmful effects of drugs, alcohol, smoking, poor-decision making, et cetera," Karen Cottrell, Meade County district health coordinator, told Mudd. "We are always very impressed with how engaged the students are in the various activities."

Cottrell told Mudd that the students who were asked to complete a survey after the fair said they enjoyed coming to the fair and especially loved the games. Each reported learning at least one new health fact.

Obama reminds the uninsured of March 31 signup deadline; McConnell continues to point out the pitfalls of reform

On the fourth anniversary of the law that has informally come to bear his name, President Obama reminded uninsured Americans that they have only one more week to sign up for coverage under open enrollment.

He also dismissed Republican calls to repeal or replace the law, first citing the relief one woman shared with him after she used her new insurance for the first time: "I felt like a human being again. I felt like I had value."

Obama said, "This is what’s at stake any time anyone, out of some outdated obsession, pledges to repeal or undermine the Affordable Care Act. And that’s why my administration will spend the fifth year of this law and beyond working to implement and improve on it." (Read more)

Senate Republican Leader Mitch McConnell took the anniversary as an opportunity to remind voters of the pitfalls of "a deeply misguided expieriment," noting in an op-ed piece that Obama "pledged that Americans could keep their health care plans and their doctors and that their coverage would be 'more secure and stable' than before" and that journalistic fact-checkers called that "the lie of the year."

McConnell cited the example of Angela Strobel of Owensboro, "a mother of five girls [who] not only lost her insurance, she also lost a trusted family doctor to Obamacare. In a perfect summary of modern liberalism, one of the billing clerks for Kentucky's Obamacare exchange told Angela that since she now qualifies for Medicaid, she'd be breaking the law if she tried to pay more out of her own pocket just to keep her old doctor. Medicaid rules forbid it. The upshot: for Angela and her family, it's either Medicaid or a monthly premium increase of nearly $1,000."

Medicaid is free, but many doctors don't treat Medicaid beneficiaries, and most insurance policies sold through the exchanges have fewer providers to choose from because some providers were not willing to limit their charges in order to be part of the insurance network.

"A recent analysis by the management consulting firm McKinsey & Co. found that only a fraction of the biggest local hospitals in a given coverage area will accept Obamacare patients," McConnell wrote. "An Associated Press study found that only four of the 19 cancer centers it surveyed would give Obamacare patients access to its cancer care through the new Obamacare exchanges in their states. This is progress?" (Read more)

One in 13 Kentuckians have health coverage through Kynect

Nearly 322,000 Kentuckians had enrolled for health coverage through the state's new insurance exchange through 6 p.m. Thursday, March 20, and three-fourths of them didn't have coverage before, according to the state's preliminary analysis.

Gov. Steve Beshear's office said in a news release that enrollments are expected to keep growing in the final 10 days of open enrollment, which ends March 31: "In the past seven days, nearly 3,100 Kentuckians have signed up each day for quality, affordable health insurance."

Of the 321,932 enrollees, 257,477, or 80 percent, qualified for coverage under the federal-state Medicaid program, and 64,455 bought private insurance. Another 10,096 have been found eligible for a subsidy to buy a policy but haven't bought one.

The release said 7.5 percent of Kentucky's population now has health insurance through the exchange, which the state has branded Kynect. The release said 32 percent of those in private health plans through the exchange are under 35, a key group for success of health reform.

“In these final days of open enrollment, we strongly encourage those folks to complete their applications and choose a plan,” said Carrie Banahan, executive director of Kynect. “After March 31, subsidies to help cover the cost of a private health plan won’t be available again until the fall enrollment period – and by that point, being without insurance may cost you on your taxes.”

Individuals who don't enroll by March 31 could face a financial penalty of $95 or 1 percent of income, whichever is greater, for every uninsured member of a household. Under federal health reform, the penalty will increase significantly from year to year.

With the first phase of Kynect about to end, Beshear's office reported the benefits of health reform to Kentucky health-care providers. It said they have been paid more than $45 million for treatment of people that reform made eligible for Medicaid.

The new income limit for Medicaid recipients is 138 percent of the federal poverty threshold; before reform, it was 69 percent. The newly eligible include individuals making less than $15,856 a year and families of four with annual income below $32,499.

