Most Kentucky hospitals in national patient-safety ratings got 'C' grades again; state is 35th in share of hospitals with 'A' ratings

By Melissa Patrick

Kentucky Health News

Most of the Kentucky hospitals graded on a nonprofit group's twice-a-year report card for patient safety again got a C in the latest report. 

The Leapfrog Group, based in Washington, D.C., rates nearly 3,000 general acute-care hospitals based on how well they protect patients. Most of Kentucky's 126 hospitals are relatively small, so they are not rated by Leapfrog; it rated 62 Kentucky hospitals.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government; nor does it grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

Leapfrog gave 'A' ratings to 10 Kentucky hospitals; Kentucky's percentage of A grades, 16.4%, ranked it 35th among states. That was up two slots from the last report, when it ranked 37th. Leapfrog gave Bs to 19 Kentucky hospitals, Cs to 27 and Ds to 5.  

The grades are based on more than 30 measures that indicate how well hospitals protect patients from preventable errors, injuries, accidents and infections. 

The spring 2024 report showed 92% of U.S. hospitals have seen improvements in at least one of three infections associated with hospitals. Methicillin-resistant Staphylococcus aureus (MRSA) decreased by 30%, central line-associated bloodstream infections decreased by 34% and catheter-associated urinary tract infections decreased by 30%. This good news comes after a six-year high for those infections was reported in the fall 2022 report. 

"While today’s results are promising, patient safety remains a crisis-level hazard in health care. Some hospitals are much better than others at protecting patients from harm, and that’s why we make the Hospital Safety Grade available to the public and why we encourage all hospitals to focus more attention on safety,” Leah Binder, president and CEO of The Leapfrog Group, said in a news release. 

She added, "According to a summary of peer-reviewed research published in British Medical Journal, an estimated 250,000 people a year die of preventable errors and infections in hospitals, which makes patient safety problems the third leading cause of death in the United States." 

The spring 2024 report also showed some improvements on patient experience measures compared to fall 2023. The release notes that these measures worsened during the pandemic and have still not returned to pre-pandemic levels. These measures look at things that have a direct impact on patient safety outcomes, including nurse communication, doctor communication, hospital staff responsiveness, communication about medicine and discharge information. 

"Patient experience is very difficult to influence without delivering better care," Binder said, "so these findings are encouraging."

The Leapfrog site offers details on the measures for each hospital under the heading Infections. It also provides detailed information under headings titled Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. The information is provided in an easy-to-read, color-coded scale that indicates how the hospital is performing.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey and other supplemental data sources. Leapfrog says hospitals are only graded if they have submitted adequate data for evaluation.

Top Scores

Hospitals getting As were Baptist Health La Grange, Baptist Health Lexington, Deaconess Henderson Hospital, Georgetown Community Hospital, Meadowview Regional Medical Center in Maysville, the Medical Center at Bowling Green, Saint Joseph-London, St. Elizabeth Healthcare-Edgewood, T.J. Samson Community Hospital in Glasgow, and TriStar Greenview Regional Hospital in Bowling Green.  

Screenshot of page for Georgetown Community Hospital

Georgetown Community Hospital received an A after getting six consecutive Cs.

Baptist Health Lexington has received an A grade for 13 consecutive grading periods. Deaconess Henderson moved up from a B grade in the fall 2023 report. The rest in this top group also received As in the fall. 

Shifts up and down

Four Kentucky hospitals moved down to a B after getting an A on the last report, including Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital and Norton Women's & Children, all in Louisville. 

Five Kentucky hospitals moved up to a B after getting a C on the last report, including Baptist Health Deaconess Madisonville, Baptist Health Richmond, Harrison Memorial Hospital in Cynthiana, Middlesboro ARH Hospital and the University of Kentucky Albert B. Chandler Hospital. 

Other hospitals with B grades are Baptist Health Louisville, Baptist Health Paducah, Clark Regional Medical Center in Winchester, Owensboro Health Muhlenberg Community Hospital in Greenville, Saint Joseph East in Lexington, St. Elizabeth Healthcare-Fort Thomas, St. Elizabeth Healthcare-Florence, U of L Health Shelbyville Hospital, UK HealthCare Good Samaritan Hospital and Blanchfield Army Community Hospital in Fort Campbell. 

Five Kentucky hospitals moved up from a D to a C: Hazard ARH Regional Medical Center, Jackson Purchase Medical Center in Mayfield, Jewish Hospital in Lexington, Kentucky River Medical Center in Jackson and UofL-Sts. Mary and Elizabeth Hospital. 

Three hospitals moved down from a B to a C: Kings Daughters Medical Center in Ashland, Monroe County Medical Center in Tompkinsville and Whitesburg ARH Hospital. 

The remaining 19 hospitals with a C all got Cs on the last report card too. 

Taylor Regional Hospital in Campbellsville moved down from a C to a D and Jennie Stuart Health in Hopkinsville moved up to a D after being the only hospital in the fall 2023 report to get an F. 

Other hospitals with D grades are Highlands ARH Regional Medical Center in Prestonsburg, Murray-Calloway County Hospital and Pikeville Medical Center. 

No Kentucky hospitals got an F on this report. 

Click here for a list of frequently asked questions about the survey. Click here to see if your hospital was graded. 

As a drug-resistant fungal disease, Candida auris, adapts to the warmer climate, cases of it rise; up 214% in Kentucky in 2022

Cases of a potentially fatal fungal disease called Candida auris have increased by 1,200 percent since 2017 and the warmer climate could be to blame, Camille Fassett reports for The Associated Press and Grist.

All of Kentucky's 29 clinical cases of C. auris were reported in 2021 and 2022. However, there was a 214% increase between the years, with seven in 2021 and 22 in 2022, according to the Centers for Disease Control and Prevention. 

Fungal disease expert Arturo Casadevall, a microbiologist, immunologist and professor at Johns Hopkins University, told Fassett that humans normally have tremendous protection against fungal infections because of our temperature. 

“However, if the world is getting warmer and the fungi begin to adapt to higher temperatures as well, some … are going to reach what I call the ‘temperature barrier’,” he said, referring to the threshold at which mammals’ warm bodies usually protect them from infection.

In other words, Fassett writes, "Over time, humans may lose resistance to these climate-adapting fungi and become more vulnerable to infections. Some researchers think this is what is happening with C. auris." 

And while C. auris is not usually dangerous for healthy people, it can be for older patients, people with pre-existing medical conditions and people in health-care settings. The death rate is estimated to be between 30% and 60%, according to the CDC. 

The pathogen was first identified 14 years ago in Japan and early on most cases in the U.S. were linked to people who had traveled from other places, Meghan Marie Lyman, an epidemiologist for mycotic diseases at the CDC, told Fassett. Now, she said, most cases are acquired locally, generally spreading among patients in health-care settings.

"In the U.S., there were 2,377 confirmed clinical cases diagnosed last year," Fassett reports. She adds, "In the U.S., the most cases last year were found in Nevada and California, but the fungus was identified clinically in patients in 29 states. New York remains a major hot hotspot."

Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth Houston, told Fassett that he thinks C. auris is “kind of our nightmare scenario.”

“It’s a potentially multidrug-resistant pathogen with the ability to spread very efficiently in health care settings,” he said. “We’ve never had a pathogen like this in the fungal-infection area.”

