Tuesday, January 31, 2023

It's SAD, but: Seasonal affective disorder, associated with winter darkness, is common and has a wide range of treatments

As much as three percent of the U.S. population is thought to experience seasonal affective disorder, a type of depression associated with winter darkness and northern latitudes. But about 10 percent of patients suffering from SAD have symptoms in the summertime instead, Sarah Gibbens reports for National Geographic.

The symptoms are the same as clinical depression, Kelly Rohan, a psychologist at the University of Vermont who specializes in the disorder, told Gibbens: “We would look for things like a persistently sad mood. Losing interest in things. Sleep changes. Significant eating or appetite change. Losing energy. Fatigue. Difficulty concentrating.”

At Yale University’s Winter Depression Research Clinic, "The most commonly reported symptoms of winter depression are hypersomnia—the desire to sleep more than usual—and an increased appetite, says Paul Desan, a psychiatrist and the clinic’s director," Gibbens reports, quoting him: “It’s like human beings are trying to hibernate.”
But not exactly: “About three times as many women as men get SAD for reasons we don’t understand,” Desan said.

Illustration by Very Well Health; to enlarge, click on it.
"Whether in winter or summer, mental health experts say there are solutions to treat SAD," Gibbens writes. "For those who think they may be experiencing SAD, experts say a professional diagnosis is a crucial first step toward treatment."

“People should really avoid self-diagnosis,” says Rohan. “Depression is a serious mental health problem, so it’s best to leave it to trained professionals.”

One of the most common treatments is sitting daily in front of a bright box of light for 30 minutes, usually first thing in the morning, Gibbens reports: "Experts say the key is to look for light boxes that provide light equalling 10,000 lux, a measure of brightness. . . . Desan's clinic’s website lists vetted boxes."

A treatment that may last longer is Cognitive Behavioral Therapy, a form of talk therapy that Rohan endorses: “Negative thinking tends to breed negative emotions, and we want to change those into slightly less negative, more neutral thoughts” “I hate winter,” might be reframed as, “Winter isn’t my favorite season, but I still find things to enjoy.”

Hobbies may also help, Rohan suggests: “People with SAD often have hobbies and interests that are summer specific—growing gardens, beach going,” Winter alternatives are knitting, joining a book club, or going to the gym.

Norman Rosenthal of Georgetown University, who first identified SAD in 1984, told Rohan that lifestyle changes can also be useful against it. "Exercising, learning ways to manage stress, or planning a sunny vacation during the winter can all help to boost your mood, he says. Whether using light or talk therapy, Rosenthal stresses that there’s no reason to not seek mental health treatment, even if symptoms are only present for a few months out of the year."

Dollar General gets into health care with three mobile clinics near southwestern Kentucky, says it will expand if successful

Cunningham, Tenn., is the site of one of three Dollar General mobile health-care clinics. (Google Maps)
Dollar General Corp., a Scottsville, Kentucky-born company that moved its headquarters to suburban Nashville but has become ubiquitous across the commonwealth, has expanded into health care.

The retailer has established two mobile clinics just south of Clarksville, Tenn, which sits on the Kentucky border at Fort Campbell, and one at Cumberland Furnace, Tenn., between Clarksville and Dickson.

The clinics are operated by DocGo, which says it operates in 26 states as a "last-mile" health-care provider. It "sends clinicians to locations to provide care that would typically require patients to visit a physical clinic," reports Advisory Board, a health-care consultancy. "If the pilot is successful, the company said it will likely expand the mobile clinics to additional locations."

The company has created a DG Wellbeing brand of health-care products. Its website says the mobile clinics will offer urgent care services, physical exams and routine checkups, vaccinations and immunizations, screening and lab testing, and care for chronic conditions, including hypertension and diabetes.

The clinics accept Medicaid, Medicare, and some private insurance. They bill at urgent-care rates. 

"Dollar General is not the first retailer to launch a 'retail health care' business," Advisory Board says. "However, some experts believe the company could be uniquely poised to expand access to care in rural, underserved communities. Dollar General's widespread presence in rural areas could serve as a competitive advantage."

The company estimates that 75 percent of the U.S. population lives within five miles of one of its stores, and "Many of its retail locations are in areas that are far from traditional healthcare options and other ;retail health care' companies," Advisory Board says.

"Still, as Dollar General continues expanding its health-care presence, some experts have noted that the retailer may face staffing issues like those that exist in the larger healthcare sector. Jeff Goldsmith, president of the consultancy Health Futures, told Advisory Board, "Anybody that wants to do something new is going to have to figure out how to staff up. . . . The fundamental question is, why work for them? What's the value proposition for the health-care worker?"

Feds let health insurers that overcharged for Medicare Advantage plans keep the hundreds of millions in excess profits from 2011-17

By Fred Schulte
Kaiser Health News

Health-insurance companies that sell Medicare Advantage to seniors dodged a major financial bullet Monday, as federal officials gave them a reprieve for returning hundreds of millions of dollars or more in government overpayments — some dating back a decade or more.

Health insurers had long feared the Centers for Medicare & Medicaid Services would demand repayment of billions of dollars in overcharges the popular plans received as far back as 2011.

Photo by Rafael Enrique/Sopa Images/Lightriocket via Getty Images
But in a surprise action, CMS announced it would require next to nothing from insurers for any excess payments they received from 2011 through 2017. CMS will not impose major penalties until audits for payment years 2018 and beyond are conducted, which have yet to be started.

While the decision could cost Medicare plans billions of dollars in the future, it will take years before any penalty comes due. And health plans will be allowed to pocket hundreds of millions of dollars in overcharges and possibly much more for audits before 2018. Exactly how much is not clear because audits as far back as 2011 have yet to be completed.

In late 2018, CMS officials said the agency would collect an estimated $650 million in overpayments from 90 Medicare Advantage audits conducted for 2011 through 2013, the most recent ones available. Some analysts calculated overpayments to plans of at least twice that much for the three-year period. CMS is now conducting audits for 2014 and 2015.

The estimate for the 2011-13 audits was based on an extrapolation of overpayments found in a sampling of patients at each health plan. In these reviews, auditors examine medical records to confirm whether patients had the diseases for which the government reimbursed health plans to treat.

Through the years, those audits — and others conducted by government watchdogs — have found that health plans often cannot document that they deserved extra payments for patients they said were sicker than average.

The decision to take earlier audit findings off the table means that CMS has spent tens of millions of dollars conducting audits as far back as 2011 — much more than the government will be able to recoup.

In 2018, CMS said it pays $54 million annually to conduct 30 of the audits. Without extrapolation for years 2011-17, CMS won’t come near to recouping that much.

CMS Deputy Administrator Dara Corrigan called the final rule a “commonsense approach to oversight.” Corrigan said she did not know how much money would go uncollected from years prior to 2018.

Health and Human Services Secretary Xavier Becerra said the rule takes “long overdue steps to move in the direction of accountability.”