"The vast majority of the nearly 20,000 newly insured patients seen by hospitals and reimbursed for services would have been considered indigent prior to Medicaid expansion and most likely would have been written off as uncompensated charity care by the hospitals," the news release said. "These figures don’t include reimbursements to health-care providers for patients with new private health insurance."

Senate committee kills bill to keep minors from using tanning beds

Legislation to ban minors from using tanning beds fell two votes short of passing the Senate Health and Welfare Committee on Wednesday. The bill, which passed the House 61-31, would have prohibited anyone under the age of 18 from using tanning beds. Kentucky prohibits all minors under 14 from using tanning beds, and requires parental permission for those ages 14 to 17.

Sen. Jimmy Higdon, R-Lebanon, told Stu Johnson of  WEKU-FM, "I just can't get to the point where I ban juniors and seniors in high school from using a tanning bed. I think they're of age to be responsible enough to understand the consequences." (Read more)

Sen. Joe Bowen, R-Owensboro, said he didn't "support the bill because it is an example of the government telling people how to live their lives," The Associated Press reports. "He noted his wife had skin cancer in her 20s that was not caused by a tanning bed." (Read more)

Seventeen states and Washington D.C. have laws banning minors from using tanning beds, and 33 states and Washington, D.C., regulate the use of tanning beds by minors, according to the National Conference of State Legislatures. California, Illinois, Nevada, Texas, Vermont and Oregon ban tanning bed use for all minors, with exceptions made in some cases for medical use. (Read more) (American Academy of Dermatology graphic of state tanning laws for minors)

Anthem gives hospital group grant to improve perinatal care, including discouraging early, medically unnecessary deliveries

The foundation of Anthem Blue Cross Blue Shield has awarded nearly $259,000 to an arm of the Kentucky Hospital Association to improve perinatal care and outcomes for mothers and their babies by discouraging early, medically unnecessary deliveries and encouraging breastfeeding.

Perinatal care, provided in the time around childbirth, is critical to ensure the good health of newborns, Anthem notes in a news release, pointing out that Kentucky's infant mortality rate is 6.6 deaths per 1,000 births, while the national rate is 6.1, and the state's rate of premature births, almost 14 percent, is well above the 9.6 percent goal set by the March of Dimes.

"The closer the baby is to full term, the better; but sometimes babies are born before they fully develop, weighing only a few pounds," the release notes. "When this occurs, long stays in the hospital neonatal intensive care unit (NICU) are necessary as these babies fight health complications while learning to breathe on their own without the use of a ventilator."

NICU stays are usually expensive. In 2012, Kentucky hospitals charged about $400 million for such treatment.

The hospital association says it has been working to reduce early, elective deliveries, with the Anthem foundation's help, and the latest grant is designed to build on that work. It says the grant to its subsidiary, the Kentucky Institute for Patient Safety and Quality, will also promote breastfeeding, reducing blood infections in the hospital, and reducing complications related to inducing labor, including Cesarean sections.

"KIPSQ will work with all Kentucky hospitals that deliver babies to assure the best care during delivery and the best outcomes for mothers and babies," the KHA release says. "KIPSQ will collect data to measure progress and provide resources, tools and technical assistance in quality improvement techniques to reduce prematurity, unnecessary Cesareans and improve the long-term health of newborns.

KHA says 76 of Kentucky’s 131 hospitals are members of KIPSQ, which is expanding its membership to include long-term care facilities and physicians' practices. "The Anthem grant will improve the delivery of perinatal health care to all of the state’s birthing/neonatal hospitals, regardless of their participation in KIPSQ," the release says.

Anthem Blue Cross and Blue Shield is the trade name of Anthem Health Plans of Kentucky, an independent licensee of the Blue Cross Blue Shield Association. The Anthem Foundation Inc. is a private, non-profit foundation.

UK picks new dean for College of Nursing

A national leader in nursing education, tobacco control and health-care outreach will be the new dean of nursing at the University of Kentucky.

