Kentucky Health News has moved to a new website. This site will no longer be updated.

The Kentucky Health News Blogger website will no longer be updated.

All new posts can be found on the Kentucky Health News WordPress site, found at this link:
https://kyhealthnews.net/

13 of Kentucky's 71 rural inpatient hospitals at risk of closing, with six of them at immediate risk, a national policy center estimates

Center for Healthcare Quality and Payment Reform map

By Melissa Patrick
Kentucky Health News

Thirteen of Kentucky's 71 rural inpatient hospitals are at risk of closing, and six of those are at immediate risk of closing, according to the latest analysis of Hospital Cost Reports by the Center for Healthcare Quality and Payment Reform, a policy center that says it works toward patient-centered, affordable health care. 

The report does not name the 13 hospitals, but it does offer a wealth of financial information about most rural hospitals in Kentucky and every other state, including critical access hospitals and rural emergency hospitals that are not designated as rural.  

The center says its analysis is based on financial data from the most recent cost reports that hospitals must submit annually to the Centers for Medicare and Medicaid Services. The financial report shows rural hospitals' operating margins, profits and losses on patient services and revenues and costs on patient services and those that are not directly tied to patient care. 

Low reimbursement rates from Medicare and Medicaid are often blamed for why rural hospitals have such ongoing financial troubles, but the center expands that list to all types of insurance, saying in the report, "losses on private insurance patients are the biggest cause of overall losses" in at-risk hospitals. 

"The only way to prevent more closures of services and hospitals is for all health insurance plans, including Medicare Advantage plans, commercial insurance plans, and Medicaid programs, to pay rural hospitals enough to cover the higher costs of delivering services in rural areas," the center says in a news release. 

The center also states that the federal  Rural Emergency Hospital program, which forces rural hospitals to eliminate inpatient services in order to receive large federal grants, "is not a solution to these problems" because it eliminates much-needed services in a community. Kentucky has one such hospital, Crittenden Community Hospital in Marion, Ky. 

Instead, the center calls for change in how rural hospitals are paid and proposes a method of payment that calls for all payers to start providing "standby capacity payments" to rural hospitals to cover the fixed costs of essential services such as emergency care, inpatient care and maternity care. 

What the numbers show

According to the center's "Data on Rural Hospitals" financial status report, using data from the three most recent years for which Hospital Cost Reports are available, 15 rural hospitals in Kentucky lost money (defined as "negative total margin");  19 others lost money on patient services, but not overall; and 10 lost money on patient services and overall. 

The 15 listed with negative total margins are in Fulton, Pineville, Irvine, Carlisle, Madisonville, Shelbyville, Albany, Manchester, Owenton, Mount Sterling, Marion, Burkesville, South Williamson, Campbellsville and Russellville.  

The 10 cited that lost money on patient services and overall are in Pineville, Irvine, South Williamson, Marion, Mount Serling, Shelbyville, Albany, Owenton, Manchester and Fulton. 

The 19 listed that lost money on patient services, but not overall are in Martin, Columbia, Prestonsburg, Benton, Hazard, Paintsville, Danville, Greenville, McDowell, Harlan, Salem, Middlesboro, West Liberty, Carrolton, Russell Springs, Monticello, Tompkinsville, Hardinsburg and Whitesburg.

The report explains several ways that a hospital could lose money on patient services, but not overall. 

"Many hospitals have managed to remain open despite losses on patient services because they receive local tax revenues or state government grants," says the report. "However, there is no guarantee that these funds will continue to be available in the future or that they will be sufficient to cover higher costs." 

For example, the report notes that the federal assistance many hospitals received during the pandemic has ended, which has resulted in more than one-third of rural hospitals losing money overall in 2022-23. 

It also says that some hospitals have financial reserves to offset the loss of inpatient services, adding that "the hospitals at greatest risk of closing have more debts than assets . . . to offset their losses on patient services for more than a few years."

What's Kentucky doing? 

The previous report said 16 rural Kentucky hospitals were at risk of closing and 10 of those at immediate risk of closure, higher than this year's 13 and six, respectively.  

More information is needed to know why the number of at-risk hospitals in Kentucky is lower than they were in last year's report, but what is known is that Kentucky legislators have passed laws to help support them. 

Kentucky Cabinet for Economic Development table 

For example, in 2020 they created the Kentucky Rural Hospital Loan Program, a revolving loan fund for distressed rural hospitals, and in 2021, funding of $20 million. 

The original bill allows the Cabinet for Economic Development to provide loans to struggling hospitals to maintain or upgrade facilities; maintain or increase staff; or provide health services not currently available. The low-interest loans can run up to 20 years and are available to hospitals in counties with fewer than 50,000 people.

So far, eight Kentucky hospitals have been approved for projects, with $7.2 million in funds authorized. They are Pineville Community Health Center, Baptist Health Deaconess Madisonville, Rockcastle Hospital & Respiratory Care Center in Mount Vernon, Trigg County Hospital in Cadiz, Crittenden Community Hospital in Marion, Ohio County Hospital Corporation in Hartfort, Deaconness Union County Hospital in Morganfield and ARC Health Systems in Ashland.  

Of this list, the hospitals in Pineville and Madisonville and the Rural Emergency Hospital in Marion have negative total margins. 

Laws have also been passed to allow Kentucky hospitals to get more money from Medicaid, basing payment on the "average commercial rate" instead of the current Medicaid rate, which is often below that amount. This legislation was passed under two bills -- the first in 2021 that addressed higher rates for inpatient care and the second, passed in 2023, that addressed higher payments for outpatient care, which is the one that is most beneficial to rural hospitals. 

More recently, the Kentucky Hospital Association gave a detailed overview of the 340B drug discount program at the July 30 Interim Joint Committee on Health Services and asked for help to secure these payments with contract pharmacies as a way to ensure rural hospitals can keep providing many of the programs they support. 

KHA President Nancy Galvagni explained that the 340B program requires pharmaceutical companies to sell drugs to covered hospitals and their contract pharmacies at their best price, allowing Kentucky hospitals to then invest their 340B savings to provide patient services that otherwise would not be available. 

For example, she said the savings from the 340B program allows some hospitals to "keep the doors open." Others, she said, use it to offer low-cost medications for the uninsured, cancer programs and hepatitis C clinics, and to support their charity care.   

Galvagni added that because some hospitals don't have in-house pharmacies, they contract with local pharmacies to provide the medications covered by the 340B program. 

"The problem we face is the large pharmaceutical manufacturers have refused to deliver the medications covered by the 340B program to our contract pharmacies," she said. "That refusal by these large, highly profitable multinational corporations to deliver medications to the contract pharmacies creates massive losses for the critical programs our patients need. Without the savings from the 340B program, critical health services will become unaffordable, and hospitals simply won't be able to provide the care that is funded from the 340B savings." 

In closing, Galvagni asked the General Assembly to enact legislation to require the delivery of these 340B medications to contract pharmacies in Kentucky, as six other states have already done and 19 more are working on. 

The center's figures can be downloaded at https://ruralhospitals.chqpr.org/Data1.html.

