Saturday, August 19, 2017

Where does your county rank in painkiller prescriptions per person? Here are the numbers, and possible reasons for them

Kentucky Health News reported in July about a Centers for Disease Control and Prevention report showing ranges of painkillers sold per person in each county in 2015 and whether there had been an increase or decrease since 2010. At at the time, the individual county data wasn't available, but now it is.

The CDC report calculated the rate of "morphine equivalent doses" sold at retail pharmacies in 2010 and 2015 in each county and whether there had been an increase or decrease if the change was greater than or equal to 10 percent Counties with changes of less than 10 percent were labeled "stable."

Morphine equivalent doses, in milligrams, are determined by a calculation that allows health-care providers to understand how potent one opioid is compared to another.

The report found that painkiller prescriptions had declined statewide, but increased or remained high in many counties from 2010 to 2015.

Opioid doses per person decreased in 71 counties, increased in 19, and were considered stable in 24. Six counties didn't have enough data to show a trend. The report does not account for people who fill their prescription in one county but live in another.

On the 2015 map, the counties are shaded by quartiles, each representing one-fourth of the total range. Here's a table of the top quartile, showing the 30 Kentucky counties with the most doses per person of opioid painkillers in 2015. Click here for a spreadsheet that gives figures for all counties.
Click here to download the full data set.
The report gives partial credit for the decline to the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system, which went from voluntary to mandatory during the period.

The report says, "The substantial variation in opioid prescribing observed at the county level suggests inconsistent practice patterns and a lack of consensus about appropriate opioid use, and demonstrates the need for better application of guidance and standards around opioid prescribing practices."

It says counties with higher amounts of opioids tended to have "a larger percentage of non-Hispanic whites; higher rates of uninsured and Medicaid enrollment, lower educational attainment; higher rates of unemployment; micropolitan status [counties with towns of 10,000 to 50,000]; more dentists and physicians per capita; a higher prevalence of diagnosed diabetes, arthritis, and disability; and higher suicide rates."

The data for the study came from the Quintiles IMS Transactional Data Warehouse. It does not include prescriptions dispensed directly by prescribers.

Frankfort Independent Schools offer programs for students at risk of attempting suicide; experts offer guidance

Frankfort Independent Schools are working to prevent teen suicide, attempts of which are probably more common than most people think.

Austin Horn reports for The State Journal in Frankfort that a 2016 survey of Kentucky high-school sophomores found that 8.2 percent said they had attempted suicide, and the rate was 8.4 percent in the Bluegrass, where Frankfort is located. The national rate is 9.4 percent.

“It’s a very serious issue,” Dr. Julie Cerel, a psychologist and professor at the University of Kentucky College of Social Work and president of the American Association of Suicidology, told Horn.

School social worker Marci Fritts told Horn that she coordinates mental-health services for at-risk students at Second Street School and Frankfort High School through a partnership with the Kentucky Counseling Center.

“We have clinical therapists working with all of our identified students that (we identified) either through talking with parents, through collaboration with teachers, through referral in school, and approaching guardians and parents about services that potentially would benefit the student,” Fritts said. “We have two full-time therapists at Second Street School, and we have a therapist on-site at the high school.”

The school system also partners with Operation Making a Change, a program designed to provide young males with mentorship, and Fritts heads her own program called “My Life, My Choice,” a prevention-based program provided to all female sophomores at Frankfort High School.

Statewide, all middle and high-school students are required to receive some form of suicide prevention education by Sept. 1, and teachers are required to receive at least two hours of training. In addition, the state is also rolling out a “Sources of Strength” peer-led prevention program this year.

The biennial “Kentucky Incentives for Prevention” survey is given to students across the state in even-numbered grades starting in the sixth grade. It has only asked about suicide since 2014, when the suicide attempt rate for Kentucky's 10th-graders was 8 percent, compared to 8.6 percent nationwide. Suicide is the second leading cause of death among Kentucky's teens and young adults.

Cerel told Horn that there is never just one factor that leads a person to attempt suicide, but one study found that teens who had attempted suicide reported that the most common reason was a recent break-up, regardless of the length of the relationship. Cerel warned parents to take these break-ups seriously.

“If a teen is stressed or feels like something has happened and they’re never going to get over it, the adult response shouldn’t be, ‘Oh, that’s nothing, you’re going to grow up and find somebody else,’” Cerel told Horn. “The response probably should be, ‘I understand that this feels like the worst thing ever; let’s figure out a way to get you some help.’”

Dr. Vicki Hayes, a psychologist in Frankfort, told Horn that sometimes there are warning signs that shouldn't be ignored.

“One of the biggest behavioral things you want to watch for as a parent is abrupt change in a child’s behavior,” Hayes said. “Pay a lot of attention to that and try to find out what’s going on. If they’re saying anything morbid or that sounds suicidal, don’t let that ride. Don’t ever call a bluff or think that they don’t mean it. It’s better to err on the side of caution.”

Bullying is often cited as a reason for youth suicide attempts in Franklin County, Hayes told Horn.

“There are very few people who have not been bullied. I think there’s a huge bullying problem in Franklin County, and I’m concerned about it — all the schools,” Hayes said. “I don’t think any of them are doing enough to stop the bullying here in this particular county.”

In the 2015-16 school year, the Frankfort schools, with an enrollment of 735, reported 47 events of harassment, a rate of 6.4 percent, while the Franklin County Public Schools, with an enrollment of 6,131, reported 312, a 5 percent rate. The county system has two high schools, Franklin County and Western Hills. "The State Journal reached out multiple times to both Franklin County public high school psychologists but did not receive a response by press time," Horn reports.

Horn notes that the recent Netflix television series "13 Reasons Why," which depicts the aftermath of a fictional teenage girl's suicide, has also exposed teens to suicide and may have "adverse effects." This series has prompted schools throughout the state to send resource letters home with guidance on how to talk to children about suicide and has also warned that "vulnerable youth" should not watch it.

"Cerel referenced a recent study that showed Google searches for suicide methods increased by as much as 28 percent in the two weeks following the release of “13 Reasons Why," Horn reports.

Friday, August 18, 2017

Trump administration wants to drop Obama rule, tied up in court, that would ban binding arbitration in nursing-home disputes

"The Trump administration is pushing to scrap a rule that would have made it easier for nursing home residents to sue nursing homes for injuries caused by substandard care, abuse or neglect," reports Robert Pear of The New York Times. "The push would undo a rule issued by the Obama administration that would have prevented nursing homes from requiring that consumers agree to resolve any disputes through arbitration rather than litigation. Nursing homes routinely require consumers to sign an arbitration agreement as a condition of admission to the home."

Many businesses are including binding-arbitration rules in their contracts with consumers, Pear notes, but nursing homes are a special kind of business, dominated by a special kind of patient. "About half of nursing home residents have Alzheimer’s disease or other dementia, according to the National Center for Health Statistics, and consumer advocates say harried family members could easily miss the arbitration clauses as they move a loved one into a home offering care," he reports.

The rules were issued in September 2016, but a lawsuit by the industry and a judge's ruling kept them from taking effect.

The Obama administration said it was “almost impossible for residents or their decision-makers to give fully informed and voluntary consent to arbitration before a dispute has arisen,” but the Trump administration makes another argument: “We believe that arbitration agreements are, in fact, advantageous to both providers and beneficiaries because they allow for the expeditious resolution of claims without the costs and expense of litigation.”

Trump-appointed officials at the Centers for Medicare and Medicaid Services have "proposed several requirements to protect nursing home residents who agree to binding arbitration," Pear reports, including “plain language” in contracts and an explanation to the consumer “in a form and manner that he or she understands.” The nursing-home industry has objected, calling the rules “hopelessly vague.”

State health department offers safety tips for Aug. 21 solar eclipse; cautions to not look directly at it without eye protection

In an eclipse, the moon shadows part of Earth.
The Kentucky Department of Public Health is warning the public to not look directly at the solar eclipse without proper eye protection.

