Friday, May 31, 2019

Ky. has the second highest per-capita spending on prescription drugs, no surprise in a state that is riddled with poor health

States with top 10 average yearly per-capita
expenditure on prescriptions. (The Senior List)
A new analysis shows how much the average resident in each state spends on prescription drugs. Kentucky took the second spot, with an average annual per-capita expense of $2,111, with Delaware spending the most at $2,331, according to The Senior List.

It should come as no surprise that Kentuckians spend so much on prescription medications, since the state ranks at or near the bottom for most health conditions.

The data came from the Kaiser Family Foundation, GoodRx and the National Conference on State Legislatures.

The top 10 states ranged from some of the poorest, where health conditions also tend to be poor, to some of the wealthiest, where ability to pay for more expensive brand-name drugs may be a factor.

Whatever the cause, Americans are spending far more on prescriptions these days than in years past. In 2017, the average American spent $1,025 per year on prescriptions, a 1,000% increase over the average $90 (adjusted for inflation) spent in 1960.

An aging population factors into this: Almost half of Americans take at least one prescription medication, but among seniors it's nearly 90%. Drug costs are taking a financial toll on some; about one in four Americans say they're having a hard time affording their prescriptions.

Part of the problem is that the U.S. pays more for the same drugs than other countries do. A month's supply of the popular blood thinner Humira, for example, costs $882 in Switzerland, $1,362 in the United Kingdom, and $2,669 in the U.S.

Judge rules foundation that pays UK doctors and bills patients is a public agency and must follow the Kentucky Open Records Act

A Fayette Circuit Court judge has ruled that the Kentucky Medical Services Foundation, which bills patients and collects millions of dollars for UK HealthCare doctors, is a public agency and must follow the state open-records law, Linda Blackford reports for the Lexington Herald-Leader. photo
Judge Kimberly Bunnell agreed with a 2015 decision by the state attorney general’s office that KMSF is a public agency because the University of Kentucky created it and UK doctors run it.

Bunnell ruled from the bench April 25 and an agreed order was signed May 29.

In a separate case in March, Blackford reports,  Bunnell affirmed another opinion from the attorney general’s office and ruled that the UK HealthCare Compensation Planning Committee, which decides how much doctors should be paid, is also subject to state open-records and open-meetings laws.

Both cases were initiated by former UK medical student Lachin Hatemi, who was seeking various financial records of KMSF and the compensation committee. His attorney, Andre Regard, told Blackford, "This has been an uphill battle that I am sure will be appealed. I give credit to Lachin Hatemi, who, as a private citizen, has taken up this battle."

KMSF could take the case to the Kentucky Court of Appeals. Jay Grider, a UK anesthesiologist who is president and CEO of the foundation, declined to comment to the Herald-Leader.

The foundation was created in 1978 to help the university pay doctors competitive salaries and support its academic and service missions, Blackford reports. According to 2017 tax documents, it had gross revenue of $258 million in 2016.

"That money pays UK doctors, but its vast coffers have also been used to help UK in real-estate transactions, construct a daycare at UK, pay for use of a private airplane for UK officials, and fund contracts worth millions of dollars with consultants and lawyers," Blackford notes. "Those contracts haven’t been subject to state procurement rules and don’t go through a bidding process or receive approval from the UK Board of Trustees."

UK calls the foundation an affiliated corporation, but insists it is a separate entity that is not subject to the state’s Open Records Act.

In support of the ruling, Amye Bensenhaver, who wrote numerous open records opinions as an assistant attorney general and recently co-founded the Kentucky Open Government Coalition, told Blackford, “I think it emphasizes the fact that you can’t establish a private entity as an alter ego to conduct public business behind closed doors."

In an op-ed for Kentucky newspapers, Bensenhaver says the issue is "whether a public agency can avoid the application of the open records law by secreting away its records in a 'foundation' that is, in reality, established, created, and controlled by the agency seeking to evade accountability."

Pineville hospital is cut off by Medicare and Medicaid, which in 2015 accounted for 93% of its patient days; city seeking rescue

UPDATE, June 4: A bankruptcy judge "approved a deal Monday that would transfer control" of the hospital to a bankruptcy trustee who "plans to reach a deal with a non-profit organization to operate the hospital for the next 60 days while the trustee searches for a potential buyer," the Herald-Leader reports.

A temporary banner, using the typeface of Americore Health,
is draped over the sign for Pineville Community Hospital.
(Photo by Anthony Cloud, Middlesboro Daily News)
The federal government has cut off Medicare and Medicaid payments to Southeastern Kentucky Medical Center in Pineville following a "scathing inspection" that found the hospital with long list of patient-care and financial shortcomings, Will Wright reports for the Lexington Herald-Leader.

After an emergency meeting of the Pineville City Council, Mayor Scott Madon told the Middlesboro Daily News that the city is “doing all it can to provide support for the efforts of the bankruptcy trustee to protect and preserve the assets of the Pineville Community Hospital Association,” the nonprofit that sold the hospital (but not its real estate) to Florida-based Americore Health Solutions, which changed the hospital's name in 2017.

The association declared Chapter 7 bankruptcy last year. Madon said the city is using a $100,000 loan secured by the real estate to "fund professionals" hired by the bankruptcy trustee, presumably to facilitate the hospital's sale. “I think we need to support our local hospital and let the professionals on both sides work out the details,” Madon said. “We hope and pray that this is resolved soon.”

According to the latest available data from the Kentucky Hospital Association, in 2015 nearly 75% of the medical center's inpatient days were covered by Medicare and 18% were covered by Medicaid.

The Centers for Medicare and Medicaid Services terminated its agreement with the hospital after a January report from state inspectors found many issues, Wright reports. Inspectors reported that the hospital didn't have an adequate operating budget, and that hospital officials said they had "no plan to ensure the facility could continue to operate."

Among the examples of bad patient care: "Last year, one patient who was experiencing abdominal pain signed a consent form for an EGD, a procedure to examine the lining of the stomach and part of the small intestine using a small camera on a tube that is inserted through the mouth. Instead, hospital staff attempted to perform a colonoscopy on the patient, without the patient’s consent, and performed a sigmoidoscopy — an examination of the lower colon and inner part of the rectum — without the patient’s consent."

The nearest hospitals to Pineville, the seat of Bell County, are about 15 miles away, in Barbourville and Middlesboro, the county's largest town.

Thursday, May 30, 2019

Nine Johnson County Middle School students get Healthy Policy Champion award for efforts to curb youth use of e-cigarettes

The Foundation for a Healthy Kentucky has named nine Johnson County Middle School students as the latest Healthy Kentucky Policy Champions for their efforts to curb youth use of electronic cigarettes, both in their school and across Kentucky.

Johnson County students with Sen. Ralph Alvarado, Foundation for a
Healthy Kentucky CEO Ben Chandler and award. (Foundation photo)
The students are Alivia Hackworth, Chloe Dyer, Laken Salyers, Emily Farler, Constance Martin, Kaylee Gibbs, Hannah Piedad, Dakota Shepherd and Jonathan Cole Butcher. Dyer and Hackworth appear in ads for the foundation's "I Just Didn't Know" peer-education campaign about the dangers of youth e-cigarette use.

The group calls itself "Juul Breakers" and their campaign "Juulsnotkuul." Juul Labs makes the most popular e-cigarette among youth because the device looks like a USB flash drive, which makes it easy to hide. They are also essentially odorless and come in flavors they like.