Kentucky maternal health roundtable explores ways to improve Kentucky maternal health; two stories from Kentucky Lantern

Centers for Disease Control and Prevention photo

The Kentucky Lantern offers two stories this week about maternal health in Kentucky, both by Sarah Ladd. One is about a roundtable held in Louisville that was moderated by Carole Johnson, the administrator of the Health Resources and Services Administration for the Biden administration. The other is a Kentucky Lantern Q&A with her. 

The roundtable discussion touched on several topics, including the Health Access Nurturing Developmental Services program, more commonly known as HANDS; praise for Rep. Kim Moser's, R-Taylor Mill, "Momnibus" bill that passed during the 2024 legislative session; and the need for a comprehensive approach toward improving the state's maternal mortality rates, including addressing social determinants of health, which includes things like transportation and housing, and the role that substance-use plays in such deaths.

Kentucky's maternal mortality rates are dismal, according to Ladd's reports. And, they are worse for women of color than white women. 

"The 2023 March of Dimes report showed the state once again had high maternal mortality, which was worse for Black Kentuckians. The state has a maternal mortality rate of 38.4 deaths per 100,000 live births, higher than the national rate of 23.5 deaths per 100,000 live births," Ladd reports.

She adds, "A 2023 state report on maternal mortality also showed substance-use disorder contributed to nearly 60% of all maternal deaths. Most maternal deaths in Kentucky — 88% — are preventable, a report from the Cabinet for Health and Family Services said." 

The links to the stories are below. 

https://kentuckylantern.com/2024/08/09/a-kentucky-lantern-q-a-with-federal-health-

https://kentuckylantern.com/2024/08/08/roundtable-explores-ways-to-improve-kentucky-maternal-health/

New study finds smoking and vaping dual use increases lung cancer risk; expert says it increases risk for other diseases too

By Melissa Patrick
Kentucky Health News

People who use electronic cigarettes and smoke traditional cigarettes are more likely to develop lung cancer than people who just smoke, according to a new study.

Centers for Disease Control and Prevention photo 

The Ohio State University study, published in the Journal of Oncology Research and Therapy, found that vaping combined with cigarette smoking was eight times more common in the cases with lung cancer than the control subjects, and the risk of developing lung cancer was four times higher among those who combined vaping and cigarette smoking than those who only smoked. These findings were consistent across genders and races and for all major cell types of lung cancer.

 

"This study presents clear evidence showing that vaping in addition to smoking can increase your risk for lung cancer," Marisa Bittoni, lead author and researcher at Ohio State's College of Medicine, said in a news release. "This is especially concerning given the rate of youth and young adults using these products." 

Dr. Randall Harris, co-author and professor of epidemiology at Ohio State's College of Public Health, added that while most people know that tobacco smoke contains cancer-causing chemicals, there is less known about the chemicals inhaled through vaping products. 

“Our findings provide the first evidence that smoking in combination with vaping significantly increases the risk of lung cancer compared to smoking alone," Harris said. 

Dual use and other chronic diseases

Amanda Bucher, director of tobacco policy research and outreach at the University of Kentucky College of Nursing, explained that because e-cigarettes contain a different mix of toxic chemicals than cigarettes do, including some new compounds that are formed when the chemicals are heated, people who are dual users are exposed to a broader range of toxins than they would be if they just used one device or the other. 

"Using both e-cigarettes and traditional cigarettes is associated with a higher risk of developing other diseases too, a higher risk than just smoking traditional cigarettes," Bucher said. "So not just a higher risk of developing lung cancer, but also cardiovascular disease, stroke, metabolic dysfunction, asthma, COPD and oral diseases."

Smoking cessation, prevention and lung cancer screening

Bucher said the good news is that Kentucky ranks second among states for lung cancer screening, but the bad news is that there is more work to be done because Kentucky continues to lead the nation in the rate of new lung cancer cases and deaths from it. 

Lung cancer screening with annual low-dose CT scans is recommended for people who: 

• are 50 to 80 years old
• smoke or have quit smoking within the past 15 years
• have at least a 20-pack-year smoking history, which means a pack a day for 20 years or two packs a day for 10 years, and so on. A pack year is the number of packs smoked per day multiplied by the number of years the person smoked.

According to the Centers for Disease Control and Prevention, around 30% of adult smokers in the United States are dual users. In Kentucky, the Truth Initiative, a tobacco-control advocacy group,  reports that 10.5% of adults use e-cigarettes and 17.4% are smokers. Among the state's high-school students, 4.9% are smokers and 21.9% vape. All of these Kentucky rates are higher than the national averages.

Bucher encouraged anyone trying to quit smoking and/or vaping to reach out to the Kentucky Quit Line at 1-800-QUIT-NOW, go to QuitNowKentucky.org or text QUITKY to 797979. 

She said help can also be found with a primary care provider who can offer counseling support and access to U.S. Food and Drug Administration-approved medications to help with cessation. 

"Research definitely shows that using medicines to help with tobacco treatment can double your chances of successfully quitting," she said. 

In addition, she said 39 local health departments receive funds to support cessation and prevention programs. Asked why all of the state's 61 district and county health departments don't offer this service, she said they used to, but reductions in funding from the state tobacco program have led to fewer of them offering such programs. 

"We know that almost 50% of Kentucky adults who smoke have tried to quit in the last year," she said. "It's really important for us to do everything we can to support those individuals." 

Bucher said policy matters when it comes to decreasing lung cancer rates and deaths in Kentucky.  

"We know that individuals who live in a Kentucky community with a comprehensive smoke-free workplace law are 8% less likely to be diagnosed with lung cancer," she said. "So just living in a place that has a certain kind of law means that you're less likely to get lung cancer. It doesn't matter what behavioral choices you are making." 

She added that only 38.1% of the state's population is covered by a comprehensive smoke-free workplace law, which means there is a lot of opportunity for communities to pass such laws to provide protections for their citizens. 

Further, she said, "We know that smoke-free laws make it easier for people to quit because they aren't exposed to those triggers. And, we also know that when fewer people are smoking and vaping inside public places, youth are less likely to start using tobacco products. So a smoke-free policy can also be something that is protective." 

Grant applications open to nonprofits that work with substance-use disorder and mental health in underserved communities

Foundation for a Healthy Kentucky photo 

By Melissa Patrick

Kentucky Health News

The second round of Foundation for a Healthy Kentucky grants to expand services and programming for substance use recovery and mental heath support in minoritized communities is open through Sept. 13. 

The Funding for Recovery Equity and Expansion program, dubbed FREE II, will provide at least 10 grants in the amount of $50,000 to nonprofit organizations, with priority given to grass-roots organizations, Black-led organizations and organizations that primarily work in minoritized, under-resourced and BIPOC communities. BIPOC stands for Black, indigenous and people of color. 

Among other things, the program aims to fund projects that work toward expanding services and programing for substance use recovery and mental health support in marginalized communities and to reduce the stigma associated with assessing evidence-based interventions that support substance use recovery and mental health. 

"With this project, we aim to reduce overdose deaths and increase the overall well-being of these historically under-resourced Kentucky communities," says the release.

This program is in partnership with the Kentucky Opioid Response Effort and the Kentucky Department for Health and Family Services. 

