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

Kentucky Health News

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

ARC.gov map, adapted by Kentucky Health News

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

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

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

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

Taxpayers pay malpractice awards involving federally qualified health centers; in Kentucky, $7.7 million was paid in 2018-2021

By Melissa Patrick and Al Cross

Kentucky Health News

Federally qualified health centers, or FQHCs, are very important parts of the health-care delivery system for the poor in Kentucky, largely because they can't turn anyone away and charge patients based on their income. In return, they get an annual grant and higher reimbursements from Medicaid and Medicare — and, for the vast majority of clinics, financial immunity from malpractice lawsuits.

The centers can still be sued for malpractice, but the federal government becomes the defendant and pays any settlements or judgments. That little-known aspect of FQHCs is examined in a story by Phil Galweitz and Bram Sable-Smith of Kaiser Health News, along with a list of the 485 payouts made on the centers' behalf from 2018 through 2021, totaling $410 million. 

Over that four years, Kentucky had nine payouts totaling $7,718,629, made on behalf of six health centers. Most of that, $5 million, was to settle a claim involving Sterling Health Solutions, based in Mount Sterling. The second largest, $2,082,337, was a judgment involving Big Sandy Health Care of Prestonsburg.

Both cases involved women's health care, which is often the object of high-dollar malpractice claims. Doctors say the cost and availability of malpractice insurance discourages opening such practices, especially in rural areas. 

Screenshot of Kaiser Health News' Kentucky list, adapted by Ky. Health News

"Malpractice lawsuits are a risk for all health-care providers and are just one barometer of quality of care," Kaiser Health News says. "The settlements and court judgments against the health centers don’t measure the clinics’ overall performance."

The clinics fill many needs. "Nearly half of the centers’ patients are covered by Medicaid, and 20 percent are uninsured," Kaiser reports. "Even lawyers who have sued on behalf of health center patients acknowledge the importance of the facilities. Rhode Island plaintiff attorney Amato DeLuca said that the health centers serve a vital role in the health industry and that he had found “a lot of really wonderful, extraordinarily capable people that do a really good job” at the centers. Yet everyone must be held accountable for mistakes, DeLuca said."

The biggest payments

Kentucky's biggest payment in 2018-21, $5 million, settled a $42 million claim by Rebecca Anderson and Randy Brooks of Montgomery County that their son, known in court documents as G.B., suffered severe and permanent injuries during and after his birth in 2015 because Dr. Byram Ratliff of Sterling Health Solutions failed to respond to fetal distress as evidenced on the fetal heart monitor strips prior to delivery. "Dr. Ratliff failed to institute prompt and proper medical care resulting in severe permanent injury," they alleged. "As a result, G.B. will require a lifetime of medical care and treatment."

A bench trial of the case was recessed for negotiations that resulted in a settlement, comprising $2.5 million of "upfront cash" to be held in escrow until all liens and claims in the case were resolved, and a $2.5 million trust fund for future medical care. The plaintiff's attorneys were awarded case expenses of $281,873 and fees of $1,250,000. Attorney fees in such cases are limited to 25% of the award. 

A document titled "Stipulation for compromise settlement and release" says the settlement is in no way an admission of "liability or fault."

Big Sandy Health Care was connected to the second largest amount paid in Kentucky during the four-year period, $2,082,337. This case was a medical negligence claim by Lisa Ann Crispen against Dr. Joanna Santiesteban, Dr. Enrico Ascani and Big Sandy Health Care for failure to diagnose uterine cancer. 

After a bench trial, Chief U.S. District Judge Karen Caldwell awarded the judgment, writing, "Chrispen proved by a preponderance of the evidence that Big Sandy's negligence in evaluating, diagnosing, and treating Chrispen's cancer caused her to suffer past and future lost wages, past and future medical expenses, past and future physical pain and suffering, and past and future emotional pain and suffering." 

The Kaiser list shows that another federal payment involving Big Sandy Health Care was made during the four-year period, in 2018 for $35,292.

Burkesville-based Cumberland Family Medical Centers was involved in the third largest payment, $225,000. This was in a case filed by Judy and John Courtier of Monroe County, alleging that the Tompkinsville center incorrectly transcribed a prescription from a rheumatologist, resulting in Judy Courtier taking a toxic amount of methotrexate (2.5 milligrams twice a day instead of two 2.5 milligrams tablets once a week), causing conditions that required hospitalization. The parties reached a settlement in October 2018.

The Kaiser list shows another federal payment involving Cumberland Family Medical Centers was made during the four-year period, in fiscal 2019 for $26,000.

The chain of clinics is Kentucky's largest federally qualified health center. It had gross revenues of $83 million in 2019, according to the Form 990 for tax-exempt nonprofits that it filed with the Internal Revenue Service. Kentucky nonprofits must also file the forms with the state attorney general's office.

Sterling reported 2019 revenues of $13.6 million. The latest filing at the attorney general's office from Big Sandy, for 2016, showed revenues of $19.5 million.

Family Health Centers of Louisville, which had 2019 revenues of $45 million, was involved in the fourth largest payment in 2018-21, $200,000. It settled a claim by Carolyn Boerste alleging failure to tell her that a radiology report noted she had a 12-inch-by-12-inch laparotomy sponge that snaked through her small intestine for 19 months before it was removed. 

Kentucky Health News offered the four health centers the opportunity to comment, but none did.

Other Kentucky payments in the four-year period involved Grace Community Health Center of Corbin, also called Grace Health; and Fairview Community Health Center of Bowling Green.

Why do taxpayers pay these settlements? 

