Libertarians want to repeal 'certificate of need' permit process for health-care facilities; they say it needs reform, not repeal

Kentucky Health News

Should Kentucky have a permitting process for health-care facilities or allow free-market competition? Or something in between? The General Assembly has begun debating the question, amid lobbying from a national libertarian group and health-care facilities that say unfettered competition would further complicate heath care and put some of them out of business.

When stand-alone birthing centers wanted an exemption from the state's "certificate of need" law this year, the legislature said no, but created a task force to examine the law and how it works. The task force heard July 17 from lobbies for hospitals, nursing homes home-health services and hospices, who think the law should be improved but not repealed, Sarah Ladd reports for the Kentucky Lantern. (This article is based mainly on her story.)

Nancy Galvagni

Without certificate of need, some facilities could close or stop offering services that don't make money, Kentucky Hospital Association President Nancy Galvagni told the task force. She said most services “are provided at a loss and must be subsidized by the few services from which hospitals derive revenue, such as elective surgery and . . . outpatient imaging. This is how hospitals pay for services such as behavioral health, obstetrics, emergency care, trauma care, and oncology, just to name a few.”

Noting that government programs pay about three-fourths of hospital bills in Kentucky, Galvagni said that without certificate of need, “Out-of-state entities would quickly swoop in to cherry-pick the few commercially insured patients away from hospitals for the most profitable services hospitals provide. Meanwhile, Medicare and Medicaid and the uninsured would be left to the hospitals. Access would soon end because hospitals will be forced to close unprofitable services and some facilities could close entirely.”

Tim Veno, president of Leading Age Kentucky, a lobby for nonprofits that provide aging services, told lawmakers that “over-duplication of health services can have multiple negative effects” on nursing homes. Too many nursing-home beds in an area could cause a home to close, or make staffing challenges worse, he said.

Home-health services also have staffing issues the inability to compete with hourly wages offered by places like Amazon and Target, said Evan Reinhardt, executive director of the Kentucky Home Care Association.

Hospitce executive Liz Fowler said certificate of need prevents fraud in her industry, which serves people have six months or less to live, usually at home. Fowler, chief executive officer of Bluegrass Care Navigators, said “bad actors” may shortchange vulnerable patients on their benefits.

The week before the task force met, Americans For Prosperity promoted repeal of the certificate-of-need law at an event in Northern Kentucky. AFP is one of the groups funded by energy mangnate Charles Koch of Wichita, known for his spending on libertarian, conservative and Republican causes.

"Both sides of the argument — those seeking to reform or repeal certificate of need and the health care groups in favor of keeping it — have spent large sums of money lobbying Congress and the Kentucky legislature in 2023, so it could impact election and lobbying spending in Kentucky for the foreseeable future," Mark Payne reports for Link NKY (republished in the Kentucky Lantern).

AFP says it recently got the process repealed in South Carolina after 10 years of lobbying. "Kentucky is one of 35 states and the District of Columbia that operate certificate-of-need programs, which vary widely among the states, according to the National Conference of State Legislatures," Payne reports.

State Rep. Marianne Proctor

One speaker at the Northern Kentucky event was state Rep. Marianne Proctor, R-Union, who has field a bill to repeal certificate of need for Boone, Kenton and Campbell counties.

“To have competition always breeds excellence,” Proctor said. Earlier this year, she said, “In Kentucky, we have 23 regulations that require permission from the state to open such as ambulatory care services, dialysis centers, substance abuse, mental-health services.”

The lobbying groups that favor the certificate-of-need process did tell the task force that it needs changes. Galvagni suggested some, including:

• Reform the application and appeals process to save time, allowing providers to apply at any time, and have shorter hearings.
• In formal-review cases, require written statements saying why an application shouod be rejected.
• In expedited-review cases, limit challenges to the issue of need and whether the applicant qualifies for expedited review.
• Allow hospitals to provide services at an additional location in the same county without an additional certificate.
• Allow hospitals to get expedited review for converting beds to adult psychiatric care if the county has no such hospital.

The next meeting of the task force is scheduled for 10:30 a.m. Aug. 21. It is seeking public input by Sept. 1; to submit a written statement, email DeeAnn Wenk at deeann.wenk@lrc.ky.gov.

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.”