The students were chosen for their efforts to educate their peers about the dangers of "vaping," and for their work on a bill that would have created an anonymous hotline for students to report concerns about e-cigarette and tobacco use. The bill also included an educational component and guidelines for how to handle the reporting.

Their bill almost made it out of the legislature, passing through the Senate and to the House floor, where it wasn't called up for a vote. But in the process of, the students educated lawmakers about teens' rampant use of these products and their dangers, and they were given partial credit for passage of the law that makes all Kentucky schools tobacco-free in July 2020 unless a district opts out.

E-cigarettes deliver high levels of the addictive chemical nicotine, which is harmful to developing brains and primes them for other addictions. E-cig aerosol (it's not a vapor) also has toxins and particles that are unsafe to inhale, according to the Centers for Disease Control and Prevention.

"I am so proud of the behavior, grit, and determination exhibited by this group of kids," Johnson County School Supt. Thom Cochran said in the foundation news release. "Even when the bill they believed in did not make it to the House floor to be voted on, this group of young people persevered. They took their message directly to superintendents throughout the state, and have continued to push for policy change in dealing with the Juul and vaping epidemic."

The award was presented in Paintsville by Foundation CEO Ben Chandler, who said, "I'm inspired by the level of homework this outstanding group of middle schoolers have given, and keep giving, to addressing what has become an epidemic of teen vaping in Kentucky and nationwide."

He added, "Adults who are health advocates ... can talk all day long about this issue, but when lawmakers look into the eyes of a group of kids trying to address a problem they see every day in their school, it touches a chord. These kids' testimony helped put us over the top in getting legislators' support to make all Kentucky school property tobacco-free, and they're raising awareness of the issue among parents, school officials and their peers, both in Johnson County and throughout the commonwealth."

The group is now eligible for the Gil Friedell Policy Champion Award, which comes with a $5,000 grant from the foundation to a Kentucky-based nonprofit of the winner's choice. The winner will be announced at the foundation's Howard L. Bost Memorial Health Policy Forum Sept. 23 in Lexington.

Evolent Health to buy 70% of Passport Health Plan; will continue to serve the company's more than 300,000 Medicaid beneficiaries

Evolent Health, a for-profit national health management company, has agreed to purchase Passport Health Plan, the struggling, nonprofit Medicaid insurer based in Louisville. image
Evolent, which has provided services and staff to Passport since 2016, will purchase a 70% share of Passport for $70 million, and invest additional funds to shore up the company's finances.

Passport has struggled since the state cut its Medicaid rates for the Louisville region last year, where it does most of its business, notes Deborah Yetter of the Louisville Courier Journal.

Scott Bowers, Evolent's national Medicaid president, has been named the new CEO of Passport, replacing Mark Carter on June 7, Yetter reports. Carter will remain on for a period as an adviser.

The company will continue to serve the more than 300,000 Kentuckians who get their Medicaid health coverage through Passport and will continue to operate under the same name, it said.

The remaining 30 percent of Passport will remain with its founding members, including the University of Louisville, the U of L Medical Center, University of Louisville Physicians, the Jewish Heritage Fund for Excellence and Norton Healthcare. U of L will get nearly $45 million from Passport's sale to Evolent, Morgan Watkins reports in a separate Courier Journal article.

The university owns 64% of Passport, and 70% of that will be sold for about $44.7 million, U of L President Neeli Bendapudi told reporters. That will leave it with a 19.2% stake in the company.

Bendapudi said $16 million from the sale would be used to retire U of L Physicians' bank debt; $3.5 million to stabilize U of L Physicians' cash position; and $16 million to reduce the School of Medicine's deficits. She declined to provide details on the nature of the deficits, and said the sale wouldn't be enough to resolve financial issues at the school and the physicians' practice.

The deal is subject to approval of state and federal regulatory authorities including the federal Securities and Exchange Commission, a process that is expected to take 60 to 90 days.

Officials with Passport and Evolent told Yetter that they are committed to resuming work on the company's new headquarters in West Louisville, which was suspended in February. Carter and Bowers told Yetter that they are still in discussions about how to revive the stalled project.

Passport is one of five companies that manage most of the state's $11 billion-a-year Medicaid program that serves around 1.3 million people. Passport is the only nonprofit; the others are subsidiaries of for-profit insurance companies.

Passport fell into trouble last year when the Cabinet for Health and Family Services changed its geographic allocation of Medicaid money, cutting the Louisville region that Passport serves by 4.1% while the rest of the state was raised 2.2%. State officials have held firm that the new rates were developed with the aid of an independent actuary and were not aimed at any individual company.

The state recently enacted revised rates that effectively restored Passport to its original, higher rate, Yetter reports, but Carter told her that that wasn't enough to make up for the roughly $100 million it lost since July 1. He said the additional investment by Evolent should make Passport solvent.

This isn't the first time Passport, which was founded in 1997 as a pilot project to control Medicaid costs in the Louisville region at the request of state officials, has found itself in the news.

In 2010, a state auditor's report found "wasteful spending of Medicaid funds" at Passport. Along with a strong reprimand from then-Gov. Steve Beshear, the report resulted in sweeping reforms, including a restructure of Passport's board, hiring new executive leadership, cutting expenses and firing its outside lobbyists, Tom Loftus reported in a 2015 Courier Journal article.

And while Beshear asked Passport to stop spending money on anything not directly related to patient care, he later asked for, and Passport provided in May 2015, a $25,000 contribution to the Democratic Governors Association in May 2015, which had already given "$600,000 to Democratic super PAC supporting the election of Attorney General Jack Conway as governor."

Beshear and Carter told Loftus that the $25,000 was not a political contribution, but for sponsorship of a one-day health policy conference co-hosted by the DGA in Louisville. Senate Republican Leader Damon Thayer, of Georgetown, disagreed, saying, "I'm not saying this is illegal, I'm just saying call this what it is -- a political contribution." Only three states elected governors in 2015.

At the time, Conway was running against Republican Matt Bevin, now governor, and they had starkly different opinions about Beshear expansion of Medicaid to people who earn up to 138% of the federal poverty line, under the 2010 Patient Protection and Affordable Care Act. Conway fully supported the expansion, while Bevin said he would end it if elected. In July, he changed positions, saying he would seek a waiver from federal rules that would make Kentucky Medicaid more like the program in Indiana, in which beneficiaries pay small premiums based on income.

Since being elected, Bevin has sought a waiver that includes premiums and "community engagement" requirements, including work, for "able-bodied" beneficiaries. A federal judge twice rejected the plan, which is now before the U.S. Court of Appeals for the District of Columbia.

Wednesday, May 29, 2019

Study finds flavors in e-cigs can damage cells that are critical for a healthy heart; cinnamon and menthol flavors were the most toxic photo
Flavors used in electronic cigarettes damage the cells that line the inside walls of blood vessels, which ultimately increases the risk of heart disease, a study has concluded.

The study, published in the Journal of the American College of Cardiology, exposed lab-grown endothelial cells, which normally line healthy blood vessels, to six different flavored e-liquids with varying nicotine concentrations.

The researchers found that following exposure, the cells were more likely to die early, showed increased levels of DNA damage, were less able to help form new blood vessels and were less able to participate in wound healing, Dennis Thompson reports for HealthDay News.

The study found that the cinnamon and menthol liquids were the most damaging to the cells, while the caramel and vanilla flavors were also damaging, but not as severely.