“Going forward, this is good news. We should all be happy that they are doing that [extrapolation],” said former CMS official Ted Doolittle. But he added: “I do wish they were pushing back further [and extrapolating earlier years]. That would seem to be fair game,” he said.

David Lipschutz, an attorney with the Center for Medicare Advocacy, said he was still evaluating the rule, but noted: “It is our hope that CMS would use everything within their discretion to recoup overpayments made to Medicare Advantage plans.” He said that “it is unclear if they are using all of their authority.”

Mark Miller, who is the executive vice president of health care policy for Arnold Ventures and formerly worked at the Medicare Payment Advisory Commission, a congressional advisory board, said extrapolating errors found in medical coding have always been a part of government auditing. “It strikes me as ridiculous to run a sample and find an error rate and then only collect the sample error rate as opposed to what it presents to the entire population or pool of claims,” he said. (Kaiser Health News receives funding support from Arnold Ventures.)

Last week, KHN released details of the 90 audits from 2011-2013, which were obtained through a Freedom of Information Act lawsuit. The audits found about $12 million in net overpayments for the care of 18,090 patients sampled for the three-year period.

In all, 71 of the 90 audits uncovered net overpayments, which topped $1,000 per patient on average in 23 audits. CMS paid the remaining plans too little on average, anywhere from $8 to $773 per patient, the records showed.

Since 2010, CMS has threatened to crack down on billing abuses in the popular health plans, which now cover more than 30 million Americans. Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies including Humana, UnitedHealthcare, Centene, and CVS/Aetna.

But the industry has succeeded in opposing extrapolation of overpayments, even though the audit tool is widely used to recover overcharges in other parts of the Medicare program.

That has happened despite dozens of audits, investigations, and whistleblower lawsuits alleging that Medicare Advantage overcharges cost taxpayers billions of dollars a year.

Corrigan said Monday that CMS expected to collect $479 million from overpayments in 2018, the first year of extrapolation. Over the next decade, it could recoup $4.7 billion, she said.

Medicare Advantage plans also face potentially hundreds of millions of dollars in clawbacks from a set of unrelated audits conducted by the Health and Human Services inspector general.

The audits include an April 2021 review alleging that a Humana Medicare Advantage plan in Florida had overcharged the government by nearly $200 million in 2015.

Carolyn Kapustij, the Office of the Inspector General’s senior adviser for managed care, said the agency has conducted 17 such audits that found widespread payment errors — on average 69% for some medical diagnoses. In these cases, the health plans “did not have the necessary support [for these conditions] in the medical records, which has caused overpayments.”

“Although the MA organizations usually disagreed with us, they almost always had little disagreement with our finding that their diagnoses were not supported,” she said.

While CMS has taken years to conduct the Medicare Advantage audits, it also has faced criticism for permitting lengthy appeals that can drag on for years. These delays have drawn sharp criticism from the Government Accountability Office, the watchdog arm of Congress.

Leslie Gordon, an acting director of the GAO health team, said that until CMS speeds up the process, it “will fail to recover improper payments of hundreds of millions of dollars annually.”

Monday, January 30, 2023

Covid-19 cases increase and flu cases decrease in Ky.; Biden says he will end public health emergencies for pandemic May 11

N.Y. Times graphs of infection rates with top 3 subdivisions excluding Virgin Islands; updates here.
By Melissa Patrick
Kentucky Health News

New coronavirus cases in Kentucky increased by 23 percent last week, continuing an up-and-down pattern that creates a rough plateau. Meanwhile, influenza cases decreased for the seventh week in a row. 

“We have not seen the substantial increases in hospitalization or cases that we saw after the holidays last year,” Gov. Andy Beshear said at his weekly press conference Jan. 26. “We’re kind of bumping up and down a little bit (from) month to month, but nothing like we previously lived through.”

The state Department for Public Health's latest weekly report showed 6,369 new cases of the coronavirus from Monday through Sunday, or nearly 910 cases per day. That's up from 701 a day the week before. Nearly 19% of the cases were in people 18 or younger. 

The share of Kentuckians testing positive for the coronavirus in the past seven days was 10.05%, down slightly from 10.27% the week prior. These numbers do not reflect at-home testing. 

The weekly new-case rate was 12.98 cases per 100,000 residents, up a bit from 12.54 the week before. The top 10 counties were Barren, 33.9 cases per 100,000; Adair, 29.8; Cumberland, 28.1; Wolfe, 27.9; Boyd, 26.6; Perry, 25.5; Metcalfe, 24.1; Clay, 23.7; Woodford, 23.5; and Breathitt, 22.6.

The New York Times ranks Kentucky's new-case rate second among the states, with a 2% increase in the last two weeks. Tennessee was first. The Times's and the state's numbers often differ; they use different methodologies.

UPDATE, Jan. 31: The Times ranks Kentucky fifth among the states, behind Tennessee, Puerto Rico, New Jersey, Rhode Island and Alabama. Close behind are South Carolina, the U.S. Virgin Islands and North Carolina.

Covid-19 hospital numbers continue to drop. Kentucky hospitals reported 294 patients with the disease, down 24; 56 were in intensive care, up one; and 24 were on mechanical ventilation, down three. 

The state attributed 52 more deaths to Covid-19 last week, up from 45 the week before. Data from the last four state reports show Kentucky is experiencing about 48 deaths per week from Covid-19. The state's pandemic death toll is now 17,890. 

The end is near: Meanwhile, President Biden told Congress Monday that he will end the twin national emergencies for addressing Covid-19 on May 11, which will restructure the federal response to treat the virus as an endemic threat to public health that can be managed through agencies’ normal authorities.

Biden's move came "as lawmakers have already ended elements of the emergencies that kept millions of Americans insured during the pandemic. Combined with the drawdown of most federal Covid-19 relief money, it would also shift the development of vaccines and treatments away from the direct management of the federal government," reports Zeke Miller of The Associated Press

The World Health Organization said Monday that Covid-19 remains a "public health emergency of international concern," but the pandemic is at a "transition point." 

Department for Public Health graph; click it to enlarge.

Flu cases keep decreasing

Flu cases in Kentucky continue to decline, but as long as there is any flu activity, the Centers for Disease Control and Prevention recommends a flu shot for anyone 6 months and older. Flu season runs through May. 

"Remember, the flu shot works really well against this strain," Beshear said at the news conference. 

The state's latest weekly flu report shows 309 new cases of the flu were confirmed in the week ended Jan. 21, down from 633 the week prior, a drop of 51%. 

The number of confirmed cases this season is 41,413, a number that includes the new cases as well as a backlog of cases from UK HealthCare that had not been previously reported. The prior report, with data from the week ended Jan. 14, reported 39,425 confirmed flu cases this season. 

Kentucky's flu activity level remains "regional," meaning cases have been confirmed in at least two, but fewer than half, of the state's 16 regions.

