Kentucky Hospital Association says its annual survey shows state continues to have an 'acute shortage' of health care workers

Kentucky Hospital Association graph; to enlarge, click on ot; to download, right-click.

By Melissa Patrick
Kentucky Health News

The Kentucky Hospital Association's annual Workforce Survey Report says Kentucky suffers from an "acute shortage" of health care workers, with nearly 13,000 job vacancies in hospitals across the state at the end of 2022.

“While the shortage of health-care workers is nationwide, it has hit the commonwealth especially hard, and KHA is working with multiple partners to find ways to address the challenges,” KHA President and Chief Executive Officer Nancy Galvagni said in a news release.

The KHA Workforce Survey Report provides an in-depth look at the non-physician hospital workforce in Kentucky. It found that Kentucky had a 15% vacancy rate among that workforce in 2022.

Of the 13,000 open jobs, nearly 5,000 were openings for registered nurses and nearly 300 for licensed practical nurses, teh survey found. And, there are over 1,000 open slots for nursing aides. 

For the first time, hospital-employed paramedics, EMTs and other EMS personnel are included in the report. They had the highest vacancy rate among non-nursing occupations (19.2%), followed by respiratory therapists (15%) and behavioral-health professionals (12%). 

Kentucky Hospital Association charts; click to enlarge

The survey report shows vacancy rates differ from region to region with only two area-development districts, Green River and Fivco in the northeast, having vacancy rates below 10% for registered nurses and all hospital employees. The Kentucky River ADD, in the southeast, has the highest vacancy rate, with nearly 24% of its hospital workforce and 34% of its RN positions vacant.

The survey shows that the shortage of registered nurses is the most pronounced, with four AD districts having registered-nurse vacancies above 20 percent – Barren River (21.2%), Lincoln Trail (22.3%), Buffalo Trace (22.4%), and Bluegrass (23.7%). Vacancies employee vacancies above 20 percent, Kentucky River (23.7 percent).

The report notes that the level of vacancies means wait times are longer for those seeking treatment.  KHA says it is working with hospitals to actively convene partners to address these provider shortages, including the Kentucky Chamber of Commerce, the Council on Postsecondary Education and the Kentucky Community and Technical College System, along with nurses and hospital administrators. 

“Our primary objectives are to expand Kentucky’s health care workforce pipeline, remove barriers to health care education, retain the current health care workforce, and redesign models of care,” Russell F. Cox, president and chief executive officer of Norton Healthcare and chair of the KHA Workforce Committee, said in the release. “Through extensive public and private sector collaboration, we are poised to help more Kentuckians attain rewarding, long-term careers in health care while improving the health of our communities.”

The news release notes that the work of this committee is crucial because a new Global Data study, commissioned by KHA and the Kentucky Board of Nursing, shows there will be a shortfall of 6,000 RNs by 2035, which is about the same as it is today. 

Ky. Hospital Assn. hands out annual quality awards to hospitals

The Kentucky Hospital Association recently gave Kentucky hospitals its annual Quality Awards, honoring them for their leadership, innovation in quality, safety and commitment to patient care. The recipients were: 

• Bluegrass Community Hospital in Versailles and Deaconess Union County Hospital in Morganfield - critical access hospitals 
• Rockcastle Regional Hospital in Mount Vernon - hospitals with fewer than 100 beds
• Ephraim McDowell Regional Medical Center in Danville and St. Claire Regional Medical Center in Morehead - hospitals with 100 to -250 beds
• St. Joseph Hospital, Lexington, and Owensboro Health Regional Hospital - hospitals with more than 250 beds
• The Brook Hospital-KMI, Louisville - psychiatric hospitals
• Continuing Care Hospital, Lexington - physical rehabilitation or long-term acute care hospital 
• St. Elizabeth Healthcare of Northern Kentucky - system project
• U of L Health, Louisville - KHA Quality-Centered Health System Award, a new one for the association

"These hospitals and systems demonstrated not only a dedication to patient safety, but their persistence in going above and beyond what is expected for providing quality care," a KHA news release said.

Freestanding birth center bill hits roadblock: Senate floor leader

3/10/23: This story has been updated. 

By Melissa Patrick

Kentucky Health News

Even though a Senate bill to remove the state's certificate of need requirements from freestanding birthing centers has passed out of the same committee twice, most recently in weaker form, and the House version of the bill has cleared a committee, the prospects of it becoming law have dimmed. 

Sen. Damon Thayer

Senate Majority Floor Leader Damon Thayer, R-Georgetown, said at the March 3 Licensing and Occupations Committee meeting that while he appreciated the sponsor's efforts to improve the bill, made at his request, bills regarding certificates of need for health-care facilities "are not moving forward this session." 

Thayer, who calls bills up for a vote on the Senate floor, said "It’s very likely that we’re going to have a task force or a working group or one or two committee meetings dedicated to the certificate of need issue this summer."

Senate Bill 67, sponsored by Sen. Shelley Funke Frommeyer, R-Alexandria, cleared the Licensing and Occupations Committee on Feb. 21 on a 9-2 vote. On March 3, it was recommitted to the same committee, and on March 7 the panel approved an amended version of the bill by a vote of 7-3. 

The "no" votes came from Republican Sens. Amanda Mays Bledsoe of Lexington, Chris McDaniel of Ryland Heights, and Thayer. Sen. Donald Douglas, R-Nicholasville, a physician, passed.

"The committee sub is good and it moves it in the right direction," Thayer said in explaining his vote. "But I think I would be disingenuous knowing that we're probably going to take a deep dive into this issue during the interim. . . . I'm going to vote no because I just don't think it's ready for prime time yet." 

The new version of the bill would only allow freestanding birthing centers that have four or fewer beds to be exempt from having a certificate of need.

"This truly is a concession to the Kentucky Hospital Association," Funke Frommeyer said.

Funke Frommeyer told Kentucky Health News that the changes to the bill that were suggested after it passed the first committee "came straight from the KHA," even though "not once did they reach out to me to talk through their concerns before I brought the bill to committee." 

Freestanding birthing centers only provide vaginal deliveries for women with low-risk pregnancies.  Funke Frommeyer told the committee that Kentucky is one of only eight states that do not offer freestanding birthing centers. 