Senior researcher Dr. Joseph Wu told Thompson that if this same effect occurs in the human body, it could potentially increase the long-term risk of heart disease and stroke. Wu is director of the Stanford Cardiovascular Institute in California.

"If you're a chronic e-cigarette [user], you're probably going to be prone to more vascular disease in the future," Wu told Thompson. "It doesn't have the carcinogens associated with smoking, but don't use e-cigarettes with the assumption that if I switch to e-cigarettes it will be good for my cardiovascular health."

Wu added that endothelial cells, which line the heart and blood vessels, are critical to heart health and need to remain flexible to help manage blood pressure. Further, he said that when they are damaged they attract more cholesterol plaques and contribute to narrowing of the arteries, and stroke.

"The remarkable thing was there were very strong effects, both in terms of the specific mechanisms they looked at and that the effects were not very different between cells from e-cigarette smokers and cigarette smokers," Dr. Rose Marie Robertson,deputy chief medical officer of the American Heart Association, told Thompson.

Robertson also warned that the e-cigarette companies are using flavorings that have been approved by the U.S. Food and Drug Administration for ingestion, but not necessarily for inhalation.

Much of the concern about e-cigarettes is centered around the growing use of these products by teens, largely because they are attracted to the flavors.

"There's so many kids who are smoking e-cigarettes. And these kids are going to become adults. And these adults can become elderly patients that I as a cardiologist will take care of later on, " Wu told Michael Nedelman of CNN.

According to the Kentucky Incentives for Prevention survey, teen use of e-cigarettes in the state nearly doubled from 2016 to 2018. It found that 26.7% of high-school seniors reported using e-cigs in the month before they were surveyed, up from 12.2% in 2016. Among 10th graders, it increased to 23.2% from 11.3%; eighth graders to 14.2% from 7.3%; and sixth-graders to 4.2% from 2.3%.

A national study found that vaping increased nearly 80% among high schoolers and 50% among middle schoolers from 2017 to 2018.

Wu told Thompson that the researchers suspect that different components of e-cigarette vapor might harm blood vessel cells in different ways.

Environmental Health News calls this study the latest linking e-cigarettes to heart problems and points to two other bodies of research that link e-cig use and heart disease.

In March, it reported that researchers presented a study of nearly 100,000 Americans that found e-cigarette users are more likely to suffer heart attacks and strokes compared to non-users. In January, it reported on a big national study of 400,000 Americans that found e-cigarette users have a 70% higher risk of stroke and a 60% higher risk of heart attack, compared to non-users.

Kentucky Hospital Association asks federal appeals court to uphold state plan for work rules in Medicaid

The Kentucky Hospital Association has filed a formal statement with the Court of Appeals for the District of Columbia Circuit asking it to uphold the state's proposed work and other "community engagement" requirements in Medicaid, James Romoser reports for Inside Health Policy.

Romoser called the move "a rare example of the hospital industry endorsing work requirements as a condition for maintaining health coverage."

The hospital association filed the friend-of-the-court brief May 21, asking the court to uphold Kentucky’s request for a waiver of the traditional Medicaid rules to require, among other things, most of the "able-bodied" individuals who gained coverage through the expansion of Medicaid to people who earn up to 138% of the federal poverty line to work or participate in community engagement 80 hours a month.

The new Medicaid program is called Kentucky HEALTH, for Helping to Engage and Achieve Long Term Health. It would be an experiment under a waiver of Section 1115 of the Social Security Act.

In March, District Judge James Boasberg ruled against the waiver, as well as a similar one for Arkansas, after concluding that the Centers for Medicare and Medicaid Services failed to show how work requirements would serve the objectives of the 1965 Medicaid Act.

This was the second time Boasberg had vacated the federally approved plan and sent it back to the Department of Health and Human Services for further review.

An appeal by CMS, joined by Kentucky and Arkansas, is before the D.C. Circuit. A brief has been filed, arguing that Kentucky HEALTH should be upheld because the new rules would be no different than what is already required of people who receive federally funded food assistance.

KHA's friend-of-the-court brief supports Kentucky’s effort to test whether work requirements will improve the overall health of Medicaid beneficiaries, Romoser reports.

The brief says, “In essence, Kentucky’s waiver proposal tests a limited population of Medicaid beneficiaries on the theory that linking Medicaid benefits to community engagement, similar to work-sponsored commercial insurance, may encourage beneficiaries to maintain, and use, health-care coverage even while healthy, because wellness health care tends to decrease prevalence of illness and its associated higher costs.”

The brief adds, “Will Kentucky HEALTH prove its theory true? If that could be known, there would be little need to implement it as an experimental demonstration project. But the theory is rational and has a reasonable corollary to health-care delivery.”

"The association further argues that the waiver is necessary to ensure the fiscal sustainability of Kentucky’s Medicaid program," Romoser reports. This argument was also made in the Trump and Bevin administration's brief; Boasberg firmly rejected it, noting that it is based on Gov. Matt Bevin's threat to end expansion of Medicaid to more than 400,000 Kentuckians if courts thwart his plan.

Romoser says KHA's intervention is "unusual because the hospital industry has mostly tried to stay out of the debate over Medicaid work requirements." He notes that the American Hospital Association has also not taken a stance, calling it a state issue, and that KHA did not intervene in the lower court.

Kentucky projected in its initial waiver application that its Medicaid rolls would have 95,000 fewer people in five years under Bevin's plan than without it, in large measure because of noncompliance.

Romoser says that could hurt hospitals by increasing the number of uninsured patients, but terminating the Medicaid expansion is "a scenario that would be even worse for hospitals."

KHA has long supported Kentucky HEALTH, often stating that it supports the plan as a means to protect Medicaid expansion.

Sunday, May 26, 2019

Doctors worry FDA can't ensure quality of foreign generics; 80% of active ingredients in U.S. drugs come from India or China

Adobe illustration adapted by The Boston Globe
Some U.S. doctors worry that the federal government is not doing a good job of policing generic prescription drugs -- which account for 90 percent of the prescription drugs Americans use, are overwhelmingly made in India or China, and are sometimes not effective, Katherine Eban reports for The Boston Globe, in a story headlined "These pills could kill you."

"The majority of generics bought in the U.S. are made overseas," writes Eban, author of Bottle of Lies: The Inside Story of the Generic Drug Boom. "Roughly 40 percent are manufactured in India; 80 percent of the active ingredients in all of our drugs, whether brand-name or generic, are made in India and China."

Doctors at the Cleveland Clinic are among those who have confirmed problems with Indian-made generics and complained to the Food and Drug Administration, which inspects more drug manufacturing plants in other countries than it does in the U.S.

The FDA says it has a reliable review system for generics, "but American physicians — particularly those who prescribe drugs that require precise dosing — are questioning the FDA’s ability to police overseas manufacturing," Eban reports. "Do the generic drugs that the agency approves actually meet the FDA’s standards, since the agency’s own investigators have discovered staggering fraud in a number of overseas drug plants?"

Eban's story includes examples of American patients put at risk by ineffective generics. She writes that while the FDA "has struggled to police a global drug supply, U.S. patients have faced a perfect storm of consequences. The ever-climbing prices of brand-name drugs have led to our reliance on the lowest-cost manufacturers overseas. Recently, dozens of versions of the generic blood pressure medicines — valsartan and losartan — have been recalled, due to ingredients manufactured in China that contained a carcinogen that had gone undetected for years. The U.S. makes almost none of its own antibiotics anymore."