To win congressional protection in the 1990s, federally qualified health centers "argued their revenues were limited and malpractice insurance would divert money that could better be used for patient care," Kaiser Health News reports. About 86% of the 1,375 clinics have this protection, which comes with a list of requirements. 

To get the protection, a clinic "must have quality- improvement and risk-management programs and must show regulators that they’ve reviewed the professional credentials, malpractice claims, and license status of their physicians and other clinicians," Kaiser reports. "Ben Money, a senior vice president for the National Association of Community Health Centers, said the process improves care and directs scarce operating dollars toward the needs of patients, versus costly malpractice coverage."

Patients who want to claim malpractice by a health center must file a claim with the U.S. Department of Health and Human Services, which can make a settlement offer or deny the claim. "If the claim is denied or not settled, or a six-month review period expires, the patient may sue in federal court under the Federal Tort Claims Act," Kaiser reports.

Here's a map showing the centers' locations in Kentucky (click on it to enlarge):

Map from the Kentucky Primary Care Association; to enlarge any image, click on it.

'Get your shot. Today!' Rep. Rogers urges at groundbreaking for hospital-linked clinic in McCreary County, which has no hospital

"Get your shot. Today!" 5th District U.S. Rep. Harold "Hal" Rogers of Somerset says in a video circulated by the Kentucky Primary Care Association. He says he tells the unvaccinated that "Vaccination is not only important to them, it's important to the rest of us," because most Covid-19 cases are among the unvaccinated, by far.

Rogers spoke after the groundbreaking for Cumberland Family Medical Center's medical facility in McCreary County, which will provide x-rays, CT scans and other medical resources in partnership with Lake Cumberland Regional Hospital in Somerset.

"In a county without a local hospital, this new facility will help save lives, offering emergency medical care after-hours and on holidays," Rogers said. The center, received a $1 million competitive federal grant in December with Rogers' support. KPCA has a video report on the project.

National Health Center Week salutes federally qualified health centers, primary-care providers for one in eight Kentuckians

Map (click on it to enlarge) shows Kentucky Primary Care Association members, their health centers and counties where they have school-based clinics. Shading of counties shows congressional districts.

Aug. 8-15 is National Health Center Week, promoted by the National Association of Community Health Centers, the common name for federally qualified health centers, which get federal funds to provide affordable primary care in areas with a shortage of health-care providers.

Such clinics "are the primary health-care providers for one in eight Kentucky residents, which is more than 550,000 people," the Kentucky Primary Care Association says in a news release.

“We have 32 federally-qualified-health-center members providing primary care and other services with clinic operations across the state,” said David Bolt, the CEO of KPCA. “The health centers are located in medically underserved communities and treat patients regardless of the patients’ ability to pay, their race, or their ethnicity. CHCs improve healthcare access and outcomes.”

"Many CHCs operate school-based clinics," KPCA notes. "The clinics are located in elementary, middle and high schools around the state," with the largest group operated by Cumberland Family Medical Center in 16 counties, from Anderson in Central Kentucky to Barren, Monroe, Cumberland, Clinton and McCreary in Southern Kentucky.

"CHCs employee a large number of physicians, nurses, other medical professionals, and administrative staff," the release says. "Estimates indicate they generate more than $740 million each year for local economies in communities throughout the commonwealth.

To find a clinic near you go to: https://www.kpca.net/, click on the directory tab and choose the FQHC category.

Ky. community health centers get $96 million for Covid-19 work

Kentucky's 25 federally qualified health centers, generally known as community health centers, will share more than $96 million in grants from the recent relief-and-stimulus bill, the American Rescue Plan Act.

"The funding will be used to expand Covid-19 services and help ensure preventive and primary care for those at higher risk" for the disease, the Kentucky Primary Care Association said in a press release.

“Community health centers provide essential, high quality, state of the art healthcare to all people, regardless of their ability to pay,” KPCA's CEO, David Bolt, said in the release. “They are located in more than 90 Kentucky counties, including nearly all of the 42 counties that do not have a local hospital. By focusing on the uninsured, the underinsured, homeless, seasonal workers, minority populations, and others who may have barriers to healthcare access, community health centers now treat more than 550,000 Kentucky residents.”

The grants were based on patient counts, with double weight for the uninsured, and a base amount for each clinic. Here's a list from the federal agency:

State announces more vaccination locations, making 156; health chief clarifies CDC mask guidance; Ky. still a new-case hotspot

State Dept. for Public Health chart, with extra labeling by Ky. Health News; click it to enlarge

By Melissa Patrick
Kentucky Health News

Looking forward to the day when Kentucky has enough coronavirus vaccines for anyone who wants one, the state now has 156 locations able to provide what the lieutenant governor called the "shot of hope," six of them new regional vaccine sites.

In addition to the six new regional sites, which can be added to the eight that have already opened, Gov. Andy Beshear announced that 10 Kroger stores, 15 Walmart stores, and 125 pharmacies, along with local health departments and community health centers, will now be providing vaccines.

“That is a big deal," Beshear said at his last news briefing of the week. "It's going to move us forward and build out what we need to ensure especially as supply increases, whenever that's going to happen, that we are ready to get it out and get it out quickly all over the state."

That day could come as soon as early spring, Dr. Anthony Fauci, the nation's leading infectious-disease expert, predicted Thursday,

“By the time we get to April, that will be what I would call, for better wording, ‘open season,’ namely, virtually everybody and anybody in any category could start to get vaccinated,” Fauci said on NBC’s "Today" show, adding that logistically, once that happens it will take several months to get everyone vaccinated who wants one.