According to the website, the collaboration will only fund projects that:

• Use a trauma-informed and resilience-informed care approach to reduce premature death of BIPOC Kentuckians
• Provide culturally responsive, evidence-based prevention, mental health treatment and recovery support services to BIPOC Kentuckians
• Strengthen treatment and prevention infrastructure through collaborative projects centering BIPOC voices

Go to healthy-ky.org/free-program to learn more  about the program and to access the application. 

Annual health-policy forum Oct. 8 in Frankfort will focus on how a civic engagement approach can change health outcomes in Ky.

By Melissa Patrick
Kentucky Health News

What if the way to improving the health of Kentuckians is to create a culture where every person shares the same goal? That will be the focus of the Foundation for a Healthy Kentucky's 2024 Howard L. Bost Memorial Health Policy Forum, to be held at the Kentucky Historical Society, 100 West Broadway Street, Frankfort from 8:30 a.m. to 1 p.m. ET Oct. 8.

The forum, titled "Finding Common Ground on our Path to Better Health," will look at how to unite the state around a shared goal of addressing unmet health needs. The event is free, but reservations are required. To register, click here.

"Kentucky is consistently ranked as one of the unhealthier states in the country, despite the efforts by a dedicated few to improve the well-being of our communities," according to a news release for the event. "To make real progress, every single Kentuckian will need to play their part because we are stronger together."

Kentucky has been ranked among the bottom 10 states in health status since the America's Health Rankings began in 1990, except in 2008, when it ranked 39th. In 2023, Kentucky ranked No. 41.

The forum will host national and local experts who will talk about how to more authentically engage community members and find common ground on the path toward better health.

The sessions include:

• Enough, Time to Build: How Communities Can Forge a Civic Path Forward: Rich Harwood, president and founder of The Harwood Institute, will talk about that the way forward is a new civic path, not more divisive politics.
• Philanthropy + Democracy: Centering Humanity: Joy Ossei-Anto, managing director of Funder Engagement, Philanthropy for Active Civic Engagement will explore the role philanthropy can play in ensuring democracy is larger than politics and that humanity is centered.
• Moving from Ally to Advocate: A Call to Action: Colene Elridge, CEO of Be More Consulting, will delve into the critical journey from allyship to advocacy within healthcare policy.

The annual forum was created in memory of Dr. Howard L. Bost, a notable health economist and founding member of the foundation's board of directors. The forum aims to raise awareness of the health issues impacting Kentuckians and highlight model strategies and policy opportunities to improve Kentucky’s health. It welcomes a range of audiences from inside and outside the health industry, including health care advocates, providers and educators, business professionals, civic leaders, policy makers and more.

Addiction Recovery Care says it’s cooperating with FBI investigation into possible fraud

Addiction Recovery Care, Kentucky’s largest provider of
drug and alcohol treatment, has offices and other facilities
 in Louisa. (Kentucky Lantern photo by Matthew Mueller)

By Deborah Yetter
Kentucky Lantern

Kentucky’s largest provider of addiction treatment services, Addiction Recovery Care, or ARC, is the subject of an FBI investigation into possible health care fraud, according to a July 30 post on a website of the federal agency’s Louisville office.

ARC, which is funded almost entirely through Kentucky’s Medicaid program, has not been charged with any crime but the agency is asking people with information to fill out an online form “if you believe you were victimized by ARC or have information relevant to this investigation.”

ARC, a for-profit company based in Louisa, and whose CEO and affiliates have emerged as prolific political donors in recent years, said in a statement from spokesman Kyle Collier that it is cooperating with the FBI.

“We have recently learned that there is a federal investigation into ARC,” the statement said. “As we all know, healthcare is one of the most highly regulated fields in the country, and addiction treatment is among the most highly scrutinized healthcare services. ARC is a trailblazer in the field of addiction services. We are confident in our program and in the services we offer. We, and our legal counsel, are cooperating fully in the investigation.”

Collier directed further inquiries to ARC’s chief legal officer, Jessica Burke, who provided a similar statement.

ARC has developed a reputation for aggressive expansion since it was launched by Tim Robinson, a Lawrence County lawyer who founded the company with a single halfway house for alcohol treatment in 2010. Fueled by the availability of new Medicaid funds for substance use disorder treatment since 2014 under the Affordable Care Act, ARC operates some 1,800 treatment beds in 24 counties and reaches hundreds more clients through outpatient services, the Kentucky Lantern reported in July.

Last year, ARC took in $130 million in Medicaid funds, the government health plan which gets most of its money from the federal government, making it by far the state’s largest provider of substance use services.

Robinson and his wife, Lelia, own ARC and some related entities which provide them with an annual income of $533,400, according to a 2022 tax filing of a related non-profit company, Odyssey Inc.

The company has been singled out for praise by politicians including Kentucky Gov. Andy Beshear, who spoke at an ARC ribbon cutting for a new ARC facility in March.

“With the help of organizations like ARC, we are working to build a safer, healthier commonwealth for our people,” Beshear said.

He also praised Robinson, ARC’s founder, in his State of the Commonwealth speech in January.

“With us today,” Beshear said, “is Tim Robinson, founder and CEO of ARC, an essential partner in our fight against addiction. … I’m proud to say we now have more treatment beds per capita than any other state in the country.”

From mid-2021 through the end of 2023 Robinson, his corporations and employees gave at least $252,500 to political committees supporting Beshear, according to reporter Tom Loftus’ analysis in the Kentucky Lantern of campaign finance records.

The donations to Democrat Beshear were a shift in the giving pattern for Robinson, a lifelong and loyal Republican. He also gave big to Beshear’s opponent in the 2019 governor’s race, Republican incumbent Gov. Matt Bevin.

The Lantern’s analysis shows that — including money contributed to Beshear committees — Robinson, his corporations and employees have made at least $570,000 in political contributions over the past decade as his for-profit company grew.

He also has donated to Kentucky Republican lawmakers, including some who wrote recent letters on ARC’s behalf, asking that rate cuts proposed to ARC and other addiction providers be suspended until further study.

The rate cuts of 15% to 20% proposed by three of the six private insurance companies that process state Medicaid claims became public recently at a legislative hearing. ARC and another provider told lawmakers that such cuts would devastate Kentucky’s efforts to turn the tide of addiction to drugs and alcohol.

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for ARC, told a July 30 legislative committee. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

Six national insurance companies known as managed care organizations, or MCOs, handle the majority of the state’s $16 billion a year Medicaid business. Under contracts with the state, they are paid a fixed rate per member to cover the cost of care.

Brown, the ARC official, told lawmakers this is no time to cut payments for addiction services, citing some indicators of success.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest annual overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

In a statement released after the hearing on the cuts, the Kentucky Association of Health Plans, which represents the MCOs, said its members “are proud to work collaboratively with quality, trustworthy providers of behavioral health and substance use disorder treatment” and access to those services is “top of mind” to ensure those in need receive care.

“Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care,” it said.

The FBI posting on the website seeking information on ARC does not provide further information about the nature of the investigation,

A spokeswoman did not immediately respond to a request for comment.

A questionnaire people are asked to fill out includes several questions including whether they have been or are a patient at ARC and if so, what services were received. It also asks whether the person responding has ever made a complaint before about ARC and if so, to whom.

Lawmakers join Ky's largest addiction treatment provider to oppose Medicaid payment cuts; centers trying to negotiate cuts

By Deborah Yetter and Tom Loftus
Kentucky Lantern

The state’s largest provider of drug and alcohol treatment is warning that looming cuts in Medicaid reimbursement to some providers could damage efforts to curb addiction that has engulfed Kentucky — just as the state is showing improvements.