When asked, Funke Frommeyer wouldn't say the bill was dead. However, she suggested an immediate way forward for freestanding birthing centers in Kentucky is for hospitals to open and run them, like the Vanderbilt model the KHA described in the committee. 

Thayer was not so optimistic when asked if there was any hope for the bill this session.

"It doesn't look good for this session," he said. "It just doesn't have the votes to pass the Senate and it's probably going to go into this entire certificate of need conversation we're going to have during the interim."

Senate Concurrent Resolution 165 to establish the CON Task Force was introduced in the Senate March 10, with 27 sponsors. The resolution calls for all findings and recommendations to be submitted to the Legislative Research Commission by Dec. 1, 2023. 

Kentucky hasn't had a freestanding birthing center since the 1980s, although it has administrative regulations for licensing them and qualifying them for Medicaid reimbursement.

The revisions also added that the Cabinet for Health and Family Services would delineate requirements for medical malpractice insurance for the freestanding birthing centers, refers to the centers as health facilities instead of institutions and adds some screening and reporting requirements. 

Proponents of the birthing centers say the greatest roadblock to these centers is the certificate-of-need law, which require a center to prove that there is an unmet need for services before it can open, which allows providers and hospitals to challenge the would-be competitor's application.   

Several hospital officials spoke against removing the requirement. KHA President Nancy Galvagni argued that the certificate-of-need process is necessary for the health and safety of patients. 

"The proposed legislation and the committee sub to remove freestanding birthing centers from CON would require a change in regulation, removing the requirement for oversight of the facility by an obstetrician with admitting privileges at a local hospital," Galvagni said.

She also noted that the bill does not require a written transfer agreement with a Kentucky hospital. "If a complication during birth arises, a quick transfer from the birthing center to the hospital is going to be critical to the health and life of the mother and child. And without those written transfer agreements in place, a complicated birth could easily lead to the death of the mother, the baby or both," she said. 

Thayer and Committee Chair John Schickel, R-Union, scolded the KHA for not bringing its issues to the committee during the interim between legislative sessions, when the issue was discussed. Galvagni said they did not testify because they thought their position on this bill was "very well known." 

House Bill 129, sponsored by Rep. Jason Nemes, R-Louisville, passed out of the Feb. 22 House Licensing, Occupations & Administrative Regulations Committee without dissent and two pass votes. It has received two of its three required readings but still awaits a vote in the full House.

Nemes told Kentucky Health News that even though the Senate bill had stalled, he was heartened by its movement forward this session, largely because it revealed the opponents objections, which will now allow them to address those concerns.  

"I still feel good about it because we got really long into the process," he said. "If we don't get this resolved this session, we're going to have a strong, strong push over the interim and try to get it done next session."

Shaping our Appalachian Region issues a plan to address Ky.'s nursing shortage in the east, where health care is main employer

By Melissa Patrick

Kentucky Health News

Hospital staffing shortages continue across the state, and are so dire in Eastern Kentucky that Shaping Our Appalachian Region, an organization dedicated to revitalizing and diversifying Appalachian Kentucky's economy, has published The Eastern Kentucky Healthcare Action Plan.

"Our regional hospital systems have thousands of well-paying career opportunities ready for hire today. These positions provide stable income and excellent benefits. But most of these available positions in Eastern Kentucky hospital systems are remaining unfilled after weeks, months — even years," says the report. "To compound the issue, hospitals are seeing record turnover rates, thus creating even more demand for trained medical professionals."

The SOAR report says the region’s turnover rates in vital health-care roles are statistically at or above the national turnover rate of 19.5%. In 2021 it was 24.6%. It says health-care jobs are responsible for 17.6% of Eastern Kentucky's economy, more than any other industry in the region. 

"If we can’t fill these open health-care roles, our Eastern Kentucky hospital systems are at immediate risk of reducing, downgrading, or eliminating critical services," says the report. "The impacts would be devastating — and cannot be understated." 

The president of the Kentucky Hospital Association, gave a similar report about nursing shortages across the state at the July 20 meeting of the legislature's Interim Health, Welfare and Family Services Committee.

"The bottom line for hospitals is that our costs are skyrocketing, health care workers are retiring in large numbers and not enough people are entering into the health professions to meet the growing need," Nancy Galvagni said. "The crisis, as you all know, has been in the making for a while; Covid-19 exacerbated it; and of course, there is no quick fix." 

The SOAR report says the personnel shortages are due to many of the same factors that the KHA survey found: "Burnout from understaffing during the pandemic, staff retiring or quitting at record rates, and staff such as RN’s choosing to leave and travel for more competitive pay."

SOAR also says rural areas have been hit the hardest because of a lack of educational infrastructure to train a health-care workforce.  

Noting a recently completed KHA workforce-shortage survey that included nearly every Kentucky hospital, Galvagni said there is a shortage of 5,391 registered nurses and licensed practical nurses in the state's hospitals and that the shortage is most acute for nurses working in medical surgical units, which are reporting a 30% vacancy rate. 

Added to the challenge, she said hospitals continue to rely on travel nurses to staff hospital units, which "come at a national rate of pay" because Kentucky hospitals are competing with wealthier states for the same labor pool. 

"The amount of money our hospitals are spending on travel nurses and premium pay, which is higher wages paid to your existing staff, is growing exponentially, and it is jaw-dropping," she said. 

Galvagni said the survey found that in 2019, Kentucky hospitals spent $88 million on nursing contract labor, and in the first six months of 2022, that number "skyrocketed" to $489 million, an increase of 455%.

In the same period, she said, premium nursing pay, for nurses regularly on hospital payrolls, went from $50 million to $185 million, a 269% increase . 

Galvagni said that while federal programs have helped to meet these enormous costs, "The staffing costs are not sustainable." 

She said the solution must go beyond simply enrolling more students; they must also take and pass the required National Council Licensure Examination to practice. She said 5,067 Kentucky students enrolled in associate degree and bachelor degree nursing programs in 2019-20, but only 3,211 took the NCLEX in 2021, and not all passed. 

Galvagni said more than 18% of hospital nurses are expected to retire over the next 10 years and that that number is even higher for psychiatric nurses (36%) and in recovery-care nurses (28%). 

"With more experienced nurses retiring, fewer entering the workforce and an aging population, the stress on the health-care system is going to demand creative solutions," she said. 