Janie Heath

Janie Heath, the associate dean of academic programs and endowed professor at the University of Virginia School of Nursing, will take over as dean at UK on Aug. 1, pending UK Board of Trustees approval. In addition to heading UK's College of Nursing, she will also hold the Warwick Professorship.

"Janie Heath has been a leader in educational, clinical and research efforts," UK Provost Christine Riordan said in a press release. "She is an ideal fit for our College of Nursing." Heath, who has been a nurse for nearly 40 years, has also worked at Georgia Health Sciences University, Georgetown University and the University of South Carolina.

Heath said, "I have known about the UK College of Nursing for a long time. I was attracted to the college's well-known strengths in advanced practice nursing and research. UK ― through its talented faculty, staff and students ― has been on the forefront of addressing major challenges in higher education and health care delivery today." (Read more)

Number of Kentucky babies born addicted keeps rising quickly as heroin replaces harder-to-get prescription painkillers

Despite the crackdown on prescription painkillers, more Kentucky babies are being born addicted, "fueled by a recent spike in heroin use," much of it by people who have found prescription painkillers harder to get, Laura Ungar reports for The Courier-Journal.

"The state has seen hospitalizations for drug-dependent newborns soar nearly 30 fold in a little more than a decade — from 28 in 2000 to 824 in 2012, according to a recent drug report from the Kentucky Injury Prevention and Research Center. Preliminary figures suggest that number will surpass 900 in 2013, according to state officials," Ungar reports, in a follow-up to a series she did on the state's prescription-drug abuse problems in 2012.

"The financial cost is also high — and climbing exponentially," Ungar writes. "Hospital charges for drug-dependent babies in Kentucky rose from $200,000 in 2000 to $40.2 million in 2012, with $34.9 million that year paid for by government Medicaid," nearly 30 percent of which comes from Kentucky taxpayers.

"Although there are no state-by-state statistics, Dr. Henrietta Bada, a neonatal-perinatal medicine doctor at the University of Kentucky, said she believes Kentucky has one of the nation’s worst problems with drug-dependent babies." the Journal of the American Medical Association reported that U.S. hospitalizations for drug-dependent babies rose 330 percent from 2000 to 2009; "Kentucky’s hospitalizations rose more than 1,400 percent during that same time," but the state has "only 55 treatment centers serving pregnant and postpartum women, the vast majority outpatient facilities," Ungar reports. That's “a fraction of what we need,” Attorney General Jack Conway told her.

Activist seeking stronger rules on reporting health-care infections says industry lobbyists misled legislative committee to kill bill

"Health-care industry witnesses appeared to have presented incorrect information" to the House Health and Welfare Committee in speaking March 6 against House Bill 460, which would require all health-care facilities to report infections associated with their treatment, Dr. Kevin Kavanagh of Somerset writes in an op-ed piece in the Lexington Herald-Leader. The bill remains in committee, but its goal could be accomplished by regulation.

Dr. Kevin Kavanagh

Kavanagh is chairman of Health Watch USA, a group that tries to focus attention on the problem of health-care associated infections, also called hospital-acquired infections. He said the industry witnesses "were asked if any of the various types of facilities in Kentucky were exempt from reporting. The answer was no, that all facilities had to report through the Centers for Disease Control's national reporting system. However, critical-access hospitals and ambulatory-surgery centers are not required to report infection to the CDC. Nursing homes also do not have to report through the CDC's system."

Kavanagh writes that nursing homes report urinary-tract infections to the federal Centers for Medicare and Medicaid Services, but "there is no data on the deadly staph infection, MRSA," or a deadly gastrointestinal infection caused by the bacteria C. Difficile, "which can run rampant in some nursing homes."

Kavanagh said the industry witnesses also misled the committee when asked "asked if a patient who was going to have hip surgery could find information on infection rates on Hospital Compare," a Medicare website. He writes, "The answers appeared to indicate that such information was available," but is "woefully inadequate" because the state doesn't have an adequate reporting system.