“Looking at an eclipse without proper eye protection can cause permanent and irreversible eye damage, including blindness” Health Commissioner Hiram C. Polk Jr. said in a news release. “We encourage everyone to enjoy this special celestial event, but urge the public not to look directly at the uneclipsed or partially eclipsed sun without special-purpose solar filters such as eclipse glasses or handheld solar viewers.”

This long awaited celestial event Polk is talking about will happen Monday, Aug 21. While Hopkinsville, Paducah and the Land between the Lakes are in the 70-mile path of totality, all of Kentucky will be able to see a "deep partial eclipse." Totality will last less than three minutes, but the sun will be partially obscured for more than two hours. Online interactive maps and guides give the times; one is

State officials offers tips on how to safely view a solar eclipse and avoid permanent eye damage:
  • Only use eclipse glasses or handheld solar viewers that meet the International Organization for Standardization international standards.
  • Homemade filters or ordinary sunglasses, even very dark ones, are not safe for looking at the sun.
  • Telescopes with solar filters on the large end can be used, but older telescopes that have small solar filters that attach to the eyepiece are not safe.
  • It is safe to use pinhole projectors and other projection techniques that offer indirect viewing of the eclipse. These can be made with paper or cardstock.
  • Do not look at the eclipse through an unfiltered camera, telescope, binoculars or other optical device.
  • Do not look at the sun through a camera, telescope, binoculars or any other optical device while using your eclipses glasses or handheld solar viewer. The concentrated solar rays will damage the filter and enter your eye(s), causing serious injury.
  • Seek expert advice before using a solar filter with a camera, telescope, binoculars or any other optical device.

The state health department also offers safety tips for those who will be spending the day outdoors while waiting on the eclipse, including: stay hydrated and drink plenty of water; avoid drinking alcohol, which causes you to lose fluid; wear light colored, loose fitting clothes and a hat; apply and reapply sunscreen throughout the day with at at least a SPF 15 rating; use an Environmental Protection Agency-registered insect repellent, and keep your hands washed to avoid spreading germs.

State health officials will deploy portable medical tents at an upcoming eclipse event in Hopkinsville and all food vendors in the region will be inspected, says the release.

Click here for a link to the state released video about eclipse eye safety. Click here for one directed toward children.

Health foundation offers workshop to help businesses implement smoke-free policies; smokers cost businesses extra $5,800/year

The Foundation for a Healthy Kentucky is offering a workshop to help businesses learn how to implement smoke-free policies in their workplaces Aug. 31 in Louisville.

"More than 70 percent of Kentucky adults and 90 percent of Kentucky businesses support smoke-free, so it's never been easier for Kentucky businesses to adopt workplace policies to protect their employees from the dangers of secondhand smoke," Ben Chandler, president and CEO of the foundation, said in a news release.

The 75-minute workshop will be part of the Kentucky Society for Human Resource Management conference Aug. 29-31 at the Galt House in Louisville. It will be led by University of Kentucky Associate Professor Melinda Ickes, who is also a faculty associate with the Kentucky Center for Smoke-free Policy. The presentation will be Thursday, Aug. 31 at 10:30 a.m. Click here to register.

"Smoking costs businesses an estimated $5,800 per smoker in extra expenditures each year, including productivity losses and additional health care costs, and puts them at risk for the health consequences for all workers exposed to secondhand smoke," says the release.

The foundation will also offer information about developing and implementing smoke-free workplace policies at its exhibit booth at the conference and on its website afterward.

Thursday, August 17, 2017

National panel studying surface coal mining's effects on health sets meetings Mon. night in Hazard, Tue. afternoon in Lexington

In a study of possible health risks from large-scale strip mining, the National Academies of Sciences, Engineering and Medicine will hold two public meetings in Kentucky.

The first meeting will be held from 6:30 to 9 p.m. Monday, Aug. 21, at the Perry County Library, 289 Black Gold Blvd. in Hazard.

The second meeting will be held from 12:45 to 5 p.m. Tuesday at the Marriott Griffin Gate Resort, 1800 Newtown Pike in Lexington.

The study was commissioned by the Interior Department's Office of Surface Mining Reclamation and Enforcement, citing a “growing amount of academic research that relates to possible correlations between increased health risks as a result of living near surface coal mine operations.”

Bill Estep of the Lexington Herald-Leader notes, "Several studies have concluded that mountaintop mining in Central Appalachia is associated with higher rates of cancer, heart disease and other health problems among local residents." The leading researcher has pointed to dust containing rare-earth metals as a likely cause. However, a 2012 study by a Yale University researcher and others for coal interests "did not find that mining or mining-related pollution directly contributed to health problems in Central Appalachia," Estep notes. "Rather, the results pointed to 'substantial economic and cultural disadvantages that adversely impact the health of many area residents,' the study said." The leading researcher says his work has accounted for those issues.

Information about the study can be found here. For more information, or to register to attend, email or call 202-334-2766.

Cabinet for Health and Family Services promotes health and wellness at state fair, and collects duffel bags for foster kids
The Kentucky State Fair is not just a great place to support Kentucky's agriculture or to spend the day on the midway; it's also a great place to learn about some of the state's health and wellness initiatives and to donate a new duffel bag or backpack to a foster child.

“Often times, when children are removed from their home and placed into state care, all their belongings are literally stuffed into a black garbage bag,” Health Secretary Vickie Yates Brown Glisson said in a news release. "This effort changes that. Donating a duffel bag or backpack is a small but meaningful way to help foster children and give them the dignity of carrying their possessions in a new bag that is all their own.”

New duffel bags and backpacks will be collected at the Cabinet for Health and Family Services' exhibit in the Health Horizons area of the South Wing B. The fair runs through Aug. 27 at the Kentucky Exposition Center in Louisville.

The cabinet's exhibit will offer daily interactive displays that features learning activities for children and adults, free health screenings and on-site health educators who can speak to individuals about wellness and prevention. It will also offer free dental screenings for children with signed consents who are entering public school kindergarten or first grade from 10 a.m. to 2 p.m. daily.

In addition to these daily health initiatives, they will also have special "focus days," including:
  • Tuesday, Aug. 22: Services for Seniors, including Adult Protective Services, Aging and Independent Living/Long Term Care Ombudsman, and the Kentucky Prescription Assistance Program
  • Wednesday, Aug. 23: Focus on Foster Care and Adoption, 10 a.m. to noon
  • Thursday, Aug. 24: Focus on Zika Education and Mosquito Control, 10 a.m. to noon
  • Friday, Aug. 25: Focus on Substance Use Disorder Strategies and Services, 10 a.m. to noon
Exhibit buildings are open daily from 9 a.m. to 9 p.m. Sunday through Thursday and until 10 p.m. Friday and Saturday. Admission at the gate is $10 for adults, seniors and children; free for children 5 years and under. Parking at the gate is $10 per car.

Wednesday, August 16, 2017

Foundation for a Healthy Kentucky calls for statewide smoking ban, pushing people to quit by raising tobacco tax $1 a pack

Ben Chandler
Kentucky's poor health is hurting its economy, and the state needs a smoking ban and a big increase in its cigarette tax to prevent disease, Foundation for a Healthy Kentucky President Ben Chandler told a legislative committee Wednesday.

"The poor health of the commonwealth is one of the main things that's holding our economy back," Chandler said, telling the Interim Joint Committee on Health and Welfare that among the 50 states, Kentucky's population is 26th but its economy is 45th.

"The single most effective policy changes we can make to improve the health of Kentuckians are changes that will reduce our smoking rates and exposure to secondhand smoke," Chandler said. "Passing smoke-free laws and raising the tobacco tax by $1 or more per pack will help reduce smoking, save health care costs, and won't cost the state a dime."

Kentucky has a relatively low cigarette tax, 60 cents a pack, and the highest smoking rate in the nation, 26 percent of adults, as well as the highest death rate from cancer. "If there's anything that needs dealing with, it's that," Chandler said. "Doing something about this smoking problem is absolutely critical to the future of this state . . . . Businesses are not going to locate here if they don't have a healthy workforce."

Republican Sen. Tom Buford of Nicholasville called for a larger increase than Chandler, "Even to a $1.60 a pack is probably not going to provide us the result that we would like to have," Buford said. But he added, "I don't know if the will is there." Alluding to the late-January filing deadline for legislative elections, he said, "I can tell you February the first if there's a chance for tax reform."