A call to action

One solution, Galvagni said, would be to work with schools to encourage middle- and high-school students to enter a health career. She also encouraged more high schools to offer health career training, including LPN training at the high school level. 

"This would allow students to enter the workforce immediately and then further advance their career through additional training," she said. 

In its call to action, SOAR offers detailed steps for a number of stakeholders, including educators, educational institutions, state and federal legislators, health-care industry leaders and Eastern Kentucky residents. 

"We can trigger a positive domino effect if we all come together across health care, government, education, and Eastern Kentucky communities," says the report. 

Sen. Ralph Alvarado, co-chair of the interim health committee and a physician, said the issue of  health-care worker shortages will likely be "front and center" during the next legislative session. 

And with a word of caution, he described what health care could look like if we don't address this issue, noting that as we start to see health-care professionals exit the workforce at a rate higher than replacement, Kentuckians will see a delay in care, even for risky conditions. 

"We don't necessarily have the right to someone else's labor. . . And there's a lot of people out there that have these abilities that are saying, I'm done. I've had enough," said Alvarado, R-Winchester. "We've relied on the goodwill of a lot of these folks to make this system work, and that goodwill is quickly escaping us." 

Sarah Ladd of the Louisville Courier Journal recently wrote  about the mental-health challenges of nurses, reporting that at least 58 Kentucky nurses have died by suicide from 2016 to 2021, according to Delanor Manson, CEO of the Kentucky Nurses Association. 

"Because we have a nursing shortage . . . mental well-being is decreasing," Manson told Ladd. "And then that leads to more people leaving the profession or leaving their job. And it also makes it challenging to recruit people to go to nursing school."

Efforts to address the nursing shortage

State officials have tried to address the nursing shortage. Gov. Andy Beshear declared an emergency in mid-December, allowing the state to take special measures to educate and license more nurses.

His order required the nursing board to approve requests for enrollment increases if a school has sufficient resources; requires schools to report vacant student seats to the board monthly to post online, and send the board a list of needed faculty; allows a school to open new campuses more quickly; and improves reciprocity with other states.

The legislature passed a bill that lifted enrollment limits for nursing programs, allowed more flexibility in nursing instructors' qualifications, helped out-of-state and foreign-trained nurses practice in the state without compromising standards of care, and set term limits and geographic requirements for the Board of Nursing.

Manson wrote in an op-ed that the legislature needed to approve $100 million to provide direct help to the nursing profession, including raises for nursing faculty and bonus pay incentives to keep nurses on the job. Instead, the General Assembly approved $10 million for a bipartisan Healthcare Workforce Collaborative between Kentucky's education and healthcare industries aimed at expanding health care workers in the state. 

A nationwide problem

Health-care worker shortages are plaguing the nation, with no end in sight, especially as the BA.5 Omicron subvariant drives cases, hospital admissions and deaths up, Krista Mahr reports for Politico. Nationwide, she reports that "as of July 22, hospitals in nearly 40 states have reported critical staffing shortages, while hospitals in all 50 states said they expect to be short-staffed within a week." 

"Hospitals are coping by making compromises," Mahr writes." They’re shifting staff between departments, handling longer emergency room waits and even eliminating routine Covid testing. They’re seeking a new balance, recognizing that they can’t forever sustain the state of vigilance that marked the first two years of the pandemic." 

Further, she writes that the current wave of Covid-19 hospitalizations, which have risen more than 40% in the last month, is also putting fresh stress on facilities at a time when the pandemic response is running out. 

“There is growing concern that this money has run out,” Nancy Foster, vice president for quality and patient safety policy at the American Hospital Association, told Politico. “It’s not really getting sufficient attention.”

Hospital administrators told Mahr that they expect these chronic hospital staffing shortages to continue, especially with the continued spread of Covid-19, a vaccine that prevents serious illness but doesn't keep everyone out of the hospital, continuing resistance to mitigation measures and an unwillingness to ring the alarm bell during a wave where fewer people are getting seriously ill and dying, compared to previous waves.

House passes bill to loan money to struggling rural hospitals; funding is still in the works, but sponsor appears confident

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Spurred to action when the hospital in his county said it was closing, state Rep. Danny Bentley filed a bill to create a loan program for financially distressed rural hospitals. It went from the House to the Senate without dissent Feb. 28, and Bentley voiced confidence that it will be funded.

Rep. Danny Bentley

House Bill 387 would allow the state Cabinet for Economic Development to provide loans to struggling hospitals for three purposes: to maintain or upgrade their facilities; to maintain or increase staff; or to provide health-care services not currently available.

Loans could run 20 years and would be available to hospitals in counties with fewer than 50,000 people.

Bentley, R-Russell, said more than 60 hospitals would qualify for the loans, and 13 of them are vulnerable to closure. One is already closing: Our Lady of Bellefonte Hospital in his home town, a Greenup County suburb of Ashland.

Most questions about the bill dealt with funding. Bentley told Kentucky Health News that it will be funded. The next day, he said that while funding details are still in the works, "Let's put it this way: It's too important not to be funded."

The bill has a powerful co-sponsor, House Speaker David Osborne, R-Prospect. He told The Associated Press that funding could come from state bonds.

“It's the goal to help turnarounds when turnarounds are possible," Osborne told reporters. “That doesn't mean that we can save every hospital that is failing, just like we can't save every business that's failing. But there are some, when given the opportunity, that can succeed, and that's our goal ... to help those that can."

Osborne told the AP that the idea stems from discussions about the state's proposed $35 million loan to the University of Louisville to help it buy Jewish Hospital and other KentuckyOne Health facilities that were at risk of closing. He said concerns were voiced about how the state could also help struggling rural hospitals. The House has passed HB 99, which would approve the loan.

On the House floor, Bentley pointed to the closing of the only hospital in his county as an example of how devastating the loss of a rural hospital can be. Our Lady of Bellefonte will close on April 30, according to a press release from the Catholic group that owns it.

Bentley said that will kill about 1,000 jobs and about $700,000 in annual tax revenue, and make care less accessible. He added, "If they close a rural hospital on us, they will never re-open them. So we've got to be concerned."

If passed and signed into law, HB 387 would take effect immediately. Many rural hospitals in Kentucky are struggling to keep their doors open.