1 in 5 hospital patients need care after discharge, but can have limited choices unless they know their options, columnist advises

Health columnist Trudy Lieberman

"One in five patients across the country needs further care after discharge from a hospital," Rural Health News Service columnist Trudy Lieberman writes. "Many times their families don’t know where to turn for help." The hospital can be a weak link, she warns: "Discharge planning is deficient, can be harmful, and sometimes results in a patient’s decline."

Discharging hospitals can limit patients' options, Lieberman writes: "If hospitals are hitting the limits of what Medicare will pay for a patient’s care, they have a great incentive for moving people out. To them it doesn’t matter if a patient is moved to another state, as I was, or to another town. Either one can make it difficult for family to visit and keep an eye on the care, which is all-important."

Patients and their families may not be aware of just what sub-acute-care facilities, home-care agencies or rehabilitation centers can do, and may not even know about a relatively new type of hospital, the long-term acute care facility (LTAC), which "treats sicker patients for an average of at least 25 days for recovery," Lieberman writes. "Neither had I, when I found myself transferred to one early in 2018 after a long hospital stay."

Kentucky has one freestanding LTAC, Kindred Hospital in Louisville, and eight that are inside or adjacent to another hospital: in the Baptist Health hospitals in Corbin, Madisonville and Paducah; St. Joseph Hospital in Lexington; UK HealthCare in Lexington; St. Elizabeth Fort Thomas; a Kindred facility in Jewish Hospital in Louisville; and the Commonwealth Regional Specialty Hospital in The Medical Center at Bowling Green.

The 32-bed ContinueCARE facility in the 273-bed Corbin hospital recently won a Respiratory Center of Excellence designation from the Center for Improvement in Healthcare Quality, making it "the first facility in the country to receive this specific CIHQ designation for respiratory therapy," Baptist Health said in a news release.

Lieberman has suggestions for dealing with care after discharge: "Medicare requires a discharge notice, which sets out a patient’s appeal rights and procedures, to be given no later than two days after a person is admitted to a hospital. Some are given at admission, usually a time of confusion, and the explanation of rights is likely to be overlooked. Be aware of it, though, and read it carefully. You may need to rely on it if you think a relative needs to stay longer in the hospital. And for all families who need more care after a hospital stay, the website of the Center for Medicare Advocacy has loads of information."

For Lieberman's full column, and her previous columns, click here.

Kentucky pastor uses his experience to offer advice to caregivers

Paul Prather
(Photo from the Herald-Leader)

As a minister for more than three decades, Paul Prather has sat with more than his fair share of people who are sick or dying.

But the pastor of Bethesda Church near Mount Sterling says nothing prepared him for the experience of taking care of his wife Renee as she struggled with cancer from 2000 to 2005.

"Caregiving is the hardest thing I’ve ever done. Nothing else comes close. Unless you’ve held that job, you have no idea how you’d fare," Prather wrote in his Sunday column in the Lexington Herald-Leader.

About 40 million Americans are caregivers, most of them unpaid, Prather notes. An American Association of Retired Persons study from 2015 estimates the economic impact of caregivers' work at $470 billion annually.

Prather used his own experiences, as well as a New York Times article by Dr. Dhruv Khullar and a Herald-Leader column by Robin Hamon, to offer advice to caregivers:

"You are not the only one. ... You’re one of 40 million." Whatever you're feeling is normal. He notes insight that a counselor once gave him: Emotions are neither good nor bad; they just are. Sometimes emotions jump from rage to fear to grief to numbness and everything in between, and that's OK, he says.

Don't beat yourself up. "You must be pretty decent or you wouldn’t be sacrificing your life for someone else," Prather writes. "Quit berating yourself for your shortcomings. Be merciful to yourself. Do your best on any given day, and leave it at that."

Remember to take care of yourself. Prather encourages caregivers to arrange for a sitter once or twice a week in order to have some time away. He also encourages healthy eating and exercise.

Ask for help. He suggests asking doctors for tips and seeking out information from books and websites.

Vent your frustrations. "You might not be able to talk candidly to the person you’re taking care of. But you might have a trusted sibling, friend, minister or adult child to whom you can speak honestly and safely," Prather writes.

Keep it in perspective. It's important to remember that this tough situation won't last forever, he says.

Prather also offers advice to those who know someone who is caring for a loved one:

"Look for the cracks," he notes. "When the sick person isn't within earshot, ask the caregiver is she's struggling."