The problem is so bad that the CDC issued a news release in March, calling the fungus "an urgent antimicrobial resistance (AR) threat" and noted that it "spread at an alarming rate in U.S. health-care facilities in 2020-21." 

"CDC has deemed C. auris as an urgent AR threat, because it is often resistant to multiple antifungal drugs, spreads easily in health-care facilities, and can cause severe infections with high death rates," the release says.

The article is published in Grist, an online journal of environmental news and commentary, as part of a collaboration with AP called Climate Connections, to explore how a changing climate is accelerating the spread of infectious disease around the world, and how mitigation efforts demand a collective, global response.

Most Kentucky hospitals in national patient-safety ratings got C grades again; state ranks 36th among states in share of A ratings

By Melissa Patrick
Kentucky Health News

Most of the 60 Kentucky hospitals graded on a nonprofit group's report card for patient safety got a grade of C.

The Leapfrog Group, based in Washington, D.C., rates nearly 3,000 general acute-care hospitals based on how well they protect patients. Most of Kentucky's 126 hospitals are relatively small and are not rated.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government; nor does it grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

Leapfrog gave A ratings to 11 Kentucky hospitals, or 18.3% of the 60 it graded; Kentucky ranked 36th among states in the percentage of A grades, about the same as 35th in the last report. It gave Bs to 16 Kentucky hospitals, Cs to 23 and Ds to 10. 

The grades are based on more than 30 measures that indicate how well hospitals protect patients from preventable errors, injuries, accidents and infections, and whether hospitals have systems in place to prevent them. 

A Leapfrog news release notes that this is the 10th anniversary of the Leapfrog Hospital Safety Grade report and that an analysis of data gathered from 2012 to 2022 suggests there has been an improvement in patient safety over time, with a 27% decrease in falls and trauma, and a nearly 29% decrease in objects being unintentionally left in bodies after surgery. Further, it found decreases in infections associated with health care.

"For five of the outcome measures that can be tracked, these improvements saved an estimated more than 16,000 lives over the 10-year period," the release says.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey and other supplemental data sources. Leapfrog says hospitals are only graded if they have submitted adequate data for evaluation. 

The Leapfrog site offers details on a number of measures, under headings titled Infections, Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing.

Screenshot of Leapfrog page for AdventHealth Manchester, which moved up  to an A from a C. 

High Scores

Hospitals getting As were: Advent Health Manchester; Baptist Health Lexington; Baptist Health Richmond;  Clark Regional Center in Winchester; Deaconess Henderson Hospital; Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital, and Norton Women's & Children's Hospital; St. Elizabeth Healthcare-Ft. Thomas; and Lebanon's Spring View Hospital. 

AdventHealth Manchester moved up from a C on the last report, Clark Regional Center moved up from a B on the last two, and Spring View Hospital got its first A ever. The rest maintained their A grades. 

Baptist Health Lexington has received an A grade for 10 consecutive grading periods, and and Baptist Health Richmond has received an A for five consecutive grading periods.  

This is the seventh straight grading period that all four Norton Healthcare adult-service hospitals in Louisville have received an A.

“By working together and keeping the safety of our patients — and each other — at the center of all they do, Norton Healthcare’s employees consistently do the hard work that is necessary to receive ‘A’ Leapfrog Hospital Safety Grades,” Russell F. Cox, president and CEO of Norton Healthcare, said in a news release. “Seven consecutive ‘A’ grades is no small feat, and I am honored to lead this exceptional team." 

Shifts up and down

After receiving four Cs in a row, preceded by nine Ds, University of Louisville Hospital rose to a B on the latest report.

"Improved data reporting, and other initiatives, implemented since UofL Health’s formation are beginning to show positive direction," UofL Health said in a statement. " As the first hospital in the system, UofL Hospital’s rising grade is an early indicator of more to come. . . . For our other facilities, the grades issued by Leapfrog reflect data that lags by several years and continue to include years of previous ownership groups." 

Other U of L hospitals graded by Leapfrog were UofL Health Shelbyville Hospital (B), UofL Health-Sts. Mary and Elizabeth Hospitals (C), and Jewish Hospital (C). 

Meadowview Regional Medical Center in Maysville moved up to a B after receiving two Cs in a row, as did Saint Joseph Hospital in Lexington, after getting four Cs in a row and Lexington's UK HealthCare Good Samaritan Hospital after getting five Cs in a row. 

Two Kentucky hospitals moved from an A grade on the last report to a C grade: Mercy Health Lourdes in Paducah and Monroe County Medical Center. Baptist Health Corbin moved from an A to a B.  

Baptist Health Paducah moved down to a C from a B, after having received only one C grade since fall 2018, and Owensboro Health moved down to a C after receiving only As and Bs since spring 2018. 

Other hospitals that moved from a B to a C were Frankfort Regional Medical Center and TJ Sampson Community Hospital in Glasgow. 

Five hospitals moved from a C grade down to a D grade. 

Flaget Memorial Hospital in Bardstown moved down to a D from a C, after having received all As and one B since Fall 2019. 

Harlan ARH Hospital moved down to a D after receiving seven Cs in a row, and Hazard ARH Regional Medical Center got a D after getting two Cs in a row. 

Jackson Purchase Medical Center in Mayfield moved down to a D after getting seven Cs in a row. 

The other five hospitals with D grades are Jennie Stuart Health in Hopkinsville, Murray-Calloway County Hospital, Pikeville Medical Center, St. Claire Regional Medical Center in Morehead, and Taylor Regional Hospital in Campbellsville. Each also got a D on the last report. 

Click here for a list of frequently asked questions about the survey. Click here to see if your hospital was graded.

Every Covid-19 metric is up this week in Kentucky, with positive-test rate nearly 17%, not counting home tests; deaths are way up

Kentucky Health News graph from state data; for a larger version, click on it.

By Melissa Patrick
Kentucky Health News

All the metrics used to measure the coronavirus in Kentucky went up last week, including new cases, the share of Kentuckians testing positive for the virus, and Covid-19 hospitalizations and deaths. 

The share of Kentuckians testing positive continued on a steady rise, increasing to 16.96% from 15.75% in the previous Monday-through-Sunday reporting period. The figures do not include home tests.

The state attributed 62 more deaths to Covid-19 last week, an average of 8.86 per day, a big jump from the previous week's 38, a rate of 5.43 per day. The state's pandemic death toll is 16,224. 

The state's report for last week shows 10,949 new coronavirus cases, an average of 1,564 per day. Last week, the daily average of new cases was 1,368. The increase from week to week was 14.3%.

The statewide incidence rate increased to 33.98 cases per 100,000 population, the highest sicne Feb. 25, up from 30.77 in the previous report. The top 10 counties were Rowan, 64.8 per 100,000; Perry, 63.8; Muhlenberg, 57.4; Wolfe, 55.9; Robertson, 54.2; Mercer, 53.4; Bourbon, 51.3; Simpson, 50.8; Lyon, 50.5; and Boyd, 49.5.

The New York Times ranks Kentucky's case rate 18th among the states, with a 7% drop in cases in the last 14 days. 

Covid-19 hospital numbers remain low, but keep ticking up. Kentucky hospitals reported 484 patients with Covid-19, up from 405 a week ago, with 72 in intensive care (up 23) and 28 on mechanical ventilation (up five). 