"For acute-care hospitals, only, bloodstream MRSA infections (a relatively rare event), colon surgeries, abdominal hysterectomies, urinary tract infections and central-line infection data can be found. Little use for patients needing hip surgery. In the past, CMS has posted on the Hospital Compare website information regarding hospital-acquired conditions, and was slated in the future to have information on neck and spine surgery. However, this information is now gone from Hospital Compare. I can only assume it, too, has fallen to the legions of health-industry lobbyists." (Read more)

For Kavanagh's March 6 testimony to the committee, click here. For his March 13 rebuttal to industry witnesses, go here.

Read more here: http://www.kentucky.com/2014/03/13/3136695/mandate-reporting-of-ky-health.html#storylink=cpy

Read more here: http://www.kentucky.com/2014/03/13/3136695/mandate-reporting-of-ky-health.html#storylink=cpy

Rogers, other drug-caucus chair file bill to reverse FDA's approval of new painkiller; competing company has alternative

Illustration from PainAndDepression.com

U.S. Reps. Hal Rogers of Somerset and Stephen Lynch of Massachusetts have introduced a bill to withdraw federal approval of a new formulation of hydrocodone that is highly addictive and produced in crushable pills, which they say threatens to start a new wave of prescription drug abuse. They are the Republican and Democratic co-chairs, respectively, of the Congressional Caucus on Prescription Drug Abuse.

But the Food and Drug Administration might act against Zohydro ER on its own, because Purdue Pharma LP has completed testing of a competing, non-crushable drug and will ask for "a priority review that would cut two to three months off the 10 months the agency sets as a goal to examine applications" for regulatory approval, Drew Armstrong of Bloomberg News reports. "Purdue’s pill is hard to crush and snort or inject."

That is important to the FDA. “If and when they, or another manufacturer, are able to create an abuse-deterrent formulation that remains safe and effective for patients, we would certainly give serious consideration to assuring that any non-abuse formulations are removed from the market,” FDA pain-drug director Bob Rappaport said in his Oct. 25 review of Zohydro’s approval.

Zohydro ER is an extended-release hydrocodone medication made by Zogenix Inc. for patients who need round-the-clock, long-term pain treatment and have found other treatments to be inadequate. Unlike recent formulations of the popular painkillers OxyContin and Opana, is not crush-resistant, but the company has said it is working on a crush-resistant version.

Citing concerns about abuse, the FDA's scientific advisory panel voted 11-2 against approving Zohydro ER, and a coalition of more than 40 health, consumer and other organizations urged the FDA to revoke its approval. Attorney General Jack Conway was among 28 attorneys general who sent the FDA a letter asking it to reconsider. Sen. Joe Manchin, D-W.Va., has introduced a companion bill to the one filed by Rogers and Lynch.

Hal Rogers (Associated Press photo)

Rogers said in a press release, "“While the FDA continues to send mixed signals to drug companies about the need to invest in abuse deterrent technologies, the Act to Ban Zohydro will make it abundantly clear – life saving measures are critical to the development of powerful painkillers like Zohydro. . . . In Southern and Eastern Kentucky, we lost nearly an entire generation when crushable OxyContin was first prescribed, and I fear this crushable, pure hydrocodone pill will take us backwards with a new wave of addiction and tragic, untimely deaths."

Kentucky ranks third in the nation for overdose deaths, with more than 1,000 Kentuckians dying each year from prescription drug overdoses. The number has leveled off following passage of laws that target pill-pushing clinics and doctors, and put stricter regulations on painkillers.

Zogenix has said it is committed to exceeding FDA requirements to make sure the drug is used appropriately, will monitor for misuse, and will allow an outside group to monitor and analyze its data. It noted that Zohydro ER will be regulated as a Schedule II drug, which means it can only be dispensed through a physician’s written prescription, with no refills, and does not contain acetaminophen, longtime use of which can cause liver failure.

Hospitals try to do more with less while not compromising quality as they adjust to changes in the health-care marketplace

A. B. Chandler Medical Center at the University of Kentucky

Hospitals are laying off employees and cutting budgets because of changes in the marketplace and the ways consumers seek care, Editor Mark Green reports in an in-depth article for The Lane Report.

Now that consumers are paying more direct costs, they are paying more attention to prices and more likely to use out-patient procedures, which are cheaper, Green writes. Also, consumers are increasingly using wellness programs to avoid health problems, and "Taxpayer-funded government compensation models are making better medical outcomes and financial efficiency important bottom-line issues."