Ask specifically what help is needed, but don't impose your agenda. Prather says most caregivers don't want to impose and will likely say, "Nothing," when asked what they need. Be specific with your questions, such as, "Would it help if I brought you a meal?" He warns, however, not to push what you think is needed onto the caregiver. Don't simply announce your plans to bring over a meal without asking.

Also, withhold judgment. "Never judge a caregiver for how she’s handling the situation," Prather writes. "Is she surly? Has she lost her faith? Is she praying that Mama will just go on and flipping die, like, today? Don’t delude yourself that you’d do better. God might let you find out."
Be a source of encouragement. Prather says that caregivers need to hear that they are doing a good job and that their work is noticed. Offer support and reassurance; it just might help him or her get through a rough day.

Caregivers can find additional resources through AARP here.

Nursing homes and other elderly caregivers will have to do national, fingerprint-based background checks on employees

Nursing homes and many other health care providers will be required to obtain national criminal background checks on new employees and others who provide direct one-on-one care to elderly residents or patients, under an emergency regulation outgoing Democratic Gov. Steve Beshear issued Friday.

Besides nursing homes, which have been the focus of concern about elder abuse, the regulation also applies to personal-care homes, intermediate care facilities, adult day health-care programs, assisted living communities, home health agencies, hospices, personal-services agencies, providers of home and community-based services, and staffing agencies, "including nursing pools that have contracts to provide staff to one or more of the listed employer types," a state news release said.

Only 7 percent of those providers are using a voluntary system to do national, fingerprint-supported background checks, Cabinet for Health and Family Services spokeswoman Beth Fisher told Kentucky Health News.

“Protecting the elderly and other individuals residing in these facilities is not only important – it is our duty as state leaders,” Beshear said in the release. “All too often, these vulnerable citizens become victims of the very individuals who are supposed to be caring for them. This regulation, based upon a federal law allowing these background checks, will ensure we are able to thoroughly track the history of anyone who has committed such an offense, whether it occurred in Kentucky or out of state, and ensure they will not be working at health care facilities in the commonwealth.”

State law requires only name-based, Kentucky-specific background checks, "creating a loophole that allowed applicants seeking employment in these long-term care and other settings to hide criminal actions committed in other states," the release said. "Meanwhile, the prevalence of alleged abuse or exploitation of seniors in these settings remained significant."

The release said that since May 2014, over 2,600 complaints have been filed against long-term care providers, almost 30 percent directly related to suspected abuse or exploitation of residents. Requiring fingerprint-supported background checks means that "applicants will not be able to hide criminal actions committed in other states," Cabinet for Health and Family Services Secretary Audrey Tayse Haynes said in the release. "National background checks are a critical initiative that dramatically improve the ability of long-term care and other providers to timely and accurately research the backgrounds of potential employees, ruling out individuals with histories of violence, abuse or exploitation that occurred in other states."

The state has operated a fingerprint-supported vetting program since 2011, using federal grants. “This program . . . has now been fully tested by voluntary participants over the last 18 months, and the feedback has been overwhelmingly positive regarding its ease of use, cost effectiveness and speed,” CHFS Inspector General Maryellen Mynear said in the release. “Our office will assist providers as they apply for initial licensure or renew their existing license to ensure a smooth and timely transition to a national criminal background check program that meets the requirements of this regulation.”

The program usually returns results in 24 to 72 hours, compared to three or more weeks using the traditional, paper-based process, the release said. However, only 85 of the 1,267 providers who will be covered by the new rule use the voluntary program, CHFS spokeswoman Beth Fisher said.

Because the rule is in an emergency regulation, Republican Matt Bevin could revoke it after he becomes governor Dec. 8, but Beshear's news release quoted Republican state Sen. Tom Buford of Nicholasville as saying,  “I commend Gov. Steve Beshear for this action to provide protections for our senior citizens.”

State Rep. Linda Belcher, D-Shepherdsville, said in the release, “I have been working on legislation to accomplish this for some time now and am very pleased Gov. Beshear has taken this step to further protect the elderly residents and patients.”