The report says flu has killed eight children and 122 adults this flu season, with four of the adult cases due to the flu and Covid-19 coinfection. There was no change from the prior week's report. 

By far the highest number of cases is among children 10 and younger, followed by people 11 to 20.

Counties with the highest number of flu cases were Jefferson, 151; Jessamine, 46; Madison, 35; Scott, 32; and Woodford, 24.

Sunday, January 29, 2023

Study identifies six factors linked with lower risk of dementia; expert says 'It may never be too late to improve your brain health'

A new study of more than 29,000 older adults in China has identified six habits "that are linked with a lower risk of dementia and a slower rate of memory decline," Annabelle Timsit of The Washington Post reports. "Eating a balanced diet, exercising the mind and body regularly, having regular contact with others, and not drinking or smoking . . . were associated with better cognitive outcomes in older adults." Specifially, the six modifiable lifestyle factors were:
  • Exercise: At least 150 minutes of moderate activity or 75 minutes of vigorous activity per week.
  • Diet: Appropriate daily amounts of at least seven of 12 food items (fruits, vegetables, fish, meat, dairy products, salt, oil, eggs, cereals, legumes, nuts and tea).
  • Alcohol: Never drank, or drank occasionally.
  • Smoking: Never smoked, or a former smoker.
  • Cognitive activity: Exercising the brain at least twice a week (examples: reading and playing cards).
  • Social contact: Engaging with others at least twice a week (examples: attending community meetings or visiting with friends or relatives).
The study was conducted from 2009 to 2019 and published in the British Medical Journal. "While researchers have long known that there is a link between dementia and factors such as social isolation and obesity, the size and scope of the new study adds substantial evidence to a global body of research that suggests a healthy lifestyle may help brains age better," Timsit writes. "It also suggests that the effects of a healthy lifestyle are beneficial even for people who are genetically more susceptible to memory decline — a 'very hope-giving' finding for the millions of individuals around the world who carry the APOEε4 gene, a major risk factor for Alzheimer’s disease, said Eef Hogervorst, chair of biological psychology at Loughborough University, who was not involved in the study."

Timsit notes, "Memory naturally declines gradually as people age. Some older people may develop dementia, an umbrella term that can include Alzheimer’s, and generally describes a deterioration in cognitive function that goes beyond the normal effects of aging. But for many, 'memory loss can merely be senescent forgetfulness,' write the authors of the BMJ study — like forgetting the name of that TV program you used to love, or that pesky fact you wanted to look up.

"Memory loss is no less damaging for being gradual, and age-related memory decline can in some cases be an early symptom of dementia. But the good news, the researchers say, is that it 'can be reversed or become stable rather than progress to a pathological state.' . . . At the start of the study, researchers conducted baseline memory tests as well as testing for the APOE gene. They also surveyed participants about their daily habits. Participants were sorted into one of three groups — favorable, average and unfavorable — based on their lifestyle. Over the course of the study, the researchers found that people in the favorable group (four to six healthy factors) and average group (two to three) had a slower rate of memory decline over time than people with unfavorable lifestyles (zero to one healthy factor). People living favorable lifestyles that included at least four healthy habits were also less likely to progress to mild cognitive impairment and dementia. . . . Notably, this held true even for people who carried the APOE gene associated with a higher risk of Alzheimer’s disease.

"Some of the study’s findings differ from the results of other large studies conducted in the United States and in Europe, says Hogervorst. For instance, the BMJ study found that the lifestyle factor with the greatest effect on reducing memory decline was a balanced diet. Other studies have suggested that diet matters less in old age than physical and mental exercise, says Hogervorst. Still, its results align with the broad scientific consensus that there is a link between how we live and our cognitive function as we age — and perhaps more important, suggest that it may never be too late to improve your brain health."

Saturday, January 28, 2023

Big health-insurance company and major health-care foundation among lead investors in Invest Appalachia venture-capital fund

Kentucky Health News

Two big players in health care are the major financiers of a venture-capital firm that calls itself "a regional social investment platform" for Eastern Kentucky and most of Appalachia. Invest Appalachia says it "has secured $19 million of new investment" and is already investing in projects.

ARC.gov map, adapted by Kentucky Health News
The fund's press release says 90% of the money is "new capital from outside the region," which it defines as as the Appalachian counties of Kentucky, West Virginia, Virginia, Tennessee, North Carolina and Ohio, and it has a target of $40 million by November. The lead investors are UnitedHealth Group, a big insurance company, which has put in $10 million; the Robert Wood Johnson Foundation, a major funder of health research and projects; and the Appalachian Regional Commission, a federal-state agency that serves 54 of Kentucky's 120 counties. The release did not list ARC's and RWJF's amounts.

Andy McMahon, a vice president of UnitedHealth, said, “Advancing health equity and addressing social needs like housing and access to health care in rural and underserved areas is an integral part of making the health-care system better for everyone. We are fortunate to work with partners like Invest Appalachia, who really understand the rich culture of Appalachia and are creating new ways to address community needs to improve quality of life and health.”

Zoila Jennings, impact investment lead with the foundation, said “Invest Appalachia is pioneering regionally controlled creative capital solutions in Appalachia that support inclusive economic growth for the region and offer new opportunities for national investors. We see the Invest Appalachia Fund as an innovative model for foundations and other impact investors who want to get capital to the people and places that need it most.”

CEO Andrew Crosson told The Rural Blog that his fund has invested in real estate for downtown revitalization, "support for consumer and business lending for flood-impacted communities" in Eastern Kentucky, "solar and energy efficient equipment for a rural grocery store, and expansion of rural eye care clinics." He said in an email that he couldn't give specifics because "these deals aren't public yet" but said his priorities are "downtown revitalization/community-focused real estate, solar and energy efficiency for rural businesses and institutions, and community health facilities and social enterprises."

CDC: Only 5 Ky. counties have high risk from coronavirus; FDA panel recommends one annual Covid-19 vaccination for everyone

Centers for Disease Control and Prevention map
By Melissa Patrick
Kentucky Health News

Only five Kentucky counties, all but one along the Virginia border, have a high level of Covid-19 risk, according to the latest weekly map from the Centers for Disease Control and Prevention. The map showed only slight shifts among medium-risk and low-risk counties.  

Gov. Andy Beshear noted at his weekly news conference, held before the CDC report was released, that new corinavirus cases in Kentucky continue to move up and down a bit, continuing the recent plateau, but the recent increase in Covid-19 hospitalizations is subsiding. 

Again, he made a plea for Kentuckians to get the new Covid-19 booster shot and encouraged Kentuckians to make "wise decisions" when it comes to other preventive measures, like masking. 

"You know, masking when you choose to is a safe and effective tool," he said. "So please consider it when you believe that you need it." 