Health Commissioner Steven Stack explained that because the state's population is not equally distributed and vaccine access also varies across the state, some sites will move to the Phase 1C category before others. Phase 1C includes people 60 and older, people with high-risk conditions, and all essential workers. He said that getting people 60 and older vaccinated is important because they account for 91 percent of the state's deaths attributed to Covid-19.

Asked if Kentucky would offer a special program like Ohio has started to continue vaccinating staff in long-term-care facilities once the federal program wraps up, Stack said there is no plan to do so, since all staff are in the health-care priority group and can get vaccinated at any of the state's vaccine sites.

As of Feb. 1, the federal vaccine program, led by Walgreens and CVS Health, had vaccinated about 73% of the residents and 45% of the staff, according to data obtained from the state.

New vaccine sites: New regional sites will be in Columbia, Frankfort, Grayson, Henderson, Louisa and Morganfield. The state already has sites in Covington, Bowling Green, Murray, Glasgow, Lexington, Danville and Paducah. Go to vaccine.ky.gov to learn how to sign up for a shot at one of these sites.

Two of the 10 new Kroger sites will be in Ashland. Others will be in Brandenburg, Campbellsville, Carrollton, Elizabethtown, London, Maysville, Murray and Paducah. Go to Kroger.com/Covid Vaccine to make an appointment.

The 15 Walmart sites are in Corbin, Berea, Campbellsville, Carrollton, Central City, Crestwood, La Grange, Mayfield, Paducah, Paintsville, Richmond, Shelbyville, Shepherdsville, Tompkinsville and Winchester. Go to Walmart.com/CovidVaccine to make an appointment.

The Federal Pharmacy Program, which brings about 13,000 first doses to the state, will be offered at 78 Walgreens branches and 47 independent pharmacies that are part of the Good Neighbor Pharmacy brand. Click here for a list of participating pharmacies. Click here to make an appointment at a Walgreens.

Stack said many of the 78 Walgreens locations still have slots available. Click here to get an address for each of the aforementioned new locations.

Lt. Gov. Jacqueline Coleman, who led most of the briefing, announced several state initiatives aimed at providing equitable access to the vaccine. "Our administration is committed to providing equitable access to the vaccine, and we know that there are significant barriers in both rural and urban parts of the state," she said.

One initiative will allow people living in Anderson, Boyle, Casey, Franklin, Garrard, Jessamine, Lincoln, Mercer, Scott, Washington and Woodford counties to get free transportation to and from vaccine sites at the Kentucky Horse Park in Lexington or Ephraim McDowell Hospital in Danville. To reserve a ride, residents should call Blue Grass Community Action Partnership Transit at 800-456-6588 at least 24 hours in advance of their vaccine appointment time.

Another initiative, through Norton Healthcare vaccine clinics, will work to reach at-risk, under-served people who are 70 and older in Louisville at St. Stephen Baptist Church and Bates Memorial Baptist Church. Stack said the state is also partnering with King's Daughters Medical Center in Ashland, which will do vaccine-outreach with other Black churches and communities in the next few weeks. Deborah Yetter of the Louisville Courier Journal reports on the "quiet" church campaign in Louisville to vaccinate more African Americans.

Another partner, the University of Kentucky, will offer four outreach clinics on successive Saturdays with mobile vaccination units in areas with under-served populations due to race, language, economic or other barriers.

    
In addition, four of the state's federally qualified health centers – or community health centers, as they are commonly called – will be providing vaccines as part of a federal program. They include the Mountain Comprehensive Health Corp., serving Letcher, Owsley and Perry counties; Primary Care Centers of East Kentucky, serving Perry and Leslie counties; Juniper Health, serving Breathitt, Lee and Wolfe counties; and the June Buchanan Clinic, serving Knott County.

David Bolt, CEO of the Kentucky Primary Care Association, said in a release, “We applaud the Biden administration’s decision . . . Our community health centers already provide the medical home for one in eight Kentuckians, more than 550,000 people."

The state's daily report shows 497,256 Kentuckians have received an initial dose of the vaccine.

Masks: Stack cautioned that beyond the new guidance from the CDC that says wearing two mask, a cloth mask over a surgical mask, or knotting and tucking a single medical-procedure mask to prevent air leakage reduces a healthy person's risk of catching the coronavirus by more than 95% – it's important to remember that masking alone is not enough.

"You need to wear a mask whenever you're anywhere near other people who you don't live with, and you need to stay more than six feet away from each other, whether you have a mask or not," he said.

Photos from Centers for Disease Control and Prevention explain new CDC guidance on masking.

Stack also said the new CDC guidance that says people who are seven days past their second dose of vaccine do not need to quarantine for up to 11 weeks if exposed to the virus also came with a warning, that we still don't know for sure if the vaccines will prevent a person from getting infected with a mild disease or be infected with no symptoms, both situations that could result in the spread of the disease. 

Therefore, he said the "key point" from this guidance is that even after being vaccinated, it will be important to follow the current guidance that calls on people to wear mask, social distance, practice good hand hygiene, and to avoid social gatherings.

"We still don't have enough people, anywhere near enough people, protected directly and so . . . we don't take our eye off the ball, we don't let down our guard," Stack said. He also advised that any decision to quarantine or not, even after being vaccinated, should be made in consultation with your local health department.

Daily numbers: Beshear announced 1,880 new cases of the coronavirus on Thursday, bringing the seven-day rolling average to 1,847, the lowest this number has been since Nov. 6. 

The share of Kentuckians testing positive for the virus in the past seven days dropped again, to 7.08%, the lowest this rate has been since Nov. 6. "That is good news," said Beshear.