Eban opines, "Solving these problems requires a multi-pronged solution to reduce brand-name drug prices, overhaul the FDA’s foreign inspection program, and revamp a system in which regulators rely on company-submitted data to verify drug quality. But along with these efforts must come a rethink of who makes our drugs where. Shouldn’t some percentage of our essential drugs be made on U.S. soil?"

Saturday, May 25, 2019

Most women with heart disease don't get enough exercise; heart disease is the No. 1 killer of women in U.S., and 5% in Ky. have it

More than half of women in the United states with heart disease aren't getting enough physical activity, and that number has increased over the past decade, a study says. In Kentucky, 4.9% of women reported they had been told by a health care provider that they had heart disease, compared to 3.2% of women nationwide, according to America's Health Rankings.

WebMD photo
“Physical activity is a known, cost-effective prevention strategy for women with and without cardiovascular disease, and our study shows worsening health and financial trends over time among women with cardiovascular disease who don’t get enough physical activity,” Dr. Victor Okunrintemi, the lead researcher, said in a news release. “We have more reason than ever to encourage women with cardiovascular disease to move more.”

Okunrintemi is a former Johns Hopkins Medicine research fellow who is now an internal medicine resident at East Carolina University. His study, published online in JAMA Network Open, used data from a national survey representing more than 18 million U.S. women with established heart disease. The researchers compared data from 2006-2007 against data collected in 2014-15.

The study found that in 2006, 58% of women with heart disease said they were not meeting the American Heart Association physical activity guidelines. By 2015, the number was 61%.

AHA recommends 150 minutes of moderate to vigorous physical activity per week, or about 30 minutes a day, five days a week.

The researchers also found that women between the ages of 40 and 64 were the fastest-growing age group not getting enough exercise, with 60% of them not getting enough exercise in 2014-15; that was a significant increase from the 53 percent reported in 2006-07.

They also found trends related to race and socioeconomic factors, with African American, Hispanic, and women with low-income levels and low education more likely to not get enough exercise.

It also found that the health care costs of women with heart disease who met the AHA physical activity guidelines were about 30% less, compared to those who did not meet the guidelines.

Costs for women in the study who did not exercise enough was $12,724 in 2006-07 and $14,820 in 2014-15. Women in the study who exercised the recommended amount spent $8,811 in 2006-07 and $10,504 in 2014-15.

Heart disease is the leading cause of death in American women, claiming over 400,000 lives each year, or one death every 80 seconds. It kills about the same number of women as all forms of cancer, chronic lower respiratory disease and diabetes combine, according to AHA.

Women with heart disease should talk to their provider about how to increase their physical activity, as a proven way to improve their health and to decrease their healthcare costs, the researchers say.

Ky. ranks in top 10 for adverse childhood experiences; $200,000 grant will address child trauma in Lake Cumberland area

The Louisville-based Bounce Coalition has been awarded $200,000 to work with Russell County Schools and the Lake Cumberland District Health Department to help children who deal with violence, addiction and other trauma.

The Foundation for a Healthy Kentucky grant will be used to create a rural program in Russell County and nine surrounding counties to address adverse childhood experiences, or ACES, which the federal Centers for Disease Control and Prevention defines as a term used to describe all types of abuse, neglect and other potentially traumatic experiences that occur to people under the age of 18.

The Bounce Coalition was launched in 2014 with another grant from the foundation to focus on ACES in Jefferson County Public Schools.

"The Bounce program helps build children's resilience to toxic stressors, which can lead to chronic illnesses as they grow into adulthood and keep them from thriving throughout their lives," Ben Chandler, president and CEO of the foundation, said in a news release. "Our initial work with Bounce in an urban setting showed highly promising results, and now we're going to pilot the program in a rural setting. Our goal is to create a blueprint for addressing ACEs in school settings across the commonwealth."

According to America's Health Rankings, Kentucky is in the top 10 states for ACEs, with 27% of its children having experienced two or more stressful or traumatic events on a list of 10. Kentucky Health Commissioner Jeff Howard said the national average is less than 22 %.

"This means our children are starting their lives at a disadvantage compared to kids in other states, which is why this program focusing on ACEs and childhood trauma is vital," Howard said in the release. "In order to have a better and brighter future, it is imperative that we address ACEs."

Bounce Coalition Leader Joe Bargione added that the good news is that trauma doesn't have to define these children's lives. According to the news release, research shows that children with resilience skill sets are three times more likely to be engaged in school than their peers who have no skills or whose skills are underdeveloped.

"There is a growing body of knowledge that helps individuals and organizations recognize and respond to trauma, building protective factors and shifting the perspective from 'What is wrong with this child?' to 'What happened to this child?'"he said in the release.

The Bounce program in Russell County will include professional development for teachers, staff and bus drivers, in-class observation and role-modeling, classroom discussions, peer support groups for students, and education for parents, caregivers and the entire community.

In the second year of the program, Bounce will work with the health department to deploy "train-the-trainer" programs to create a system of self-sufficiency for the community. The program will begin in August.

"This is such an exciting opportunity for Russell County Schools' staff and students," Supt. Michael Ford said in the release. "We know that when our students' emotional needs are met, they are better able to participate in the learning that is taking place in their classrooms."

Health cabinet says it will revise proposed rule that would have banned tattooing over scars, due to 'unintended consequences'

WFPL photo
After almost two weeks of mystery, speculation and complaints, the state Cabinet for Health and Family Services has explained in a news release why it wants to ban tattoos over scars, saying it wants to address "potential health issues of tattooing over unhealthy skin."

"The concerns are being heard," said the cabinet, which had declined to say why it had proposed the regulation. It offered a reason: "to address potential health issues of tattooing over unhealthy skin, including recent or healing scar tissue. Because of such potential risks, some states currently restrict tattooing of skin that has a rash, evidence of an infection, open lesions, or recent scar tissue."

The proposed regulation simply reads, "Tattooing of scarred skin is prohibited." That prompted complaints that it was written too broadly.

David Levine, a researcher and doctor at the Morehouse School of Medicine in Atlanta, told Lisa Gillespie of Louisville's WFPL that he knew of no research that would warrant such a ban. “It probably should have been more specific to the reason that the skin was scarred in the first place,” he said. “There are people that are using cosmetic tattooing to actually reduce the appearance of scars.” Those include mastectomy patients.

Health Commissioner Jeffrey Howard said in the news release, "The specific language in the proposed regulation had some unintended consequences and will be addressed. We believe the final regulation will be improved by the comments we have received." The release said that would happen after the public comment period ends May 31.

Comments can be emailed to: A public hearing on the regulation is scheduled for May 28 in Frankfort.

Mike Martin, president of the Alliance of Professional Tattooists, told Gillespie that the industry already has rules in place about tattooing over scars, and there is typically no problem as long as the scar isn't fresh.

Friday, May 24, 2019

Kentucky dropped one spot in latest America's Health Rankings Report for seniors, to 49th; ranked last in health outcomes

By Melissa Patrick
Kentucky Health News

A new report shows that Kentucky continues to be one of the worst states in which to grow old, which isn't great news for the one in six Kentuckians who are already over the age of 65 and the growing number of Baby Boomers who will soon fall into that category.

Kentucky ranks 49th for seniors' health in the most recent America's Health Rankings Report, down one slot from last year. Mississippi is the only state ranked worse. Kentucky has been in the bottom 10 states for senior health since 2013, the first year AHR did the report.

The report looked at 34 measures of senior health that are known to influence health, which were then broken into five categories.