Kentucky Health News reported in October that a Navigant Consulting Inc. study concluded that 16 of Kentucky's rural hospitals, or about one-fourth of the total, are at high risk of closing unless their finances improve. Another study at the University of North Carolina said eight rural Kentucky hospitals are at high risk of financial distress and 23 more are considered to have mid-high risk. The Kentucky Hospital Association, using 2017-18 data, concluded that 35 of the 70 hospitals it considers to be rural are in poor financial health, with 14 of them "very vulnerable." The numbers vary because the studies measure financial distress differently.

Five rural Kentucky hospitals have closed since 2009, four of them since 2014, according to a UNC report.

Bentley said one reason rural hospitals struggle to make ends meet is because most of their patients are on Medicare or Medicaid, which pay less than the full cost of care.

But that's just part of the problem. The Navigant report pointed to other issues, including: a shift from inpatient to outpatient care, which has left hospitals overstaffed and underused; shrinking populations that tend to be older and poorer, meaning that there are more Medicaid and Medicare patients; and not enough money in their budgets to invest in updated, innovative technology.

The hospital association also says changes in federal reimbursement policies have also hurt Kentucky hospitals. It supports Bentley's bill.

KHA President Nancy Galvagni said in an e-mail. "We do not expect HB 387 to be a panacea for the challenges facing some rural hospitals, but it will be an important support for both the hospitals and for our rural communities." She added, "Kentucky’s hospitals are not just buildings where people seek health care; they are also crucial economic players in our communities across the commonwealth."

Michael Rust retires as head of Kentucky Hospital Association; Nancy Galvagni was appointed new president and CEO in May

By Melissa Patrick
Kentucky Health News

Michael T. Rust, who led the Kentucky Hospital Association for 24 years, has retired.

Rust said it was a privilege to have worked for the KHA for 24 years, and attributed the bulk of his success to his communication and listening skills.

Michael T. Rust

"You can be the smartest person in the world, but you've got to stay in touch with these guys, the administrators and the hospitals, and you've got to listen to them," he said. "And that I think was the biggest part of my career, that I really listened to these guys. I may not have had the answer all of the time, but at least I listened and got back to them and communicated with them pretty well."

Rust added that one of his greatest accomplishments was that he was able to recruit and maintain 100 percent of the state's 127 hospitals as members of the association, which he said is quite rare among hospital associations.

Rust said he came to Kentucky by way of Florida, where he had been the senior vice president of the Florida Hospital Association. He worked there for 13 years. Prior to that he served as an administrator of a small rural hospital and the vice-president of operations for a 300-bed hospital, both in West Virginia.

He was also a member of the American College of Health Care Executives and became a fellow of that organization in 1998. In 2001, he was elected to the Council of Regents, the legislative body of the American College of Health Executives.

Asked about challenges facing Kentucky hospitals, Rust said the state's shift from a fee-for-service payment system to a "value-based" system in Medicaid remains a big challenge, largely because 70 percent of Kentucky's patients are covered by a government payor whose payments to hospitals don't cover the full cost to treat patients.

He said the state also struggles with healthcare workforce shortages, but “The hospitals of Kentucky are resilient and staffed with outstanding leadership and the highest quality providers. I have the utmost faith that they will face all these challenges head on and continue to succeed at providing outstanding health care for every citizen of the commonwealth.”

Nancy Galvagni

Nancy Galvagni was appointed KHA's new president and chief executive officer in May. “I am pleased to pass the baton to Nancy Galvagni as I know she will serve the association and its members with distinction," Rust said.

Galvagni joined KHA since 1979 and was senior vice president for the past 20 years, She has served as the executive director of the Kentucky Institute for Patient Safety and Quality, a federally certified patient safety organization and a subsidiary of KHA.

Galvagni is a graduate of Pennsylvania State University, is a past president of the Kentucky Society for Health Care Planning and Marketing and is a member of the American Association of Hospital Accounts. Prior to joining KHA, she worked at the New York Hospital Association.

KHA represents hospitals, related health-care organizations and integrated health-care systems. It is celebrating its 90th year. Galvagni is only the fourth chief executive officer in its history.

Ky. Hospital Assn. gets grant for emergency-room software that tracks patient histories from other sites; could thwart 'ER hopping'

By Melissa Patrick
Kentucky Health News

The Kentucky Hospital Association has been awarded a $250,000 grant to equip Kentucky's emergency departments with software designed to help physicians have access to patient information from multiple sources in real time.

The grant for the software, called EDie, came from Anthem Foundation, the philanthropic arm of Anthem Inc., a major health insurer.

“Information is a powerful tool in medicine, especially emergency medicine when life and death decisions must be made quickly,” Harold C. Warman, president of Highlands Regional Medical Center in Prestonsburg, the first hospital in Kentucky to go live with the software, said in a news release. “EDie instantly consolidates information from multiple sources that would otherwise take hours to obtain, and lets emergency physicians make faster, more informed clinical decisions.”

EDie works by collecting data from thousands of hospitals, urgent cares, clinics and health plans and then packages the data and delivers it to emergency room physicians in real time.

"In one concise report, the ED team can see patient history, visit summaries, medical providers, security events, and even care recommendations like preferred language and drug allergies," says the release.

The grant funds, combined with discounts from Collective Medical Technologies, a Salt Lake City firm that developed the software, will cover one year's costs for nearly every hospital in the state, said Ginger Dreyer, director of communications for the hospital association.

"There are also separate grants to pay the cost for small, rural hospitals to have access to the EDie solution," Dreyer said.

The release says 10 Kentucky hospitals have adopted the technology and 28 others are in the process of installing it.

Dreyer said six five of the 10 that have adopted the program are actively using it, In addition to Highlands Regional, they are Breckinridge Memorial Hospital in Hardinsburg; Hardin Memorial Health in Elizabethtown; Wayne County Hospital in Monticello; and St. Claire Regional Medical Center in Morehead. ; and Twin Lakes Regional Medical Center in Leitchfield.

The release notes that this software will help hospitals identify and support high-risk patients across care settings, with the goal of reducing avoidable readmissions and further enabling statewide efforts to address the opioid epidemic,

“One particularly powerful application of this technology is in fighting Kentucky’s opioid epidemic,” KHA President Nancy Galvagni, said in the release. “Emergency-room hopping is a serious obstacle in helping people suffering from addiction and this software can tell a treating physician if the patient has a history of ER visits for pain treatment. EDie can be the difference between enabling addiction and treating it.”