Less inpatient treatment means fewer employees are needed at Kentucky hospitals, but not all are financially burdened, Green reports; those who provide the best service at the least cost are increasingly reaping the profits.

While the Patient Protection and Affordable Care Act may make care more affordable, it also "puts pressure on health-care providers to keep costs in check,” Carl Herde, chief financial officer for Baptist Health, told Green. “However, many of the issues facing health care were in place before the ACA came into effect.”

Dr. Michael Karpf, administrator of UK HealthCare since 2003, told Green that hospitals are adjusting from a model that was based on volume to one that is based on value. Karpf has said for years that the "health-care industry is on an unsustainable financial course."

“There is a real need to decrease utilization to get healthcare costs under control. It just puts pressure on institutions,” Karpf told Green. “We won’t be doing business the same old-fashioned way we’ve been doing it.”

Some hospitals are still showing a healthy profit, but are also cutting costs and looking for increased efficiency, like UK HealthCare, whose $920 million hospital budget is producing a seven to eight percent cash flow, Green reports. But KentuckyOneHealth expects a $218 million deficit in its $2.5 billion budget, laid off 500 of its 15,000 workers last month, says that it won't fill 200 openings and will close the emergency room at Medical Center Jewish Northeast in Louisville on April 1. The company told Green that it might close an entire hospital, without telling which one.

KentuckyOne CEO Ruth Brinkley told Green, “The recession has come to health care, and that is causing the industry to transform. There are many causes for the changes, among them: the economy, reduced payments from government and commercial payers, increasing consumerism, and shifts in how care is organized and delivered. We have seen large and respected healthcare organizations announcing restructuring, budget cuts and layoffs. Among them are Vanderbilt University Medical Center and Cleveland Clinic. This situation is even more acute in Kentucky, with steep declines in inpatient volumes.”

Baptist Health, a Louisville-based system that has the most hospital beds in Kentucky, had a $22 million operating loss in fiscal 2013, but $78 million in investment income erased that deficit, Herde told Green: “There is increasing pressure for hospitals to do more with less without sacrificing quality, so we are exploring creative ways to contain costs, but we are financially sound now – and we are confident that we will remain so in the future.”

Owensboro Health's hospital (HGA.com photo)

When the state turned management of Medicaid over to insurance companies, that created higher administrative costs for hospitals, said John Hackbarth, chief financial officer for Owensboro Health, which in 2013 opened a $385 million medical center.

“After movement to a managed-care model, we have five insurance plans, plus some patients remaining on Kentucky Medicaid indemnity,” Hackbarth said. “This has increased costs in many areas such as contracting, compliance, billing, IT and case management because we are dealing with five times the amount of rules and hoops to jump through for a slower payment and ultimately less reimbursement.”

State officials say the expansion of Medicaid under health reform, to those with incomes up to 138 percent of the federal poverty level, is forecast to bring Kentucky providers an extra $15 billion for care and create 17,000 new jobs. But not yet.

Green reports that the most common response from five major hospital operators was that "Medicaid expansion eventually should lower their annual charity care and bad-debt burden, which is hundreds of millions of dollars." But first they are focused on adjusting their services to meet an increased demand for care by the formerly uninsured.

The Louisville region's biggest provider, non-profit Norton Healthcare expects that when the federal subsidy for expanded Medicaid is reduced, to 90 percent, the state will have to cut the number of Medicaid enrollees or reimbursements to providers. The reform law's overall impact to date, Gough said, is “decreases in Medicare reimbursements.”

Poll: Kentuckians who report excellent or very good sidewalks and road shoulders are more likely to be physically active

Kentucky adults who ranked their neighborhood sidewalks and road shoulders as excellent or very good are more likely to be physically active, but only 26 percent of Kentuckians rank them that highly, according to the latest Kentucky Health Issues Poll.

"Adults who report excellent or very good neighborhood sidewalks/shoulders are more likely to report being very or somewhat physically active (84 percent) than residents who report fair to poor sidewalk/shoulder conditions (74 percent)," says a press release from the Foundation for a Healthy Kentucky, which sponsors the poll with Interact for Health, formerly the Health Foundation of Greater Cincinnati.