Critics of a tobacco-tax increase have said it would penalize lower-income people, who are more likely to smoke. Chandler told the House-Senate committee that a big increase is needed to push them into quitting.

"You have to raise the tax by $1 or more to get the health benefits," he said. "Otherwise, it's just an added tax burden on the poor." He said cigarette companies would counter an increase of 30 to 40 cents a pack with discount coupons.

Asked where he would spend the money, Chandler, a former congressman and state attorney general, said some should be spent to discourage Kentuckians from smoking.

"We have a very good, in many respects, health-care system, but it's a rescue system," he said. "And people don't want to talk about this, but . . . we spend money largely, for the most part, on health care, to rescue people who are already sick. And we ought to spend a bigger portion . . . on health, as opposed to health care."

Referring to a smoking ban, which she supports, Sen. Julie Raque Adams of Louisville, the committee co-chair, said, "It's not really a freedom issue because every one of us pays out of pocket for those costs."

Chandler told the committee, "We have to focus on promoting policy changes that lead to healthier outcomes by addressing the things that cause poor health in the first place. . . . now have a rescue system."

Appalachian Kentucky continues to be the least healthy region of the state, and the disparity is increasing, Chandler said.

"While all of Kentucky lags behind the nation as a whole, it's generally people living in more rural Eastern counties with more challenging health issues," he said. "The latest numbers show that the health disparities between Central Appalachia and the rest of the nation, or even the rest of Appalachia, are large. And they're continuing to grow."

For example, he said the national death rate from heart disease "declined nearly 58 percent from 1980 to 2014, but not in Eastern Kentucky. In Owsley County, cardiovascular disease mortality actually increased over that 34-year period."

Another big Kentucky health problem is obesity. Chandler said, "Some of the evidence-based programs that help reduce obesity include making the healthy choice the easiest choice by replacing sugary drinks and snacks in school and government vending machines with healthier options, such as fruit and water; increasing the tax on sugary drinks; passing policies that require new streets to be walkable and bikeable; building sidewalks, walking trails, playgrounds and other places where residents can safely engage in physical activity; and adopting policies that enable farmers' markets to thrive."

A video of Chandler's testimony is on the KET website.

Tuesday, August 15, 2017

Scenario for reviving Obamacare repeal: Name Manchin to head Energy Dept. and replace him with a Republican senator

Senate Majority Leader Mitch McConnell could get the 50th vote he needs to pass an Obamacare repeal bill through a political shuffle by President Trump, who has been sniping at McConnell about failure to pass one.

It would work this way: Trump would name Energy Secretary Rick Perry secretary of homeland security, replacing Gen. John Kelly, who recently became Trump's chief of staff. Then Trump would name Democratic Sen. Joe Manchin of West Virginia energy secretary, and GOP Gov. Jim Justice would appoint a Republican to fill Manchin's unexpired term.

"Some congressional Democrats think it's possible, even likely," reports Harris Meyer of Modern Healthcare. "If the 49 GOP senators who voted for McConnell's stripped-down repeal bill last month backed the new legislation, the McConnell wouldn't need the votes of the three Republicans—Susan Collins, Lisa Murkowski and John McCain—who voted no last time."

"Rep. Karen Bass (D-Calif.) said Monday morning at a health-care town hall in Chicago that she and other Democrats expect Manchin will be offered the job and he will accept it," Meyer reports. "Then, they expect McConnell to quickly launch a new drive to pass a repeal-and-replace bill. That's what Trump has been needling McConnell to do since the previous bill failed by one vote on July 28, when McCain dramatically turned his thumb down."

There is also the possibility that McCain could resign from the Senate if his brain cancer progresses, Christopher Condeluci, a health-care lobbyist and former Senate Republican staffer, told Meyer. Arizona also has a Republican governor.

"Ron Pollack, chairman-emeritus of Families USA, who helped build grassroots support for ACA's passage in 2010, said he is skeptical about the Manchin replacement scenario, but he cautioned that ACA supporters should remain vigilant," Meyer reports. "Even if Republicans succeed in executing this personnel switcheroo, McConnell wouldn't necessarily have 50 votes he needs to pass either the so-called skinny repeal bill or a broader repeal-and-replace package."

Tom Miller, a conservative health policy analyst at the American Enterprise Institute, told Meyer, "The next hurdle is finding 50 real votes for skinny repeal when McCain isn't available to bail out up to a half-dozen or more Republican senators who voted for it very reluctantly last time."

The Hill notes, "Manchin was reportedly considered for the job after Trump's election in November." Manchin, who faces a potentially tough re-election battle in 2018, represents a state that has swung sharply Republican, largely because of troubles of its signature industry, coal, during the Obama administration.

Monday, August 14, 2017

Trump doesn't want to compromise or 'move on' from health bill, as McConnell called for, but aides disagree, Politico reports

"There's a divide between the president, who doesn't want to compromise or move on, and officials who would quietly prefer to leave health care alone after a bruising fight that climaxed in Trump's public clashes" with Senate Majority Leader Mitch McConnell, Josh Dawsey of Politico reports.

Sunday, August 13, 2017

Health secretary says 'No one is going to be pushed off Medicaid,' but plan says fewer will have it, and has pitfalls to lose coverage

Health Secretary Vickie Yates Brown Glisson on KET
By Melissa Patrick
Kentucky Health News

Gov. Matt Bevin's proposal to overhaul the state's Medicaid program, with its latest modifications, says it would leave 95,000 fewer Kentuckians on Medicaid in five years than there would be otherwise.

Exactly what that means depends on whom you ask.

"No one is going to be pushed off of Medicaid, no one is losing their benefits," Health Secretary Vickie Yates Brown Glisson told Renee Shaw on KET's "Connections with Renee Shaw."

Glisson's comment prompted a Twitter storm from Dustin Pugel, a research and policy associate for the liberal-leaning Kentucky Center for Economic Policy: "What happens when someone fails to report that they got a couple extra shifts, or their tips lowered their wages? . . . What happens if someone fails to make their $1-$37.50 monthly premium one month? . . . What happens if someone works 19 hours one week instead of 20 and can't find an extra hour of qualifying volunteer work? . . . What happens if someone loses track and doesn't re-enroll at the end of a year's coverage? Kicked off."

Asked to clarify Glisson's comment, Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an e-mail: "Kentucky HEALTH does not change income eligibility thresholds. People who participate in the program will have access to the same health coverage and benefits they have today." He added, "There will be no changes in benefits for certain low-income adults, caregivers, children, pregnant women, the elderly, and those with disabilities."

Pugel said in an interview, "If you add these new requirements that people can't meet, those requirements are responsible for people losing coverage." He added, "Indiana’s requested work requirement is very similar to ours, and it states that a quarter of the people who must comply with a work requirement will lose coverage because they are unable to meet it. Also in Indiana, the premiums they charge led to tens of thousands either losing coverage or never getting coverage to begin with because people didn’t pay them."

Glisson said on KET that with the help of a "continuum of services" to be offered in the new Medicaid plan, called Kentucky HEALTH, able-bodied adults without dependents who are on Medicaid will eventually transition to better paying jobs that offer employer health insurance.

"We need to connect you with the jobs, we need to get you the training for those jobs. And if you chose to, we're hoping that you're going to be able to transition to an employer-sponsored insurance product," Glisson said.

In the separate interview, Pugel argued that the high-paying jobs with health benefits that the Bevin administration expects these able-bodied adults to move to simply don't exist in Kentucky.

He said many Kentucky counties have fewer jobs than they did before the recession, and the handful of counties that have seen some job growth are seeing it in temporary-agency work, which he said "nearly never" offers benefits like health insurance.

"There are a lot of folks who live in areas where there just aren't jobs, let alone the kind of jobs that would offer the kind of benefits she is talking about, Pugel said.