The latest Centers for Disease Control and Prevention national Covid-19 risk map, which estimates risk through new-case numbers and hospital capacity, shows 37 counties with a high level of coronavirus transmission and 44 with a medium risk. The map is updated on Thursday evenings.

Feds won't reveal data on spread in hospitals

Politico reported in June that the Biden administration considered publicly releasing data detailing how prevalent Covid-19 spread inside individual hospitals during the Omicron wave, but decided to keep it secret.

Rachel Levy reports, "The decision to withhold the names, based partly on concerns about duplicative data and partly on fears of embarrassing hospitals, denies patients the opportunity to steer clear of health systems with poor track records and allows facilities to avoid public scrutiny, patient advocates say." 

The American Hospital Association wants facilities’ infection numbers to stay private. “Reporting aggregate data is the most appropriate approach given the very low occurrence of hospital onset Covid-19,” Nancy Foster, an AHA executive, said in a statement.

Ginger Dreyer, senior director of communications for the Kentucky Hospital Association, and Susan Dunlap, spokeswoman for the Cabinet for Health and Family Services, both said they did not have any data on hospital-transmitted Covid-19 infections. 

Dr. Kevin Kavanagh of Somerset, an infection-control activist and board chairman of Health Watch USA, writes about this issue in an op-ed for the Louisville Courier Journal, calling the design to measure hospital-acquired Covid-19 "severely flawed," resulting in what he says is likely a big undercount.

"The estimates of the hospital-acquired Covid-19 in the United States are almost assuredly drastic undercounts, but no one knows because no one is truly counting," he writes, adding that many hospital employees don't feel safe, "worsening the chronic nursing staff shortage. The CDC must set the highest standards for the world to emulate, not standards that are pliable for our profit-driven health care systems." 

The state's latest report shows five of  Kentucky's 10 hospital regions are using at least 80% of their intensive-care beds, with Northern Kentucky having the highest percentage of Covid-19 patients in them, 7%. Eastern Kentucky is only at 59.55% ICU capacity, but 8.6% of its ICU patients have Covid-19.

USA Today reports on its analysis of Covid-19 deaths in nursing homes last winter, with a focus on Trilogy Health Services

Some Trilogy Health Services residents who died of Covid-19 (Photos contributed to USA Today)

USA Today recently published its findings from an in-depth analysis that looked at Covid-19 nursing home deaths during the 2020-21 winter surge, with a focus on one company that had twice the national average of deaths for nursing homes and has as many as 20 facilities in Kentucky. 

The year-long analysis was done by Letitia Stein, Jayme Fraser, Nick Penzenstadler and freelancer Jeff Kelly Lowenstein. It was published mid-March as a series of  stories, titled "Dying for Care."  

USA Today says, "In a first-of-its-kind analysis, they identified nursing-home ownership webs invisible to consumers. They scored the performance of every nursing home in America to probe questions of corporate responsibility left unanswered by government regulators and dozens of research papers on the pandemic's 140,000-plus nursing home deaths."

The series opens with pictures of people who died in nursing homes of Trilogy Health Services, found to have the "highest death rates reported by any large nursing home chain at the height of the pandemic."  

The analysis found that residents in Trilogy's 115 homes died of Covid-19 last winter at twice the national average for nursing homes, based on figures facilities must file weekly with the federal government. 

After being presented with USA Today's findings, the company told the newspaper that it had mistakenly reported hundreds of deaths during the surge and offered a revised tally that reduced the count by more than 40 percent, but it declined to provide documentation of those claims. It has since "filed new numbers with the federal government and hired a consultant to help it review its death count," the newspaper reports. 

But even with those lower numbers, the paper found Trilogy's Covid-19 death rates were "well above the national average" during the winter surge. 

The paper's analysis found that the deaths were not driven by residents who were older or more fragile, and could not be explained solely by the company's presence in states hard-hit by the virus. An unusual distinction was that Trilogy had been acquired by a company specializing in real estate in a test of a business model new to large nursing-home chains. 

The analysis found that "millions of dollars continued to flow from Trilogy to a California-based real estate venture busy preparing its next investment pitch – a stock listing expected to launch this year." 

The story digs into the business model behind these nursing homes and their efforts to increase profits, including staff cuts. It says Trilogy "went further than any other major chain in shrinking care hours delivered to residents before the pandemic," that "half of its facilities were cited by health inspectors for violating Covid-19 safety rules in 2020" and that "Trilogy's poor Covid outcomes stood out by measure after measure." 

The company divided its facilities "into red, yellow and green zones to limit exposure to the virus," the story says, but "Eyewitness interviews and the reports filed by health inspectors indicate this safety regimen was often a charade." The story also includes interviews with families of those who died. 

The series also includes short stories about some of the Trilogy residents who died and another includes a video of families reflecting on their loss. In addition, there is a link to share the story of how you lost a loved one in a nursing home due to Covid-19. 

Also in the USA Today "Dying for Care" series: 

The reporters break down their findings into four key things to know about their investigation into nursing home failures during Covid-19, including why Trilogy stood out, impact of staffing on care, impact of ignoring safety lapses pointed out in inspections, and impacts from the real-estate business model. 

In response to the story, federal nursing home regulators have said they need to collect better information about real estate ownership model's like Trilogy's, they report. Further, President Joe Biden  proposed reforms in February that would track problem owners across states  and shed light on Wall Street profits from nursing homes. 

The analysis revealed ownership webs invisible to consumers and said "problems across chains eluded federal officials overseeing nursing homes, who were focused on individual facilities during the pandemic." 

A story by Fraser walks through the details of how they did the analysis. She writes that USA Today took a closer look at nursing-home performance in the winter surge from October 2020 to February 2021 because half the nation's 140,000 Covid-19 deaths in nursing homes happened during that period, "months after best practices were established and federal aid issued for coping with the coronavirus." 

Another story, written by Penzenstadler, offers a guide to choosing the right nursing home for a loved on in three steps. 

Penzenstadler also explores the question, "When does a nursing home Covid-19 death count?" 

There is also a section that allows you to look up nursing-home ratings from the analysis and see how they fared during the pandemic's winter surge, 2021-21. 

There are no Kentucky data in the spreadsheet; USA Today reports there are 13 Trilogy Health Services facilities in Kentucky, but its website lists 20: Cooper Trail Senior Living in Bardstown; Cedar Ridge Health Campus in Cynthiana; Walker's Trail Senior Living in Danville; The Willows at Harrodsburg; The Springs at Oldham Reserve in La Grange; The Willows at Citation in Lexington; The Willows at Fritz Farm in Lexington; The Willows at Hamburg in Lexington; Forest Springs Health Campus in Louisville; Franciscan Health Care Center in Louisville; Glen River Health Campus in Louisville; Park Terrace Health Campus in Louisville; The Legacy at English Station in Louisville; The Springs at Stony Brook in Louisville; The Willows at Springhurst in Louisville; Westport Place Health Campus in Louisville; Sanders Ridge Health Campus in Mt. Washington; Calumet Trace Senior Living in Owensboro; Shelby Farms Senior Living in Shelbyville; and Boonesboro Trail Senior Living in Winchester. 