The CDC map, which is based on Covid-19 cases and hospital numbers to determine transmission and risk, shows number of high risk counties, shown in orange, dropped 54.5 percent from the prior week when the state had 11 counties in this category. 

All the high-risk counties continue to be in the eastern part of the state: Wolfe, Pike, Letcher, Harlan and Bell counties. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

The map shows 49 Kentucky counties at medium risk, shown in yellow; and 66 at low risk, gown in green. 

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

Centers for Disease Control and Prevention map
The CDC also has a transmission-level map, largely used by researchers and health-care facilities, that shows the level of virus spread in each county, at one of four levels. For the first time in a while, it shows one county with a low level of transmission: Todd. Twenty-six counties had with a moderate level of transmission, up from 15 in the prior week, and the rest had either substantial or high levels of transmission.

State officials have encouraged Kentuckians to use the other CDC map to guide their preventive measures.

On Thursday, Jan. 26, a U.S. Food and Drug Administration advisory panel voted unanimously Jan. 26 in favor of moving to an annual Covid-19 vaccine made up of one formula, with every person getting the same vaccine whether they are already vaccinated or not.

Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas, "said he prefers a twice-a-year routine to account for the anticipated summer and winter surges each year," The Houston Chronicle reports.

“What they're really doing is balancing the science that says, ideally, semi-annually, with the reality that Americans are not really accepting the boosters barely anyway,” Hotez said. But Pfizer and Moderna "are considering raising the price of a single vaccine dose to $130, and the Biden administration has said it no longer has the Covid-19 funding to make additional purchases," the Chronicle notes.

Meanwhile, a committee of the World Health Organization began meeting Jan. 27, to discuss recommending that the agency declare Covid-19 is no longer a major global health emergency. The WHO said no recommendations would be issued before Monday.

Friday, January 27, 2023

Since the 988 suicide and crisis lifeline launched in July, calls from Kentucky numbers have gone up 26% and texts by 401%

By Melissa Patrick
Kentucky Health News

In the six months since the new, easy-to-remember 988 suicide and crisis lifeline launched, calls have increased 26 percent, Gov. Andy Beshear said Thursday. 

Beshear said at his regular weekly news conference that the "mental health version of 911" is designed to connect people in a mental health emergency with someone who is specifically trained to help them. 

Since the new number launched in July 2022, Beshear said trained counselors have responded to an average of 2,450 calls per month. 

“That means that since 988 has been instituted, we’ve had a 26 percent increase in calls per month in comparison to the first half of 2022,” he said.

Susan Dunlap, a spokeswoman for the Cabinet for Health and Family Services, told Kentucky Health News in an email that text messages have also increased. She said there had been 646 suicide hotline texts from a Kentucky-based phone number in the first half of the year, and 3,238 in the six months since 988 was launched, a 401% increase. 

The new line is proving its value in other ways. Beshear said there has been a 14% decrease in abandoned calls and 92% of Kentucky's 13 participating call centers have answered calls in less than 20 seconds. 

"You don't want to have somebody on hold when they're going through a mental-health crisis," he said. "This is great news. It means the 988 helpline is working." 

Beshear encouraged Kentuckians struggling with a mental health crisis to use this resource. 

"Remember, it's OK to not be OK, right? We all go through difficult times and sometimes we go through trauma that our bodies and our minds are not designed to take, that nobody could handle no matter how strong we are. So please reach out. These are people who have trained and who have helped other people, that are ready to help you through your most difficult time," he said.

"I mean, let me tell you, you got people out there that love you, whether it feels like it or not, they love you. They want you to be with them the next day, and the next year, and the next decade. So if you need that help, please dial 988, no stigma, no shame, just a community and a commonwealth that loves you, and wants you to get the help that you need."

New VA policy is expected to save some Ky. veterans by providing free emergency mental-health care to all vets, even if not enrolled

By Sarah Ladd
Kentucky Lantern

This story discusses suicide. If you or someone you know is contemplating suicide, please call or text the National Suicide Prevention Lifeline at 988. Veterans and service members calling 988 can press 1 for specific crisis help from the Veterans Crisis Line.

Combat veteran Jeremy Harrell founded
Veteran’s Club, based in the Louisville
area, and advocates for mental health.
(Photo courtesy of Jeremy Harrell)
Once a veteran has decided to take their own life, “every minute counts,” said Army combat veteran Jeremy Harrell.

That’s why he believes a new federal policy aimed at decreasing veteran suicides through free emergency mental health care will be “an actual lifesaver” for Kentucky, which is home to about 370,000 veterans. It’s unclear how many of those aren’t enrolled in the Department for Veterans Affairs health-care system. Up to 9 million could benefit nationwide.

The new policy went into effect Jan. 17. It bypasses VA's enrollment rules, which Harrell said have kept some veterans from enrolling, Harrell said.

The policy allows veterans – both those enrolled in the VA system and those who are not – can go to any health-care facility – VA or non-VA – to get free emergency mental-health care in the case of a suicide crisis.

Enrollment in the VA system is open to veterans who served 24 continuous months or their entire active-duty stretch. The minimum-duty rule doesn't apply to those discharged because active duty caused or worsened a disability, and those who served before Sept. 7, 1980. 

The new, free emergency care includes 30 days of inpatient or residential care and outpatient care for up to 90 days, says the VA.

“This is a really, really big step in the right direction when it comes to veteran suicide,” said Harrell, who founded Veteran’s Club, based in the Louisville area, and advocates for mental health through a variety of organizations.

The new access also makes his job as an advocate easier, he said. He always recommends the suicide prevention lifeline, 988, to folks who call him in crisis. But in the past he also had to ask a series of eligibility questions to find out how to help the person. That takes up precious time.

“The clock is ticking,” Harrell said. “What we know is that when a person makes the decision, particularly in the veteran community, to take their own life … every minute counts.”

Now, help is simpler. Call or text 988. Or, he said, “find your way to the nearest emergency room.”

In 2020, there were 119 veteran suicides in Kentucky, up from 100 in 2019, according to the VA. Data for 2021 and 2022 is not yet available. Harrell said he’s aware of six Kentucky veterans who died by suicide since November.

“It’s heartbreaking to know,” he said, “how many lives that we may have lost because of the bureaucracy.”

Who is eligible?

Eligibility criteria for this program are, according to the VA: 
  • Veterans who were discharged or released from active duty after more than 24 months of active service under conditions other than dishonorable.
  • Former members of the armed forces, including reserve service members, who served more than 100 days under a combat exclusion or in support of a contingency operation either directly or by operating an unmanned aerial vehicle from another location who were discharged under conditions other than dishonorable.
  • Former members of the armed forces who were the victim of a physical assault of a sexual nature, a battery of a sexual nature, or sexual harassment while serving in the armed forces
Are there enough mental health professionals in Kentucky?

Kentucky has a shortage of mental-health-care providers, according to the Health Resources & Services Administration. In fact, 2022 data from the Rural Health Information Hub showed every single Kentucky county as a mental health shortage area.