Kentucky ranked in the bottom 10 states in four of the five main categories, 49th for behaviors; 47th for community and environment; 44th for clinical care; and 50th for health outcomes.

Its highest ranking was for senior health policies, 32nd. This ranking was largely driven by positive scores in two categories, one that shows Kentucky has a low percentage of seniors living in nursing homes who require a low level of care, 7.4%; and another that shows the state has a high percentage of seniors with prescription drug coverage, 87%.

Other good news is that only 5.5% of Kentucky seniors are heavy drinkers, though it was 4% three years ago. The state also has a high percentage of seniors who are managing their diabetes, 81.6%.

This year, the report also looked at how many seniors had avoided care due to cost. It found that in Kentucky, 7% of seniors said there was a time in the past year when they needed to see a doctor, but could not because of cost. Nationally, that rate was 5.2%.

It also took a national look at young seniors, between the ages of 65 and 74, and found that compared with 15 years ago, smoking rates are 16% lower, early deaths are 22% lower and those reporting they are in better health is 11% higher. However, the report also found excessive drinking in this age-group is 42% higher, obesity is 36% higher, diabetes is 36% higher and suicide rates are 16% higher.

Ongoing challenges in Kentucky

The report says its purpose is to promote data-driven discussions that can drive positive changes and improve the health of seniors -- and most of Kentucky's data shows a lot of room for improvement.

Kentucky seniors rank No. 2 in smoking, at 12.5%. The report notes that it's never too late to stop smoking, and that even in older adults it has been shown to improve health outcomes.

Kentucky also ranks in the bottom five states for several other measures.

It ranks 47th for physical inactivity, with 36% of the state's seniors reporting they were inactive. Overall, the report found that females are 1.2 times more likely than males to be inactive.

It also ranks 47th for community support expenditures, which are used for funding personal care, meals, transportation and nutrition-education programs for seniors, at $225 dollars per adult aged 60 and older in poverty, compared with the average of $571 dollars for all states.

Kentucky ranked 46th for home-delivered meals to seniors, delivering meals to only 4.9% of its seniors aged 60 and older who have difficulty living independently. The national average for this measure is 8.9%, and the top ranked state for this measure, New Hampshire, delivers meals to 37.5% of seniors in need.

Kentucky ranks as the worst state for its high number of preventable hospitalizations, at 76.6 discharges per 1,000 Medicare enrollees. The national average for this measure is 49.4.

They are also more likely to die early. The report found 2,369 deaths per 100,000 adults aged 65 to 74 in Kentucky, compared to 1,791 nationwide.

Kentucky seniors also suffer from more mental distress than seniors in other states, 10%, compared to 7.9% nationwide.

The state's seniors also rank last among states for volunteerism by seniors, with only 18.9% volunteering, and nearly last, 48th, for the number of seniors reporting high health status, 31.7%. The national average for these measures are 28% and 41.3% respectively.

Chronic disease can lead to mental-health issues, especially among seniors in isolated rural areas like Casey County

"Rural America has some of the highest rates of chronic disease in the nation – the more remote a community, the more heart disease, cancer and diabetes. And there’s a side effect from having a chronic condition many people don’t think about – depression, anxiety and even suicide," Lisa Gillespie reports for Louisville's WFPL. "This is especially true for older adults, who’ve lived their entire lives in places with little access to places to exercise, with diets high in fat and sugar and in a culture that still hasn’t given up tobacco."

Dennis and Gay Pond (WFPL photo)
Gillespie's example is Dennis Pond, 67, of Casey County. "He often feels useless, in large part because his diabetes has caused terrible pain and numbness in his feet, and that affects his ability to drive, to help out around the house, to even go out in the yard," she reports, quoting him: “The pain gets so bad that I actually feel like cutting my feet off or just taking care of myself, if you know what I mean Ending it.” But he doesn't tell his psychiatrist about such thoughts: “When they ask me those questions, I got to try to watch what I’m saying because if I don’t I’ll end up in the psychiatric unit,” he said. “I try to say no, but I have thoughts.”

"His dark thoughts are in part an outgrowth of the toll chronic conditions have taken on him. Every day, he takes blood thinners for blood clots in his lungs, pain medication for his bad back, insulin for his diabetes," Gillespie reports. "Then there’s the nerve damage from his diabetes – what he describes as thousands of needles piercing the bottoms of his feet when he walks."

Pond lives 30 miles from the nearest town and hospital, Gillespie reports, adding, "Rural residents often have a hard time accessing medical care for their chronic conditions and psychiatric care for the attendant mental health issues. That contributes to the increased risk of suicide in rural areas, which are already at higher risk because of a lagging economy and substance abuse. For example, "suicide rates in 2017 were 30 percent higher in Appalachia than in the rest of the country." Within the region, suicides were concentrated in Eastern Kentucky, West Virginia and East Tennessee, areas that struggle with high opioid-addiction rates and poverty.

Gina Piane, a professor at National University in San Diego, was one of the first researchers to link chronic disease and mental health. Giving rural youth more health and nutrition education is a key way to prevent such issues, she told Gillespie.

Psychologist John Fulton, who works in Casey County, said he tries to teach his patients coping skills and recommends that they develop a support system of friends and family if they don't already have one. "I try to say, you know, you’re sitting there focusing on the bad things, and all that’s going to do is drag you down deeper,” Fulton told Gillespie. "[I] try to get them to, you know, turn around and start thinking about, 'Well, I’ll go outside and look at dogs or I’ll watch wrestling on TV' — get their mind off the illness and how bad they feel."

"Fulton also recommends people try to develop a strong support system if they don’t already have one. That’s something Pond does have in his wife, Gay. They married in 2013 after he did work on her house," Gillespie writes. "And there might be hope for Dennis’ pain and diabetes. He’s likely going to get surgery that could increase blood flow in his feet, helping avoid an amputation."

Thursday, May 23, 2019

Kentucky schools lack immunization certificates for thousands of children, worry about immuno-compromised students and staff

American Academy of Family Physicians photo
A Louisville Courier Journal analysis found that as of March, the Jefferson County Public Schools had no record of whether 4,300 students had received their shots for measles, mumps and rubella, despite a law that requires students to hand in those documents within two weeks of enrollment.

That's a story that can be told in school districts across the state.

According to the state Department of Education, in the 2017-18 school year, of the 99,113 first and sixth graders who were supposed to have immunization certificates, 7,738 of them had expired certificates, 5,993 were missing, 241 had medical exemptions and 695 had religious exemptions.

The KDE data is broken down by school and grade to show how many students have a current immunization certificate, including whether it is a provisional, standard, medical or religious certificate. The data are not broken down by type of vaccination, and current-year data aren't posted.

Jefferson County school officials told the Courier Journal that many students may have simply not turned in their immunization documents, but they worry about those who haven't been vaccinated.

"We're putting immuno-compromised children, children too young to get immunized — and pregnant teachers and pregnant moms at risk," Troi Cunningham, an immunization nurse with the state, told reporter Allison Ross about the low immunization rates in some areas.

Public health officials say about 95% of students need to be fully immunized in order to protect vulnerable kids and others who are immuno-suppressed from measles, which is highly contagious.

Jefferson County data shows that it's not just the measles, Ross reports; some schools are also missing immunization records for other diseases, like chickenpox and hepatitis A.

It's a challenge to know what to do when students don't turn in their immunization documentation, Dr. Ruth Carrico, an infectious-disease expert at the University of Louisville, told Ross.