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Bowling Green hospital no longer releases information about births, in an effort to keep infants safe from possible abduction

The Medical Center at Bowling Green no longer releases information about births to the news media or through social media, following recommendations from the National Center for Missing and Exploited Children.

“This is a decision we recently made for safety reasons,” Jill Payne, executive vice president and chief nursing officer of the large hospital, told Don Sergent of the Bowling Green Daily News. “We’re always assessing and updating our practices.”

Parents who still want to announce the birth of their baby can still do so in the newspaper.

“We will still give people the opportunity to announce the births online and in print,” Joe Imel, director of media operations for the Daily News, told Sergent. “For more than 150 years we’ve listed births, deaths and anniversaries. We still want to offer the community the opportunity to announce these proud moments.”

The National Center for Missing and Exploited Children made this recommendation as an attempt to reduce the number of child abductions.

Graphic from National Center for Missing and Exploited Children; to view a larger version, click on it.

An analysis by the center, which it clearly states is not a scientific study, concluded that there have been 325 confirmed infant abductions in the U.S. since 1965, with 43 percent from health-care facilities, 42 percent from homes and 14 percent from other locations.

A map on the center's website says Kentucky has had four cases of infant abduction in that 53-year period.

The center recommends not posting a mother’s or infant’s full name where it is visible, and not using full names in announcements to the news media, Payne told Sergent. She added that the hospital is working to educate parents about this safety concern.

“We’re starting to inform folks now,” she said. “We’re making parents aware and educating them about using social media. It’s a great way to publicize these things, but sometimes it can be a dangerous place to put information.”

The Kentucky Hospital Association says it does not track such policies of the 47 Kentucky hospitals that offer maternity services. (The state has 92 acute-care hospitals.) Mike Rust, president and CEO, said KHA hasn't taken a position on the issue, and decisions are up to individual hospitals.

Kentucky Hospital Association will be part of a national effort to reduce infections, other acquired conditions, and readmissions

The Kentucky Hospital Association says it will again be part of a national effort to reduce preventable hospital-acquired conditions and readmissions.

“Kentucky hospitals work very hard to provide the highest quality and safest care possible. We are constantly adopting new evidence-based practices to improve our patient outcomes," KHA President Michael T. Rust said in a news release. "Quality improvement is never finished, and we proudly pledge to continue finding ways to sustain the patient safety gains we’ve made, while improving overall quality and safety across Kentucky.”

KHA will participate as part of the American Hospital Association's role in one of 16 "Hospital Improvement Innovation Networks," which will work through 2019 to achieve a 20 percent reduction in overall patient harm and a 12 percent reduction in hospital readmissions within 30 days of discharge. They will also work to assure health equity for Medicare patients, the release says. All efforts will be monitored by the Centers for Medicare and Medicaid Services.

Some areas of patient harm to be addressed include adverse drug events, infections related to central lines, surgical sites and catheters, antibiotic stewardship programs, sepsis, pressure ulcers and injuries from falls.

The release says KHA will build on its ongoing Hospital Engagement Network efforts, which has provided leadership and support for 77 Kentucky hospitals as they reduced preventable readmissions and hospital-acquired infections and other conditions over the past four years.

Bevin names hospital association executive Stephen P. Miller to be Kentucky's new Medicaid commissioner

Stephen P. Miller
image from hfmaky.org

Gov. Matt Bevin has appointed Stephen P. Miller, a hospital industry executive, as the state's new Medicaid commissioner

“As we work to redesign the Medicaid program and transition it to a more affordable, sustainable model tailored to Kentucky’s needs, it is important to have someone with a deep understanding of the healthcare industry leading the Department of Medicaid,” Gov. Bevin said in a news release. “The Commonwealth is fortunate to have someone of Stephen Miller’s caliber, financial acumen, and business experience willing to serve in this role.”

Miller has spent the past 24 years as vice president of finance with the Kentucky Hospital Association. He is a graduate of the University of Louisville, where he received a bachelor's degree in accounting.

“I look forward to heading the agency that provides the safety net for the most vulnerable of Kentucky citizens,” Miller said in the release.

Miller, his wife Mary and their two married daughters live in Louisville.

Medicaid expansion brings increased revenue to hospitals, but has also created different financial challenges

Kentucky's hospitals have seen a $1 billion increase in revenues since the expansion of Medicaid and the launch of Kynect, the state's health insurance exchange program, but the influx of so many new Medicaid patients into the health system has created a new set of financial challenges, Josh Shepherd reports for The Lane Report.

Mike Rust, CEO of the Kentucky Hospital Association, told Shepherd, that "many healthcare systems have seen an overall improvement in their financial position," but Elizabeth Cobb, KHA vice president of health policy, told him that this increase in revenue varies greatly among hospitals and that "some of them are still struggling to keep their doors open despite increasing numbers of payers and a reduction in uncompensated care statewide."

Kentucky leads the nation in reducing its uninsured population, which Health Secretary Audrey Tayse Haynes told Shepherd that the Cabinet for Health and Family Services estimates has "introduced about $2.2 billion in new revenue into the healthcare industry, $1 billion of which has been shared among the state’s hospitals." and that the "ACA influence is credited also with the creation of 11,900 new jobs in the professional healthcare and social work sectors."

Kentucky's uninsured rate is currently at 9 percent, compared to the nation's rate of 11.7 percent, according to the latest data from The Gallup Organization.

But this reduction has caused a "major payer-mix shift," Shepherd writes.

“When it’s said that revenues are up, it’s a relative term,” Carl Herde, chief financial officer for the Baptist Health system, told Shepherd. “We are seeing more patients, doing more services and certainly our charges are up. But we are also experiencing a significant shift in our payer mix. If you are caring for the same or more patients but not getting the same (amount of revenue) as you used to get for services, it creates an operational challenge.”

Medicaid expansion changes"payer mix," creating new financial challenge

Payer mix, loosely defined as "the ratio of patients with commercial insurance coverage, Medicaid/Medicare or other forms of government reimbursement, and those few who still self-pay," varies per community demographic and is a "critical variable" used to assess hospital revenues, Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, told Shepherd..

Cobb explained that even if hospitals are seeing more patients and performing more services, if most of the patients are on Medicaid, the revenue gained from these patients will not cover the cost of treatment because "Medicaid doesn't cover 100 percent of the costs of care." Medicaid reimburses between 70 and 80 percent of charges.