He added that employers don't offer health insurance as a benefit nearly as much as they used to, especially in the kinds of jobs held by people who earn near the Medicaid income limit, $16,400 for an individual. He said the share of Kentucky workers who received insurance through their employer has fallen from 70 percent in 1980-82 to 53.7 percent in 2011-2013. The Kaiser Family Foundation reported that only 47.8 percent of private sector firms in Kentucky offer health insurance in 2015.

"These folks work in jobs like construction and child care and restaurants. These are not jobs where employers offer coverage, or coverage that these folks can afford," Pugel said. "Medicaid fills a role. It really does for working Kentuckians."

Kentucky submitted its proposal to overhaul the state's Medicaid program to the federal Centers for Medicare and Medicaid Services about 11 months ago. Glisson told Shaw that the state expects to submit its final version in mid- to late August.

The proposal, which is expected to be approved, focuses on "able-bodied" adults without dependents who qualify for Medicaid under the expansion of the program to those who earn 138 percent of the federal poverty level, under the 2010 Patient Protection and Affordable Care Act.

Kentucky has 1.4 million people on Medicaid, with around 470,000 of them covered under the expansion. Bevin has said the state can't afford to pay for this expanded population (the state's share is 5 percent this year, rising in annual steps to the ACA's 10 percent limit in 2020) .

The new plan is designed to not only save Kentucky money, but to also encourage participants to have some "skin in the game" through premiums and work or community engagement requirements that encourage people to have a higher level of involvement in their care.

The state proposed modifications to the original proposal in July. Glisson called the changes that strengthened the work and community engagement requirements and added a six-month lock-out period for those who fail to report changes in their work and employment status within 10 days of the change, "fairly minor."

To this, Pugel tweeted, "The 'minor changes' she's referring to kicks an extra 9,050 people off Medicaid and reduces spending by tens of million." Actually, the "kicked off" number is the difference between the number who are expected to be on the program in five years and the number expected to be on it if no changes are made.

More than 1,000 Kentuckians submitted comments about the added changes to the proposal, and almost all of them opposed it.

Saturday, August 12, 2017

Kentucky newspapers showed much more interest this year in the County Health Rankings, no matter if they were good or bad

By Elizabeth Spencer and Al Cross
Institute for Rural Journalism and Community Issues
University of Kentucky School of Journalism and Media

More Kentucky newspapers are writing about their communities' health, even when it presents an unfavorable picture, when measured by coverage of the annual County Health Rankings.

Kentucky papers reported on the rankings at a record rate in 2017, according to an analysis by researchers at the University of Kentucky's Institute for Rural Journalism and Community Issues.

The researchers examined 106 of the approximately 140 paid-circulation newspapers outside Kentucky's three major urban areas, covering 115 of the state's 120 counties. They found that 31 papers in 30 counties published 36 separate articles about the rankings in the five weeks after the rankings were released in late March. That was many more than in previous years.

Williamsburg Mayor Roddy Harrison led a one-mile walk to
promote health. (Photo: Corbin Times-Tribune, Angela Turner)
Not only did more papers report the rankings, there was no discernible difference in the likelihood of publication in healthier or unhealthier counties, unlike most previous years.

In the first few years of the rankings, residents of highly ranked Kentucky counties were much more likely to read that news in their local paper, while such stories in poorly ranked counties were scarce.

That pattern disappeared two years ago, but recurred in 2016, when relatively few Kentucky papers published stories about the rankings. This year, with a much larger sample, there was a strikingly even distribution of stories, with as many in poorly ranked counties as highly ranked ones.

That indicates that newspapers in lower-ranked counties have seen a need to inform citizens about their communities' lower health status, and to at least implicitly suggest a need for their readers to consider their health behaviors.

The County Health Rankings and Roadmaps is a program at the University of Wisconsin Population Health Institute and funded by the Robert Wood Johnson Foundation. The rankings are based on health outcomes, such as statistics on disease and death; factors that affect health, such as health behaviors like smoking, as well as social and economic factors; and local policies and programs, such as clinical care and the physical environment.

The rankings compare counties within each state, not nationwide. Communities can use the comparisons to identify problems that individuals, community organizations and local leaders need to address.

Research details

The main source for the latest research was the archive of printed Kentucky newspapers at the University of Kentucky. Papers unavailable in the archive were searched online. Not all Kentucky papers could be searched, because some newspapers do not have websites. Not all the published articles may have been found, because some papers that have websites do not place news articles there, and some that do greatly limit their online publication of stories that are not locally generated.

Because the Institute for Rural Journalism focuses on rural news media, the study did not include newspapers in Kentucky's five most urban counties: Jefferson, Fayette, Kenton, Campbell and Boone.

Researchers found 36 County Health Rankings articles in 31 newspapers. In one county, two papers had a CHR story. In three counties, the newspaper published more than one story, including an editorial in The News-Enterprise of Elizabethtown.

The Corbin Times-Tribune, which covers Whitley and Knox counties and part of southern Laurel County, did a three-part series on the rankings, one of which promoted a community walk held by the Whitley County Health Department. The county ranked 107th in health outcomes and 87th in health factors. Knox County ranked 102nd and 115th, respectively.

Analysis of the coverage included whether or not the paper framed the story with a county-specific localization of the data. Of the total sample, 89 percent included some form of localization, but two of those stories were localized only by the headline. Thirty-one percent of the stories included a comment from a local authority on health factors and outcomes. Only 11 percent quoted a community member.

Newspaper staff members wrote 69 percent of the stories. One-fourth of the coverage used the Kentucky Health News story, which focused on the rise in Kentucky's premature death rate. KHN is an independent news service of the Institute for Rural Journalism, funded by the Foundation for a Healthy Kentucky.

Overall, 34 percent of the sampled papers published a story about the County Health Rankings. The publication frequency for 2016 rate was only 7.6 percent.

In 2015, the publication rate was 24.53 percent, and in 2014, it was 18.52 percent. In those years, Rural Journalism researchers examined one-third of all papers in the state, drawing a random sample from those available in the printed archive.

The research also examined whether the stories described the rankings and the county's health status in a positive or negative light. Not surprisingly, 16 had a positive framing, 16 had a negative framing, and 11 percent (four) of the stories offered a more balanced perspective. While some stories reflected celebration of an improved ranking, there are still serious health issues in every county.

Because the differences among closely ranked counties are small, maps with the rankings separate them into quartiles, or fourths. An online interactive map gives the individual rankings, and clicking on a county gives a detailed breakdown of the factors contributing to the rankings, as well as its recent trend.

Deadline for Obamacare individual-market insurers extended to Sept. 5; insurers still unsure if cost-sharing subsidies will continue

By Melissa Patrick
Kentucky Health News

Insurers in the Obamacare marketplace for individual coverage have been given three more weeks to finalize their 2018 rates, pushing the deadline to Sept. 5. The most recent filing deadline was Aug. 16.

This is in response to the uncertainty around whether the Trump administration will continue to fund the cost-reduction payments that help low- and moderate-income people afford the tax-subsidized health insurance. These reimbursements to insurers are around $7 billion a year.

The Aug. 10 Centers for Medicare and Medicaid Services memo says the extension will allow the agency to make risk-adjustment formula changes to account for this potential "uncompensated liability."

“Many state departments of insurance have permitted issuers to increase rates for their silver-metal-level plans for the 2018 benefit year in order to account for uncompensated liability that issuers may face for cost-sharing reductions provided to eligible insured individuals," CMS said, adding that it will propose a new risk-adjustment methodology "in which all marketplace issuers increase silver metal plan rates to account for cost-sharing reduction payments."

The cost-sharing payments have been challenged in court but are being paid to insurers on a monthly basis, with no commitment from the Trump administration to continue them. President Trump has threatened to stop making the payments, calling them a "bailout" for insurance companies. The next payments are due Aug. 21.

Insurers have said they will have to raise their premiums by as much as another 20 percent to make up for the lost reimbursements or in some cases pull out of the Obamacare marketplaces altogether. Kaiser Family Foundation estimates that in Medicaid-expansion states such as Kentucky, rates for a typical plan would have to rise an additional 15 percent to make up for the lost reimbursement.

Politico reports that the non-partisan Congressional Budget Office will soon release a report breaking down the effects of cutting Obamacare's cost-sharing reduction payments.