However, other states have improved too, and Kentucky's infection rate in the week ended Feb. 7 was sixth highest in the nation, according to the latest report from the White House Coronavirus Task Force. A daily compilation by The New York Times ranked Kentucky third on Thursday.

White House Coronavirus Task Force chart, with Kentucky's rank highlighted; click it to enlarge.

Deaths from the virus remain high. Beshear announced that the state had listed 36 more deaths, 31 confirmed and five probable. That took the death toll to 4,211. The 14-day death average went way down, to 42.9; the deadliest day, 69, was 15 days ago. The seven-day average also dropped, to 41.4, because one of the two days tied for second most deaths, 58, was eight days ago. 

Beshear honored the life of Gladys Lowenthal Bass, whose obituary said she died of "Covid-19 and a broken heart." Bass was 94 and the wife of Humana co-founder Lewis "Sonny" Bass, who died from the virus just eight weeks ago.

"So this is vicious. It takes people that we know and love," Beshear said. "Let's make sure we continue to do the right things to protect those around us. I don't want to have 35 deaths again in the course of this pandemic, and we can do something about that. What we do is wear those masks, engage in social distancing, and then prepare to vaccinate people as quickly as possible." 

In other coronavirus news Thursday:

• The state's daily report said the statewide case-incidence rate for the last seven days fell to 37.4 per 100,000 residents. Counties with rates more than double the statewide rate are Russell, 98.8; Allen, 98.5; Clinton, 90.9; McCreary, 90.4; and Marion, 74.9.
• Counties with 10 or more new cases were: Jefferson, 283; Fayette, 109; Kenton, 104; Boone, 59; Daviess, 48; Warren, 48; Pulaski, 46; Hardin, 39; Campbell, 34; Laurel, 34; Barren, 33; Madison, 32; Russell, 31; Montgomery, 30; Franklin, 29; Christian, 27; Bullitt, 26; Taylor, 26; Marshall, 25; Whitley, 25; Rowan, 23; Lewis, 22; Shelby, 22; McCracken, 20; Scott, 20; Allen, Boyle, Hopkins and Nelson, 19; Boyd, 18; Jessamine, 17; Floyd, Henderson and Metcalfe, 16; Harlan, Logan, McCreary, Marion, Pike and Wayne, 15; Lincoln and Perry, 14; Hart and Woodford, 13; Clay, Grant and Trigg, 12; Bell. Grayson, Knott and Washington, 11; and Clinton and Knox, 10.
• The 36 fatalities listed Thursday were a Barren County man, 91; two Calloway County men, 53 and 63; a Clay County woman, 77; a Crittenden County woman, 78; a Fayette County woman, 89; a Fleming County man, 91; three Harlan County men, 38, 59 and 73; a Hart County man, 66; a Jefferson County woman, 92; two Jefferson County men, 66 and 71; a Laurel County man, 55; two Lawrence County women, 92 and 94; two Letcher County women, 69 and 82; a McCracken County woman, 62; three Madison County women, 82, 86 and 91; four Madison County men, 66, 75, 76 and 96; a Marion County woman, 89; two Marshall County men, 64 and 69; a Meade County woman, 75; two Mercer County women, 84 and 85; two Nelson County men, 84 and 88; and a Perry County woman, 70.
• Hospitalization numbers returned to normal after a one-day spike. Kentucky hospitals reported 1,142 Covid-19 patients, down 49 from Wednesday; 278 intensive-care patients, down 58; and 156 of them on ventilators, down 13; but the percentage of ICU patients on ventilation rose to 56%, 4 percentage points above average.
• In long-term-care, 22 more residents and 19 more employees have tested positive for the virus; cases are active in 285 residents and 201 staff. Beshear said four more deaths can be attributed to the virus in these facilities, bringing their death toll to 2,209. Covid-19 deaths of residents of the facilities are down to 54.6% of the state's total.
• Four of the 10 hospital-readiness regions are using more than 80% of their intensive-care beds: Barren River, 82.4%; the northeast region, 84.4%; the easternmost region, 81.6%; and Lake Cumberland, 97.8%. 
• Starting Feb. 15, Kentuckians needing assistance with rent or utilities to cover their past-due or future bills should reach out to the Healthy at Home Eviction Relief Fund. People in Fayette County should apply at covid19renterhelp.org; people in Jefferson County should apply at stopmyeviction.org; and the other 118 counties should apply at teamkyhherf.ky.gov. Click here for the news release. 
• Click here for an unemployment update in the governor's press release. 
• Local health departments in Eastern Kentucky report on their new coronavirus cases and deaths, Hazard's WYMT reports.

Group of primary-care clinics in east-central Kentucky picked for national pilot project to improve at-home health care

White House Clinics operates in five counties.

A group of community health centers in east-central Kentucky will participate a national pilot project to transform at-home health care.

The National Association of Community Health Centers chose White House Clinics for its "Leading Change: Transforming At-Home Care" initiative. 

The group, named for the site of its first clinic, in Jackson County, also serves Madison, Estill, Garrard and Rockcastle counties. It will receive 20 kits for patients to monitor conditions such as diabetes, hypertension, obesity, depression, and more, said a news release from the Kentucky Primary Care Association. Clinic staff will also receive various technical assistance tools from NACHC, with support from the Centers for Disease Control and Prevention.

The project is designed to capture data through June 2021. Cheryl Modica, director of the Quality Center at NACHC, said "White House Clinics brings a wealth of experience implementing at-home care" through work with the federal government's Million Hearts initiative to self-measure blood pressure.

“We are excited and extremely honored to be one of 20 health centers chosen for this initiative from a pool of national applicants,” Stephanie Moore, CEO of White House Clinics, said in the release. “We believe it speaks to our commitment to innovation and to continuously seeking ways to better support our patients in the management of their chronic illnesses.” 