Currans from Harrison Memorial and Herde from Baptist Health told Shepherd that they have seen a shift in their payer mix to more Medicaid patients.

Currans told Shepherd that rural hospitals are affected more than urban ones because they have a proportionately larger Medicaid/Medicare patient population, but Herde said he had not seen "much difference" in this among the hospitals he monitors.

Medicaid expansion has provided free health coverage to more than 400,000 Kentuckians.

Shepherd also writes that there has been speculation that "the influx of Medicaid patients may include low-income individuals and families formerly covered by commercial insurance through an employer," but also notes that this has not been proven.

High-deductible plans and bad debt

A KHA report to CHFS earlier this year showed "dramatic improvement in 2014 in the rate of uncompensated care," because of Medicaid expansion and the influence of Kynect, but Shepherd also writes that the "incidence of bad-deb accounts for hospitals actually is on the rise."

"The ACA’s intent to make healthcare more affordable to a greater number of people is happening, Rust said, but an issue of “under-insured” individuals remains," Shepherd writes.

"This typically involves people who opt for cheaper health insurance plans with high deductibles, which they then can’t pay when they receive care." Shepherd writes.

This is a challenge for hospitals, but is preferable to treating uninsured patients, which still accounts for nearly 10 percent of Kentucky's population, Shepherd writes.

“It’s a lot better for both the patient and hospital to try and work out a payment plan to cover a $5,000 deductible than writing off debts of over $100,000 in cases of injury or a catastrophic illness,” Haynes told Shepherd. Rust agreed: “At least a portion of that debt is getting paid.”

ER overuse and other fiscal pains

Most hospitals are working to decrease the overuse of emergency rooms. Some are working on the development of advance triage units to assess, prioritize and treat critical cases; Baptist Health has opened medical clinics and urgent treatment centers during off-hours; Harrison Memorial is considering adding a clinic next to its ER; and KentuckyOne Health is utilizing telehealth to address this problem, Shepherd reports.

How Kentucky will pay for the expansion continues to be a topic of debate.

The federal government is currently paying 100 percent of the cost, but that will decrease to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and then 90 percent thereafter.

Haynes told Shepherd that "she believes the program is capable of sustaining itself in the long-run and that staying the course long term will result in a healthier Kentucky population and a more vigorous economic engine moving the state’s collective private and public healthcare enterprises forward."

Bill would require Medicaid managed-care firms to pay contracted fees for ER visits; Senate hearing targets two companies

This story has been updated with comments from Wellcare of Kentucky.

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Managed care is touted as a way to achieve value-based care in the Medicaid program, but hospital emergency rooms in Kentucky aren't finding much value in not being paid the contracted price for their services by two of the managed care organizations.

Officials of two Kentucky hospitals told the Senate Health and Welfare Committee Feb. 25 that Wellcare of Kentucky and CoventryCares of Kentucky are denying payment for as many as half of their emergency-room patients who seek care in their facilities, reimbursing the hospital a flat $50 "triage fee," less the patient's $8 co-payment, regardless of diagnostic tests performed in the ER.

Cheri Sibley, CEO of Clark Regional Medical Center in Winchester, noted that emergency rooms are required by law to screen patients with appropriate diagnostic tests to rule out an emergency condition if they come to the emergency room and ask for care.

Wellcare and Coventry are two of the five Medicaid managed-care organizations that oversee care for the state.

Wellcare said in an e-mail that it is required by the Department of Medicaid Services to "have an affirmative program to address the high cost of emergency room treatment for conditions that do not require this level of care." The company said the triage fee is just one measure it has taken; it said an "emergency room prudent layperson program" has helped "identify and sometimes prevent payments as much as 500 percent to 1,300 percent more in an emergency room as compared to a physicians office for common ailments such as ear aches and sore throats."

Sen. Ralph Alvarado, a physician from Winchester, has sponsored a bill that would require MCOs to pay the previously negotiated rate for emergency-room examinations and allow the ER doctor to determine whether a patient's condition is an emergency or not,.

"This bill is an attempt to keep our Medicaid managed-care organizations accountable," Alvarado said at the meeting. "MCOs have been shortchanging our providers and our hospitals -- and, I would argue, purposefully -- for the past three years. . . . MCOs are basically managing health-care cost by non-payments to providers."

Since the advent of managed care in 2011, hospitals have complained about late and denied payments and difficulty dealing with MCOs. "The problem has reached critical mass, threatening the survival and financial viability of our hospitals, and almost every legislature has been contacted by their local hospital provider regarding these (issues)," Alvarado said.

Kentucky implemented managed care as a way to save money. Basically, insurance company subsidiaries get a certain sum per patient and increase their profits by controlling costs. The Cabinet for Health and Family Services maintains that managed care focuses on quality and provides better accountability for care as opposed to the traditional fee-for-service model, but provider complaints about slow payments and rejections of claims have persisted since its inception.

Hospitals bill insurance and Medicaid based on the level of complexity of emergency-room care provided based on the symptoms the patient presents, regardless of the final diagnosis. Payment has typically been based on a fee that was pre-negotiated between the hospital and the MCO.

Wellcare and Coventry have since implemented a non-negotiated "triage policy," which allows these organizations to determine, after the fact, whether a patient had an emergency. If they determine that a patient was a non-emergency, regardless of presenting symptoms and cost of diagnostic procedures (X-rays, CT scans, lab tests, and so on), they only pay $50 minus the $8 co-payment, or $42. Wellcare implemented this policy in September 2012 and Coventry in April 2013.

The legislaure's Administrative Regulation Review Subcommittee found last May that the triage policies did not follow federal standards, according to Sibley and Alvarado.

"One side seems to be meeting their contractual obligation, while the other side seems to be deficient in meeting their contractual obligations," said Sen. Julie Raque Adams, R-Louisville, chair of the committee.

Hospitals can appeal MCOs' decisions, but "hospitals report that only a small number of these are overturned with no explanation of decision given," Sibley said.

Sibley gave an example of a claim that had been determined a non-emergency by one of these companies at her hospital: An 18-month-old girl was brought to the ER because she was blue in color, wheezing and short of breath. She had an X-ray, other diagnostic tests and a breathing treatment, but the hospital was paid $42 by the MCO plus the $8 co-payment, if the patient paid it.