Hospitals agree to follow higher quality standards to get more money from Medicaid, which covers 1/3 of state's population

By Melissa Patrick
Kentucky Health News

With up to 28 rural Kentucky hospitals vulnerable to closure if their finance don't improve, Tuesday's announcement of a new payment model to increase the amount Kentucky's hospitals are paid for Medicaid patients is cause for their celebration.

"Improved reimbursement for Kentucky's hospitals is vital for their survival. Medicaid . . . does not cover the full cost of caring for the patients we serve," Nancy Galvagni, president of the Kentucky Hospital Association, said at Gov. Andy Beshear's news briefing Tuesday. "Every year our state's hospitals see a shortfall from treating Medicaid patients. And with more than a third of the state's population covered by Medicaid, this is an unsustainable model."

Galvagni told Kentucky Health News that the risk of closure is real for many Kentucky hospitals, noting that Our Lady of Bellefonte Hospital in Ashland closed last year, and Jewish Hospital in Louisville likely would have closed if it had not been taken over by the University of Louisville. 

"When you are operating with a majority of your patients who are being paid below cost, they can't reinvest in the facility or the capital requirements," she said.

In order to receive these funds, hospitals will have to abide by higher quality standards that are still being decided by KHA and the Cabinet for Health and Family Services. Quality standards include things like hospital-acquired infections, medication errors and readmission rates.

Friedlander and interpreter Virginia Moore
announced the new hospital payment program.

Health Secretary Eric Friedlander told Kentucky Health News that the new model will allow the state's hospitals to get paid an "average commercial rate," which is what private insurers would pay for health care in hospitals, instead of the current Medicaid rate, which he said is "way below that amount." 

Gov. Andy Beshear said at the briefing that this new Medicaid payment model will send an extra $800 million to $1 billion a year to hospitals. 

Friedlander called the payment model a "creative response" to what is allowed by the Centers for Medicare and Medicaid Services. He said the University of Kentucky and University of Louisville hospitals already have a similar mode of payment.

The next step is for the General Assembly to approve the program by passing House Bill 183, sponsored by Rep. Brandon Reed, R-Hodgenville. It would give the cabinet the authority to spend the money, which will be provided by the hospital association. It also allows for increased flexibility by allowing the state to exempt hospitals that would not benefit from the program.  

Friedlander explained that this new program does not incur any additional cost to the state because Kentucky's hospitals have agreed to cover it.

Further, he said a move to this new payment model will result in more money for the state. Beshear's news release says the Department for Medicaid Services will have access to an additional $50 million to $80 million in funding. 

Calling it a "fantastic win" for everyone, Galvagni said, "This could mean the difference between keeping the lights on and closing the doors to many of our hospitals across the state."

Friedlander added that this increased funding is important for a myriad of reasons. "This is designed to improve quality," he said. "It is designed to improve reimbursement to hospitals so that they're not taking the losses on their Medicaid patients. This will be designed to support financially, keeping all the hospitals in Kentucky open so we won't see more closures. This will go to improve infrastructure. And this ends up not being a cost to the state." 

Further, he said it will decrease uncompensated care at hospitals and will serve as an incentive to get everyone who is eligible signed up for Medicaid, "because the difference between a Medicaid patient now and somebody who is not insured is immense."

Carl Herde, vice-president of financial policy at the KHA, in a phone interview spoke to the importance of keeping hospitals open, not only because of the jobs they bring to a community, but also because studies show that communities without hospitals have higher mortality rates.

"When we get House Bill 183 passed and we move this forward, I think this really does create a path for financial stability, for specifically the small rural hospitals," he said, adding that most of the most financially vulnerable hospitals in the state are the small, rural ones. "And so we do think this creates a sustainable path for financial viability into the future for those communities."

The state plan amendment for these changes was filed Sept. 30, which means the federal government will allow the state to back-pay hospitals at the new rate starting July 1. 

Friedlander added that this new model, which must be approved annually, will help most of the state's hospitals and that the state and KHA has committed to making sure it does not harm any of them.

Friedlander and KHA said they were unsure, but thinks Kentucky is the first state to implement this particular payment model statewide. KHA added that other states have Medicaid payment programs that are funded at this level, but are done differently. 

More Ky. hospitals got As on safety-grade report; most still get Cs

By Melissa Patrick

Kentucky Health News

More Kentucky hospitals than the last time got a grade of A on a nonprofit group's rating of patient safety in hospitals, but for the fifth grading period in a row, most of the 45 Kentucky hospitals got Cs.  

The Leapfrog Group, based in Washington, D.C., rates more than 2,600 hospitals. Most of Kentucky's 126 hospitals were not rated, but those that are have a majority of the hospital beds in the state.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government, nor does it grade specialty hospitals, government hospitals, or hospitals for which there aren't enough publicly reported data. 

Leapfrog gave As to 16 Kentucky hospitals, or about 36 percent of those it graded, up from about 26% getting As on the last report. Based on the number of hospitals with As, Leapfrog ranked Kentucky 21st among the states, up from 33rd in the last report. It gave Bs to eight hospitals, Cs to 19, and Ds to two.

The twice-yearly grades are based on 27 performance measures of patient safety that indicate how well hospitals protect patients from errors, injuries, accidents and infections. The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey, and other supplemental data sources. Hospitals are only graded if they have submitted adequate data for evaluation, Leapfrog says.

The Leapfrog site offers details on each measures, under headings titled Infections, Problems with surgery, Practices to prevent errors, Safety problems, Doctors, Nurses and Hospital staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing. 

Screenshot of Laepfrog page for Whitesburg ARH Hospital, which got a C, shows detail
for infection issues and tabs for other issues. For a larger version of the image, click on it.

The news release from Leapfrog notes that the data from the report does not yet reflect the impacts of the coronavirus pandemic.

“We see in the news every day the extraordinary courage of clinicians and staff caring for patients stricken by Covid-19,” Leapfrog CEO and President Leah Binder said in a news release. “What’s less apparent — yet equally laudable — are the untold efforts behind the scenes to protect patients. Hospitals’ commitment to the fundamentals have saved lives too, like preventing infection, ensuring universal hand hygiene, and double and triple checking everything to avoid errors.”

High scorers

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

Other hospitals on the A list are: Baptist Health hospitals in La Grange, Lexington, Madisonville and Richmond; Clark Regional Medical Center in Winchester; Flaget Memorial Hospital in Bardstown; Harrison Memorial Hospital in Cynthiana; Mercy Health Lourdes in Paducah; Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital, and Norton Women's & Children Hospital; Saint Joseph-London; St. Elizabeth Healthcare-Ft. Thomas; and St. Elizabeth Hospital-Florence.

Baptist Health La Grange earned its first-ever A in the patient safety report after receiving only Cs since fall 2018. 

“This rating is a testament to our staff who have been working so hard to provide the high quality, compassionate care for which Baptist Health is known – in the midst of a pandemic,” Clint Kaho, Baptist Health La Grange president, said in a news release. “It is especially meaningful for us to receive Leapfrog’s highest rating in patient safety when we are taking extraordinary measures to protect our patients, our staff and our communities during a pandemic and otherwise.”

Baptist Health Madisonville also moved up to an A after receiving only Cs since fall 2017. The last time it got an A was spring 2016. 