 

David Bolt, CEO of the Primary Care Association, said “The selection of White House Clinics for this national pilot project is another example of the value and quality of care provided by our community health center partners. . . . These centers now provide one in eight Kentuckians with a medical home and holistic care, regardless of the patient’s ability to pay. Just like this project aims to transform at-home care, our community health centers are transforming Kentucky’s health-care system.”

Six Kentucky health centers awarded more than $1.7 million in first-of-their-kind grants to be used for oral health infrastructure

Six health centers in Kentucky have received more than $1.7 million in competitive federal grants to be used toward improving oral health.

The Health Resources and Services Administration awarded over $85 million to 298 health centers as part of its Oral Health Infrastructure program.

The six in Kentucky and their headquarters towns are: Cumberland Family Medical Center in Burkesville, Big Sandy Health Care in Prestonsburg, Healthfirst Bluegrass in Lexington, Healthpoint Family Care in Covington, Shawnee Christian Healthcare Center in Louisville and Pennyroyal Healthcare Service in Princeton. All got $300,000 except Pennyroyal, which got $226,345.

A news release from Department of Health and Human Services the says the money can be used for things like "minor alteration and renovation to modernize existing facilities, purchase and installation of dental and radiology equipment, training and consultation to increase oral health integration, and purchase of mobile dental units to increase access to oral health care."

"These are the first awards HRSA has ever made solely for health centers’ oral health-care infrastructure, and they will support better access to oral health services in communities across the country, including under-served urban and rural areas," HHS Secretary Alex Azar said in the release.

Cumberland Family Medical Center plans to use its grant money to purchase portable equipment for its school-based health centers, which provide preventive oral health care to its students, according to a separate news release from Senate Majority Leader Mitch McConnell. The release notes that McConnell contacted HRSA on behalf of the center, which has more than 25 locations.

"We applaud Senator McConnell's efforts to ensure that we and other community health centers can continue to provide high quality care to patients who need it the most," Tracey Roy Antle, the center's chief operating officer, said in the release.

Daytime mental-health programs shrink, citing problems with managed-care Medicaid; pastoral counselors to be licensed

Access to daytime mental-health care "is on a steep decline in Kentucky, leaving what some fear is a gap in care that isolates the mentally ill at home or drives them out into the streets, hospitals or jail," Mike Wynn of The Courier-Journal's Frankfort Bureau reports. The Kentucky Association of Regional Programs, the lobby for community mental-health centers, "reports that 33 of the roughly 50 programs offered across the state have closed in the past 18 months while four others have reduced their hours by half," affecting an estimated 1,000 people.

The state Department for Behavioral Health, Developmental and Intellectual Disabilities says these community mental-health centers should embrace "a shift away from using day programs," Wynn writes, but mental-health advocates "say the centers have struggled to get enough coverage authorized under Kentucky's Medicaid managed-care system to keep the services operating. That has forced programs to close before new services are available to replace them, they argue."

The advocates say that among companies that manage care in Kentucky under Medicaid, Coventry Cares and its subsidiary MHNet "are by far the worst about denying coverage or reducing hours for therapeutic day programs. Coventry and MHNet are owned by insurance provider Aetna," which "says complaints are off target and that it is committed to providing patients with high-quality care. MHNet has approved two-thirds of the requests it received for therapeutic rehabilitation since January 2013, Aetna said in a statement."

Steve Shannon, executive director of the centers' lobbying group, "said that even mild reductions — such as approving services for three days a week rather than five — can wreak havoc on a program's financial viability," Wynn writes. "He also argues that centers may have stopped requesting services once they realized that MHNet would not approve them." (Read more)

Meanwhile, Kentucky has become the sixth state to license pastoral counselors under a new law that will also allow them to be paid for their services. The sponsor of Senate Bill 61, Sen. Alice Forgy Kerr of Lexington, told Jack Brammer of the Lexington Herald-Leader that the counselors must have a master of pastoral counseling degree, in addition to the same qualifications as other licensed counselors, and must also pass a written examination. (Read more)

Obamacare raised woman's premium 74% but she's thankful it has extended health care to those who didn't have it

"Beneath the loud debate" about the Patient Protection and Affordable Care Act, it is "quietly starting to change the health care landscape," writes Abby Goodnough of The New York Times, in the latest installment of her series looking at the law through the lives and businesses of Kentuckians.

"In Kentucky alone, more than 350,000 people — about 8 percent of the state’s population — have signed up for coverage," Goonnough notes. "Insurers and medical providers are reporting steady demand from the newly covered for health care, ranging from basic checkups to complex surgical procedures." About 80 percent of the signups in Kentucky are for Medicaid, and that number is likely to increase, because while open enrollment in private plans for 2014 closes tonight at midnight, Medicaid accepts enrollees year-round.

Goodnough's story looks at a new Medicaid enrollee, a man who is having difficulty affording his subsidized policy, and a woman whose income is so high that she couldn't even get subsidies for a new policy through the state health-insurance exchange — but who, like the other two, came to one of the Family Health Centers in Louisville because her doctor wasn't in the network for her new policy. The centers "primary and preventive care in low-income neighborhoods where private doctors are scant," and just over half their patients last year had no coverage, Goodnough reports.

New York Times video; to play it, click on image

Donna Morse, 61, is a widow who "lost her insurance last year because it did not meet the new law’s standards. Now she has a new plan with much higher premiums, and which few doctors and hospitals will accept," Goodnough writes. "She is paying $448 a month for a new Humana plan, up from the $258 monthly premium she paid before," an increase of 74 percent. And when she took her prescription to her neighborhood Walgreens, she "discovered that the chain did not accept her new Humana policy, a so-called narrow network plan with a limited number of providers."