The release said the voluntary program "has performed more than 2,200 background checks and has screened out applicants who had been convicted of serious violent offenses in other states but had no criminal history in Kentucky." The program’s website, http://chfs.ky.gov/os/oig/kares, contains provider enrollment information, general information for both providers and the public, frequently asked questions and links to related programs and content. Additional information is available via email to KARES.Helpdesk@ky.gov or by calling 502-564-2159.

How to avoid and treat poison ivy, oak and sumac

Now that school is out and summer is here, more people will be venturing into the woods to enjoy hiking, camping and other outdoor activities. Poison ivy, poison oak and poison sumac cause more allergic reactions than any other source, said Renee Miller, R.N., a certified specialist in poison information at the Tennessee Poison Center at Vanderbilt University Medical Center.

The leaves, vines and roots all contain the oils that cause the reaction. "Only about 15 percent of people are resistant to these plants, and sensitivity tends to decrease with age," Miller said.

The most effective way to avoid an itchy reaction is to avoid coming into contact with the plant. Wearing long pants, long sleeves, gloves and boots will help. If a person is exposed to poison ivy, he or she should wash the area with soap and lukewarm water. "If you wash within the first 15 minutes of exposure, 100 percent of the oils can be washed away," Miller said. "If you wait an hour, zero percent can be washed away." Pets and clothes can also carry the oils.

Usually the rash shows up in 24 to 48 hours, but it can take longer or appear more quickly. "Once an exposure has occurred, topical steroids and antihistamines are the mainstay for treatment," Miller said. "Prescription cortisone can halt the reaction if used early." But once the reaction has progressed to the vesicular stage including small fluid-filled blisters, treatment with systemic steroids is the only effective option.

As session nears end, bills on heroin, dating-violence orders, managed-care appeals and lawsuit review panels are hanging fire

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – The General Assembly has sent Gov. Steve Beshear four health-related bills, and several more could reach his desk in the legislative session that ends Wednesday. Legislators will return briefly after 10 days to reconsider any bills Beshear vetoes; they could also pass more bills, but would not be able to override any vetoes.

Here are some of the health-related bills that were pending on Monday; bills with two readings are ready for floor action.

Heroin: tougher penalties and needle exchanges?

Both the Senate and the House have heroin bills and both remain in committee in the other chamber, but hope remains high in both chambers that a compromise can be reached so that a heroin bill will pass this session. Senate Bill 5 is sponsored by Sen. Christian McDaniel, R-Latonia; House Bill 213 is sponsored by Rep. John Tilley. The main differences are how traffickers would be punished and whether to start needle-exchange programs for addicts. The Senate's penalties are tougher and it has opposed needle exchanges, which advocates say prevent disease and death from dirty needles and can lead addicts to treatment.

Now the Senate is moving toward accepting needle exchanges, James Pilcher reports for The Cincinnati Enquirer. Rep. Dennis Keene, D-Wilder, and Sen. Wil Schroder, R-Wilder, said exchanges "are much more likely to be included than when the session started," Pilcher writes. Schroeder told him, "I think there is a real possibility that we could include needle exchanges and then get our tougher penalties." Pilcher reports, "The possible legislative position shift comes as health officials throughout the Tristate have expressed deep concerns about the spread of diseases that can be contracted using dirty needles."

Protective orders for dating violence

House Bill 8, sponsored by Rep. John Tilley, D-Hopkinsville, has received its second reading and is awaiting passage in the Senate. This bill would allow dating partners to petition for interpersonal protective orders if they have been the victim of domestic violence, sexual abuse or stalking. Such orders are now available only to those who are married, live together or have lived together, or an unmarried couple with a child in common.

Kentucky is the only state that offers no protection for such victims. Legislation to do that has stalled in the Senate in earlier sessions, but a Senate committee substitute addresses a key objection, by creating a new chapter in the statutes for the bill, separate from the existing domestic-violence chapter.

Advocates say domestic violence is a health issue not just because of the physical injuries it causes. They say victims are more likely to be depressed, have unplanned and premature pregnancies, go to fewer prenatal visits, and to miss more well-child visits with their children.

Prescription synchronization, managed-care appeals

Senate Bill 44, sponsored by Sen. Julie Raque Adams, R-Louisville, has had its second reading in the House. This bill would allow patients with multiple prescriptions, in consultation with their health-care provider and their pharmacist, to synchronize prescriptions so that they may be picked up at the same time.