“Baptist Health Madisonville aims for constant and consistent improvement in our processes, using best practices to deliver excellent care to our patients,” Teresa Dillingham, quality director, said in a news release. “This grade reflects the dedication of our staff to high standards of patient care.”

Baptist Health Richmond, Flaget Memorial Hospital, Harrison Memorial Hospital and Saint Joseph London all moved up from a B in the last report. 

Shifts up and down

Baptist Health Corbin moved up to a B after getting three Cs in a row. Baptist Health Louisville moved up to a B after getting four Cs in a row. Baptist Health Paducah regained its B, after getting a C in the last grading period. 

Deaconess Henderson Hospital moved up to a B after getting two Cs, an F and a D in the last four reports.

And after getting four As in a row, Georgetown Community Hospital moved down to a B. 

Other hospitals on the B list are Owensboro Health, Glasgow's T.J. Samson Community Hospital, and Bowling Green's TriStar Greenview Regional Hospital. 

Forty-two percent of the Kentucky hospitals got Cs, and 13 of the 19 hospitals on that list also got a C on the last report. 

All three University of Louisville hospitals, which include recent additions Jewish Hospital and Mary and Elizabeth, got Cs on the report card.

U of L Hospital moved up to a C after getting nine Ds in a row. Mary and Elizabeth moved back up to a C after getting two Ds in a row. Jewish maintained its C after getting an F in the fall of 2019 and seven Ds prior to that.

U of L, which officially took ownership of the former KentuckyOne Health hospitals in November 2019, told Tessa Duvall of the Louisville Courier Journal that the data used for the Leapfrog report still reflects previous ownership.

"Since forming UofL Health in November of 2019, we have seen a consistent improvement in quality metrics," the hospital said. "While the Leapfrog survey is not the scorecard we use to drive improvement throughout our organization, we will never be satisfied with anything other than providing top-quality patient care."

Saint Joseph Hospital in Lexington moved down to a C after getting six Bs in a row. Saint Joseph East, also in Lexington, moved down to a C, after getting Bs on the last two reports. 

Whitesburg ARH Hospital down to a C, after getting six As, one B and one "no score" since fall 2016. 

Frankfort Regional Medical Center moved back to a C, after getting a B in the last report. 

Hazard Regional Medical Center got its fourth D in a row and Highlands Regional Medical Center in Prestonsburg went back to a D, after getting a C in the last report and four Ds prior to that. 

 
Click here for a list of Kentucky hospitals and their Leapfrog safety grades. Click here for a list of frequently asked questions about the report. The group has also provided a playbook titled, "Protecting Yourself During the Respiratory Illness Season: A Playbook for the Community," to serve as a guide for the public on steps to take to decrease the risk of sickness. 

Morehead hospital says covid-19 surge came from patients who delayed treatment for other conditions; telehealth is here to stay

St. Claire Regional Hospital (Youtube photo, from The Daily Yonder)

At the end of 2019, St. Claire Regional Healthcare System restructured its finances after finishing the fiscal year about $9 million in the red. In March, the novel coronavirus hit and basically brought the hospital to a standstill and forced it to make even more changes, Liz Carey reports for The Daily Yonder.

Headquartered in Morehead, St. Claire provides services to eight Eastern Kentucky counties. in addition to its hospital, it hascclinics in Frenchburg, Olive Hill, Owingsville and Sandy Hook. It also provides mental and behavioral health services, palliative care, aesthetics care, dental care, and pharmaceuticals. 

Donald H. Lloyd, II, the hospital system's president and CEO, told Carey that the restructuring had resulted in a positive cash flow by February, but then the pandemic hit Kentucky and Gov. Andy Beshear banned elective surgeries, which account for 90 percent of those at the hospital. This forced them to make more personnel changes, including furloughs.

The first case of covid-19 showed up in Rowan County in March. By then the hospital had been converted into two separate areas, a hot zone for patients suspected of covid-19, and a cool zone for all the rest, Carey reports.  

“You would walk down a corridor and you would see this huge barrier that you had to don and doff protective equipment and then zip through a series of barrier walls in order to enter where the actual patients were,” Lloyd told Carey. “It was just so surreal. It was like from a science-fiction movie.”

Lloyd and his staff found that patients with heart attacks weren't coming into the hospital's emergency room, Carey writes.

“On the video calls with my colleagues, not only here in the commonwealth but across the United States, we were all asking ourselves ‘Where are the heart attacks, where are the strokes?’ We all thought the coroners must be extremely busy,” he said. “My chief medical officer and myself had numerous conversations with our coroners and a realization came that if we did begin to see a spike in deaths in the general population that our coroners would actually be the first to observe them.” 

This realization set the hospital into action to find high-risk patients and a way to care for them. “We aggressively worked to contact these patients, especially those that we knew have chronic conditions, and reminded them that it was imperative that you know they needed their conditions to be monitored and managed,” Lloyd said, estimating that they reached out to more than 25,000 of their 200,000 patients. 

It turned out that the surge caused by covid-19 was indirect: untreated chronic conditions caused by fear of infection. When those patients finally sought medical attention, they had "acute exacerbations," Lloyd said.

This also led to a move toward telehealth, and that led to the realization that many patients did not have access to high-speed internet. So, Carey reports, the hospital set up an area in its empty parking lot where patients could park, use the hospitals' tablet computers, access its wi-fi and visit their health-care provider through telehealth. 

“Our patients have really embraced that, and we perceived that people that, you know, that maybe live at the margins, or that maybe have a lower education level, would be intimidated by the use of that technology. On the contrary, they have embraced it,” Lloyd told Carey. “Many of our patients (in outlying counties) can’t afford to travel to Morehead or they have very limited transportation ability. It is amazing to me how effective this technology and the use of telemedicine has been for us to connect with them now.” 

Since mid-May, Lloyd said, the hospital has started to come back to normal, but telehealth is here to stay. He said, “I think [telehealth] is part of the new reality going forward in the way we deliver care and that there is going to be, for Saint Claire Healthcare and our enterprise, at least 25 percent of our future patient encounters will be virtual."

Most Kentucky hospitals get a 'C' on a twice-a-year safety report card, including Jewish, which got a rare 'F' on the last report

By Melissa Patrick
Kentucky Health News

For the fourth grading period in a row, a nonprofit group that rates patient safety in hospitals has given Cs to most of the 49 Kentucky hospitals it rated.

The Leapfrog Group, based in Washington, D.C., rates more than 2,600 hospitals. Most of Kentucky's 126 hospitals were not rated,. The group does not grade hospitals with  "critical access" status because they don't have to report quality measures to the federal government, nor does it grade hospitals for which there aren't enough publicly reported data or specialty or government hospitals.

Leapfrog gave As to 12 Kentucky hospitals, or about 24 percent of those graded. It gave Bs to 10, Cs to 24, and Ds to 3. Most of the changes from the last report, in November, came from hospitals in the two lowest grades moving into the C category, with only a few swaps in the upper grades.

The only hospital to get a failing grade last fall, Jewish Hospital in Louisville, jumped to a C grade in this one, after having received a string of Ds since the spring of 2016 before getting a failing grade in the last report.

The University of Louisville acquired Jewish Hospital and other facilities from KentuckyOne Health last fall. David McArthur, public relations director for U of L Health, told Chris Larson of Louisville Business First that the system continually strives for patient safety improvements.