About 36,000 of the 82,000 Kentuckians with individual Obamacare policies qualified for these subsidies in 2017. Most Kentuckians who gained health insurance through Obamacare did so through the expansion of Medicaid to those who earn up to 138 percent of the federal poverty line.

Anthem Health Plans of Kentucky, the only insurer offering individual marketplace plans in every Kentucky county in 2018, has made an initial request for a 34.1 percent rate increase in the state, one of the largest in the nation.

CareSource, which will offer plans in 61 counties, withdrew its initial request for a rate increase of 20.8 percent on Aug. 3, but recently refiled it again at the same rate. These rate requests can fluctuate through the new deadline of Sept. 5.

The final deadline for insurers to sign their contracts to participate in the Obamacare marketplace is Sept. 27, and open enrollment begins Nov. 1.

New state public-health veterinarian appointed; her responsibility is diseases that spread from animals to humans

Dr. Kelly Giesbrect
According to the World Health Organization, nearly 75 percent of the new diseases that have affected humans over the past 10 years originated from an animal or an animal product. Kentucky has just appointed a new public health veterinarian, Dr. Kelly Giesbrecht, to help protect Kentuckians and the state's animal populations from such diseases.

“We are very pleased to have Dr. Giesbrecht join our staff at the Cabinet for Health and Family Services,” Health Secretary Vickie Yates Brown Glisson said in a news release. “Her wealth of experience in public health and veterinary science is a perfect fit for this extremely important role and will be a tremendous asset to our work to improve the public health of Kentucky.”

Among other things, Giesbrecht is tasked with identifying and evaluating diseases that are spread between animals and humans, called zoonotic diseases.

The federal Centers for Disease Control and Prevention says every year tens of thousands of Americans get sick from diseases spread between animals and people, which are caused by harmful germs like viruses, bacteria, parasites and fungi.

Zoonotics are transmitted in several ways, including direct contact with the body fluid of an infected animal; indirect contact from touching a contaminated surface; being bitten by a tick, flea or mosquito; or eating contaminated food.

Some of the more recognizable ones in the United States are Zika virus, West Nile virus, bird flu (Avian influenza), rabies, cat scratch disease, Lyme disease, E.Coli and Salmonella, though there are many more.

Giesbrecht, who will be part of the Division of Epidemiology and Health Planning in the state's Department of Public Health, will develop policies, guidelines and strategies to control zoonotic and foodborne diseases and share information as needed to health experts and the public.

Giesbrecht comes to the department with over 22 years of combined experience in veterinary medicine and public health. She has a doctorate in veterinarian medicine from the University of Florida and a masters of public health from the University of Texas. After clinical practice, she spent 11 years in the U.S. Air Force as a public health officer and most recently worked at the Northern Kentucky Health Department as a regional epidemiologist.

Friday, August 11, 2017

Top-hospital list includes 7 in Ky.: UK, St. Elizabeth, Baptist in Lexington and Louisville, Norton, Jewish and, newly, Owensboro

Seven of Kentukcky's hospitals have met the "high U.S. News standards" and been named "Best Regional Hospitals" in the annual rankings by U.S. News & World Report magazine.

They are, in order of ranking: the University of Kentucky hospital, St. Elizabeth Healthcare Edgewood-Covington, Baptist Health Lexington, Louisville's Norton Hospital, Baptist Health Louisville, Louisville's Jewish Hospital and Owensboro Health Regional Hospital.

This is the first year the Owensboro hospital has made the list, reports the Messenger-Inquirer of Owensboro.

UK HealthCare, for the second consecutive year, claimed the No. 1 ranking with its Albert B. Chandler Hospital. It ranked in the top 50 hospitals nationally for four adult specialties, including diabetes and endocrinology (#37) , geriatrics (#43), neurology and neurosurgery (#44) and cancer (#50). Among specialties, UK received a "high performing" rank in five, including gastroenterology, nephrology (kidneys), orthopedics, pulmonology (lungs) and urology. The magazine gives this distinction to the top 10 percent of hospitals nationally.

“We are committed to providing the best programs and best care available in Kentucky so that no one has to travel far from home for world-class advanced specialty care and these rankings speak to the hard work and dedication of our physicians, nurses and our entire health-care team,” Dr. Michael Karpf, UK's soon-to-retire executive vice president for health affairs, said in a release.

The rankings compared more than 4,500 medical centers nationwide in 25 specialties, procedures and conditions. This year's report provides information on nearly every hospital in the nation. Kentucky has more than 120 hospitals.

St. Elizabeth, ranked No. 2 in Kentucky, also holds this distinction in the Cincinnati metro area. It is also the only other Kentucky hospital to qualify for a high-performance ranking this year in a specialty category, getting this distinction for geriatrics and pulmonology.

The report also recognizes hospitals that are "high performing" for nine common adult procedures and conditions, including: abdominal aortic aneurysm repair, aortic valve surgery, chronic obstructive pulmonary disease, colon cancer surgery, heart bypass surgery, heart failure, hip replacement, knee replacement and lung cancer surgery.

Baptist Health Lexington was ranked high-performing in all nine. UK and St. Elizabeth were for all except abdominal aortic aneurysm repair, in which both received an average rating. Norton Hospital was rated high-performing in six: COPD, colon cancer surgery, heart failure, hip replacement, knee replacement and lung cancer surgery.

Baptist Health Louisville was ranked high performing for five: COPD, colon cancer surgery, heart failure, hip replacement and knee replacement. Jewish Hospital was high performing for COPD, colon cancer surgery and heart failure. Owensboro Health Regional Hospital was high performing for heart failure, hip replacement and knee replacement. It received a below-average ranking for aortic valve surgery.

The report offers an overview of more than 100 Kentucky hospitals and a breakdown of each of the measured categories, as relevant to the services the hospital provides. Click here for more information on how the magazine ranks the hospitals.

Nationally, the Mayo Clinic in Rochester, Minn., claimed the No. 1 spot on the Best Hospitals Honor Roll. The Cleveland Clinic ranked No. 2, followed by Johns Hopkins Hospital in Baltimore at No. 3, said the magazine's news release.

Foundation for a Healthy Kentucky seeks information from health coalitions for directory

The Foundation for a Healthy Kentucky is updating its directory of local health coalitions and is asking groups that work to improve health in their communities to provide their contact information online by Sept. 8 if they want to be included.

The 2016  Kentucky Health Coalitions Directory includes about 400 such groups and statewide coalitions. The application defines a coalition as: community coalitions, collectives, collaborations, groups, networks and partnerships working to improve the health of the people of Kentucky.

"The Foundation's Health Coalitions Directory raises awareness of efforts to improve health in local communities and across the state, and fosters sharing and collaboration," Ben Chandler, President and CEO of the foundation, said in a news release. "These coalitions are largely local groups comprising neighbors and colleagues who are working together to identify and solve health-related issues in the communities where they live, work and raise their families."

The efforts of coalitions in the directory vary; some work to increase access to healthy food and physical activity; others plan needed health screenings and provide health education for people at risk for serious health problems such as cancer, diabetes and other chronic diseases; and others work to enact smoke-free or complete-streets ordinances.

Click here to enter your coalition's information.  For more information, contact Rachelle Seger at or 502-326-2583.

Thursday, August 10, 2017

State gives 28 school districts grants to teach children healthy life choices and to avoid drugs, alcohol and tobacco

By Melissa Patrick
Kentucky Health News

If you have ever heard Kentucky's Health Commissioner Hiram Polk speak, you have likely heard him talk about his plan to create an education program to teach young children how to live healthy, drug-free lives, and it looks like his plan is about to become reality.

As part of Dr. Polk's initiative, the state Department of Public Health has distributed $942,938 to 28 school districts statewide to receive "Early Childhood Healthy Living" grants, reaching 96 schools.

"If there is a secret to drug, tobacco and alcohol addiction, it is through very early childhood education. I believe that," Polk told Kentucky Health News in September 2016, after being in the position a few months.

The one-time awards vary between $15,000 and $40,000 per school district and Polk hopes to be able to provide additional funding in the future, Doug Hogan, spokesman for the Cabinet for Health and Family Services, said in an email.