That’s “very much a concern” for Harrell, he said, pointing to pandemic-induced burnout as a culprit and the need for more social workers.

Private entities also need to be trained in military lingo so they can best communicate with veterans who come in, he said.

But for now: “My hope is that, if nothing else, (hospital staff) can help stabilize the individual, putting eyes on the individual, and at least try to support them, because that’s a big part of it.”

Thursday, January 26, 2023

Ky. Opioid Abatement Advisory Commission subcommittees consider five grant applications, with only two getting a yes vote

This story has been updated to reflect that Jason Roop does not serve on the Reform and Compliance Committee. He serves on the Treatment and Recovery Committee.

Commission subcommittees discuss applications. From left: Allen Brenzel, Eric Friedlander, Von Purdy, Scott Hornbuckle, Carlos Cameron, Allison Ball, Lorran Ferguson and Danny Bentley.

Story and photo by Melissa Patrick
Kentucky Health News

Two of the three Kentucky Opioid Abatement Advisory Commission subcommittees reviewed five grant applications asking for funds to fight the opioid epidemic and approved two with caveats, classified two as "maybes" and gave a firm "no" to one on Jan. 24.

The settlement funds come from opioid manufacturers and distributors and are required to be used for reimbursement of prior expenses and the funding of new programs related to the prevention, treatment and recovery of people with opioid-use disorders and co-occurring substance-use disorders, or mental health issues.

So far, Kentucky is getting $842 million from these settlement funds, half of which will be allocated by the state advisory commission, with the other half going to cities and counties. Funds are to be disbursed annually, on various schedules, through 2038.

Members of the Prevention Subcommittee and the Reform and Compliance Subcommittee spent an hour deciding the initial fate of five applications referenced only by an assigned number, to keep them private.

Details from the applications were occasionally and vaguely mentioned during the committee discussion.

However, it was apparent that one of the two applications that got a "yes" vote, both with caveats and adjustments, dealt with harm reduction, while the other was for unnamed program for a small youth cohort. The "maybe" group included a national organization that would partner with existing programs in Kentucky and an elective class to be offered to younger students. The application that got the "no" vote involved a group from New York that proposed something already being done in Kentucky.

Concerns and questions were raised on the "yes" and "maybe" applications that must be answered before they move forward to the full commission.

The main concern with all four applications was money, with a general consensus that they were asking for too much to execute their plans. Other concerns dealt with coverage areas, a need for assurance that the monies would be spent in Kentucky, questions about staffing models and salaries, and a need to know how the programs might overlap with existing programs.

The committee said all of the applications were different from each other and could not be grouped together.

Application criteria

Bryan Hubbard, executive director and chair of the advisory commission, opened the meeting by reading the 12 criteria established in an emergency administrative regulation to guide the assessment of the applications.

The regulation says the commission, in awarding funds, shall consider:
  • Compliance with applicable law;
  • The entity or agency's record and responsibility in utilizing effectively any funds received previously from the commission or local governments, as described in KRS 15.293;
  • The geographic reach of the application;
  • Amounts received from the commission or local governments;
  • The utility and effectiveness of any part of the application;
  • The extent to which Kentucky residents are served by the application;
  • The extent to which prior allocations from the commission have served similar purposes;
  • The extent to which the application proposes to serve a portion of the population that otherwise would not receive such service;
  • The extent to which the application proposes to incorporate relevant partnerships that are likely to increase the efficiency and effectiveness of programming;
  • The extent to which the application proposes, among other things, to educate the public about opioid misuse and opioid-use disorder, reduce the occurrence of opioid misuse and opioid-use disorder, promote resistance to opioid misuse and opioid-use disorder, promote the effective treatment of opioid-use disorder, and/or combat the effects of opioid misuse, including co-occurring mental-health issues;
  • The extent to which the application activities align with accepted evidence-based practices; and/or
  • The sufficiency of records to validate the requested amounts.
Hubbard then instructed the subcommittee to place the reviewed applications into a yes, no or maybe category, adding that the maybes should also include a list of questions and concerns that would be addressed by the applicant so that they could then be placed into a yes or no category.

He said the applications placed in the "yes" category would be assessed for their coverage areas, that like proposals would be grouped together and that unique, stand-alone proposals would remain so.

"That is our process," he said.

Later in the meeting, Scott Hornbuckle, a staffer with the commission, clarified what a yes vote for an application meant: "Yes means it's a good idea, we want them to participate at some level, we need to look into it further. It does not mean, yes, we approve their grants at this price point," but the application would move to the next step in the process.

Hubbard told the legislature's health committees Jan. 19 that the commission had received 32 completed applications and 231 more are in progress. He said the total asked by the completed applications is $63.6 million.

Applications are being accepted on a rolling deadline, and the application date is open-ended, at least for now. The commission plans to make the first awards in the spring, with hopes of making three more later this year.

Members of the subcommittees

Members of the Prevention Subcommittee in attendance were Von Purdy, representing citizens at large and chair of the joint subcommittee; Eric Friedlander, representing the Cabinet for Health and Family Services; and Carlos Cameron, district director for Fifth District U.S. Rep. Hal Rogers, who was appointed by state Senate President Robert Stivers.

Dr. Allen Brenzel, medical director of the Department for Behavioral Health, Developmental and Intellectual Disabilities, who serves if Friedlander is absent, also attended the meeting.

Members of the Reform and Compliance Committee in attendance were state Rep. Danny Bentley, appointed by House Speaker David Osborne; Vic Brown, representing law enforcement, who attended via telephone; and state Treasurer Allison Ball. Jason Roop, representing victims of the opioid crisis, was absent. was not absent. He serves on the Treatment and Recovery Committee. 

Also present was Lorran Ferguson, Ball's chief of staff and deputy treasurer.

Tuesday, January 24, 2023

Doctors will no longer have to take special training to prescribe opioid that is used to treat addiction but is short of prescribers

Photo by Joe Raedle, Getty Images, via Politico Pulse
The federal government has lifted extra requirements for doctors who want to prescribe buprenorphine, a partial opioid that is used to help drug users beat addiction. That will be a boon for rural areas, including most of Kentucky, that have a disporportionate share of overdoses and a shortage of doctors willing to prescribe it.

Gone is "a time-consuming process that both discouraged doctors from prescribing the drug and created an unhelpful stigma around the medication, advocates say," Krista Mahr and Daniel Payne report for Politico Pulse. "As deaths from opioid overdoses reached record numbers, access to buprenorphine remained elusive: Just 11 percent of people diagnosed with opioid use disorder received FDA-approved medication in 2020.
That changed with the Mainstreaming Addiction Treatment Act, "which was added to the year-end omnibus bill passed in December," Politico reports. "Practitioners who want to prescribe buprenorphine to their patients will still be required to get a DEA license, as they would any other controlled substance like morphine or Xanax. But they won’t have to face additional administrative requirements that have slowed down patient access to the drug for years."