"This finding stresses the impact of environment on activity choices," Susan Zepeda, president and CEO of the foundation, said in the release.

Despite the relatively poor rating for sidewalks and shoulders, more than half of those surveyed said their neighborhoods are excellent or very good locations to walk, jog, or bike.

Of those whose incomes are at or below 200 percent of the federal poverty threshold, 74 percent said they feel somewhat or very safe being physically active outside in their neighborhoods, but only 45 percent reported walking, jogging, and biking conditions as excellent or very good.

Only 11.9 percent of Appalachian Kentuckians rated their sidewalks and shoulders as excellent or very good. The poll defines Appalachian Kentucky as the 46 counties in the Big Sandy, Buffalo Trace, Cumberland Valley, Fivco, Gateway, Kentucky River and Lake Cumberland area development districts. Just 18.9 percent of Western Kentucky residents rated their sidewalks and shoulders as excellent or very good.

To see the full geographic breakouts, click here.

With smoking ban dead for this year, its Senate sponsor holds a last-ditch discussion as she looks to another office

By Melissa Patrick
Kentucky Health News

Republican Sen. Julie Denton, sponsor of the Senate bill for a statewide smoking ban, held a last-ditch discussion Wednesday with the committee she chairs about why Kentucky needs such a law.

It was a discussion with no action possible because Senate President Robert Stivers, R-Manchester, who opposes Senate Bill 117, assigned it to the Judiciary Committee, of which he is a member, instead of the Health and Welfare Committee, headed by Denton, who is running for the Louisville Metro Council rather than re-election.

A frustrated Denton opened the discussion with personal stories about growing up with a grandfather who smoked heavily and the effects this has had on her father who has asthma and frequent respiratory infections. She said her daughter, who has asthma, cannot tolerate exposure to any smoke.

Denton (Legislative Research Commission photo)

"This is a public health issue, not about personal rights," Denton argued.

She said governments infringe on personal liberties "all the time" to support public health. She gave examples of speed-limit laws, seat-belt laws, laws that prohibit texting while driving, laws that prohibit drinking and driving, building codes and car-seat law requirements.

"To say this is different than all the others is disingenuous," she said.

As for the argument that non-smokers did not have to enter establishments that allow smoking, she said that is not an option for many who work in places that allow smoking: "People can't afford to just go to another job."

Denton said if the bill had been sent to her committee it would have been sent to the full Senate for a vote, but "Politics is standing in the way." Not only is Stivers against it, leaders of the House's Democratic majority blocked a vote on the House smoking-ban bill, citing members' concerns about political repercussions in the fall elections, when Republicans hope to take over the House.

Democratic Sen. Julian Carroll, a former governor, commended Denton, saying her comments were both "relevant and very important."

Carroll said "I am strongly in support of this bill" because of the cost Kentucky pays for people who smoke. He said the current state budget spends $9.5 billion on health care, and smoking is a strong contributor to that number.

Ashli Watts of the Kentucky Chamber of Commerce said smoking costs Kentucky $1.5 billion every year, creates work absenteeism, raises tax and insurance costs and is bankrupting the state. She said more than 90 percent of Chamber members in a 2013 survey supported a ban, and it is time to join the other 24 states with such laws.

Dr. Sylvia Cerel-Suhl of the American Heart Association gave a long list of reasons to support the bill. "There is no longer any debate that second hand smoke causes death," she said, adding later, "Just in Kentucky, we are losing 1,000 people a year to secondhand smoke." Sherri Irwin of the Kentucky Rural Health Association cited the same number.

Smoke-Free Kentucky map; click on it for larger version

As a parting suggestion, Denton said Kentucky might consider allowing local governments to opt out of a statewide ban. Dozens of localities have bans, thought some have significant exemptions.

Denton acknowledged a collective frustration in the committee and said, "I won't be here next year; hopefully, you all will push through."

Sen. Reginald Thomas, D-Lexington said, "Perseverance does pay off. We will make this bill law one of these days."