The grants will support "evidence-based" programs that focus on reducing substance abuse, violence, bulling and suicide, as well as ones that promote physical activity, improve academic success and promote parental and caregiver supports. They target preschool through fourth grade.

"The early development years are essential to equipping our children to make healthy life choices when they face the temptations of drug, alcohol and tobacco use in later years," Hogan said.

Kentucky's children face those temptations earlier than you might think.

The biennial 2016 "Kentucky Incentives for Prevention" survey, which is given to students across the state in even-numbered grades starting in the sixth grade, found that 21.5 percent of the more than 30,000 sixth graders polled thought that tobacco use was a problem at their school, 12.8 percent thought alcohol was a problem and 15.3 percent thought drug use was a problem.

"Waiting until fifth grade, or middle school, to provide these programs is too late," Hogan said. "Starting programs to reach students sooner is a must."

Recipients of the grants will report the results of their projects at the end of the fall semester, and will then share this information with other school districts in March or April, Hogan said.

These programs are part of an initiative to combat the opioid epidemic that is sweeping Kentucky. Last year, 1,404 Kentuckians died as a result of an opioid overdose -- a 7.4 increase from 2015.

“We need to build a foundation in our children for healthy lives, free from substance abuse,” Lynne M. Saddler, director of the Northern Kentucky Health Departmenttold The River City News of Northern Kentucky. “The programs being implemented with these grant funds can reduce the use of alcohol, tobacco, and illegal drugs and drive down youth suicide rates. They can improve children’s social and emotional health by reducing violence and bullying. Such programs can build strong systems for teachers and parents and improve the long-term health of our community.”

Five Northern Kentucky school districts received grants, including Kenton County and the independent districts of Beechwood, Dayton, Erlanger-Elsmere and Walton-Verona.

Other districts include: Paris in Bourbon County; Danville in Boyle County; Bullitt County; Franklin County; Menifee County; Rowan County; Henderson County; Union County; Casey County; Pulaski County; Russell County; Lincoln County; Hardin County; Marion County; West Point in Hardin County; Marshall County; Shelby County; Crittenden County; McCracken County; Carroll County; Barbourville in Knox County; Whitley County, Corbin and Williamsburg.

Wednesday, August 9, 2017

Appalachians die sooner than 20 years ago, and region has a higher infant-death rate than U.S.; both attributed to smoking

By Melissa Patrick
Kentucky Health News

People who live in Appalachia are dying sooner than two decades ago, and the region has a higher infant death rate compared to the rest of the nation. A new study blames both largely on the region's high smoking rate, as well as its other bad health habits.

“What this report shows is the extreme damage that tobacco is causing our people, and how we are getting hammered by it worse than any other place in this country," said Ben Chandler, president and CEO of the Foundation for a Healthy Kentucky.

Click on map to view or download larger version
The study, published in the academic journal Health Affairs, compared infant mortality and life expectancy disparities in Appalachia to the rest of the United States between 1990 and 2013, using national vital statistics data.

It found that Appalachia and the rest of the nation had similar rates for infant morality and life expectancy in the 1990s, but by 2013 infant mortality was 16 percent higher in Appalachia, and adults in the region were living 2.4 fewer years than people who lived in the rest of the country: 76.9 and 79.3 years, respectively.

The study attributes these widening gaps to "persistent or increasing disparities in general living standards and health-risk behaviors such as adult smoking, smoking during pregnancy, obesity, physical inactivity, and heavy consumption of alcohol."

Heart disease, lung cancer and other respiratory diseases were among the leading causes of death in the Appalachian region during the study period, all conditions that can be caused by smoking.

"We are the cancer-mortality capital of the nation right now, and we just cannot let that stand," Chandler said. "If we truly want to change Kentucky’s health statistics, the single most effective thing we can do is to reduce our smoking rates."

Kentucky has the highest smoking rate in the nation, 26 percent of adults. But smoking affects children, even those who don't smoke. Smoking during pregnancy is a risk factor for both birth defects and SIDS, according to the federal Centers for Disease Control and Prevention.

While the number of Kentucky mothers who smoked during pregnancy dropped from 26 percent in 2006 to almost 20 percent in 2015, this is still significantly higher than the national rate of 8 percent. Overall smoking rates and pregnancy smoking rates are highest in the state's Appalachian counties.

The report says the higher rates of birth defects and Sudden Infant Death Syndrome deaths in Appalachia accounted for 60 percent of the difference in infant mortality between the region and the rest of the country in 2009-13. Other contributors included diabetes, kidney diseases, suicide, unintentional injuries (such as traffic accidents) and drug overdoses.

There could be other causes for the increasing disparity. The researchers said it is possible that more affluent, healthier Appalachian residents may have migrated to more urban and affluent areas of the U.S., thus increasing the health and economic inequalities between the region and the rest of the nation.

They called for policies that address the region's high smoking rates, high unemployment rates, low education levels, poor access to health care, high obesity rates, transportation and housing issues, and try to increase access to healthy foods, to decrease the current gaps in health outcomes.

“Given the national gains in life expectancy, seeing the increasing disparity between Appalachia and the rest of the United States should serve as a wake-up call,” Rebecca Slifkin, co-author of the study said in a news release. “Many of the reasons for the disparities we observe are due to differences in social determinants of health. We really need new investments to ensure that health is not determined by where one lives. As a society, we invest huge sums in medical care to extend an individual’s life; imagine the gains we could make if similar resources were devoted to public health.”

The study used the 2008 Appalachian Regional Commission definition of Appalachia, which covers 428 counties in 13 states, 54 in Kentucky.

Sunday, August 6, 2017

Most public comments about changes to Medicaid proposal opposed it; comments of approval came with concerns

By Melissa Patrick
Kentucky Health News

More than 1,000 Kentuckians submitted comments about Gov. Matt Bevin's proposed modifications to the state's Medicaid waiver request, and almost all of them opposed the changes.

The modifications include stronger work and volunteer requirements, which would require Kentuckians who qualify for expanded Medicaid to work or participate in community service activities 20 hours a week or 80 hours a month. The original proposal called for a graduated increase in hours to the maximum of 20 hours after one year.

The revision also adds a six-month disqualification for those who fail to report changes in their work and employment status within 10 days of the change, and drops the expansion of a program that allows providers to give care to people who are presumed eligible for Medicaid, in favor of a "fast track" enrollment process that requires full enrollment and payment of premiums before coverage.

A cursory analysis by Kentucky Health News found that almost all of the submitted comments were against the modifications and the few that were favorable included concerns and qualifiers. Some comments were submitted more than once. Click here to link to the comments.

The Insure Kentucky Campaign, coordinated by Kentucky Voices for Health, collected and submitted comments from nearly 1,300 Kentuckians living in 108 of the state's 120 counties, according to a news release from the group.

Kentucky submitted its original proposal to the federal Centers for Medicare and Medicaid Services about 11 months ago, seeking a waiver from Medicaid rules. The proposal focuses on "able-bodied adults" who qualify for Medicaid under the program's 2014 expansion to those who earn up to 138 percent of the federal poverty level ($16,400 for an individual) under the 2010 Patient Protection and Affordable Care Act. The Trump administration is expected to approve the waiver.

Benefits would not change for pregnant women, children, the non-expansion population or the medically frail.

Kentucky has about 1.4 million people on Medicaid, with around 470,000 of them covered by the expansion. Bevin has said the state cannot afford to pay its share of the expansion, which is 5 percent this year, rising in annual steps to the reform law's 10 percent limit in 2020.

The updated proposal estimates that the changes would save taxpayers an additional $27 million over the next five years, bringing the state's total savings to $358 million by 2021, by having 9,000 fewer Kentuckians on Medicaid, 95,000 total. than if the changes weren't implemented.

Almost all opposed the changes

Many of the comments offered personal stories about how Medicaid and the expansion have improved their lives or improved the health of their friends and family. Almost all of them opposed the changes.