"What do we do when a child is not vaccinated? Where do they go?"she asked. "If they get sent home, they miss out on education. If we don't send them home, they may not realize we really mean it that you need that vaccination."

Earlier this year, the Northern Kentucky Health Department barred students who had not been vaccinated against the chickenpox from attending school and all extracurricular activities at a private Catholic school because of an outbreak. One of the students sued the health department over the ban, but the courts ruled in the health department's favor.

Eva Stone, district health coordinator for JCPS, told Ross there are several obstacles to getting children immunized, including a lack of access to medical care; that very few health-care providers will give vaccines to children on Medicaid, which forces parents to take their children somewhere else, like the local health department; and that parents have told her that doctor's offices charge for copies of updated immunization records.

"This is a community issue," Stone said. "How do we make sure children have access to health care?"

Cunningham, the nurse with the health cabinet, told Ross that the state is trying to encourage pediatricians and other health-care providers to use the state's immunization registry to keep track of patients' vaccinations.

Bevin and Trump agencies argue work requirements in other public-assistance programs pave the way for likewise in Medicaid

The administrations of President Trump and Gov. Matt Bevin argue that Kentucky's proposed Medicaid program, which includes work and other "community engagement" requirements, should be upheld because the new rules would be no different than what is already required of people who receive federally funded food assistance, Darla Carter reports for Insider Louisville.

In briefs filed last week with the U.S. Court of Appeals for the District of Columbia, they maintain that Health and Human Services Secretary Alex Azar used proper judgment to approve the state’s new Medicaid plan, which called for a waiver of the traditional Medicaid rules to require some "able-bodied," non-elderly Medicaid recipients to work or participate in a list of approved community engagement activities 20 hours a week to get their health benefits.

The official name for the state's new Medicaid plan under the Section 1115 waiver is Kentucky HEALTH, for "Helping to Engage and Achieve Long Term Health." The administrations liken the work rules to those already in use by food-aid programs such as the Supplemental Nutrition Assistance Program, formerly food stamps, and Temporary Assistance for Needy Families (TANF), generally known as "welfare."

“There is no reason why a Section 1115 waiver cannot test a community-engagement program in Medicaid, given that SNAP and TANF already have work-oriented programs,” the state argues in its brief. “Surely Section 1115 allows the secretary to test whether long-standing work-oriented programs from other public-assistance programs will work in Medicaid."

Carter reports in detail about the brief, which is part of an appeal from the March decision by District Judge James Boasberg that stopped similar plans proposed by Kentucky and Arkansas. This was the second time that Boasberg had vacated the federally approved plan and sent it back to the Department of Health and Human Services for further review. He said both times that HHS had not sufficiently considered the state's projection that its Medicaid rolls would have 95,000 fewer people in five years with the rules than without them, in large measure for failing to follow the rules.

The state takes issue with Boasberg's criticism that Azar failed to estimate the number of Medicaid recipients who would shift to other coverage because of Kentucky HEALTH, saying Azar is not required to know results in advance because that would defeat the purpose of the demonstration.

The new filing argues that Boasberg "was influenced by portrayals of the food-aid work requirements being counterproductive to low-income people, making him skeptical that a demonstration project like Kentucky HEALTH could lead to employment," but Congress disagrees, Carter reports.

The Kentucky Center for Economic Policy and Kentucky Voices for Health have reported that since last year, about 21,400 people have lost their SNAP benefits because of a work requirement in Kentucky.

Samuel Brooke, a deputy legal director at the Southern Poverty Law Center, which represented the 16 Kentucky Medicaid recipients who filed suit against Bevin's plan, said May 22: “When the waiver briefly went into effect in Arkansas, everyone saw the devastating effect it could have – thousands lost coverage in a matter of months. We are confident the appeals courts will similarly agree with the district court that the Medicaid program is designed to provide access to health care, and efforts to undercut that are contrary to Congress’s intent.”

In addition to arguing that Azar was within the scope of what is allowed and that his rationale was "careful and well-reasoned," the state says he was right in concluding that Kentucky HEALTH is likely to help sustain the state’s Medicaid program. Bevin issued an executive order last year that ends the expansion of Medicaid to people who earn up to 138% of the federal poverty line six months after any final court decision that blocks his plan.

Wednesday, May 22, 2019

Ky. has new tool to track the ongoing changes to its Medicaid program, including county-by-county enrollment numbers

Kentucky has a new website that shows an up-to-date timeline of all the changes in the state's Medicaid program since 2014; provides links to Medicaid resources such as contracts, court documents, state notices and research; and provides a place for people to share stories about how changes to the program have affected them or their loved ones. It also provides Kentucky-specific Medicaid data, including county-by-county enrollment.
Screenshot showing example of looking up county-by-county data on the Kentucky Medicaid Tracker
The Kentucky Medicaid Tracker is a combined project of the Kentucky Center for Economic Policy, the Kentucky Equal Justice Center and Kentucky Voices for Health.

Each of these nonprofit organizations are part of InsureKY, which describes itself as a statewide coalition of nonprofits formed to promote more affordable insurance, better care and stronger consumer protections for all Kentuckians. They support the 2014 expansion of Medicaid.

Kentucky Medicaid has seen many changes since then-Gov. Steve Beshear announced in 2013 that the state would  expand Medicaid to Kentuckians with household income up to 138% of the federal poverty line, under the 2010 Patient Protection and Affordable Care Act. Prior to the expansion, the program was limited mainly to very poor pregnant women and children, disabled people and low-income elderly in nursing homes.

Since its implementation in 2014, about half a million Kentuckians have been added to the Medicaid rolls, most of them working.

Under Republican Gov. Matt Bevin, the state asked for a waiver of federal Medicaid rules to make changes that included, among other things, work and other "community engagement" requirements for most of the "able-bodied" individuals who gained coverage through the expansion. InsureKy has strongly opposed these changes, mainly on grounds that they would create barriers to care.

The latest entry on the timeline notes that a federal judge once again blocked Bevin's proposed changes. His administration and that of President Donald Trump have appealed the ruling. The judge struck down a similar program in Arkansas at the same hearing.

Monday, May 20, 2019

McConnell files bill to raise legal age to buy tobacco products to 21, with some provisions Kentucky health advocates wanted

By Melissa Patrick and Al Cross
Kentucky Health News

Senate Majority Leader Mitch McConnell today introduced his promised bill to raise to 21 from 18 the legal age to buy tobacco products in the United States, in response to what he called a public-health epidemic of electronic-cigarette use by teenagers.

Senate Majority Leader Mitch McConnell talks tobacco.
"Youth vaping is a public health crisis," McConnell said during a floor speech to introduce the bill. "It's our responsibility as parents and public servants to do everything we can to keep these harmful products out of high schools and out of youth culture. We need to put the national age of purchase at 21."

Most adults who smoke start before they turn 21, so increasing the tobacco age to 21 will keep youth from starting, save lives and improve public health, says the Institute of Medicine. McConnell said he would make enacting the bill one of his highest priorities.

McConnell's co-sponsor is Sen. Tim Kaine, D-Va. "As senators from two states with a long history of tobacco production and consumption, [they] have seen this phenomenon firsthand, and heard the compelling stories from concerned constituents throughout their states," said a short explanation of the bill and the reasons for it. The bill is called the Tobacco-Free Youth Act.

McConnell gave a detailed history of how tobacco helped shape the nation and Kentucky. He said the state had almost 30,000 tobacco farmers when he helped end the federal tobacco program in 2004, but now has only 2,600.