Nevertheless, Morse, a dental hygenist, told Goodnough that she was “very pleasantly surprised” by her experience at the clinic and “I’m really thankful that a lot of people are getting health care that couldn’t have it in the past.”

That describes David Elson, 60, "a self-employed businessman with a multitude of health problems and medical bills," and forgot to pay the first month's premium for his subsidized policy; and Tamekia Toure, 40, a diabetic and single mother who moved to Louisville from Alabama and got on Medicaid but found a job at Amazon soon after her clinic appointment. "She was elated to find work so quickly . . . but also a little scared," Goodnough writes. "Would her new income make her ineligible for Medicaid, so soon after she had signed up? With the expanded program, this so-called churning in and out of Medicaid, based on changes in income, is expected to be common, and for many, problematic." (Read more)

Seven Ky. communities get grants to reduce risks for chronic diseases among children and 'Invest in Kentucky's Future'

Seven diverse Kentucky communities are getting money to reduce the risk of chronic disease among Kentucky's youth. The initial grants announced Thursday are part of the Foundation for a Healthy Kentucky's new Investing in Kentucky’s Future initiative, a five-year, $3 million program.

“The health of our next generation is at stake,” said Susan Zepeda, CEO and president of the foundation. “Our goal is to help communities make positive changes in policies and service access that will help our children grow into healthy, productive adults. Regardless of the challenges, we want to help communities find new pathways to positive solutions.”

Community groups will use their initial grants to collect and analyze local health data. That analysis will guide development of innovative strategies for effective, sustainable measures to improve children's health. Those communities chosen for the initiative are:

• Clinton County School District, Albany: initial grant of $27,755 for the Clinton County Healthy Hometown Coalition. “We are thrilled that our community was chosen to participate in this important initiative,” Asst. Supt. Paula Little said. “The members of the Healthy Hometown Coalition are committed to helping children grow up in a physical, social, and cultural environment that supports good health habits. With help from the foundation, we can develop our capacity to make a lasting, positive change in our community.”

• Fitness for Life Around Grant County, Williamstown: initial grant of $21,643 for FFLAG and the Northern Kentucky Health Department. “We are pleased and excited to be given the opportunity to work with the Foundation for a Healthy Kentucky,” FFLAG Chairman Jeff Walters said. “We are a small group that has been working on improving the health of our community and we believe we’ve had a positive impact thus far. This grant will accelerate the process and the work that’s been started.”

• Foundation for Appalachian Kentucky, Hazard: initial grant of $32,558 for Perry County Wellness Coalition. “We’ve been working for several years to improve the menu and encourage better eating habits in and out of school,” said Linda Campbell, nutrition director at Perry County Schools. “It’s not as easy as changing a menu or just buying whole wheat bread. We’re changing a culture, and that’s not a simple thing. Working together, as a community, we can really start to make a difference. This grant from the Foundation for a Healthy Kentucky allows us to take the next steps toward helping our kids to become healthier.”

• Green River Area Development District, Owensboro: initial grant of $40,483 for Partnership for a Healthy McLean County. “The Partnership for a Healthy McLean County realizes the impact community organizations, schools, work sites and health care have on the health of families,” said Jiten Shah, executive director of the district. "Obesity is a major factor for many chronic diseases which can begin in childhood and continue into adulthood. "

• Kentucky Heart Foundation Inc., Ashland: initial grant of $19,245 for Healthy Kids, Healthy Communities in Ashland. “Investing in Kentucky’s Future is a perfect fit for the work of the Healthy Kids Coalition and gives us the opportunity to continue to work on policy, system and environmental changes to improve the health of children in Boyd and Greenup counties,” said Laura Patrick, coordinator of Healthy Kids, Healthy communities. “We know that this approach will help sustain change for years to come and what is great about it is that it is sustainable.”

• Kentucky River Community Care, Inc., Jackson: initial grant of $34,156. “This foundation grant will help Breathitt County plan more opportunities for youth and families to participate in healthy lifestyle activities,” said Bridget Turner, KRCC director of clinical services. “We need to develop a strategic plan to specifically address the many barriers that face our children and threaten their future. Education, prevention, behavioral health, physical health, nutrition, employment, substance abuse are a few of the issues that we are trying to deal with in our county.”

• Louisville Metro Department of Public Health and Wellness: initial grant of $34,160. “If we are ever going to realize a healthier future for our citizens, we must improve the health of our young people,” said Dr. LaQuandra Nesbitt, director of the department. “These funds from the Foundation for a Healthy Kentucky will facilitate a coordinated, systemic approach to overcome the health barriers that many of our youth face. The grant will allow us to formulate policies and strategies to improve health that are based on accurate data with buy-in from stakeholders across the community.”

Reducing chronic diseases to improve Kentuckians' health
 
Chronic diseases such as cancer, diabetes and heart disease, are those that last over time, decrease quality of life, increase the risk of early death and occur at higher rates in Kentucky than in surrounding states; substance abuse and some mental illnesses are also chronic diseases.

Kentucky’s children are at greater risk than most for chronic diseases, including high rates of obesity and smoking. When children grow up, they are at an increased risk for heart disease, cancer or stroke, and Kentucky is above the national average in deaths from these diseases.

The Investing in Kentucky's Future initiative will help Kentucky communities confront this cycle of problems. The foundation is encouraging local leaders to identify how best to engage the community in order to have the biggest impact.