"The two MCOs in question should not be deciding which patients are non-emergencies," Sibley said. "They should be abiding by their negotiated contract and paying the contract rate," 95 percent of allowed cost.

Sibley presented Kentucky Hospital Association data from 64 hospitals affected by these triage policies. The report found that during calendar year 2014, the hospitals reported submitting nearly 380,000 emergency room claims to Wellcare and Coventry, of which 140,000 were denied except for the $50 fee. The overall denial rate was about 37 percent; Wellcare's was 48 percent.

The KHA report said the difference in the flat fee and the contracted rate totaled $37.4 million, and that the more complex visits (and this likely the more expensive) were the ones most often denied payment.

"With one in four Kentuckians now on Medicaid, this problem is only going to get worse, if this is not corrected by this Senate Bill 88," Alvarado's legislation, Sibley said.

Georgetown Community Hospital CEO William Haugh said almost 30 percent of its ER visits in 2014 were Coventry or Wellcare clients. Wellcare classified almost 60 percent as triage cases and paid only $50 each. The hospital appealed 92 percent of those cases, with a success rate of 16 percent, or 285 patient encounters. Haugh said that amounted to a $334,258 underpayment, plus an estimated $40,000 cost for preparing and prosecuting the appeals.

Haugh said Coventry classified 26.4 percent of its clients' Georgetown ER visits as triage and paid only $50 each. The hospital appealed 94 percent of those and had a success rate of 36 percent, or 366 patient encounters. He estimated an underpayment of $148,000 plus $22,000 in labor for appeals, and said the overall financial impact to the hospital was $543,894.

Wellcare said its appeals process allows three opportunities for review, with at least two independent medical directors.

The state Medicaid program's chief medical officer, Dr. John Langefeld, said the emergency-room problems are not a "straightforward, easy issue," He said many patients go to ERs for reasons beyond medical care. The cabinet has said that some hospitals have relied too much on ER revenues.

Sen. Reginald Thomas, D-Lexington, said rural hospitals need to change their business models and wondered if the bill was an attempt to mask that problem. Meanwhile, he added later, there is "documentation that hospitals have benefited from Medicaid expansion" under the federal Patient Protection and Affordable Care Act, in a recent report from Gov. Steve Beshear.

Adams replied that Beshear says, ""It is great, and it's putting all this money back in the system," but in fact we are not seeing it on the provider level."

Alvarado said, "There is a difference between what actually happens and what the governor's office wants to show you. So when you have KentuckyOne [Health] coming out publicly declaring a $218 million dollar loss in one year, that is hardly a profitability for them based on the ACA."

Alvarado said Citibank reported the companies have made $155 million in profits off of Kentucky Medicaid. "I'd get rich, too, if I didn't pay my bills," Alvarado said. "It is an outrage."

Kentucky Hospital Association backs state smoking ban

The Kentucky Hospital Association on Thursday reiterated its support of smoke-free workplaces and public places throughout the state in hopes that 2015 will be the year that legislators pass a statewide ban on smoking in enclosed spaces.

“Kentucky hospitals have treated illnesses like asthma and heart disease as a result of secondhand smoke exposure for too long, only to send patients back out to the very job conditions where they are getting sick," KHA president Michael Rust said. "Secondhand smoke exposure-related illnesses are completely preventable by simply asking smokers to step outside."

Kentucky leads the nation in smoking and lung cancer. The state's lung-cancer death rate is 46 percent higher than the national average, and nearly 1,000 Kentuckians are estimated to die each year from secondhand smoke. And all of these statistics come with a price tag.

"Smoking costs Kentucky $1.92 billion a year in health care costs, $487 million of that in Medicaid costs alone," KHA said in a press release. "It also costs Kentucky $2.3 billion in lost productivity. Secondhand smoke exposure costs Kentucky an estimated $106 million in health care costs each year. Kentucky can no longer afford to shoulder these costs."

Dennis Johnson, KHA board chair and president of Hardin Memorial Health, said "If Kentucky wants to improve our health and attract economic development opportunities, it must make indoor workplaces and public places smoke-free.”

Rust closed the press conference by urging calls to legislators at 1-800-372-7181. "Tell them you support a smoke-free law which would make Kentucky workplaces and public places smoke-free."

Rep. Susan Westrom, D-Lexington, will again be the lead sponsor of the statewide smoking ban bill, according to her office.

Norton Healthcare chief, Hardin judge-executive, former Lincoln coroner receive awards from Kentucky Hospital Association

The Kentucky Hospital Association gave some awards during its annual convention in Lexington on May 9, according to a KHA press release. Stephen A. Williams, chief executive officer of Norton Healthcare in Louisville, received KHA's highest honor, the Distinguished Service Award. Recipients of this award must have not only provided extraordinary service to the association but also shown exceptional leadership in the health-care field.

Hardin County Judge-Executive Harry Berry, board chair of Hardin Memorial Health in Elizabethtown, and Bill Demrow, Stanford funeral director and former Lincoln County coroner who is vice board chair of Ephraim McDowell Health in Danville, received the Health Care Governance Leadership Award. It is bestowed upon people "who have had a positive and sustainable impact on the quality of care in their community," according to the release.

Kentucky hospitals gave $1.96 billion to communities in 2011, including $576.7 million cover of Medicare, Medicaid shortfalls

In 2011, despite economic and financial obstacles, Kentucky hospitals' estimated value of benefits to their communities up 17 percent from the year before, to $1.96 billion. So says the Kentucky Hospital Associated 2011 Community Benefits Report, compiled by the Kentucky Hospital Association with data submitted by hospitals. (Chart gives a breakdown of hospitals' total community benefits and services expenditures in 2011.)

Kentucky hospitals say they absorbed $576.7 million in 2011 shortfalls from Medicaid and Medicare, which cover 19 and 55 percent of Kentucky hospital patients; those losses were 26 percent larger than 2010, and may nearly double under federal health reform, to an estimated $852 million by 2019.

Bridging gaps created by Medicaid and Medicare underpayment is only one example of how the 131 Kentucky hospitals demonstrate their commitment to local communities by investing in community needs, the report says. In addition to covering government shortfalls, community benefits include providing charity care, forgiving bad debt and supporting medical research.