Matt Brown

“Kentucky has made significant strides in access to treatment,” Matt Brown, chief administrative officer for Addiction Recovery Care, or ARC, told a legislative committee Tuesday. “With these cuts, it could completely set back addiction treatment in our state 20 years.”

A handful of companies that provide substance use disorder treatment, including ARC, have been notified they face cuts of 15% to 20% from some private insurers that handle most Medicaid claims, Brown told the committee.

Brown noted that overdose deaths in Kentucky have declined for the past two years after years of rising. Kentucky also has the most treatment beds per resident, most of them through ARC, he said.

The state’s latest annual overdose report, released in June, shows a decrease in deaths to 1,984 from 2,200 the year before, a decline of 9.8%.

Brown was joined by Deron Bibb, chief financial officer for Stepworks, a recovery program based in Elizabethtown, and ARC executive John Wilson, also executive director of the Kentucky Association of Independent Recovery Organizations, speaking to the interim joint Health Services Committee about the cuts.

“This will likely result in higher overdose rates, higher recidivism, more crime and incarceration,” Bibb said. “We need to understand the full scope and impact of these cuts.”

The cuts have been announced by three of the six managed care organizations, or MCOs, private insurance companies that handle claims for most of the state’s $16 billion-a-year Medicaid program, Brown said.

Under their contracts with the state, the MCOs generally have authority to set rates they pay providers. The state pays MCOs a fixed amount per member to cover Medicaid costs.

One company also has begun notifying patients it will no longer cover addiction services at ARC effective Sept. 30, Brown said.

He did not identify the MCOs that have announced cuts and declined to do so after the hearing, saying ARC and other companies are still attempting to negotiate with them.

The Kentucky Association of Health Plans, which represents the MCOs, said in a statement released Thursday by spokesman Tyler Glick, that its members “are proud to work collaboratively with quality, trustworthy providers of behavioral health and substance use disorder treatment” and access to those services is “top of mind” to ensure those in need receive care.

“Health plans strive for the best networks possible and are encouraged by the state to prioritize plan member outcomes and value-based care,” it said.

Sen. Stephen Meredith, R-Leitchfield and co-chairman of the health committee, said Tuesday the lawmakers likely would seek more testimony on the subject, including from the MCOs.

“I know there’s two sides to every story,” he said.

Wellcare, with 420,000 members, is the largest of the six MCOs followed by Passport by Molina, Aetna, Anthem, Humana and United HealthCare. Together they oversee payment of Medicaid claims for about 1.4 million Kentuckians.

Wilson said the recovery organization he represents wants to make sure lawmakers are aware of the situation and already has asked them to voice concerns.

“There’s going to be real world consequences and I think it’s important to let legislators know what’s taking place,” he said.

Some defenders benefitted from owner’s largesse

Several lawmakers have signed letters urging that the MCOs suspend any cuts to substance use treatment until the General Assembly can further review the matter. They include some in key leadership positions and some who have benefited from campaign donations from ARC founder and owner Tim Robinson and his employees.

ARC, a for-profit company based in Louisa, has emerged as the state’s largest and fastest growing provider of addiction services, financed largely by Medicaid, the government health plan with the majority of funds from the federal government. Growth took off after 2014 when substance use treatment was included in the Medicaid expansion authorized by the Affordable Care Act.

The Lantern reported the company took in about $130 million last year in Medicaid funds and was by far the largest recipient of the about $1.2 billion the state spent on substance use treatment.

The company and Robinson also have become among Kentucky’s major political donors with more than $500,000 in contributions over the last decade — with funds divided among Republican causes and those of Gov. Andy Beshear, a Democrat, the Lantern reported earlier this month, citing campaign finance and other public records.

Sen. Phillip Wheeler, R-Pikeville, who has received $19,900 in contributions from Robinson, his wife Lelia and ARC employees since 2016, on July 9 sent a letter to Kentucky Medicaid Commissioner Lisa Lee urging the cuts for addiction services be suspended “until the legislature fully understands the reasons behind them.”

“Kentucky has made great progress in tackling the addiction crisis that has touched so many of our constituents, neighbors, colleagues, friends and family members,” Wheeler said.

Cutting reimbursement now “could negatively affect some of our most vulnerable citizens and prevent us from seeing these positive trends continue,” his letter said.

A similar letter addressed to “to whom it may concern” was signed by Rep. Patrick Flannery, R-Olive Hill, who has received about $17,000 in campaign contributions from Robinson and ARC employees.

Another letter was signed jointly by Senate President Robert Stivers, R-Manchester, House Speaker David Osborne, R- Prospect, Rep. Kimberly Moser, R-Taylor Mill and Meredith. Moser and Meredith are co-chairs of the joint Health Services Committee which heard from ARC and other treatment officials Tuesday.

Republican supermajorities control the Kentucky House and Senate.

Robinson has given $10,000 to the Kentucky House Republican Caucus, and $15,000 to the Kentucky Senate Republican Caucus in the last four years.

Robinson also has given other contributions to campaigns of Republican state legislators in the past decade including $4,100 to Moser and $2,000 to Osborne.

From 2021 through 2023, ARC companies and employees gave about $252,000 to a political committee supporting Beshear, whom Robinson, a Republican, has said he admires and would like to see run for president.

Bibb, Stepworks’ chief financial officer, gave $500 to Flannery in December 2023 and $2,500 to the Kentucky House Republican Caucus in October 2022, according to Kentucky Registry of Election Finance records.

Not asking for more money, just no cuts, says company official

Brown said that one concern of the MCOs is the cost of treatment, in particular long-term treatment for addiction.

ARC understands concerns about costs, but experience shows people with addiction benefit the most from long-term services, Brown told the committee.

“It is not just about surviving from their addiction but thriving in their communities,” he said. “Long-term treatment is vital.”

Without quality treatment, costs to the state will rise elsewhere, Bibb said.

“These costs will not go away,” Bibb said. “They simply will shift back to the emergency room, the judicial system, foster care, homelessness.”

ARC is willing to work with the MCOs and the state to ensure it is using money efficiently and effectively, Brown said after the hearing.

“Everybody’s got to be good stewards,” he said. “We’re committed to helping provide a solution.”

Brown and Wilson said representatives of treatment providers plan to meet with MCOs and state officials in coming weeks to try to resolve their differences.

“We’re not asking for more money,” Brown said. “We’re asking for no cuts.”

Wheeler, in an interview, said he appreciates the support of Robinson, a longtime friend since college together at the University of Kentucky, but that’s not why he sent the letter.

Rather he’s concerned about the impact of cuts of up to 20% on ARC’s services, which he said have helped many people in the region including a brother who benefited from its treatment program.

Also, he said, ARC is a major employer in the area where jobs have been scarce and also trains its clients for jobs.

EMS staffing shortages are at crisis level, says Kentucky EMS board chair

Centers for Disease Control and Prevention photo

By Melissa Patrick
Kentucky Health News

Kentucky's Emergency Medical Services are facing severe staffing shortages, with low pay, "abysmal" reimbursement rates and high turnover identified as the key reasons for the problem.