“This is the first step in our multi-year approach, which will lead to implementation of permanent solutions for healthier communities,” said Zepeda. “We believe that by working together on the local level, civic leaders with vision can develop innovative strategies to improve the health of our children.”

More than 50 interested organizations responded to the foundation’s request for proposals in October last year, and 22 were invited to submit a full proposal. The foundation’s board of directors approved funding for seven as part of the initiative. Click here to read more about the foundation.

Community health centers get federal grants to hire employees to help you shop for health insurance coverage

Kentucky's online health insurance exchange, Kynect, opens Oct. 1, 2013, and most Kentuckians must have health insurance by January of next year or face tax penalties having it. To help you get health insurance if you don't have it, the federal government is giving 20 of the state's 21 health centers outreach and enrollment grants totaling $2.83 million.

The government estimates that the money will help 61,539 people learn about and enroll in new health insurance plans through the Kynect website, and that the health centers listed below will boost their local economies by hiring a total of 52 additional workers.

These recipients are among 1,159 health centers across the country getting a total of $150 million.

If you're a Kentuckian shopping for insurance, you can use the Kynect website to see if you qualify for payment assistance, special discounts or tax credits to help cover the cost of the insurance.  You may qualify for insurance programs like Medicaid or the Kentucky Children's Health Insurance Program, and the website can also be used to compare insurance plans.

As October draws nearer, there will be additional assistance for Kentuckians, such as people called "Kynectors" who can be reached by phone or online and help you gather more information about what type of coverage may be best for you and your family.  Check here for more information or here to read more about the federal grants.

Working with a local, regional or state health coalition? A simple step can help make healthy changes in Kentucky

The Foundation for a Healthy Kentucky is asking you to help update last year's Kentucky Health Coalitions Directory, a list of local groups working to better Kentucky's health, so that additional coalitions can be identified and groups can work together toward their shared goal of bettering the state.

“These are local residents working on solutions to health issues in their cities and towns,” said Susan Zepeda, CEO and president of the foundation. “These groups have differing levels of organization and are pursuing various goals. The Coalitions Directory is a resource for them and allows them to connect with other groups working to make their community a healthier place to live, work, and play.”

Now, across the state's 120 counties, there are 143 coalitions with varying health interests: some are increasing access to healthy food and physical activity, others focus on education about risk-factors for serious health problems like diabetes and other chronic diseases and others are improving working conditions through smoke-free ordinances.

All groups are working to positively change Kentucky's health, and an updated directory will help the foundation raise awareness of the coalitions' local efforts, foster collaboration, build local capacity and provide assistance to groups. Follow this link to submit new or revised information to the Coalitions Directory.

Managed care, pension payments causing problems for community mental health centers; Edelen, C-J call for changes

"Kentucky mental health centers are cutting back services and struggling to assist patients the first time they’re admitted because of ongoing struggles with Medicaid managed care," Don Weber reports for cn|2. "At the same time, they’re losing out on federal grants because of red flags caused by their administration costs being inflated by increasing contributions to the public pension system."

NorthKey Community Care Mental Health Center in Northern Kentucky, which serves eight counties, had to close its adult day-treatment programs for the seriously mentally ill. Dr. Owen Nichols, the president and CEO, told Weber, “I get calls periodically from elderly parents in the community wanting help with their adult child that suffers from schizophrenia because they’re now wandering the streets, having some difficulties with local authorities.”

A recent editorial in The Courier-Journal addresses Kentucky's need for better mental health treatment, saying that Kentucky has "an underfunded, fragmented and now —thanks mostly to Medicaid managed care —hopelessly complicated system of mental health care."

The editorial notes last week's C-J articles in which reporters Laura Ungar and Chris Kenning uncovered the problems families face when navigating a fragmented mental-health system while trying to provide appropriate treatment for a loved one suffering form a severe mental illness, in addition to the "F" grade Kentucky received for its poor mental-health funding.

The editorial also describes how structural issues with managed care, which began in November 2011, have complicated the state's mental-health system. It notes the community mental-health centers asked to be left out of managed care, "pointing out they already operate efficiently and amount to only about 3 percent of the state’s $6 billion a year Medicaid program."

In addition, the editorial notes, "State Auditor Adam Edelen recommended the Cabinet for Health and Family Services take mental health out of managed care and let the state resume running it." Against his advice and the requests of community mental-health centers, the state expanded managed care of mental health. Now some haven’t been paid for Medicaid services since January, when managed care took effect, the editorial says.

"The nightmare needs to end for the many Kentuckians who need basic mental health services," says the editorial. "It’s time for the state to fully explore this system and, if folks are serious about improving it, fix the problems and find the money to fund it." (Read more)

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.

Research suggests dental therapists could provide care to Medicaid-eligible kids at terrific savings

The recent revitalization of the Kentucky Oral Health Coalition was a reminder that our state ranks 49th in dental health, behind only West Virginia. So was the news then Tuesday from the University of Connecticut, where research suggests that adding a new kind of health provider -- dental therapists -- to clinics known as federally qualified health centers could significantly expand the availability of care for millions of American children. (Pew Center photo)

The white paper from the Pew Children's Dental Campaign of the Pew Center on the States notes that, "In particular, by including dental therapists as providers in school-based programs operated by FQHCs, the researchers estimated states could provide access to care for 6.7 million Medicaid-eligible children, nationwide." The analysis also suggests that this significant increase in access could be realized for a cost of approximately $1.8 billion or just one half of 1 percent of combined state and federal 2009 Medicaid spending. To read the full Pew report, go here.