"The Leapfrog grade increase for Jewish Hospital reflects improvement by U of L Health for the self-reporting of process data," McArthur told Larson in an e-mail. "U of L Hospital was already meeting the self-reporting standard." That hospital again got a D, as did Sts. Mary & Elizabeth Hospital, which was one of the facilities bought from KentuckyOne.

McArthur said Leapfrog is using the same federal outcome data from fall 2019, so "With no new data, no score improvement was expected there." Because of the coronavirus pandemic, hospitals were allowed to use their survey responses from 2019 in 2020, unless they chose to update it, Leapfrog said.

Hazard ARH Regional Medical Center got a D for the third time in a row, after getting Bs and Cs in prior reports.

Screenshot of Hazard ARH scores shows detail for infection issues and tabs for other issues.

The twice-yearly grades are calculated using 28 performance measures of patient safety that indicate how well hospitals protect patients from errors, injuries, accidents and infections. The report uses data from the federal Centers for Medicare and Medicaid Services, Leapfrog's own survey, and other supplemental data sources. Hospitals are only graded if they have submitted adequate data for evaluation.

The Leapfrog site offers details on each of the measures under headings titled infections, problems with surgery, practices to prevent errors, safety problems, doctors, nurses and hospital staff. It also includes an easy-to-read, color-coded scale that indicates how the hospital is performing. For example, as shown in the graph above, Hazard ARH performed below average in three infection-control categories, but above average on two.

"While many hospitals are good at keeping their patients safe, some hospitals aren't," says Leapfrog. "As many as 440,000 people die every year from preventable errors in hospitals."

High scorers

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

Other hospitals on the A list are: Baptist Health Lexington; Clark Regional Medical Center in Winchester; Georgetown Community Hospital; Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital and Norton Women's & Children's Hospital; St. Elizabeth Heatlhcare-Ft. Thomas; St. Elizabeth Hospital-Florence; Mercy Health Lourdes in Paducah and Whitesburg ARH Hospital.

Mercy Health Lourdes and Whitesburg ARH were the only two on this list to change their status since the last grading period, both moving up from a B.

Saluting the repeated As for all his adult-service hospitals, Norton Healthcare President and CEO Russell Cox called it "a testament to the hard work of our dedicated providers and employees, who consistently strive to deliver safe, high-quality care to our patients. Never has this been more apparent than during the current public health crisis with the covid-19 pandemic.”

Shifts up and down

Flaget Memorial Hospital in Bardstown fell to a B after getting its first-ever A in last fall's report, after getting four Cs in a row. Harrison Memorial Hospital in Cynthiana also dropped to a B, after receiving three As in a row.

Baptist Health Richmond moved up to a B, after getting three Cs in a row, and Frankfort Regional Medical Center regained its B status after a C in the last report.

Other hospitals on the B list are Owensboro Health, Saint Joseph East and Saint Joseph Hospital in Lexington, Saint Joseph-London and Glasgow's T.J. Sampson Community Hospital.

Most of the hospitals got Cs, and most of the changes were to that status.

Hardin Memorial Hospital in Elizabethtown moved to a C after getting a B in the last report; Baptist Health Paducah dropped to a C, after getting three Bs in a row.

Highlands Regional Medical Center in Prestonsburg moved up to a C, after four Ds in a row.

And after getting their first Ds since the spring of 2016, the University of Kentucky Albert B. Chandler Hospital and UK HealthCare Good Samaritan Hospital and moved back up to a C status.

Only a few Kentucky hospitals have ever received a failing grade from Leapfrog. Other than Jewish Hospital last fall, they have been Lexington's Saint Joseph East in fall 2015 (it got a B this time); Methodist Hospital of Henderson, spring 2019; and Campbellsville's Taylor Regional Hospital in spring 2013. Both got Cs this time.

Click here for a list of Kentucky hospitals and their Leapfrog safety grades. Click here for a list of frequently asked questions about the report.

Just as virus was found to be more infectious than first thought, protections for patients, health workers were relaxed, doc writes

Kavanagh (Herald-Leader photo)

By Kevin Kavanagh, M.D.,
for Infection Control Today

Last week there were several revelations which caused grave concerns. The covid-19 virus was found to be more infectious, more dangerous; and at the same time health-care workers and patient protections appear to have been relaxed.

Infectivity of a virus is measured by the R0 (pronounced "R naught"). This is the average number of individuals each infected person will infect. For the flu, this number is approximately 1.3. Initially, many were under the assumption that the covid-19 virus was slightly more infectious than the flu. A few weeks ago it was described as 3 times as infectious, and last week the U.S. Centers for Disease Control and Prevention released a report that the R0 was equal to 5.7. At this level, over 80 percent of the population would have to be immune before herd immunity starts. Part of the infectivity can be explained by the findings that under certain circumstances the virus can spread in aerosol form and spread with talking and singing. The distance of spread from a sneeze has been estimated to be up to 27 feet.

These observations compound the problems with asymptomatic spread, with 25% of covid-19 positive patients being asymptomatic carriers, and another group are presymptomatic carriers. CDC Director Robert Redfield, M.D., has stated that there are “individuals that may not have any symptoms that can contribute to transmission, and we have learned that in fact they do contribute to transmission.”

There have also been a number of reports which indicate that the covid-19 virus is not just a respiratory virus but can affect organs throughout the body. Researchers have found that 19.7% of those hospitalized had heart damage, and of those 51% died. The virus can also affect the liver, kidneys, gastrointestinal tract and central nervous system. The latter can give rise to problems with the sense of smell and in some cases has even been postulated to decreased respiratory effort.

The CDC has replaced guidelines and issued emergency guidance for PPE use, extended use and limited use. The CDC’s recommendation of using a bandana as a last resort to stop the covid-19 virus places our healthcare system at the level of a Third World country and underscores the severity of the current pandemic and erosion of our healthcare system’s infrastructure. Although cotton masks probably help in preventing transmission, questions have been raised regarding surgical and cotton masks effectively filtering SARS–CoV-2 during coughs by infected patients.

The reusing of protective gear has erroneously been viewed as an “acceptable practice.” It is not, nor are facility practices of “only allowing use of N95s with confirmed covid-19 patients, with few exceptions.” Suspected patients need to be treated the same as confirmed patients.

In this backdrop of increased spread, known dangers and already relaxed regulations, the CDC has also outlined guidance for allowing covid-19 confirmed or suspected healthcare workers to return to work. I feel the non-test based criteria should be abandoned, since there are reports of asymptomatic patients having a positive covid-19 RT-PCR after resolution of symptoms.

Until the issue of viral reactivation in covid-19, recovered patients can be clearly delineated, recommendations for restriction of covid-19 recovered healthcare workers’ contact with severely immuno-compromised patients should be extended to all non-covid-19 patients with high-risk co-morbidities, including those with hypertension, heart disease, diabetes, cancer and over 60 years of age; and for an indefinite period of time. In addition, covid-19 recovered healthcare workers should be tested at least weekly. Finally, the use of N95 masks needs to be specified.

The recent CDC recommendations are not intended for maximal safety, they may be necessary but only as a last-ditch effort to do the least harm where proper PPE is not available. There have already been reports of frontline staff sounding the alarm of contamination of patients and staff, along with reports of wearing contaminated masks from patient to patient and reusing the same mask for five days. Health-care workers need to be properly informed of the risks to themselves, their families, and their patients along with being provided adequate healthcare and worker compensation benefits if they acquire covid-19.