"We lose more paramedics every year than we gain, unfortunately. . . . We're hemorrhaging providers, we're losing more paramedics than we can replace,"  Kentucky Board of Emergency Medical Services Chairman John Holder told lawmakers at the July 30 Interim Joint Committee on Health Services.

Holder said Kentucky has an attrition rate of 21%, which means two out of 10 of their emergency medical technicians, commonly known as EMTs, will not return or certify again next year. Further, he said only 40% of their EMTs work with an EMS service. 

"That means that less than half of those who are certified are actually going to work on an ambulance and treat members of their community," he said. 

Holder said that even with new rules that allow only one paramedic per service, regardless of the size of the service, some EMS services can't even manage that level of staffing

“We're receiving regular calls from EMS services who are saying gentlemen were having to self-report that we cannot meet the staffing requirement as set by regulation, which means they don't have enough paramedics to staff their ambulances,” Holder said. “It truly is a crisis. I mean, we have services that are going to shut down if we can't find a solution to this problem.”

EMS staffing challenges have been ongoing, while the need for services increase. According to Holder's presentation, there were "31,006 more requests for ambulance transport annually than five years previous." 

One of the key challenges is poor compensation, which Holder said is directly related to "abysmal reimbursement."

 

"These EMS services are losing money when they make ambulance runs, which is hard," he said. "So a lot of folks will tell you, 'Oh, well just pay them more. We wish we could. And we would if we could, but with reimbursement the way it is, the pot is just not big enough to draw any more funds out of." 

Another challenge, he said, is poor access to education. 

"So especially in our in our rural parts of the state, our providers are having to travel hours, multiple times a week to try to find this education and they're either unwilling or unable to do it in a lot of cases because they're needed at home," he said. 

Holder said that while there have been efforts to address the workforce shortage, such as decreasing the initial requirements for EMS educators, removing licensing fees for newly certified providers, allowing reciprocity for providers from other states and decreasing the number of providers required for coverage, it hasn't been enough to fix the problem. 

What they need, he said, is increased reimbursement for services in order to increase wages and to secure funding for additional training sites and student scholarships. 

First Federally Qualified Health Clinic residency program opens in Kentucky, with hopes of bringing more rural doctors to state

Update, Aug. 8, 2024: Dr. Jerry Eddis has since resigned from the program. 

By Melissa Patrick
Kentucky Health News

Kentucky's first residency program operated by a Federally Qualified Health Center opened July 1 in Northeast Kentucky, with hopes that the resident doctors will set up practice in rural Kentucky after they complete their training. 

The PrimaryPlus Family Medicine Residency Program will be headquartered in Maysville, Ky.  The primary focus of the residency program will be family medicine with plans to use specialty services such as obstetrics and gynecology and pediatrics to provide residents with a well-rounded experience.

Dr. Tyler Elam

Dr. Tyler Elam, director of the residency program, said FQHCs can play an important role in training physicians because of the populations they serve, who are largely indigent, uninsured or underinsured.  

"I think there is a greater . . . mutual benefit for having the learners present in an FQHC," he said. "It helps us close care gaps for the indigent, while also being able to train new physicians."  

Kentucky's program is one of 81 Teaching Health Center Graduate Medical Education programs that operate in 24 states and Washington, D.C., said Elam. 

Research shows that medical students who trained in rural areas are almost twice as likely to practice in rural areas whether or not they grew up in a small town, a topic explored in a blog post from the National Rural Health Association. Further, studies shows that physicians from rural backgrounds were more than twice as likely to practice in a small town, compared to urban counterparts.

And that is the goal of the PrimaryPlus residency program. "That really is part of our mission, is to train them here and keep them here," Elam said. 

There is a great need for rural primary care physicians in Kentucky, according to the 2022 Kentucky Physician Report from the University of Kentucky Center of Excellence in Rural Health. The report says 43 of 120 Kentucky counties meet the criteria for a primary care physician Health Provider Shortage Area. Nearly 73% of of Kentucky's 2,741 primary care physicians practice in urban counties despite the majority of the population living in rural counties.  

PrimaryPlus's residency program will bring four new primary care residents into the state each year.

The first class of residents are Dr. Devaki Dravid and Dr. Jerry Eddis, both from Pennsylvania. Devaki received her medical degree from Philadelphia College of Osteopathic Medicine and Long received his from American University of the Caribbean School of Medicine. Dr. Brion Long is from Breckinridge County, Ky. and Dr. Sara Roberts is from Bath County, Ky. Both Long and Roberts attended the Kentucky College of Osteopathic Medicine at the University of Pikeville. 

Elam said the new residency slots will help to meet the ongoing demand for more primary care physicians, especially as baby boomers continue to need more care.  

"There's not necessarily enough residency spots to keep up with the increasing medical school class sizes. And so, you know, there's like a supply and demand mismatch as a result," he said. "So the more residency spots we can open up, it definitely closes that care gap downstream."

Already, Elam said the resident doctors have been able to close some of the care gaps in the community and have contributed to the wellness of the medical community, who often work short-staffed. 

"The residents are thriving and loving it here," he said. "They'll come to my office and be like, 'Man, this is so great. I didn't know that learning could be like this. I feel like I'm part of the team. I feel like I'm making a difference. And I feel like I'm learning simultaneously.'"

Study finds blood test diagnosed Alzheimer's disease 90% of the time; early diagnosis is crucial with new medications available

2024 Alzheimer's disease facts and figures
special report graphic

By Melissa Patrick
Kentucky Health News

A new blood test can diagnose Alzheimer's disease better than a memory specialist or a primary care physician, according to a new study. 

The study, published in the Journal of the American Medical Association, found that the blood test, called PrecivityAD2, was 90% accurate in diagnosing Alzheimer's disease, compared to a 61% success rate among primary care doctors and a 73% success rate among memory specialists. All of the physicians used standard clinical methods for diagnosis that did not include brain scans or spinal taps. 

The researchers at Lund University in Sweden followed 1,213 people with an average age of 74 who were undergoing cognitive evaluations in both primary care and specialty clinics in Sweden.

Dr. Greg Cooper, director of the Norton Neuroscience Institute Memory Center in Louisville, explained that there are protein biomarkers that are indicative of Alzheimer's disease and can be identified through a a spinal tap, which is invasive, or a brain scan called a PET scan, which he said are not always available, are expensive and are not well-covered by insurance. 

But now, he said, there is a blood test that can accurately detect these biomarkers. The blood test works by measuring a combination of two ratios within a blood sample, including the phosphorylated tau protein and two amyloid-beta proteins, both considered  hallmarks of Alzheimer's disease. 

"Most people would prefer a blood test over a spinal fluid exam, a spinal tap," he said. 

Cooper added that the blood test should be used only on people who show signs of memory loss or have a diagnosis of mild cognitive impairment or dementia. In this group, he said, "It is a very accurate test." 

Further, he said this blood test will help people get an early diagnosis, which is needed to qualify for the two new drugs approved to modestly slow the symptoms of Alzheimer's: Leqembi and Kisunla. At this time, Cooper said it can take months or even years before a person can receive a diagnosis. 

"As newer medications become available . . . we need to do a better job of identifying people very early on, when they are the best possible candidates for these medications that we believe actually slow the progression of the disease."