"For many in Kentucky, tobacco made the American dream possible," he said, but also talked about the negative impact tobacco has had on Kentuckians' health. The state leads the nation in cancer and the percentage of cancers tied directly to smoking. "Our state once grew tobacco like none other — and now we’re being hit by the health consequences of tobacco use like none other," he said. "We’re proud of our past, we’re proud of who we are, but Kentucky farmers don’t want their children to get hooked on tobacco products while they’re in middle school or high school anymore than any parent anywhere wants that to happen. . . . The health of our children, literally, is at stake.”

According to the Kentucky Incentives for Prevention survey, teen use of electronic cigarettes in Kentucky nearly doubled from 2016 to 2018. The survey found that 26.7% of the state's high-school seniors reported using e-cigarettes in the 30 days before they were surveyed in 2018, up from 12.2% in 2016. Among 10th graders, it increased to 23.2% from 11.3%; eighth graders jumped to 14.2% from 7.3%; and sixth-grader use increased to 4.2% from 2.3%.

McConnell pointed to a nationwide survey that found the use of tobacco products increased by nearly 40% between 2017 and 2018, driven almost entirely by vaping. "The brain is still developing at this young age. When teenagers use tobacco, they're quite literally altering their brain chemistry and making it more susceptible to addiction," he said.

Enforcement is up to the states

Federal law does not establish a penalty for violating the current age limit of 18, but leaves enforcement up to the states and makes certain federal grants dependent upon enforcement.The McConnell-Kaine bill would leave that system in place. Laws in Kentucky and many other states have penalties for under-age youth who buy, possess or use tobacco products.

Advocates will have to work with state legislators to remove those laws, said Bonnie Hackbarth, vice president for communications at the Foundation for a Healthy Kentucky, which has endorsed McConnell's bill.

"Our interest was to make sure that there was nothing in the federal bill to impose penalties on the actual purchaser, but to rather put those penalties on the retailers where they should be and that is the way the bill is written," Hackbarth said. "That would be our goal, that the penalties would be on retailers and not the purchasers."

Foundation President and CEO Ben Chandler said in a news release, “Since Sen. McConnell stood in our offices just last month and announced plans to file this bill, new data has come out showing that youth e-cigarette use in Kentucky doubled over the past two years. We’re gratified that the provisions we sought to help reduce this explosion in youth vaping and other tobacco use have been included in the bill: It covers all tobacco products, including e-cigarettes as well as heated products; it prohibits sales to everyone under age 21, with no military exemption; it puts responsibility for compliance where it should be – on retailers, and it preserves the right of states to enact stricter laws.”

Chandler added, “We urge Congress to pass this bipartisan bill quickly and states to begin getting their own T21 bills in order. Every extra day it takes to put this important legislation into effect is an opportunity for thousands more kids to access a tobacco product that can damage their developing brains now and cause debilitating health issues throughout their lives.”

The bill has already received the support of several organizations, but others are being more cautious before they give it their approval.

"Increasing the minimum sale age for all tobacco products to 21 offers a common-sense way to keep harmful tobacco products out of reach of our kids and prevent life-long addictions to nicotine," Dr. Terry Brooks, executive director of Kentucky Youth Advocates, said in a release. "We urge Congress to support this bipartisan bill and for our leaders in Frankfort to begin work aligning state law to protect more youth from the lasting harms of tobacco use."

Some advocates want more

The American Lung Association also supports the bill, though it calls for more action, including a ban on flavored tobacco products, restricting online sales of the products and increasing funding for the Centers for Disease Control and Prevention's Office on Smoking and Health.

The Campaign for Tobacco-Free Kids said it was still evaluating the bill to make sure it is strong enough, including strong enforcement penalties on retailers, no exemptions and no "special interest provisions that block other policies needed to protect kids and public health, such as prohibitions on flavored tobacco products."

With the support of McConnell and Kaine, the bill is expected to have little trouble in the Senate, but its House prospects "are unclear," The Wall Street Journal reports. "House Democratic aides said they are still reviewing it, though they pointed to more expansive legislation introduced in the House that would also restrict flavored e-cigarettes and regulate marketing to young people, among other measures, in addition to raising the age for purchasing tobacco. Legislation that takes similar measures—but doesn’t raise the purchasing age—has received bipartisan support in the Senate."

McConnell's bill addresses some of the advocates' concerns. It does not exempt people in the military, as he originally said it would, and it would allow states to pass stronger tobacco laws.

McConnell told Deborah Yetter of the Louisville Courier Journal that he was aware of health advocates' concerns that tobacco companies support the legislation only because it could shield them from more aggressive enforcement and a possible ban on flavorings.

"Just the fact that they're for it doesn't mean it's a bad idea," he said. "This is just a floor, not a ceiling. I don't think it relieves them of any of the battles they're going to have to fight at the state and local levels in the future."

A bill to raise the legal age to buy tobacco products in Kentucky failed in the last session of the legislature, after opponents said it would hurt the tobacco industry. The bill, and similar legislation passed in Virginia and 13 other states, is backed by Virginia-based Altria Group, the nation's largest cigarette maker. Altria recently bought 35% of Juul Labs, maker of the most popular e-cigarette.

Friday, May 17, 2019

Study suggests kids with hypertension more likely to have heart disease as adults; Ky. teens 3rd in U.S. in top risk factor, obesity photo
By Melissa Patrick
Kentucky Health News

Just like adults, children can have high blood pressure. The only way to know is to check for it, and it's important because children with hypertension are more likely to grow up to be adults with heart disease -- the number one killer of adults in Kentucky. And in the biggest risk factor for heart disease, obesity, Kentucky high-school students are the third most likely in the U.S. to be obese.

"Children don't have a lot of symptoms with high blood pressure, so we don't know they have it until we check," said Dr. Donna Grigsby, chief of general pediatrics at UK HealthCare. " If they don't get it under control when they are young it's likely to persist into adulthood. . . . There are a lot of long-lasting consequences to living with high blood pressure that is not well-managed."

Untreated hypertension in adults can lead to heart disease, heart failure, vision loss, stroke and kidney disease.

Grigsby noted that the American Academy of Pediatrics issued new blood-pressure guidelines for children in 2017, and that diagnosing hypertension in children is a little trickier than diagnosing it in adults because it varies by a child's age, height and gender. She stressed that health-care providers have to do more than just take a child's blood pressure; they also have to interpret it.

A recent study in the American Heart Association journal Hypertension suggests kids with hypertension are at a higher risk of heart disease as adults.

Using data from nearly 4,000 children who were followed for 36 years, the study found that the newer guidelines classified 11% of children as having hypertension; the old guidelines classified 7%.

It also found that 19% of the children with high blood pressure according to the new guidelines had an enlarged heart (left ventricular hypertrophy, or LVH) as adults. Under the old guidelines, it was only 12%.

Sperling's Best Places map
A possible pitfall in the study was that all of the children in this study come from one community: Bogalusa, Louisiana, just across the Pearl River from Mississippi, a town of 12,000 with a 57% white and 41% population. Also, the study used no information about actual heart attacks and stroke.

Overall, the study found that 8% of the children who were reclassified to having high blood pressure under the new guidelines were more likely than those without hypertension to develop heart disease as adults; and the children who were reclassified to the lower blood-pressure categories with the new guidelines had similar results as those who had never been diagnosed with hypertension.