Needless to say, additional PPE is desperately needed, hopefully both increased manufacturing and sterilization techniques will relieve the shortage. In addition, the strategy adopted by New York state to designate some facilities to exclusively treat covid-19 patients and others for non-covid-19 patients to help improve patient safety should be adopted in other areas of the nation.

We must make protecting our front-line health-care workers and patients a priority. Rapid testing will go a long way in assuring the safety of patients by identifying asymptomatic carriers in health-care workers and staff.

Dr. Kevin Kavanagh of Somerset is a retired physician and founder of HealthWatchUSA, a group focused on preventing infection in health care.

Ky.-based Infection-control activist calls for screening all patients, isolating infected ones, making hospital risk ratings more reliable

An infection-control activist says every hospital patient in the U.S. should be screened for a certain type of staph infection that can be deadly, citing data that shows this is the best way to decrease the spread of such infections.

Dr. Kevin Kavanagh of Somerset, chair of Health Watch USA, made several assertions and recommendations in a commentary published in the medical journal Antimicrobial Resistance & Infection Control, and also wrote an op-ed about the issue for BioMed Central. 

The commentary was prompted by new data from the federal Centers for Disease Control and Prevention showing that more than 119,000 people in America had a staph infection in 2017, and nearly 20,000 of them died from it.

These numbers reflect rates for all Staphylococcus aureus infections, including methicillin-resistant Staphylococcus aureus, or MRSA, and methicillin-susceptible Staphylococcus aureus, or MSSA.

Centers for Disease Control and Prevention chart; click on it for a larger version

After dropping by an average of 17 percent a year between 2005 and 2012, the rate of decline for hospital-onset MRSA has stalled. The report notes that the U.S. is not on track to meet its goal of 50% reduction by 2020.

Department of Veterans Affairs hospitals had a much larger decrease in MRSA infections, as opposed MSSA, since 2005: 55% and 12%, respectively.

Kavanagh says the difference is that the VA has universal MRSA surveillance and isolates all MRSA carriers, and those results mirror the results in the United Kingdom's National Health Service, which has similar infection-control practices.

"These findings support the contention that the marked decline in hospital-onset MRSA infections observed in these studies is due to interventions which are specifically targeted towards MRSA," he writes.

Kavanagh argues that because MRSA is regularly found in 2% of hospital patients, all U.S. hospitals should screen all patients for MRSA when admitted.

He says hospitals have moved away from early identification and isolation of MRSA carriers as a first line of intervention, to strategies that are based on poorly designed studies — perhaps as a reaction to patient-advocacy groups' push to mandate MRSA testing and isolation, which is costly.

Kavanagh further argues that daily bathing with the antiseptic chlorhexidine, a common practice in U.S. hospitals, is not supported by solid research. He says one study supporting it has data interpretations that have been questioned, and has "apparent conflicts of interest." He also argues that random, controlled trials haven't demonstrated uniform effectiveness of chlorhexidine bathing.

Kavanagh also points out instances where facilities have asked for "risk adjustments" to be made for their rates of hospital-acquired infections, such as adjusting the numbers to allow for high rates of infection among opioid users. He holds firm that this should not be allowed.

He argues that instead of adjusting numbers to make the problem seem less than it really is, hospitals should follow a standard of care that includes not only screening and isolation, but decolonization, which means getting rid of the MRSA virus in people who carry it in their nose or on their skin even though they are not sick with a MRSA infection.

Kavanagh says some of Kentucky's major hospitals have the highest numbers of MRSA infections in the U.S., but after manipulating the data for "risk adjustment" they are designated "no different from national benchmark."

He calls for a different way of thinking about MRSA in the U.S. that includes increased transparency; making surveillance, isolation and decolonization a standard of care that is fully funded; and a more comprehensive tracking system.

He concludes, "Until these reforms are universally enacted in the United States health-care facilities, I have grave reservations that the epidemic of drug-resistant bacteria will be brought under control."

Oct. 4 Health Watch USA conference in Lexington will focus on health-care transparency and patient safety

Somerset-based Health Watch USA will hold its 12th annual Healthcare Transparency and Patient Safety conference Oct. 4 in Lexington.

This year's conference will look at the importance of nursing in the prevention of adverse events, how infectious disease puts both patients and staff at risk, the importance of patient access to their medical records and the value of patient advocacy.

Christine Pontus, associate director of the Division of Health and Safety for the Massachusetts Nurses Association, and Jonathan Rosen, the principal consultant for AJ Rosen & Associates, which provides occupational-safety and industrial-hygiene services to labor unions, government agencies and organizations throughout the U.S., will review key occupational hazards confronting nurses, including the importance of safe staffing and infection control.

Jayne O'Donnell, USA Today's health-care policy reporter, will discuss what she's learned while covering patient safety and will offer strategies for healthcare workers to use when talking to reporters about medical safety lapses. She will also discuss the roadblocks reporters face when reporting on patient safety.

Dr. Joycelyn Elders, a former U.S. surgeon general, will lead a discussion on the importance of patient advocacy, followed by six patient advocate presentations.

Lisa Danielpour, a marketing, social-media and nonprofit-management consultant, will show how giving patients full access to their records can improve patient safety and health outcomes.

The conference will run from noon to 9 p.m. at the Eastside Branch Library in Lexington and will offer continuing education credits for certain medical professionals. The conference hotel is TownePlace Suites, 1790 Vendor Way, Lexington, KY, Hamburg Shopping Center. Click here for more information and a link to register.

UK and Norton hospitals rank high in resistant bloodstream infections; UK cites complex cases, recent improvements

Lexington Herald-Leader table by Chris Ware, adapted by Kentucky Health News, lists safety ratings and rankings of selected Kentucky hospitals by various rating groups, and number of methicillin-resistant staphlyococcus aureus bloodstream infections in fiscal 2017.

"Kentucky's two biggest hospital systems had some of the country's highest instances of an often deadly bacterial bloodstream infection known as MRSA" in the fiscal year that ended June 30, 2017, Linda Blackford reports for the Lexington Herald-Leader.

The Albert B. Chandler Hospital at the University of Kentucky and Louisville's Norton Healthcare each had 40 bloodstream infections of methicillin-resistant staphylococcus aureus, according to the Centers for Medicare and Medicaid Services. Of the 3,800 hospitals reporting, Norton and UK ranked sixth and seventh, respectively.

"UK's MRSA number was deemed 'no different from the national benchmark,' which considers a hospital's size and mission, according to a report by the CDC that compares hospitals," Blackford reports. "Still, UK's number was higher than many comparable teaching hospitals, such as the University of Cincinnati hospital, which had 27, or the University of North Carolina, with 33. . . . Norton and the bottom six hospitals were deemed 'worse than the national benchmark'."

Officials from both hospitals told Blackford that they follow precautions recommended by the federal Centers for Disease Control and Prevention, and that using the raw number of cases can be misleading because it doesn't take into account how many patients are admitted each year and how long they stay.