According to the Alzheimer's Association, nearly 7 million Americans are living with Alzheimer’s disease, with this number projected to rise to nearly 13 million by 2050. In Kentucky, the association reports that 81,000 people aged 65 and older are living with Alzheimer's.

Cooper said the Norton memory center is already using this blood test, but there remains some barriers.

"The biggest barrier right now has been in terms of payments," he said. "So we are using this exact same test that was used in this study and the results are really quite good. But payment is an issue.Insurance does not always cover this and so there is often an out-of-pocket expense."

He said he is hopeful that with studies like this one and future U.S. Food and Drug Administration approval, insurance will eventually pay for it. " I think it is only a matter of time before insurance starts paying for it, "he said. "At this time, it's just simply too new." 

He said it "remains to be determined" if primary care doctors should do this blood test, largely related to their ability to do cognitive memory testing in their practices. With the advent of these new medications that require early diagnosis, he said there is a sense of urgency to diagnose people early on and a patient's first point of contact is often their primary care provider. 

"The worst thing in the world is to tell someone had I seen you six months or a year earlier, you might have been a candidate for one of these new treatments -- and now you're not," he said. "Tests like this will help accelerate that process and allow more people to benefit from these therapies."

Recognizing that many people are afraid of getting an Alzheimer's diagnosis, Cooper said: "I would simply argue that not receiving a diagnosis, if you have that underlying disease, doesn't make the disease go away. You can't ignore it. It will catch up with you eventually. But now, we have opportunities to take a proactive approach. Maybe we can't cure it, but we can do things that meaningfully impact the disease and can meaningfully impact and promote our quality of life. So it is an awful diagnosis, I can't take that away. But we can't help unless we take that first step. And so always keep in mind, there may be things that we can do. Don't run away from that." 

State judge dismisses constitutional challenge to anti-vaping law

Kentucky State Capitol Building

By Sarah Ladd
Kentucky Lantern

Franklin Circuit Judge Thomas Wingate has dismissed a lawsuit challenging the constitutionality of a 2024 law banning the sale of some vaping products.

Wingate sided with the lawsuit’s defendants — Allyson Taylor, commissioner of the state Department of Alcoholic Beverage Control, and Secretary of State Michael Adams — who filed a motion to dismiss. The law designates the ABC as its enforcement agency.

The Kentucky Smoke Free Association, which represents vape retailers, had argued that the law was too broad and arbitrary to be constitutional because it is titled “An act relating to nicotine products” but also mentions “other substances.” The state constitution says a law cannot relate to more than one subject.

In his opinion, Wingate said the law doesn’t violate the state constitution.

The law’s title “more than furnishes a clue to its contents and provides a general idea of the bill’s contents,” he wrote.

The law’s “reference to ‘other substances’ is not used in a manner outside of the context of the bill, but rather to logically indicate what is unauthorized,” Wingate wrote.

The lawsuit centers on House Bill 11, which passed during the 2024 legislative session and is scheduled to take effect Jan. 1. Its backers said it will curb underage vaping by limiting sales to “authorized products” or those that have “a safe harbor certification” based on their status with the U.S. Food and Drug Administration.

Opponents have said it will hurt small businesses and favor big companies, and could drive youth to traditional cigarettes.

Altria, the parent company of tobacco giant Philip Morris, lobbied for the bill and is pushing similar bills in other states. Altria, which has moved aggressively into e-cigarette sales, markets multiple vaping products that have FDA approval.

“The sale of nicotine and vapor products are highly regulated in every state, and the court will not question the specific reasons for the General Assembly’s decision to regulate and limit the sale of nicotine and vapor products to only products approved by the FDA or granted a safe-harbor certification by the FDA,” Wingate wrote in a Monday opinion. “The regulation of these products directly relates to the health and safety of the commonwealth’s citizens, the power of which is vested by the Kentucky Constitution in the General Assembly.”

Kentucky's first emergency psychiatric unit opens in Lexington

The unit has a separate entrance. (UK photo by Hilary Brown)

By Allison Perry
University of Kentucky

State officials, community leaders and UK HealthCare officials celebrated Tuesday's opening of a new emergency unit in Lexington dedicated to the treatment of patients experiencing a mental health crisis.

The EmPATH (Emergency Psychiatric Assessment, Treatment and Healing) Unit is the first of its kind in Kentucky. It will open at 7 p.m. Tuesday, July 30, on the campus of Eastern State Hospital.

“The EmPATH model is a game-changer for mental-health care, and we are so proud to be the first in the state to open this unit,” said Robert S. DiPaola, UK's co-executive vice president for health affairs. “For many, seeking care for a mental-health issue can be difficult, frustrating and even frightening. With EmPATH, we’re using a proven, evidence-based approach that allows our behavioral health team to provide fast, appropriate evaluation and care that’s easier for patients to access in an environment conducive to healing.”

The U.S. has about 30 EmPATH units. UK HealthCare and New Vista, a mental-health care provider in 17 counties in the Lexington area, have collaborated with leadership from the state Cabinet for Health and Family Services to bring this new model of emergency behavioral health care to Kentucky.

Pioneered by DR. Scott Zeller, an internationally known emergency psychiatry expert , EmPATH units are carefully designed physical environments that help patients experiencing an acute mental health issue receive immediate support. Instead of individual treatment rooms, the units are wide open spaces with comfortable seating. Upon arrival, individuals will interact with supportive health care providers including psychiatrists, nurses, social workers, and even peer support specialists and can stay in the unit for up to 23 hours.

Eastern State Chief Administrative Officer and psychologist Lindsey Jasinski says peer support is one of the main factors that has made the model so successful. Patients will have the chance to speak to others who have deal with taking medication, receiving therapy, and participating in different programs.

“We have those folks here in the unit to say, ‘Can I share my experience with you?’” Jasinski said. “It can be helpful to hear from someone who has been in a difficult place and been able to successfully navigate that. It provides hope, and that’s what the EmPATH model is all about.”

At roughly 11,000 square feet, the EmPATH unit has room for up to 12 patients. Providers and support staff will regularly assess the individual’s symptoms and develop a care plan, which could include a treatment plan and discharge home with connection to appropriate outpatient services, or admission as an inpatient for round-the-clock care.

Studies show that 60 to 70 percent of individuals who come to an EmPATH unit are stabilized and back home within 24 hours; patients treated in these units are also far more likely to continue their care. A study published in Academic Emergency Medicine showed that 60% of individuals in rural areas with suicidal thoughts or ideation sought follow-up care after their initial treatment in an EmPATH unit.

In addition to providing faster, more appropriate care for psychiatric patients, the EmPATH unit will help reduce the load on traditional emergency departments. A 2020 study of emergency-room visits related to mental health showed an increase from 6.6% to 10.9% from 2007 to 2016. Zeller and the physician-owned partnership Vituity, which helps hospitals develop their own EmPATH units, estimate that 12 to 15% of ER visits are related to behavioral health.

While ERs can provide critical care to acute injuries, illnesses, and traumas, they often do not have the resources or staffing to effectively treat individuals in a mental health crisis. Because ERs must prioritize patients with life-threatening issues, those coming to an ER for mental-health care are likely to experience long wait times in an environment that isn’t conducive to helping these individuals.