Nationwide, 830,000 emergency room visits in 2009 were due to preventable dental problems, according to the center, many of those in rural areas. Most of the children lacking care don't have insurance, live in areas without enough dentists or can't find doctors who accept Medicaid. Problems accessing dentists could grow in 2014, when 5 million more children are expected to get dental insurance under the federal healthcare reform law.

Despite the undisputed need, not everyone is behind the concept. The American Dental Association argues that dental therapists lack the training and education needed to perform irreversible surgical procedures and to identify patients' other medical problems, writes Anna Gorman in the Los Angeles Times. Therapists would be properly educated and would help close vast gaps in care that can lead to costly emergency room visits for dental problems, said Shelly Gehshan, director of the Children's Dental Campaign. In 2005, Alaska became the first state to try out the new dental care model, when therapists began treating native populations. Minnesota authorized the new tier of practitioner in 2009, and the first graduates of dental therapy programs began practicing last year. 

Six Kentucky community health centers receive $3.7 million in grants

Kentucky has received $3.7 million in grants to expand six community health centers, part of an effort to improve access to primary care. The federal funds were distributed through the Affordable Care Act.

Centers that will receive funds include Cumberland Family Medical Center in Burkesville ($608,333); Grace Community Health Center, Inc. in Gray ($650,000); Community Health Centers of Western Kentucky, Inc. based in Greenville ($599,055); Health Help, Inc. in McKee ($650,000); Sterling Health Solutions, Inc. in Mount Sterling ($650,000); and Mountain Comprehensive Care Center in Whitesburg ($541,667).

Nationwide, $128.6 million were handed out in 41 states, the District of Columbia, Puerto Rico and the Northern Mariana Islands. Money was awarded to 219 health centers, which will improve care for more than more 1.25 million patients and create about 5,640 jobs, according to a press release by the U.S. Department of Health & Human Services. In Kentucky, about 27,000 more patients are expected to benefit from the funds.

"Health centers serve more than 20 million patients nationwide and are an integral part of our health care system," said Mary K. Wakefiled, administrator of the Health Resources and Services Administration. "These awards demonstrate our commitment to increasing access to quality health care through the creation of new health center sites." (Read more)

Local health care centers in Ky. get $16.5 million in federal grants

Kentucky recently received $16.5 million in grant for health care centers as part of the Affordable Care Act.

Recipients include Family Health Center Inc. in Louisville ($5 million); Cumberland Family Medical Center in Burkesville ($4.86 million); Grace Community Health Center Inc. in Knox County ($4.33 million); and Big Sandy Health Care Inc. in Prestonsburg ($977,375). The grants were made through a building-capacity program, reports Greg Kocher for the Lexington Herald-Leader.

Grants given under the "immediate facility improvement program" include $425,000 for Mountain Comprehensive Health Corp. in Whitesburg; $380,000 for Family Health Center Inc. in Louisville; $360,863 for Cumberland Family Medical Center in Burkesville; and $216,543 for Big Sandy Health Care in Prestonsburg.

The awards will help serve about 29,475 new patients, states a news release from the U.S. Department of Health and Human Services. Nationwide, $728 million was awarded for renovation and construction projects. (Read more)

What would solve primary-care crisis, create jobs and help banks? Building community health centers, writer contends

The federal health-care reform law will mean a glut of new patients who will be newly insured and bog down the primary-care system. Thousands of construction workers are out of jobs as the economy remains stagnant. And the banking sector is still reluctant to lend. The answer to all three problems? Build more community health centers, writes Jeffrey Leonard in an opinion piece in The Washington Monthly. (Photo: Vista, Calif., Community Clinic)

"The way to meet the flood of new patients coming down the pike is to expand the nation's existing network of community health centers — nonprofit clinics that offer primary care to the medically under-served, often in rural areas or inner cities," writes Leonard, CEO of the Global Environment Fund and chairman of the magazine's board of directors. "But to get this done, there's no need to appropriate billions more in direct government spending. Rather, there is a way to lure skittish banks in lending private capital to finance a health-center construction boom in all 50 states, simply by tweaking the language of an existing federal lending program."

Though community health centers generally have difficulty raising their own funds to expand or build facilities, in part because they serve uninsured, low-income patients who can't donate to building projects, they are sound investments, Leonard contends, pointing out only "one or two" of the 1,200 community health centers in America today have ever defaulted on a loan.

Still, they have trouble getting loans from banks, even once they have been able to raise a chunk of funds, in large part because centers "in an economically distressed inner-city neighborhood serving a mixture of Medicaid patients and the uninsured, or one in a depressed heartland town where real estate prices are spiraling downward" are seen as a risk, Leonard explains.

Leonard suggests the centers be eligible for the Small Business Administration's 504 loan program, in which a small business asks a non-profit lender to issue "low-interest, fixed-rate, government-backed bonds to finance up to 40 percent of the project," Leonard writes. As of now, the loan program is only open to some for-profit businesses. But Congress could change that, thus opening up possibilities. Moreover, the loan program is "routine and efficient to process" and the "interest rates are among the lowest on the market," Leonard contends.

Another option would be for construction companies and real estate developers to put up the equity themselves, build the facilities and then rent them out to nonprofits "on a long-term lease or through various lease-to-own arrangements." "Indeed, hungry developers and construction firms would find any number of ways to get the hammers swinging," Leonard writes.

Overall, it's a win-win, Leonard argues."It's hard to imagine Congress appropriating any more direct spending to fuel the construction of health centers," he writes. "But there's no good reason why they shouldn't change a few words in a statute to achieve the same end. Not only would it quickly create much-needed jobs in the construction trades, it would also spark economic activity over the long run in some of the places in America that need it most." (Read more)