"At UK HealthCare, we take quality and safety very seriously and have implemented multiple processes to help reduce the number of infections to keep patients safe," spokeswoman Kristi Willett told Blackford. "Our large patient volumes and high level of patient complexity make us unique in the state of Kentucky as those things are known risk factors that can increase the risk of infection." MRSA is resistant to most antibiotics, and is most dangerous as a bloodstream infection.

UK handles many of the state's most complex medical cases, which require longer stays, making them more vulnerable to infection, said Derek Forster, UK's medical director for infection prevention and control. He said that since 2016, when it added precautions for patients in intensive care, the hospital's "standardized infection ratio" is down 55 percent, and MRSA infections in its ICUs have been reduced by half.

Norton's chief medical officer, Steven T. Hester, "said Norton noticed an increase in MRSA cases in 2016, and convened a system-level task force to deal with the issue," Blackford reports, quoting him: "Unfortunately, Kentucky is a state with a high incidence of opioid and intravenous drug abuse. We had concerns that our increase in MRSA could be related to the increased incidence and risk with substance dependent patients, specifically intravenous drug users."

Blackford reports, "Among other hospitals in Kentucky, the University of Louisville Hospital had 17 MRSA cases, Pikeville Medical Center had 12 and Hazard ARH had 10 cases. Hazard's number was deemed to be 'worse than the national benchmark.' Most of Kentucky's small, regional hospitals had fewer than five cases."

"Hospitals can and must do better," retired Somerset physician Kevin Kavanagh, board chair of Health Watch USA, writes in an op-ed for the Herald-Leader, in which he takes a close look at hospital ratings, especially on safety issues.

National speakers will headline conference on patient safety and health-care transparency in Lexington Nov. 3

The 11th annual Conference for Healthcare Transparency and Safety, sponsored by Kentucky-based Health Watch USA and Consumers Union's Safe Patient Project, will be held Nov. 3 at the Four Points Sheraton in Lexington, off Newtown Pike near Interstates 64 and 75. The cost, including lunch, is $48 ($35 for full-time students).

Lisa McGiffert, Consumers Union

Speakers will include Deborah Nelson, a Pulitzer Prize winning-investigative reporter, speaking on conflicts of interest and infectious-disease policy; Dr. Ivan Oranski, distinguished writer in residence at New York University and co-founder of Retraction Watch, on articles that have been retracted from peer-reviewed medical journals; Lisa McGiffert, director of the Safe Patient Project, on patient safety and health-care accountability. For a full list of speakers and presentations, and information on registration and continuing-education credits, go to www.healthconference.org.

Registration is open for Nov. 3 HealthWatch USA conference in Lexington on health-care transparency and patient safety

Somerset-based HealthWatch USA will hold its annual Healthcare Transparency and Patient Safety conference Nov. 3 in Lexington.

In addition to exploring issues around problems that occur with medical devices and implants, the importance of creating cultures of safety and health-care accountability, this year's conference, "The Setting of Strong Quality Standards and Research Integrity," will include two nationally renowned investigative reporters who will discuss research integrity and how it influences health-care policy.

Deborah Nelson, a Pulitzer Prize-winning investigative reporter and associate professor of investigative journalism at the University of Maryland, will discuss conflicts of interest and how this issue influences infectious disease policy.

Dr. Ivan Oransky, distinguished writer in residence at New York University and co-founder of Retraction Watch, will discuss the characteristics of articles retracted from peer-reviewed academic journals and how research integrity affects health-care policy.

The conference will run from 8:30 a.m. to 4:30 p.m. at the Four Points Sheraton in Lexington and will offer continuing education credits for medical professionals. Click here for more information and a link to register.

Researchers call for better tracking of antibiotic-resistant infections to determine best way to fight them; big issue in Ky.

By Melissa Patrick
Kentucky Health News

If the United States really wants to figure out the best way to fight infections that are resistant to antibiotics, a big problem in Kentucky, researchers say it first needs to create a better system for tracking the infections.

The study, published on BioMed Central, looked at the incidence rate of Methicillin-resistant Staphylococcus aureus (MRSA) by analyzing data from five different reports and determined the data varied so widely between them that any sort of real comparison would be difficult.

Report notes that this MRSA infection
might not be reported, depending on
the data-reporting guidelines. (CDC)

The variances included the types of populations studied (general population, military facilities, medical centers, pediatric patients and different geographic areas); the types of infections measured (total MRSA infections versus bloodstream infections only) as well as variances in how baseline data was gathered. In addition, it said the terminology used to describe the results also varied.

Taking all this into account, the researchers said they did not find any "definitive evidence" that MRSA rates had decreased significantly in health-care facilities or in communities since 2010-2011, and found they had increased between 2014 and 2015. However, the U.S. Veterans Health Administration had over an 80 percent reduction in MRSA.

Dr. Kevin Kavanagh

Why does this matter?

The U.S. Department of Health and Human Services has set a goal of reducing MRSA infections by half by 2020, but lead researcher Dr. Kevin Kavanagh of Somerset, an infection-control activist who leads Health Watch USA, said in a separate opinion piece about the study that the nation "is nowhere near on track to meet this target."

The researchers note that health-care facilities use two main strategies to fight these infections, and one seems to have better results than the other, but they say that until all of the tracking measures are equal, a "best practice" cannot conclusively be determined.

The strategy used by VA hospitals is based on identification and isolation, along with strict hand-washing rules. The other, used by more than 60 percent of U.S. hospitals, is based on the "Reduce MRSA" study and involves a protocol of daily bathing with chlorhexidine along with intranasal mupirocin, an antibiotic.

Many health experts have concerns about the "Reduce MRSA" study because Sage Products, the maker of the chlorhexidine wipes, provided "funding and millions of dollars in wipes for studies" to Rush University Medical Center in Chicago to test the efficacy of the product, and that Rush has since "published 11 articles on six trials that endorse daily washing of patients with Sage's patented wipes, which is an 'off label' use," the Reuters news service reports in an in-depth investigative story. The U.S. Food and Drug Administration has only approved the wipes for cleaning patients before surgery.

"The industry money funding chlorhexidine research muddies the message of the results, in the view of many health experts," Deborah J. Nelson and Ryan McNeill report for Reuters.

They also report that experts have voiced concerns about routine use of such a "potent biocide," and the FDA recently issued warnings about increased "reports of allergic reactions, including a couple of deaths, and other adverse events linked to the chemical." In addition, Sage has also recalled the product twice because the chlorhexidine cloths have been "tied, ironically, to dozens of infections by Burkholderia cepacia, a pathogen that wreaks havoc on hospital patients," they write.

Dr. Robert A. Weinstein, an infectious-disease specialist at Rush and senior researcher on the chlorhexidine wipe studies, told Reuters that the maker funding his research has not influenced his findings. He has published one negative report on the product.

Reuters, in another investigative story, also found that infections and deaths from antibiotic-resistant infections are not reported or tracked routinely, saying that the federal Centers for Disease Control and Prevention estimate that 23,000 Americans die each year from an antibiotic-resistant infection is "mostly guesswork" and that the real number is likely much higher.

In its analysis, Reuters looked at health-department records and compared them to death certificates during the same time period and found that while health departments reported about 3,300 deaths from antibiotic-resistant infections in 2003-2014, death certificates reported 180,000 such deaths. In the same time frame, Kentucky's health departments reported nine such deaths, but the Reuters investigation found 3,027.