“Our emergency departments give amazing care and save countless lives every day,” said Dr. Andrew Cooley, a UK HealthCare psychiatrist who has served as chief medical officer for Eastern State Hospital since 2013. “But we know that patients who come in with a life-threatening injury will need to take priority, and patients experiencing a behavioral health crisis will be further down the list to receive treatment. EmPATH is the alternative to that – a patient shows up here, and we immediately greet them and begin care.”

The EmPATH unit is open to adults age 18 and over experiencing a behavioral health crisis, which has a broad definition: any mental-health problem that impairs their ability to perform normal daily functions, take care of themselves, and keep themselves safe. That could include those seeking help for a substance use disorder, those experiencing depression and anxiety, someone who is thinking about self-harm or suicide, and more. Patients may be brought in through emergency medical services, or may self-refer and bring themselves in.

“The patient defines the crisis. We’re very open-door,” said Marc Woods, Eastern State's chief nursing officer. “We immediately try to assess what their needs are – not only for behavioral health, but also their basic needs. It allows our clinicians to say, ‘Are you hungry? Would you like a Coke?’ We’re quickly building a relationship so we can help address not only a mental health issue, but also get them connected to other services to improve their overall health and wellness.”

The EmPATH unit is part of UK HealthCare and will have its own entrance at Eastern State's campus, on Bull Lea Road in Lexington. The entire hospital is owned by the state Department for Behavioral Health, Developmental and Intellectual Disabilities and is managed by UK HealthCare. It operates 195 acute-care beds and provides critical, recovery-focused psychiatric care for adults from a 50-county region of the state.

UK expands heart and vascular care to hospitals across the state

By Melissa Patrick
Kentucky Health News

One of the many ways that UK HealthCare strives to improve the heart health of Kentuckians is through its Gill Heart and Vascular Institute Affiliate Network, which includes a community of hospitals across the state working to ensure patients receive high-quality cardiac care close to home. 

The program serves a great need, since heart disease is the leading cause of death in Kentucky and the state has one of the country’s highest rates of heart disease. 

Dr. Navin Rajagopalan

Dr. Navin Rajagopalan, director of the affiliate network, said it is made up of over 20 hospitals throughout the state.  

"Our key mantra is always . . . one of collaboration," he said. "The University of Kentucky is a big hospital, we have lots of services here. But we never want to be seen as competing with local, community hospitals for their patients. So we want patients to stay local for as long as possible to receive optimal cardiovascular care." 

He added that while it's important for UK's program to remain strong for patients who may need higher levels of care, the goal of the network is to "provide resources, education, and training, where appropriate, to the hospitals in our network." 

New to the network is Owensboro Health Muhlenberg Community Hospital in the Muhlenberg County seat of Greenville, featured recently in a UK news release. CEO Ed Heath said being in the network "furthers our mission to heal the sick and to improve the health of the communities we serve." 

“We look forward to utilizing the expertise of UK HealthCare and the perks of this affiliation to better serve our patients," he added.

Rajagopalan stressed that the program isn't about UK taking over a hospital's cardiovascular program, but is designed to foster collaboration and expertise-sharing among the member hospitals. Members of the network have access to educational resources, quality-improvement initiatives and specialized training, and Rajagopalan said the network can provide outreach clinics or assist with cardiovascular imaging. "The idea . . . is that patients can receive specialized care close to home," he said.

When Dr. Michael Karpf was running UK HealthCare in 2013, he said it needed to expand its geographical reach to maintain its newly raised national status and to ensure access to quality care for Kentuckians. "We want the hospital to be the first choice when it comes to complex care,” he said, identifying several regional competitors. First on his list was Vanderbilt University in Nashville, which is 80 miles closer to the Greenville hospital than UK and gets many patients from Western and Southern Kentucky. It has locations in Hopkinsville and Franklin.

Asked if UK's program is driven by competition in any way, Rajagopalan said, "No, we make it very clear that this is not based on referrals." 

Hospitals in UK's Gill Heart and Vascular Institute Affiliate Network (UK HealthCare map)

Rajagopalan said UK is not actively recruiting new hospitals into the network and already had some relationship with many of them. More often, he said, hospitals will call UK with a question about something and that's how they learn about the program. He added that UK HealthCare also offers the Markey Cancer Center Affiliate Network and a Stroke Care Network. 

As for money, he said fees collected within the affiliate network are put back into the program in some way: "We don't make any money off the network." 

According to the news release, the affiliate network includes 24 hospitals, more than 15 outreach locations and more than 12 sites where Gill provides cardiac image interpretation services across cardiovascular imaging modalities.

Rajagopalan told Kentucky Health News that the work they are doing at the Gill Heart and Vascular Institute Affiliate Network is "relatively unique." 

"We're kind of hoping to have more success stories and kind of share what we're doing to  other academic centers," he said. "Because I think the way that we, as an academic institution, interact with the community hospitals in our region is rather unique in terms of the spirit of collaboration and in trying to support all the hospitals  in the community."

UK HealthCare offers a program to treat pelvic floor disorders, providing up-to-date care and a better quality of life for women

The UK Urogynecology and Reconstructive Pelvic Surgery division is
(from left) Dr. Gerardo Heredia Melero; Briana Bell, advanced-practice
provider; and Dr. Johnnie Wright Jr. (UK photo by Carter Skaggs)

By Hilary Brown
University of Kentucky

A woman's pelvic floor, whether she realizes it or not, is constantly under stress. Pregnancy, obesity and physically demanding jobs can strain the pelvic-floor muscles, which are the network of tissues that support the intestines, bladder, urethra, rectum, cervix, uterus and vagina.

Those muscles are responsible for a number of functions, including controlling urination and bowel movements, as well as supporting the organs within the pelvis. A weak or dysfunctional pelvic floor can lead to a host of symptoms, ranging from occasional urinary incontinence to pelvic organ prolapse, which occurs when an organ in the pelvis slips down from its normal position.

UK HealthCare has a new subspecialty program to treat pelvic floor disorders called the Urognecology and Reconstructive Pelvic Surgery program. The providers are Dr. Gerardo Heredia Melero and Dr. Johnnie Wright Jr. and advance-practice provider Briana Bell. 

This team of experts in pelvic medicine and reconstructive surgery work with patients to develop a treatment plan; those treatments can be as simple as exercises or medications or as complex as robotic surgery.

“At UK HealthCare, we are among the few providers in Kentucky equipped to diagnose and treat common conditions that frequently go undiagnosed,” said Wright. He said the program offers "comprehensive and tailored treatments to women."

He said time is a factor because these disorders need to be addressed early before they are beyond the help of surgical intervention. “The majority of patients come to see us for the management of pelvic floor prolapse,” said Wright. “Probably 40 percent of them experience some degree of urinary dysfunction – either urgency, frequency or urge incontinence.”

Wright and Heredia identified a need for comprehensive care for patients who experienced complications during or after childbirth, both after delivery and years after the fact.

Many women experience urinary incontinence and other symptoms after having children but dismiss them as a normal aftereffect of pregnancy. Other risk factors, such as obesity and occupational hazards such as heavy lifting, can contribute pelvic floor stress. Over time, a weakened pelvic floor could lead to pelvic organ prolapse, which can involve a vaginal hernia. 