House Majority Caucus Chair Johnny Bell, D-Glasgow, has filed a floor amendment on an unrelated issue, to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies. It is the same as or similar to Senate Bill 120, sponsored by Sen. Ralph Alvarado, which has given it a first reading without assigning it to a committee. The Cabinet for Health and Family Services opposes a state appeals process, saying it would have a conflict of interest (successful appeals would cost the state money) and providers have the courts available to them to resolve contractual issues. UPDATE: Bell withdrew his floor amendment to Senate Bill 44 March 9. 

Review panels for suits against health-care providers: Senate Bill 6, filed by Alvarado, remains in the House Judiciary Committee, but a discharge petition was filed March 4 to bring it to the floor, bypassing leaders of the House's Democratic majority. This bill would establish panels of three medical experts, two chosen by each side and the third chosen by the other two, to review suits against health-care providers to determine if the case has merit before the lawsuit can proceed. Panel findings would be admissible in court, but not legally binding. Opponents say that Kentucky already has laws to punish attorneys for filing frivolous cases and that this just adds another barrier for patients seeking justice.

Newborn screenings for fatal disease: Senate Bill 75, sponsored by Sen. Alice Forgy Kerr, R-Lexington, has had two readings. It would require all newborns to be tested for Krabbe disease, a neurological disorder that destroys the protective coating of nerve and brain cells and is fatal once symptoms occur. Treatment with stem cells from an umbilical cord blood transplant is sometimes successful it the infant is treated early enough. The cabinet opposes the bill, saying the screening will cost half a million dollars a year at a time when local health departments are suffering budget cuts.

Spina bifida: Senate Bill 159, sponsored by Sen. Julie Raque Adams, R-Louisville, is in the House and the three-day posting rule has been waived. This bill would require medical providers to supply written, up to date, accurate information to parents when their unborn child is diagnosed with spina bifida so parents can make informed decisions on treatment

Physician assistants: House Bill 258, sponsored by Rep. Denver Butler, D-Louisville, is awaiting Senate passage. This bill allows a physician to supervise up to four physician assistants at the same time, rather than two.

In-home care: House Bill 144, sponsored by Rep. Tom Burch, D-Louisville, is awaiting Senate passage. It would establish a 60-day, hospital-to-home transition program through an approval waiver from the Department for Medicaid Services. The daily cost would have to be less than the average daily nursing home payment allowed by Medicaid. The bill would also provide non-medical support services to the applicant as needed.

BILLS SENT TO THE GOVERNOR

Colorectal cancer screening: Senate Bill 61, sponsored by Sen. Ralph Alvarado, R-Winchester, received final passage in the House March 4. This bill requires that a fecal test to screen for colon cancer, and any follow-up colonoscopy, be considered preventive measures that health insurance is required to cover without imposing additional deductible or co-insurance cost. The bill would apply to health plans issued or renewed on or after Jan. 1, 2016, if it becomes law. A similar measure, House Bill 69, sponsored by Rep. Tom Burch, D-Louisville, is awaiting passage in the Senate with a committee substitute by Sen. Julian Carroll, D-Frankfort, calling for a Medicaid savings study.

Medical order scope of  treatment (MOST) form: Senate Bill 77, sponsored by Sen. Tom Buford, R-Nicholasville, received final passage in the House March 3. This bill creates a medical order scope of treatment (MOST) form that specifically directs the type of treatment a patient would like to have, and how much intervention he or she would like to have, during end-of-life care. It is considered a physician's order, travels with the patient between health care facilities, and must be reviewed annually. The bill clearly defines the order of controlling documents for end-of-life care: the living will first, the MOST form second and the health-care surrogate, which is chosen by the patient and listed on the form, third. The MOST form is already used in 32 states.

Emergency care for strokes: Senate Bill 10, sponsored by Sens. Stan Humphries, R-Cadiz, and David Givens, R-Greensburg, received final passage in the House March 4. The bill requires that a list of all acute stroke-ready hospitals, comprehensive stroke centers and primary stroke centers in Kentucky be posted to the cabinet's website and be made available to all emergency medical services providers, who are required to set their own internal protocols toward assessment, treatment and transport of stroke patients.