The action by Congress superseded the plan of the Department of Health and Human Services, whch said last April that it would allow most medical providers to prescribe buprenorphine for opioid-use disorder without being trained and getting a waiver. Assistant Secretary for Health Rachel Levine said in the press release that rural patients seeking such therapy can have a hard time accessing it because of transportation issues and the relative lack of qualified prescribers. But buprenorphine can be prescribed for a month at a time and taken at home, meaning rural patients don't have to travel so much, and can easily get it even at mobile clinics. About 40 percent of U.S. counties don't have a health-care who is approved to prescribe buprenorphine, an active ingredient in Suboxone, the preferred drug in medication-assisted treatment for substance-use disorder, according to a federal report.

Monday, January 23, 2023

Covid-19 cases and deaths dropped in Ky. last week, but New York Times says state's infection rate remains one of the highest

New York Times graph, adapted by Kentucky Health News; for a larger version, click on it.
By Melissa Patrick
Kentucky Health News

After increasing for two weeks, new coronavirus cases in Kentucky dropped 35% in this week's state report, and Covid-19-related deaths also decreased, but the state's infection rate ranks high nationally.

The state Department for Public Health's latest weekly report showed 4,913 new cases of the coronavirus, or 701 cases per day. That's down from 1,080 a day the week before. Nearly 18% of the cases were in people 18 or younger. 

The share of Kentuckians testing positive for the coronavirus in the past seven days was 10.27%, down slightly from 10.37% the week prior. These numbers do not reflect at-home testing. 

The weekly new-case rate was 12.54 cases per 100,000 residents, down a bit from 13.06 the week before. The top 10 counties were Wolfe, 39.9 cases per 100,000; Elliott, 30.4; Barren, 30.3; Wayne, 29.5; Boyd, 27.2; Perry, 26.6; Butler, 26.6; Breathitt, 23.8; Green, 23.5; and Simpson, 22.3.

The New York Times ranks Kentucky's infection rate second among the states, trailing only Tennessee and suffering a 167% increase in cases in the last two weeks, contrary to the state report, which uses different methodology.

The Times explains a possible reason for the difference: "The Times data is sourced from states, counties and regional health departments. Local officials often report earlier than the states do, so this can be a source of variation."

Kentucky hospitals reported 318 patients with Covid-19, down 88 from the week prior; 55 of them were in intensive care, down eight; and 27 were on mechanical ventilation, down four. 

The state attributed 45 more deaths to Covid-19 last week, down from 59 the week before. The state's pandemic death toll is now 17,838.

Meanwhile, the U.S. Food and Drug Administration proposed a simplified approach for future Covid-19 vaccination, which would allow most adults and children to get a shot once a year "to protect against the mutating virus," The Associated Press reports. "This means Americans would no longer have to keep track of how many shots they’ve received or how many months it’s been since their last booster."

AP notes, "Boosters have become a hard sell. While more than 80% of the U.S. population has had at least one vaccine dose, only 16% of those eligible have received the latest boosters authorized in August." In Kentucky, that figure is only 12%.

The FDA's panel of outside vaccine experts will consider the proposal Thursday.

How to avoid vision problems from diabetes, which 13.6% of Kentuckians have, 7th in U.S.; 33.8% more have pre-diabetes

Diabetes can cause blindness. (smirart/iStock/Getty Images)
By Joseph Brown
University of Kentucky

Diabetes is a disease so prevalent in the U.S. that it is considered to be an epidemic. In Kentucky, according to the American Diabetes Association, approximately 13.6% of the adult population has diagnosed diabetes, seventh in the nation.

Another 33.8% of Kentuckians have been diagnosed as having pre-diabetes. Diabetes can result in devastating consequences financially and physically for the families and those who have it.

With a diabetes diagnosis, you must be aware of the risk factors you face. One of these risk factors is that you can develop a serious eye condition called diabetic retinopathy. It causes vision loss and blindness in those who have diabetes by causing issues with the blood vessels connected to the retina.

If you have diabetes, it is important to get an eye exam once a year, since you may not notice any symptoms in early stages. Catching this condition early on will be the best course of action in preventing vision loss.

What are the symptoms?
  • Changes in vision such as trouble reading or blurred vision
  • Fluctuating vision
  • Spots or dark streaks floating in your vision
  • Dark or empty areas in your vision
  • Eye pain or redness
  • Difficulty seeing in the dark
What can I do to prevent diabetic retinopathy? The best course of action is managing your diabetes with a healthy diet, regular exercise and following your doctor’s instructions with medications. You should also ensure you get a regular eye screening, and monitor your blood sugar, cholesterol and blood pressure at all times.

What kind of treatment is available? If caught early, your doctor will likely recommend more regular eye exams. However, in the later stages, there are a variety of treatments available to stop your vision from worsening, such as injections, laser treatment or eye surgery. Overall, it is important to see your doctor with any concerns you may have to find the right course of action for you.

Sunday, January 22, 2023

Craft says empty chair at table was a 'close family member' who 'was able to overcome the addiction and move on with their life'

A Kelly Craft campaign ad shows tables with an empty chair. After this scene, she says, “As a mother, this is personal to me, because I have experienced that empty chair at my table. This has to stop.”
By Al Cross
Kentucky Health News

For 10 days, Kentuckians have seen and heard this message from Kelly Craft, one of the Republican candidates for governor:

“All across Kentucky, an empty chair. A place missing at the table. Families suffering because fentanyl and other dangerous drugs have stolen our loved ones away. As a mother, this is personal to me, because I have experienced that empty chair at my table. This has to stop. We need leadership. And as your governor, I’ll back up our police and stop drugs at our border. So there’s no spot missing at the family table.”

The 30-second television commercial has left some viewers wondering who formerly occupied that empty chair, when, and what happened to them.

In an interview with Mark Vanderhoff of Louisville's WLKY last week, Craft declined to identify the person and said the ad refers to “a family member that has had an addiction.” Then, in an impromptu interview, Craft told Ricky Sayer of Lexington's WLEX that the family member is living.  

In a statement Sunday to Kentucky Health News, Craft's campaign identified the person as "a close family member" who lived in her household, "battled addiction and went to rehab. By the grace of God, that family member was able to overcome the addiction and move on with their life, but we all know the struggle never ends for a family and remains ongoing."

The statement added, "An empty chair represents a long road of pain, whether caused by the passing of a loved one or years away from the table. It’s insensitive and malicious to think an empty chair implies only death, and shows that those implying such don’t understand the pain caused by the drug epidemic."

That last line could be taken as a reply to Nick Storm of Kentucky Fried Politics, an online newsletter that said Craft's explanation that the family member is still living showed that the ad "is hyperbole," which Webster's Dictionary defines as "extravagant exaggeration." The Oxford Languages Dictionary, which Google uses, calls it "exaggerated statements or claims not meant to be taken literally." The ad makes no specific claim.