"Medicaid has changed so much in my family and my friends. They don't panic over getting sick. You don't know how stressful it is to be so scared of getting sick or being scared of having to make decisions about whether someone is sick enough to take them to the ER. Having Medicaid changes the way you feel all the time, knowing you have health insurance," one person said. (Comment #229621)

The commenter added, "These changes, all of them, they just make things more difficult. The 10-day reporting requirement and lock-out are pains in the ass. What is the point? It can't do anything but make things more difficult and make more people get kicked off Medicaid."

"The system we have now isn't perfect, but it is changing lives and needs more time before any changes are attempted!' said another comment (#229105).

"Ideally, program participants should be given at least 30 days to report changes; 10 days is not possible for most people. People would lose their jobs sitting at the DCBS [Department for Community Based Services] office trying to save their Medicaid! That isn't fair," said another (#229109).

"Some clients who have a persistent and severe mental-illness struggle to keep up with things like re-enrollment dates and deadlines and losing coverage would be detrimental," said a mental health therapist (#229197).

"Every one of these changes will impede access to treatment and therefore negatively impact overall health of Kentucky's citizens, especially its most vulnerable populations. None of my clients have extra money for premiums. Very few of my clients have reliable transportation, or phone minutes all month. I don't know how they are going to try to keep up with all this; I can't even keep it all straight. I don't know how they are going to manage these different accounts, or stay enrolled. This sounds like the goal is to make it so hard to get medicaid that people just don't and that's not right. People deserve health care," said a Bath County mental health therapist (#229477).

"The ability to obtain immediate access to Medicaid is very important; I totally disagree with change in the fast track!" said another (#229417).

Kentucky Voices for Health wrote: "We share Gov. Bevin’s goals of improving health outcomes and creating a more sustainable Medicaid program. But to accomplish that, we should start by reducing barriers to coverage, not increasing them. We should make the program easier to understand and use, not harder. And we should focus on encouraging people to use their coverage to improve their health, not enforcing new rules that are outside the scope of the Medicaid program."

The few supportive comments came with concerns

One commenter said, "I like the work requirement in spirit," but listed concerns about how the "community engagement" mandate will affect able-bodied caregivers who care for people who are not clearly defined as their dependent—such as extended family members; the challenges people have in finding employers that offers affordable health insurance; and the challenges they have, especially in the service and food industries, to get steady hours from week to week. "This requirement would mostly just hurt the people I think you are trying to help; it is maybe well intentioned, but not thought through," they wrote.

A retired home-health nurse said,"Yes, there should be accountability and responsibility," but asked: "Will there be job training programs, incentives for businesses to hire? Many of these people would work if they had opportunity. Losing their coverage for some would be detrimental to their health and the health of family. Will there be education programs to inform people of these changes if they are made? It would take a lot of people in every county to be available to help people, like Kynectors. Will there be a person to help upload documents? There is so much administration here, so much bureaucracy!"

Many questions

It was clear from the responses that Kentuckians still have many questions about the details of the new Medicaid plan. Here are just a few:

"I could not afford any medical bills without Medicaid. I'm on limited income. For the required work hours for medicaid, what about if you live in a area where there is no work to be found?" (Comment #229149)

"Will individuals who work jobs with varying wages that fluctuate over/under 138% on a regular basis, but annually remain under 138%, report changes? . . . Will residents of counties where SNAP [food stamps] work requirements are waived due to a lack of opportunity for work/volunteer hours (waived in 100 of 120 counties) also receive a waiver for the CE [community engagement] requirement, particularly since the modification states it is being modeled after the SNAP work requirement? . . . Will at least a one-time grace be offered for anyone who doesn’t understand the new guidelines, particularly those who are illiterate (English or any language) or have learning or language/cultural barriers/comprehension difficulties?" (part of InsureKY comments)

"Will mileage be paid for going to the work? Who will help find people jobs or pay to transport them if they don't have a car? Who will provide childcare or care for elderly relatives while "able bodied" people are trying to "earn" what should be their right as a Kentuckian: quality health care," asked one respondent (#229629).

"Is the state going to provide transportation to these volunteer positions? Is the state going to create volunteer positions? Is the state going to pay for the training for people? The management of the people? Is the state going to pay for the background checks? How about the child care?" asked another (#229637).

Several professional organizations oppose the changes

The Cystic Fibrosis Foundation, in addition to other concerns, said the 10-day reporting requirement was too short, and stressed that it should not be connected to any suggestion of fraudulent activity:

"The classification of failure to report changes in circumstance within 10 days as 'fraudulent activity' is a mischaracterization, as there may be people who fail to understand the process for completing redetermination paperwork or reporting changes that may impact eligibility. Using such terminology may discourage participation in the program by those fearful of inadvertently committing 'fraud' because they are unable to report changes within the 10 days." (Comment #266941)

Among other things, Centerstone , a behavioral health-care provider in seven Kentucky counties, said that while it supports the "overarching goal of encouraging engagement and responsibility for one's health care and increasing patient outcomes," added that the lock-out policy would "put undue burden on our consumers, specifically for consumers who fall just outside of the medically frail designation. For example, with patients struggling to overcome depression or take the first steps toward tackling addiction (employment, income, and daily functioning) may vary quite significantly. . . . Laborious reporting requirements would likely only result in a lapse in coverage, thus being locked out of evidence-based, preventative treatments that could otherwise keep an individual out of more costly inpatient facilities." (#272325)

Rich Seckel, director of the Kentucky Equal Justice Center, said in the InsureKY news release, "The waiver piles on complication after complication to coverage, with a startlingly punitive ‘lock out’ for not managing red tape—and no mention of accommodation for people who will find that hard. Instead of setting up consumers to fail, we should make programs work for working Kentuckians."

Some other organizations that sent detailed comments against the changes include: AARP (#269105), the Kentucky Center for Economic Policy (#269005), the American Congress of Obstetricians and Gynecologists (#268789), the National Health Law Program (#266877), the HIV Health Care Access Working Group (#270389), the American Diabetes Association (#269125), the Kentucky Equal Justice Center (#271369), Kentucky Voices for Health (#273677) and the Advocacy Action Network (in the Insure KY comments).

Several of the organizations offered research to support their claims as well as suggestions on how to move forward.

Saturday, August 5, 2017

Pediatric heart surgery has resumed at UK, in partnership with Cincinnati Children's Hospital

Magdalen Wilson, one of the first
UK pediatric heart surgery patients
since it re-opened, with parents Thom
and Lauren Wilson of Nicholasville
By Melissa Patrick
Kentucky Health News

After a five-year hiatus, Kentucky Children's Hospital is performing pediatric heart surgeries again, this time in partnership with Cincinnati Children's Hospital Medical Center – and it has already performed more than 12 since it opened in May.

"It is an important day here at the University of Kentucky and UK HealthCare to acknowledge that we've resumed the pediatric congenital heart program," said Bo Cofield, the hospital's chief clinical operations officer. "While we've got a fantastic pediatric cardiology program, we paused our surgical program a couple of years ago because it wasn't what we wanted it to be – a world class program – and we really believe that we've got that now through this partnership."

UK voluntarily suspended heart surgeries on children in 2012 after five died in 11 months. The program's chief surgeon, Dr. Mark Plunkett, left the program in 2013 with a $1 million settlement and an agreement to not talk to the news media. The letter of intent to partner with Cincinnati Children's was signed in 2015 and finalized in January 2016.

An internal review of the program didn't say why it was suspended. UK refused to release the program's death rates, but did so after the state attorney general ruled that it had to and CNN reported on the problem. The annual mortality rates averaged 5.8 percent, ranging from 5.2 percent in 2010 to 7.1 percent in 2012. The national average for a program of similar size was 5.3 percent.

The new program is a "one program, two sites" model that benefits both facilities, said Dr. Andrew Redington of Cincinnati Children's. He said the partnership allows UK's program "to provide the same level of care as we provide in Cincinnati" and Cincinnati's program to focus on "that high level of surgery that perhaps UK doesn't do," such as transplants.

Asked what specific changes they made to re-open, Cofield said, "We think there was some requirement for investment in certain things – more people, more training for the people that we brought in and clearly a focus on ensuring that we have the clinical infrastructure necessary to safely care for patients," including a "tele-video-conferencing" system that allows for seamless communication between the locations.