Funding for UK cancer research center: House Bill 298, sponsored by Rep. Rick Rand, D-Bedford, received final passage in the Senate March 4. This bill authorizes the state to appropriate $132.5 million, half of the cost, for construction of a new medical research center at the University of Kentucky. The university will raise money to cover the other half. The facility will target prevalent diseases in Kentucky, including cancer, diabetes and cardiovascular disease. The bill required a 60 percent vote in each chamber because it affects the state budget and the legislature is in a non-budget session; it passed the House 83-9 and the Senate 36-1 (Sen. John Schickel, R-Union).

AARP ranks Kentucky last in the nation for long-term care and support for aging, disabled and family caregivers

Kentucky ranks last in the nation in its long-term care services and support for seniors, people with disabilities and family caregivers according to a report compiled by AARP, formerly the American Association of Retired Persons. The state ranked 46th in the last study, in 2011.

Long-term services and support, which includes home-care services, family-caregiver supports and residential services such as nursing homes, were evaluated in five different areas with a total of 26 indicators.

Kentucky ranked 51st in affordability and access, 50th in choice of setting and providers, 50th in quality of life and quality of care, 46th in support for family caregivers and 42nd in effective nursing-home transitions.

“The vast majority of older Kentuckians want to live independently, at home, as they age – most with the help of unpaid family caregivers,” Jim Kimbrough, state president of AARP Kentucky, said in the group's online newsletter. “Even facing tight budgets following the Great Recession, most states made clear progress to help older residents achieve that goal. It’s time for Kentucky to step up to the plate, and this Scorecard shows what we have to do.”

The highest ranked states – Minnesota, Washington, Oregon and Colorado – have implemented laws and policies that build stronger Medicaid programs and support family caregivers, AARP said. These states show a decreased use of nursing homes and a minimized disruption in the transition between health care settings.

The report said Kentucky spends 81 percent of its funds aging and physical disability on institutional care, and only 19 percent on community-based care. In addition, waiting list for many programs at the Department of Aging and Independent Living are as long as five years.

AARP reports that more than 730,000 Kentuckians are considered unpaid family caregivers often because the cost of long-term care remains unaffordable for most middle-income families.

Since 2011, 24 states increased the percentage of Medicaid funds that support home- and community-based services. Kentucky did not, and ranks 50th among the states and the District of Columbia.

"Marsha Hockensmith, executive director of Kentucky Protection and Advocacy, a state agency that advocates for Kentuckians with disabilities, said many people who end up in a long-term-care facility can often be cared for adequately at home if they had access to the services they need," Mike Wynn of The Courier-Journal reports.

Community paramedics program could help provide primary-care services, help address state's provider shortage

Next spring, the Kentucky Board of Emergency Medical Services could establish a community paramedics pilot program that has the potential to ease the state's shortage pf primary-care health providers.

The idea was prompted by the likelihood that the state's expansion of the Medicaid program would lead to a shortage of primary-care personnel. It would add community paramedics to a local health care delivery system, reports Chuck Mason of the Bowling Green Daily News.

“We’re in the first stages of looking into this,” Michael Poynter, executive director of the EMS board, told Mason. “Vulnerable populations with new health insurance plans will not have access to a provider because of the increase in demand.” The provider shortage, particularly in rural areas, especially affects those without to transportation, said Poynter.

Under the program, a primary-care partner could refer a patient to EMS personnel to provide services such as fall prevention, blood draws or medication administration, in the patient’s home. The paramedic would provide documentation to the patient’s primary care physician.

The program has the potential to allow paramedics to play a more active role in care delivery, changing the face of emergency medical services, writes Mason. "The big question at this point is how health care providers would receive reimbursement from the government for expenses related to community paramedics and how the concept would integrate into the health care systems already in place in Kentucky," Poynter told Mason.

Some say such a program could reduce overall health care costs, reports Mason. It could even help reduce hospital re-admissions, potentially saving them millions of dollars because federal health reform penalizes them for re-admissions.

EMS personnel "have the training, expertise and scope of practice to provide essential primary care services," Poynter told Mason. He said such programs have been successful in Colorado, Minnesota and Pennsylvania, where paramedics are practicing community medicine after completing a training program.