Other common symptoms of pelvic floor dysfunction include:

• A heavy dragging feeling in the vagina or lower back
• Feeling of a lump in the vagina or outside the vagina
• Urinary symptoms such as slow urinary stream, a feeling of incomplete bladder emptying, urinary frequency, urgency and urinary stress incontinence
• Bowel symptoms, such as difficulty moving the bowel or a feeling of not emptying properly
• Pain or discomfort during sexual intercourse

Those symptoms can lead to issues that go beyond the pelvic floor. Depression and anxiety are linked to urinary dysfunction; someone who feels they no longer can control their bladder may withdraw and become more socially isolated.

The first and arguably most important step in diagnosing and treating pelvic floor disorders is helping patients understand urinary incontinence is not normal, and that a better quality of life is possible, Wright said

“The greatest impact we can have is with education,” he said. “There’s a small subset, both in patients and referring providers, who believe that if there’s no pain and it’s not cancer, then there’s no reason to worry.”

Urogynecology has been a board-certified subspecialty for 11 years, but many providers have not had the opportunity to participate in a subspeciality fellowship or training. Additionally, Wright and Heredia say a number of patients they see have already had pelvic reconstruction surgery performed with materials and techniques that are no longer standard practice.

Wright and Heredia are working with referring providers throughout the state, spreading awareness of not just the specialized program at UK HealthCare, but about pelvic floor health in general. Surgery should be the last resort, Wright said; physical therapy, relaxation techniques, medication and targeted therapies can offer lasting relief.

“I call it ‘pelvic floor empowerment,’” said Wright. “We welcome anyone who is experiencing incontinence, discomfort or pain.”

With fall sports around the corner, it's time for a sports physical

Centers for Disease Control and Prevention photo

By Dr. Scott Black
University of Kentucky

The potential benefits of letting your child participate in sports are innumerable, but sports also come with inherent risks -- many of them that can be avoided with a sports physical. 

From the intensity of competitive play to the physical demands of training, athletes face potential injuries that could range from mild strains to more serious issues like an irregular heartbeat.

That’s why a sports physical should be at the top of every annual preseason checklist. Not only are sports physicals often required by states and schools prior to athletic participation, they’re also essential for injury prevention and catching preexisting conditions that could keep an athlete off the field.

What happens at a sports physical? While a sports physical should not substitute for an annual checkup or well-child visit, sports physicals are similar in that a medical provider will perform a physical examination of your child to evaluate if they can safely take part in sports.

The health-care provider may inquire about your child’s medical history by asking about any known medical problems like asthma or diabetes, past injuries like concussions or broken bones, allergies, medical issues that may run in the family, medications your child is taking, including over-the-counter medicines or supplements and their diet. 

The provider will also typically record your child’s height and weight, check their blood pressure, listen to their breathing and heartbeat, examine their reflexes and muscle, bone and joint health and test their vision

If the doctor determines your child’s health is fit for the field, they’ll clear them for competition. Should they identify anything of concern, the provider might offer a treatment plan or refer your child to a specialist for further evaluation.

It’s recommended to schedule your child’s sports physical several weeks prior to the start of the school year. That way, if there is an issue, your child can begin treatment well before the beginning of the season.

Where should we go for a sports physical? Many families go to their primary care providers to get their sports physicals done. Some schools or clinics may offer free sports physicals on a particular day, but that examination may be less personal, especially if your child doesn’t already know the provider.

Do we still need to do a check-up? While a sports physical is similar to an annual checkup, they’re not the same. Annual check-ups are crucial to making sure your child’s development is on track, is up to date on vaccinations and that your child is generally healthy.

A sports physical can’t replace a check-up, but you can ask your provider’s office if they can be done at the same time.

Dr. Scott Black is clinical director of the University Health Service at the University of Kentucky.

Drug to reverse opioid overdoses is more available than it used to be; health official says stigma still exist around carrying it

By Shepherd Snyder, WEKU

The annual Kentucky Drug Overdose Fatality Report says overdose deaths in 2023 dropped by 9.8 percent from the year prior; 2022’s report showed a 5 percent decrease compared to 2021.

Photo from Wikimedia Commons

That comes as access to naloxone has improved, in part because of state and federal programs that support local health departments and emergency services.
Holly Buchenroth, an assistant professor in Eastern Kentucky University’s Emergency Medical Care Program, says requesting access to naloxone has become an easy process.

“Any first-responder agency can get access to this naloxone if they qualify and are in a rural county that's eligible, and all they have to do is complete a training, make a request and document the usage or distribution,” Buchenroth said.

Naloxone is a nasal spray medicine that reverses opioid overdoses with no negative side effects. It’s also sold under the brand names Narcan and Evzio.

Kentucky got $800,000 last year from the federal government to dispense Narcan to first responders in rural counties. Last year, more than 160,000 units of the medicine were distributed across the state.

Scott Lockard, public health director of the Kentucky River District Health Department, says the added resources have been a big help. The health department serves Knott, Lee, Leslie, Letcher, Owsley, Perry and Wolfe Counties. 

“A couple years ago, Narcan was much harder to access, and we've seen much more awareness around harm reduction and the importance of getting Narcan, naloxone out there,” Lockard said. “So pretty much there's no excuse now.”

Other agencies, like the Pike County Health Department have fared similarly. Director Tammy Riley says in 2021, the agency wasn’t able to distribute any naloxone kits to individual community members, with just 82 Narcan kits distributed to the county in total.

They’ve since been able to turn that around.

“Compare that to our 2023 data, 3,500 Naloxone kits were distributed through the harm reduction program, 25 Naloxone kits through first responder and community organizations and 240 Naloxone kits to individual community members,” Riley said.

Riley says they’ve also focused on education. For every box of Narcan they give out, they inform its receiver on how to use it.

“When you see those numbers of distribution, every box that's distributed to an individual is provided with about a five to 10 minute education session,” Riley said. “We don't just hand naloxone to an individual and say, ‘Good luck.’”

The life-saving drug is also getting cheaper. Buchenroth says that’s in part because of its availability over-the-counter at chain pharmacies.

“You can pick up a generic two pack now for about $35, so the price has come down,” Buchenroth said.

But access in rural areas could still improve. Riley says in places like Pike County, where the health department covers a large area, it’s harder to follow up with those in recovery compared to urban areas like Lexington or Louisville.

“We need a Quick Response Team in Pike County, so when those individuals do refuse those 911, first responder services, we could deploy a Quick Response Team to find that individual in the throes of reversal when they're most likely to seek treatment,” Riley said.

Other officials, like Lockard, say getting rid of the stigma that carrying Narcan involves is also an issue.

“Although the resource of the service may be here, they're still reluctant to make themselves available to the resources that they can access,” Lockard said. “So how do we reduce the stigma? How do we do more training in the communities?”

Maria Slone is a social worker with Lexington’s community paramedicine program and works with a quick-response team. She says there’s a simple way to bridge that gap: community involvement.

“They're not going to have as many resources as we have, but how much buy-in is in their community members and their law enforcement and their courts and EMS providers?” Slone asked. “What does that look like for them to have that buy-in?”

Most recently, the state has launched a website that shows a map of all the locations naloxone is available, both for free and for purchase. It’s available at findnaloxone.ky.gov.