In 2011, the reports says, Kentucky hospitals financed $451 million in charity care, which means they cared for the sick and injured even if those patients could not afford care.

In Glasgow, T.J. Sampson Community Hospital and Dr. Bharat Mody (left), a general surgeon, have teamed up to fulfill the unmet health care needs of low-income, working, uninsured or under-insured adults of Barren County through a charity program called Community Medical Care. The program provides assistance with basic coverage for those who qualify, in addition to helping cover the cost of medications, glasses or hearing aids.

In 2011, Kentucky hospitals absorbed $426.5 million in bad debts, losses due to patient non-payment that often occur in hospital emergency rooms. Dennis Manners, who had a $500,000 medical bill and sometimes visited the ER 25 times a month, is one patient out of the total 22 percent of University of Louisville patients who cannot afford care and often cannot even afford their $15 co-pay. Highlighting its efforts to give back to the community, the reports says U of L developed a new treatment plan for Manners, which included sending him to a treatment center outside of Cincinnati.

Many health-improvement services in Kentucky communities, such as health fairs, screening programs, immunization clinics, health needs assessments and community planning, are financed by Kentucky hospitals. According to the report, $43.7 million was spent by these hospitals on such outreach programs that serve all ages and a number of special needs populations. For example, Northern Kentucky's St. Elizabeth Healthcare is fighting against cardiovascular disease, diabetes and stroke with its Cardiovascular Mobile Health Unit that brings vascular services to the community for easy access, screenings, risk appraisals and education.

Hospitals also spend a lot of money, an estimated $127.5 million in 2011, to ensure health professionals are properly educated -- a great need in Kentucky, where 59 of the 120 counties are designated as health professional shortage areas. One effort, the Rural Physician Leadership Program on the campus of St. Claire Regional Medical Center in Morehead, addresses this shortage by training physicians to serve in rural areas of Kentucky and the nation.

Other community benefits include subsidized health services, estimated at $32.3 million, to support programs like Highlands Regional Medical Center's Highlands Center for Autism in Prestonsburg (left). The center is the first of its type in the state and was created in 2009 to address autism in Kentucky, which is estimated by the Center for Disease Control to be diagnosed in one out of every 88 children, says the report. Each child at the Highlands center has a customized treatments plan involving psychologists, educators, behavior analysts, speech pathologists, pediatricians and neurologists, who collaborate to help children with autism reach their full potential.

The annual KHA report reminds people what hospitals do for the state and provides education about ongoing efforts. A more recognizable contribution is that Kentucky hospitals had a combined spending of $6.4 billion in 2011 on staff salaries, purchases or supplies and services that create a‘ripple effect” in the overall economy to generate state businesses, jobs, and tax revenue. The reports says St. Joseph Mount Sterling, for example, provided 213 jobs and generated about $12 million in annual local payroll in 2011. Kentucky hospitals' compensation comprises 5.8 percent of all wages and salaries in the state.

The reports says hospitals are more important than ever to the overall economic health of Kentucky communities. This is the fourth year for the report, generated by the voluntary KHA survey and other data sources, including the annual survey by the American Hospital Association; Kentucky Hospital Statistics, 2013; and Kentucky Hospitals’ Economic Importance to Their Communities, 2011. The KHA report covers community benefit expenditures made in 2011, which is the most recent year for which statewide data is available.

100 Kentucky hospitals join network to improve patient safety, fight hospital-acquired conditions such as infections

To help hospitals reduce preventable readmissions and hospital-acquired infections, 100 of Kentucky's 131 hospitals have joined the Kentucky Hospital Association's hospital engagement network. The group's goal is to help hospitals find ways to improve patient safety, reduce readmissions and hospital-acquired conditions such as infections, and share learning among hospitals.

The network hopes to reduce the incidence of adverse drug events; catheter-associated urinary tract infections; central-line-associated bloodstream infections; injuries from falls and immobility; obstetrical adverse events; pressure ulcers; surgical site infections; venous thromboembolisms or deep vein clots; ventilator-associated pneumonia; and preventable readmissions.

The two-year project is supported by a contract with the federal Centers for Medicare and Medicaid Services as part of the "Partnership for Patients" campaign, launched earlier this year by the U.S. Department of Health and Human Services. The goal for the project is to reduce preventable  readmissions that occur within 30 days of discharge by 20 percent and hospital-acquired infections by 40 percent (compared to 2010) by the end of 2013.

"The commitment to patient safety and quality by hospitals across Kentucky has resulted in lives saved, fewer complications and reduced costs," said Mark J. Neff, chair of the KHA board of trustees and president and CEO of St. Claire Regional Medical Center in Morehead. For a list of hospitals participating in the network, click here.

Health care reform will be costly to hospitals, Kentucky Hospital Association chief says

Many of Kentucky's 132 hospitals will lose money and be forced to merge because of the new health care law, says the president and CEO of the Kentucky Hospital Association.

Speaking to the Madisonville-Hopkins County Chamber of Commerce, Michael Rust, left, said one in three Kentucky hospitals is already losing money. Under the new law, reimbursement rates for Medicare are set to go down by 10 percent, which will further put the pinch on health-care facilities. "The proposed 10 percent reduction will cut jobs and wages by an estimated $5.3 million, reduce sales to businesses by $19.6 million and reduce state and local revenues by $1 million," Ron Sanders reports on iSurfHopkins.com.

Rust said the expanded coverage afforded by the law, known as the Patient Protection and Affordable Care Act, will cost Kentucky $1 trillion. Half of that will be financed by new taxes. The other half will be paid for through Medicare cuts, representing a $3.4 billion loss in Kentucky hospital revenue, Sanders reports. Hospitals are, in turn, "working to reduce costs through strategic affiliations or mergers or acquisitions," Sanders reports from Rust's speech. (Read more)

Kentucky Voices for Health Executive Director Jodi Mitchell told Kentucky Health News, "We know the law is not perfect and there are areas of concern that are valid. However, status quo is not an option given that we had a broken and costly health care system. We anticipate the reforms will continue to happen and there will be corrections and amendments to the law to improve upon it." Kentucky Voices for Health is a coalition of more than 100 organizations and individuals working to build a healthier Kentucky and does not have a formal stance on the new health care law, Mitchell said. "It is the law of the land and we are trying to provide objective information in regards to the valuable consumer protection provisions that are in the law."