Kentucky's training could be provided by colleges and universities, Mason writes. Western Kentucky University is exploring coursework for emerging jobs in the health care field. "Patient education, teaching about healthy best practices and health care screening could be some of the roles filled by the community paramedic," Poynter told Mason. "The idea is not to replace home health or physician office visits, but rather to augment the health care." (Read more)

Home-health agency for Madison, Estill and Powell counties says it has to cut staff because of issues with Medicaid and Medicare

Declining reimbursements from Medicaid and Medicare are behind the Madison County Health Department's layoff of seven home-health employees last week. Director Nancy Crew said the cuts should not mean a reduction in care but that cuts were being made because "we've done all we can do without involuntary layoffs," Bill Robinson of the Richmond Register reports. The department's MEPCO subsidiary, which has offered home-health services in Madison, Estill and Powell counties since 1974, has been under financial pressure for two years despite cutting costs and not filling eight now-vacant positions. It had a deficit last year of $610,000.

Only about 15 percent of MEPCO's revenue comes from private insurance, said David Reed, the health department's financial director. That leaves MEPCO with a disproportionate number of Medicaid patients at a time when those re-reimbursements often are denied by managed-care companies, Reed said. Challenging those denials is a complicated process, sometimes requiring going to court to recover costs. The problem is not all with Medicaid. MEPCO’s Medicare reimbursements began a steep decline from nearly $3.24 million in 2008 to $2.55 million in 2012.  (Read more)

Home-health industry is the latest to complain about late payments since state switched to managed-care Medicaid

Kentucky's new Medicaid managed-care system is three months late in making payments to home-health agencies, officials told the House Health and Welfare Committee Thursday.

Nurses Registry and Home Health has outstanding claims of $300,000 to $400,000, Jeannie Lemaster, chief compliance officer, told lawmakers. "Kip Bowmar, executive director of the Kentucky Home Health Association, said only 8 percent of the claims from the approximately 150 home-health agencies have been paid since the switch to managed care Nov. 1," reports Beth Musgrave of the Lexington Herald-Leader.

"If these problems don't get corrected, there is a likelihood that some agencies could go out of business," Bowmar said.

Therapists who work with abused, neglected and at-risk children have likewise told lawmakers of back payments. Independent pharmacists have said "reimbursement rates are much lower than they were under traditional Medicaid, which means they are having to lay off employees," Musgrave reports.

In November, Kentucky made the switch to managed care for its 500,000 Medicaid recipients outside the Louisville region. The move is expected to save the state more than $1 billion in the next three years. Three companies, Coventry Cares, Wellcare of Kentucky and Kentucky Spirit, broker the care and are paid on a per-patient, per-month rate.

Lemaster said most of her agency's problems are with Coventry, which has denied 82 percent of their claims. "Lemaster said that because there are differences in the managed care companies and what is being approved for payments, there are inequities in the Medicaid system," Musgrave reports. "Some people are receiving services and others aren't."

Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services, said problems related to the changeover are being ironed out. "The primary focus of the Medicaid program staff is and continues to be the prompt resolution of any issues that arise as we ease the transition of providers to managed care," she said. (Read more)

Kentucky looking at 'telecare' for Medicaid patients to cut costs

Kentucky is considering making tele-caregivers — off-site guardians who provide care by monitoring cameras and sensors in a patient's home — available to some disabled Medicaid patients. The move is expected to save money by requiring less onsite care, The Courier-Journal's Patrick Howington reports. Because they are being monitored remotely, such as by telecaregiver David Crowe (C-J photo by Jordan Kartholl), it also allows patients to stay in their own home, rather than go to a nursing home.

The service is offered by Rest Assured, a subsidiary of ResCare, which is based in Louisville. The Cabinet for Health and Family Services "has asked permission from federal officials to use Medicaid funds for 'telecare' services like Rest Assured, as is allowed in Indiana and at least one other state," Howington reports.

Electronic monitoring is about half as expensive as in-home care and far less than the $5,000 or more a month it costs for a Medicaid patient to live in a nursing home. Rest Assured charges about $10 an hour for its service, resulting in $2,400 a month for eight hours of daily care. Though not expected to solve the state's Medicaid budget shortfall, "anything we can save at this juncture is wonderful," said state Sen. Julie Denton, R-Louisville.

Rest Assured has about 375 clients nationwide "Depending on clients' needs, the system can provide limited services such as medication reminders and food-preparation guidance for an hour or two a day or comprehensive monitoring for up to 24 hours," Howington writes. Telecaregivers use video and sensors that monitor temperature change, carbon monoxide levels and how long a patient is in the bathroom. (Read more)