Craft, a former ambassador to Canada and the United Nations, told WLKY, “It was very painful at first to be able to open myself up. It's very emotional. But after traveling throughout the state of Kentucky, my pain is minuscule compared to what I'm hearing and that's because we have a crisis in this state.”

In 2021, Kentucky documented a record 2,250 drug-overdose deaths, 15 percent more than 2020, which had 54% more than 2019. Toxicology reports showed that fentanyl was involved in 73%, or 1,639. That was 16% more than the 1,413 overdose deaths involving fentanyl in 2020.

"Ambassador Craft is really putting her finger on one of the most important issues in Kentucky," Kentucky Public Radio Frankfort reporter Ryland Barton told "Kentucky Edition" host Renee Shaw on Jan. 18. "There was some question there, you know, who exactly was she talking about, you know, how close actually is she to this issue?"

That was the central question asked by Kentucky Health News. The written reply from Craft's campaign began, "As a mother, Kelly knows that the pain caused by the drug epidemic affects almost every family in Kentucky. Kelly has dealt with the chaos addiction causes, first hand. She knows what it means to miss a close family member at the dinner table. Kelly knows the pain that is felt as a family member misses holidays, family dinners, church, school, work, and family events as they confront an addiction ravaging their life."

In interviews, Craft has criticized Gov. Andy Beshear for not mentioning the drug problem in his State of the Commonwealth speech to the legislature on Jan. 5. Her latest ad says Beshear and President Biden are "ignoring the border crisis," which she connects with the importation of fentanyl.

Beshear began his weekly press conference Thursday, Jan. 19, by inviting Kentucky communities to apply for "Recovery Ready" certification, which measures their prevention, treatment and recovery support to residents seeking help for drug or alcohol addiction.

Thursday night in London, Craft called drugs the No. 1 issue in Kentucky and possibly in the U.S. That was the first clip from her in Sayer's three-and-a-half minute report on WLEX, which began by saying that Craft was "choosing to keep private part of a story she made public."

University of Kentucky political-science professor Stephen Voss told WLEX, "I think most people seeing the ad likely inferred that she's saying that a family member died, but that's really sort of on the audience. It doesn't say that. She says there's an absent family member. She doesn't say why they're absent. The important thing for the electorate is, she's claiming a special understanding of the policy issue."

Voss, who was a newspaper reporter in Louisiana before becoming a political scientist, defended the reporters' questions: "Once a candidate brings a family member into the debate and tries to use them to try to establish some kind of expertise or some kind of competence or understanding of an issue, then it's hard for election watchers not to demand, 'Who is this family member? What are you actually saying you experienced with them?'"

Saturday, January 21, 2023

Governor wants firm guidelines on how to spend opioid settlement money, now up to $842 million; Cameron appointee says no

Slide from Office of the Attorney General; click it to enlarge
This has been updated.

By Melissa Patrick
Kentucky Health News

Kentucky's local and state governments continue to reap more millions from settlements with drug manufacturers and distributors, and are looking for guidance on how to spend the money to provide relief from the opioid epidemic, as the settlements require.

The state is getting $842 million, half of which will be allocated by the state Opioid Abatement Advisory Commission, with the other half going to cities and counties. Funds are to be disbursed annually, on various schedules, through 2038.

The head of the commission, appointed by Attorney General Daniel Cameron, envisions a practical, strategic, "flexible and dynamic" process. Gov. Andy Beshear and one of his appointees who serves on the commission want firmer guidelines and a scoring system for grant applications.

At the commission's Jan. 10 meeting, its treatment and recovery subcommittee set the calendar to start making recommendations for the grant awards, and some members said they need formal guidelines, such as scoring rubrics.

One member said it would be important for the group as a whole to be working from the same guidance. Another said such guidance would allow for transparency and consistency in the selection process. 

Van Ingram
"We need some common themes from the other groups, as well as ours," said subcommittee member Van Ingram, director of the Kentucky Office of Drug Control Policy. "I think we need that before we move forward, so, you know, nobody's rubber-stamping everything that comes through or nobody's denying everything that comes through; that we have some common themes we want to look at." 

The next treatment and recovery subcommittee meeting is Feb. 7. Ingram said, "If we don't have the guidance before Feb. 7 or on Feb. 7, I don't think we need to be making any decisions. We can discuss. We can look at. But . . . we don't want to make decisions and then the guidance come later."

Ingram works for Beshear, a Democrat who is seeking re-election. One of the Republicans running for his job is Cameron, who named lawyer Bryan Hubbard chair and executive director of the Opioid Abatement Advisory Commission. 

Hubbard was asked Jan. 19 if the guidance Ingram wanted would be forthcoming. He said, "This is not a process by which we can use strict, academically developed, rigid rubrics to assess the viability of a project. We've got to think practically, strategically. And we've got to be able to recognize what is going on, on the ground, so that we can deliver the necessary resources to advise good work that's being done. The application process that we've come up with gives us the due-diligence tools to ensure we have competent qualified organizations who can participate, and we aim to resource as many of them as well possibly can."

Meanwhile, Kentucky Health News asked Beshear at his regular weekly news conference if he shared Ingram's concerns, and he said he did. "Certainly any process where there's an application for government funds, has to have guidelines, has to have scoring criteria," he said, adding later, "That is a great concern that they have taken all of these applications without giving organizations . . . the scoring criteria that will be used. So my hope is that we'll see some major changes."

Beshear alluded to the election: "This isn't about me or anybody else in office; this is about wanting to make sure that this money, which is blood money, is used the right way, is used the smart way. And if they don't come up with criteria, how are they going to tell all the amazing organizations that there might not be enough funding for in this round why? . . . They're going to need an explanation about why one thing was funded and another wasn't early on." 

Cameron's communications director, Krista Buckel, said regulations unanimously approved by the commission and signed by Beshear outline how it will review the grant applications. 

"The regulations . . . clearly outline factors for the commission to use in reviewing grant applications," Buckel said. "These guidelines provide the flexibility necessary for the commission to strategically and adeptly respond to the opioid crisis."

Bryan Hubbard (Photo by Melissa Patrick)
Hubbard told the Health and Senate Health Services committees Jan. 19 that the commission had received 32 completed grant applications and that 231 more are in progress. He said the total asked by the completed applications is $63.6 million. 

Local officials also seek guidance

At the Jan. 17 Woodford County Agency for Substance Abuse Policy meeting, County Judge-Executive James Kay told Hubbard that the county and its two cities would like a “free blessing” from the commission saying that a program they are considering falls within the law for spending the settlement money.

“I can tell you already that we’ve already had ideas that people [say], 'I don't know if that fits the statute',” Kay said.

Hubbard told Kay, “Insofar as that's an idea that your fellow judge-executives would be receptive to, we would love to assist in any way you think is helpful.”