"What we want to do is provide the best level of care to as many children as possible, as close to home as possible," said Redington. "For patients and children who travel maybe a hundred or two or three hundred miles to get to Cincinnati, that's a burden and we recognize that."

Choosing care close to home was important to a Nicholasville family, whose infant is one of the first pediatric patients to undergo surgery in the new program.

Five-month-old Magdalen Wilson, who was born with several congenital heart defects, underwent open-heart surgery July 5 at Kentucky Children's Hospital and is doing well, said Thom and Lauren Wilson, her parents.

After learning about Magdalen's heart defect when Lauren was about seven and a half months pregnant, the Wilsons traveled between Nicholasville and Louisville twice a week to see specialist during the pregnancy. The Wilsons have three other children.

Magdalen was able to go home after she was born, but at about three months, she quit eating and her parents took her to UK's pediatric emergency center where she was admitted and assessed by the pediatric heart team. They learned about UK's new pediatric heart surgery program.

"We made the decision at that point to transfer our care to UK because it was close to home and the doctors and cardiologists we encountered in the pediatric intensive care unit were attentive and showed great concern for Magdalen's well-being," Lauren Wilson said in the news release.

Thom Wilson thanked all of their caregivers at UK and said they had received "excellent care." He later added that they appreciated that UK's pediatric heart surgery program was part of "a very well-known established program."

Magdalen's surgery was performed by Dr. James Quintessenza, who Cofield described as a "world-class pediatric cardiothoracic surgeon" and Redington called "one of the best surgeons on the planet." Quintessenza described the new program as a fine-tuned "orchestra." He added, "We are off to a great start."

Friday, August 4, 2017

Registration is open for Nov. 3 HealthWatch USA conference in Lexington on health-care transparency and patient safety

Somerset-based HealthWatch USA will hold its annual Healthcare Transparency and Patient Safety conference Nov. 3 in Lexington.

In addition to exploring issues around problems that occur with medical devices and implants, the importance of creating cultures of safety and health-care accountability, this year's conference, "The Setting of Strong Quality Standards and Research Integrity," will include two nationally renowned investigative reporters who will discuss research integrity and how it influences health-care policy.

Deborah Nelson, a Pulitzer Prize-winning investigative reporter and associate professor of investigative journalism at the University of Maryland, will discuss conflicts of interest and how this issue influences infectious disease policy.

Dr. Ivan Oransky, distinguished writer in residence at New York University and co-founder of Retraction Watch, will discuss the characteristics of articles retracted from peer-reviewed academic journals and how research integrity affects health-care policy.

The conference will run from 8:30 a.m. to 4:30 p.m. at the Four Points Sheraton in Lexington and will offer continuing education credits for medical professionals. Click here for more information and a link to register.

Thursday, August 3, 2017

Trump threat to stop ACA subsidies makes insurers jumpy; one pulled its rate filing for 61 Ky. counties, has until Aug.16 to refile

Update 8/11/17: The Centers for Medicare and Medicaid Services has extended the rate filing deadline for 2018 Obamacare marketplace plans until Sept. 5. The deadline for signing final contracts remains the same. 

By Melissa Patrick
Kentucky Health News

President Trump's threats to stop funding the cost-reduction payments that help low- and moderate-income people afford Obamacare health insurance has created great uncertainty for insurers, and is likely the reason CareSource just withdrew its initial rate filing in Kentucky.

CareSource, which planned to offer individual plans in 61 Kentucky counties, originally requested a 20.8 percent rate hike, but withdrew this initial filing request Aug. 3. It has until Aug. 16 to file another one.

“We are currently in the filing and review period for marketplace plans and CareSource is continuing to evaluate its offerings for 2018. CareSource is committed to providing Kentuckians affordable and quality coverage options.” Claire Zois, a spokeswoman for CareSource, said in an e-mail when asked why the filing was withdrawn.

Trump's most recent threats to remove the subsidies have come by way of tweets sent in response to Senate Republicans being unable to pass a partisan health law to repeal and replace the Patient Protection and Affordable Care Act.

One tweet said, "If a new HealthCare Bill is not approved quickly, BAILOUTS for Insurance Companies and BAILOUTS for Members of Congress will end very soon!" (An Obama administration rule allowed members and their staffs to enroll through the small-business exchange for the District of Columbia, providing an employer match from the government.)

Even if Trump ends the cost-sharing payments, which total about $7 billion a year, insurers would remain responsible for providing them, but wouldn't be reimbursed. Insurers have said they would respond by raising premiums by as much as another 20 percent to make up the lost revenue; the Kaiser Family Foundation has estimated that in Medicaid-expansion states such as Kentucky, rates for a typical plan would have to rise 15 percent to make up for the lost reimbursement.

Anthem Health Plan of Kentucky, the only insurer offering individual marketplace plans in every Kentucky county in 2018, has already requested a 34.1 percent rate increase in Kentucky, one of the largest in the nation.

Anthem has said that if this uncertainty isn't resolved soon, it may have to refile for bigger hikes and decrease its level of marketplace participation, The Wall Street Journal reports. Anthem has withdrawn from three states and much of California, the most populous state.

Harland Stanley of Louisville, an independent researcher who pays about $400 a month for a plan from Anthem, $120 more than last year, told the Journal that he is concerned about these rate hikes. “It’s going to hurt,” said Stanley, 53. “I worry about, what if it keeps going? When is this going to stop?”

The Kentucky Department of Insurance expects to finalize private health plans by Aug. 16, the last day for insurers who want to participate in the federal marketplace to file rates. Insurers have until Sept. 27 to sign federal contracts to offer plans in 2018.

An Axios map shows that Kentucky, with about 36,000 people qualifying for cost-saving reductions in 2017, would be one of the states least affected by the cuts. The overwhelming majority of Kentuckians who gained health insurance through Obamacare did so through the expansion of Medicaid to those who earn up to 138 percent of the federal poverty line.

Vox reports, "Those that stand to suffer the most are actually enrollees with slightly higher incomes, who do not qualify for subsidies and would be stuck paying the full price of that rate hike."

It doesn't look like this uncertainty is going to end any day soon. Trump's budget director Mick Mulvaney told Chris Cuomo on CNN's "New Day" that they would continue deciding monthly whether to make the subsidy payments. July's payments have been made and the next round of payments is due Aug. 21.

In a new issue brief, the Kaiser Family Foundation looks at how administrative actions would affect market stability, which might happens if the market fails, and what might be done to strengthen it.

Court rulings, governors and bipartisan efforts

Trump's threat to stop the payments may be harder to carry out since a federal appeals court ruled Aug. 1 that 16 state attorneys general, including Kentucky's Attorney General Andy Beshear, can defend the cost-sharing subsidies on behalf of their consumers, The Hill reports. "This could make it harder for the Trump administration to quickly and unilaterally end cost-sharing subsidy payments to insurers," Kaiser Vice President Larry Levitt said in a tweet.

The ruling allows the states to intervene in a lawsuit over the payments. It said, "The states have shown a substantial risk that an injunction requiring termination of the payments at issue here . . .  would lead directly and imminently to an increase in insurance prices, which in turn will increase the number of uninsured individuals for whom the states will have to provide health care."

Several governors from both parties have called on the administration to fully fund payments, The Hill reports. “A first critical step in stabilizing the individual health insurance marketplaces is to fully fund CSRs for the remainder of calendar year 2017 through 2018,” the group said.

Senate Majority Leader Mitch McConnell of Kentucky said when his last-ditch Obamacare-repeal bill died July 28 that he wanted alternative ideas from Democrats, but "Bailing out insurance companies without any thought of reform is not something I want to be part of." Nevertheless, some bipartisan efforts have begun.

Sen. Lamar Alexander, R-Tenn., announced Aug. 1 that the Senate health committee he chairs would hold bipartisan hearings in September on how to repair the individual market. In the House, a bipartisan group of 40 lawmakers called the Problem Solvers Caucus endorsed an outline of ideas aimed at making urgent fixes to the law, CNN reports.