"Children who were reclassified to higher blood pressure categories based on 2017 guidelines were at increased risk of hypertension, metabolic syndrome and LVH in later life," the report says.

Metabolic syndrome is a group of risk factors that raises a person's risk for heart disease, stroke and diabetes. They include high blood pressure, excess fat around the waist, high blood-sugar levels, high triglyceride levels and low levels of good cholesterol, or HDL. Having any three of these risk factors produces a diagnosis of metabolic syndrome.

Grigsby said all children should start having their blood pressure checked at age 3, and children who are considered at higher risk of developing high blood pressure should have it done sooner, including those who were born prematurely or who have kidney or heart disease.

The Centers for Disease Control and Prevention reports that an estimated 1.3 million youth between the ages of 12 and 19 have hypertension under the new guidelines, which is about 4% of the population. For example, the CDC says that in a classroom of 30, one would have high blood pressure and about three more would have "elevated blood pressure," once called "prehypertension."

Kentucky-specific data were not available, but the primary risk factor for high blood pressure in children is obesity, and that's a real problem in Kentucky. According to the State of Obesity report, one in five, or 20.2%, of the state's high-school students are obese, the third highest in the country.

"The children that we worry about are the children who are overweight and obese because we know that is a big risk factor for having high blood pressure," Grigsby said.

She said high blood pressure in children is primarily treated with lifestyle changes, like decreasing screen time, increasing activity, and improving diets -- and these changes are most successful when the whole family makes them.

"Instead of diet and weight loss, we talk a lot about healthy lifestyles because this is a change that they are going to have to be able to sustain," she said.

The Kentucky Department for Public Health suggests the 5-2-1-0 prescription to significantly reduce childhood obesity, which says to eat five or more servings of fruits and vegetables each day; limit screen time to no more than two hours a day; be physically active for at least one hour a day; and drink zero sweetened beverages. The website offers free resources to help meet these goals.

Most Ky. hospitals got an average patient safety score, one failed; low scoring hospitals have increased risk of "avoidable death"

By Melissa Patrick
Kentucky Health News

For the second grading period in a row, a nonprofit group that rates hospitals has given Cs to most of the 52 Kentucky hospitals it rated; and for the first time since 2015, one hospital got an F, along with only nine other hospitals nationwide. In the percentage of hospitals with A grades, Kentucky continues to rank 33rd among the states.

The Leapfrog Group, a nonprofit group based in Washington, D.C., rated more than 2,600 hospitals. Most of Kentucky's 129 hospitals were not rated, since rural hospitals with "critical access" status don't have to report quality measures to the federal government.

Leapfrog gave As to 11 Kentucky hospitals, or nearly 21% of those graded, lower than the national average of 32%. It gave Bs to 10, Cs to 25 , Ds to 5 and an F to 1. With the exception of the one failing grade, these numbers are similar to the fall report.

Methodist Hospital of Henderson was one of only nine hospitals nationwide that got a failing grade, putting it in the bottom 1% of hospitals scored. Leapfrog shows that the hospital's score has dropped steadily since the spring of 2016 when it got an A; that was followed by two Bs, two Cs, a D and an F.

The twice-yearly grades are calculated using 28 performance measures of patient safety that indicate how well hospitals protect patients from preventable medical errors, accidents, infections and injuries. The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey, and other supplemental data sources. Hospitals are only graded if they have submitted adequate data for evaluation.
The Leapfrog Group Hospital Safety Grade website is easy to use and offers
information on 52 Kentucky hospitals.
The Leapfrog site offers details on each of the measures under headings titled infections, problems with surgery, practices to prevent errors, safety problems, doctors, nurses & hospital staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing.

For example, Methodist Hospital of Henderson scored below average on 16 of the measures, average on one measure, and above average on nine; and two measures weren't evaluated.

Only two other Kentucky hospitals have ever received a failing grade from Leapfrog: Saint Joseph East in Lexington in fall 2015 and Taylor Regional Hospital in Campbellsville in the spring 2013.

According to the Leapfrog researchers, hospitals with grades lower than an A can put patients at an increased risk of "avoidable death." The news release says patients at D and F hospitals face a 92% greater risk of avoidable death; patients at C hospitals on average face an 88% greater risk of avoidable death; and patients at B hospitals on average face a 35% greater risk of avoidable death.

Leapfrog estimates that 160,000 lives are lost every year from avoidable medical errors that are accounted for in its grading process. It says that's a significant improvement from 2016, when it estimated the number to be around 205,000.

“The good news is that tens of thousands of lives have been saved because of progress on patient safety,” Leah Binder, president and CEO of the Leapfrog Group, said in the release. “The bad news is that there’s still a lot of needless death and harm in American hospitals.”

High scorers

St. Elizabeth Healthcare-Edgewood has received As on every Leapfrog report card since spring 2014, the first year it was graded.

Other hospitals on the A list are: St. Elizabeth hospitals in Florence and Fort Thomas; Baptist Health Lexington; Clark Regional Medical Center in Winchester; Georgetown Community Hospital; Harrison Memorial Hospital in Cynthiana; Norton Audubon Hospital, Norton Brownsboro Hospital and Norton Women's & Children Hospital, all in Louisville; and Whitesburg ARH Hospital.

Norton Brownsboro and Norton Women's & Children hospitals were the the only two on this list to change their status since the last grading period, both moving up from a B.

Low scorers

The five hospitals that got Ds are: Taylor Regional Hospital, Hazard ARH Regional Medical Center; Highlands Regional Medical Center in Prestonsburg; Jewish Hospital in Louisville; and the University of Louisville Hospital.

This was the first D assigned to the Hazard hospital, which since the spring of 2016 had received Bs and Cs. Taylor also moved from a C to a D.

Jewish and the U of L hospital have received Ds since the spring 2016.

U of L Hospital, which separated from KentuckyOne Health on July 1, 2018; KentuckyOne Health, which owns Jewish and Sts. Mary & Elizabeth Hospital; and Baptist Health, on behalf of several of its hospitals across the state, sent statements to Darla Carter of Insider Louisville saying they took issue with the grades, namely because they are based on older data.

“We have reviewed our (publicly) reported data since July 2017, and utilizing the Leapfrog Group’s own calculator for scoring with that data, our calculated grade would have been a C,” Dr. Jason Smith, chief medical officer of U of L Hospital, told Insider Louisville. “This improvement is in line with what we anticipated our ranking would be at this point when we re-assumed oversight of our hospital in July 2017.”

Shifts up and down

TriStar Greenview Regional Hospital in Bowling Green dropped to a grade of B, after receiving five As in a row.

Others on the B list include: Baptist Health Paducah, which maintained its B from the last grading period after getting four Cs in a row; Frankfort Regional Medical Center, which maintained its B from the last period after receiving five As in a row; and Mercy Health Lourdes in Paducah, which maintained its B from last time after getting two Ds and three Cs. The two University of Kentucky hospitals got Cs for the second straight grading period, after getting four Bs in a row.

Three hospitals on the C list dropped from a B in the last grading period: Jackson Purchase Medical Center in Mayfield, Harlan ARH Hospital and T. J. Samson Community Hospital in Glasgow. Saints Mary & Elizabeth Hospital in Louisville got its second C in a row, after having received a D grades since spring 2016.

The Leapfrog Group says its analysis was developed under the guidance of the nation's leading patient-safety experts and is peer-reviewed. Click here to see all of Kentucky hospital's Leapfrog hospital safety grades. Click here for Leapfrog recommendations on how to use the grades.