A few days later, Hubbard told Kentucky Health News, "We want to be supportive without being dictatorial. And insofar as there is anyone within local leadership across the state that wants us to bless anything, it's not a necessity, but we're happy to do it with him."

Alison Chavies, Hubbard's executive staff advisor, told KHN that all programs and projects using opioid-settlement money must fall within existing statutes and regulations, which are strictly bound to opioid-use disorder or co-occurring substance-use disorder or mental-health issues. Further, she said in an e-mail, "Kentucky League of Cities will be handling questions for the cities and Kentucky Association of Counties will be handling questions from the counties. They would, in turn, contact us."  

Asked if the commission is figuring out things as they go along, Hubbard said, "This is an entrepreneurial endeavor within the framework of government. And we are very much engaged in an entrepreneurial exercise in which we have to be flexible and dynamic." 

Latest town hall focuses on high overdose rates of Black Kentuckians 

For a larger version of the chart, click on it.
Hubbard told the health committees that in 2021 the overdose death rate was higher among Black Kentuckians than among white Kentuckians for the first time.

"Those deaths are almost exclusively driven by fentanyl, fentanyl poisoning," Hubbard said. "That began to really show up in state statistics in 2017 and the trend line is a sharp trend line upward. And it is something that we have got to get our hands around and drive awareness of." 

In partnership with Lexington Councilwoman Denise Gray, the commission held its latest town hall at the Consolidated Baptist Church Jan. 17 to address the growing crisis of opioid overdoses in the Black community, Grason Passmore reports for WKYT

The commission heard from doctors who treat people with substance-use disorders and people who had lost loved ones to the disease. 

“When you come into the clinic as someone who is addicted to opioids, there’s already a stigma that you’re trying to get over on someone. We have to get rid of that stigma,” said Quentin Moore, a nurse practitioner.

He added, "Within the Black community we don’t see us as having a problem. Even though somebody just took a pill their aunt was prescribed. They just took the pill because they had back pain. Then they went back again. Then again. And after that, they just can’t stop going back." 

Hubbard told the health committees that common themes in the 11 town hall meetings have been the need for increased prevention programs for youth, creation of recovery support programs, recovery housing, transportation, second-chance employment, expungement of criminal records, acute-phase treatment with seamless transitions to treatment, and addressing the stigma that plagues this disease. 

"In our town-hall meetings, it is very clear that Kentuckians wish for those of us who hold public trust to understand the depth and just the immense dimension of pain that exists in the state, that has been produced by this epidemic," Hubbard said. "We are losing a small town a year and have been for at least a decade."

Flu keeps declining, but shot recommended while activity remains

Kentucky Department for Public Health graph
By Melissa Patrick
Kentucky Health News

Influenza cases in Kentucky continue to decline, dropping again for the sixth week in a row, according to the state's latest weekly flu report

"The flu is somewhat declining, but it still remains at an elevated level," Gov. Andy Beshear said at his regular weekly news conference Thursday. "Get your flu shot. It works against the strains that are out there, it's still worth getting the flu shot now." 

A flu shot is recommended for everyone 6 months and older as long as flu activity continues. Flu season runs through May.

The report shows 633 new cases of the flu were confirmed in the week ended Jan. 14, down from 967 the week prior, a drop of  34.5 percent. The number of confirmed cases this flu season is 39,425. 

Kentucky's flu activity level remains "regional," meaning cases have been confirmed in at least two, but fewer than half, of the state's 16 regions.

The report says flu has killed eight children and 122 adults this flu season, with four of the adult cases due to the flu and Covid-19 coinfection. 

By far the highest number of cases is among children 10 and younger, followed by people 11-20.

Counties with the highest number of flu cases in this report were Jefferson, with 151; Jessamine, 46; Madison, 35; and Scott, 32.

Spending reports by health-care lobbying interests reflect their success at having their way in the Kentucky General Assembly

The legislature meets in the Capitol. (State photo)
Kentucky Health News

Seven of the top eight spenders on lobbying the General Assembly last year had health-care issues in play. Most of the seven were mainly focused on health issues, and most of them were successful.

Lobbying reports to the Kentucky Legislative Ethics Commission showed the Kentucky Chamber of Commerce, which lobbies on some health issues, ranked first by spending $408,301, mainly for the 16 lobbyists it employs. The Kentucky Hospital Association was second at $304,707.

"Included in the hospital advocacy group's spending was $23,000 on digital advertising for its priority legislation that passed into law after stops and starts, loosening requirements on ambulance services to improve slow response times," notes Joe Sonka of the Louisville Courier Journal. "KHA also successfully lobbied for two bills providing incentives to attract and retain nurses and health care workers and one to expand hospitals' remote access to pharmacy databases."

The third-place spender, at $269,685, was tobacco company Altria, parent of Philip Morris USA. Altria "successfully lobbied to block a bill raising taxes on cigarettes and vaping products and another that would give local governments the ability to add extra regulations on the display of tobacco and vaping products," Sonka reports.

The fourth-ranking spender was the ACLU of Kentucky, at $195,489. Among other things, it lobbied unsuccessfully against bills to restrict abortion.

The main lobbying group for doctors, the Kentucky Medical Association, ranked fifth at $157,416. KMA spent $30,000 "for polling it commissioned late in the year to craft messaging for one of its top legislative priorities" in the session that begam Jan. 3 and will resume Feb. 5. "The KMA has a website promoting a "physician-led, team-based care model," urging people to contact legislators and oppose legislation to lift limits on services that can be provided by nurse practitioners," Sonka rpeorts.

Hospital firm HCA Healthcare, which has hospitals in Bowling Green and Frankfort, was seventh in lobbying spending at $146,548. LifePoint Health, which has hospitals in Flemingsburg, Georgetown, Lebanon, Mayfield, Maysville, Paris, Somerset, Versailles and Winchester, reported spending $110,002, ranking it 17th. 

The Pharmaceutical Care Management Association ranked eighth, at $142,257. The group represents pharmacy benefit managers, who are middlemen between drug manufacturers and insurance companies; the managers have come under much legislative scrutiny in recent years. The group successfully oppposed a bill to rein in in pharmacy benefit managers; House Bill 457 "breezed through the House by an 88-3 vote but then ground to a halt in the Senate without any readings or committee hearings — all while the association spent more than $52,000 on advertisements urging legislators to defeat the bill," Sonka writes. "Senate President Robert Stivers said the bill stalled after his caucus began to hear concerns from the business sector about the measure increasing the costs of health plans, mirroring the association's messaging."

The other lobbying group in the top eight was the Kentucky League of Cities, which ranked sixth at $151,308. Its main legislative interest, a constitutional amendment to give cities more taxing options, including sales taxes, was defeated by the No. 9 group, the Kentucky Retail Federation, which reported spending $142,237. Overall lobbying expenses hit a record $24.3 million in 2022.