Kentucky's first emergency psychiatric unit opens in Lexington

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

By Allison Perry
University of Kentucky

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

As part of resetting its relationship with rural hospitals, UK will not build a new hospital at interstate junction in southeast Lexington

By Al Cross

Kentucky Health News

FRANKFORT, Ky. -- The University of Kentucky will not build a hospital in southeast Lexington because it wants to do what its network of rural hospital partners want: focus on its mission as a top-level care facility for the sickest patients, a UK vice president told a legislative subcommittee Wednesday.

Mark D. Birdwhistell (UK photo)

The proposed Hamburg-area hospital "was perceived as us stepping outside of our swim lane" by the university's clinical affiliates out in the state, Senior Vice President for Health and Public Policy Mark Birdwhistell told the Budget Review Subcommittee on Health and Family Services.

"We heard loud and clear, 'We want UK HealthCare to focus on taking care of the sickest of the sick. We don't want UK out doing primary care and secondary care.' . . . That was very eye-opening."

Birdwhistell reiterated, "The message we received loud and clear from our clinical affiliates was, 'When our folks get that sick, we want them to come to UK. We want them on campus. We don't them in a community hospital.'"

UK was in the planning process for a new hospital at the southern junction of Interstates 75 and 64, and had bought the property and done some initial work. Baptist Health is in the process of opening a new hospital on an adjacent site.

Instead of a hospital, UK will build a clinic with specialty services like the one it has built in a former department store in the Turfland Center in southwest Lexington, but larger, Birdwhistell said after the meeting: "Turfland plus."

He told the legislative subcommittee that the university will also build other clinics to serve its employees in Lexington and the Bluegrass region, many of whom are "having to get health care outside the system. . . . We feel like that is our obligation."

Birdwhistell spoke to the subcommittee in a new role, which he said will include centralizing the university's "government-relations activities across campus," including "building a better partnership with the General Assembly. I felt I was uniquely positioned to do that."

 

Previously, Birdwhistell was UK HealthCare's vice president for health system administration and chief of staff. He was secretary of the state Cabinet for Health and Family Services under Republican Gov. Ernie Fletcher, and helped Republican Gov. Matt Bevin propose changes to the federal-state Medicaid program, which he had run before becoming cabinet secretary. He appeared with Angela Dearinger, executive vice dean of the UK College of Medicine, who was briefly health secretary at the end of Bevin's term.

The General Assembly is firmly controlled by Republicans. In the recent legislative session, Birdwhistell was the university's point man in changing legislation that helped Pikeville Medical Center and some other rural trauma hospitals but in its original form would have reduced some of the extra Medcaid payments that UK gets for being a "safety net" hospital.

That relates to UK's recent takeover of other hospitals in Ashland and Morehead, which Birdwhistell discussed at Wednesday's legislative subcommittee meeting. Speaking of UK's absorption of King's Daughters Medical Center in Ashland, he said "Where we failed . . . is when you put that UK brand in front of that name, that brings with it an expectation of service, not predator," which he said was the perception of some.

"And so, we're readjusting a lot of the narratives to say, 'When you have UK in front of your name, you go to a partner and say, 'What can we do to help you be successful?' It's not 'What do we do to crush you?' And this is community health care. This is not our forte, so we've learned that lesson. . . . We can grow the workforce for those providers and not have to do it ourselves."

Birdwhistell said UK can also serve as a backstop for its rural partners, noting that UK doctors rearranged their schedules one weekend to keep open the neonatal intensive-care unit at Pikeville, which would have had to close temporarily due to employee vacations. "That's what we do," he said. "That's where we excel and that's where we need to get back to."

UK's latest acquisition is St. Claire Medical Center in Morehead, where it has run a satellite medical-school program for several years. The College of Medicine also has satellites in Bowling Green and Northern Kentucky, and Dearinger said it has seven residency programs in Bowling Green, the state's third largest city, and is starting residency programs in Ashland and Pikeville.

"We are trying to grow the number of doctors to stay in our state," Dearinger said, calling UK's Rural Physician Leadership Program "one of our crown jewels." She said it has produced 120 doctors, most of whom are practicing in Kentucky, "the vast majority" in rural parts of the state. Later, she said 42 percent of all recent medical-school graduates from UK have stayed in Kentucky, far above the 24% of "a few years ago."

Two Democratic legislators from Louisville, Sen. Karen Berg and Rep. Lisa Willner, asked Dearinger if UK has had fewer applicants for medical school or residencies due to restrictions on medical education, by which they meant the recent state law that bans abortions except in cases of threat to the woman's life or permanent damage to a life-sustaining organ.

Dearinger said "To be honest, we have not seen a decrease." She said she has heard anecdotal reports of students or graduates interested in obstetrics and gynecology going elsewhere, but "We are still inundated with OB applicants to do a residency at the University of Kentucky."

Another Louisville Democrat, Rep. Sarah Stalker, noted a May 16 Kentucky Health News story, from Kentucky Public Radio, that said 15% fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, and there was a 23% decline in those for obstetrics and gynecology, according to the Association of American Medical Schools., which blamed the decline on the state's near-total abortion ban.

Dearinger said UK is still getting hundreds of "very good applicants, and we don't have any problems filling our residency programs and fellowship programs with very high-quality young physicians. We are prioritizing as much as we can, Kentucky students, so that they will stay" in the state.

Roll call: Most members of the subcommittee did not attend the late-morning meeting. The chairman, Sen. Donald Douglas of Nicholasville, a physician, noted that at the start of the meeting and made an unusually pointed comment: "I expect my colleagues in the General Assembly to show up."

Brooke A. Flinders, a double graduate of Frontier Nursing University, will become its next president on Aug. 1

Brooke Flinders

Kentucky Health News

Brooke A. Flinders, who earned her advanced degrees from Frontier Nursing University, has been named the next president of the Versailles institution. 

Flinders has extensive experience as an advanced practice nurse, educator, and college administrator. She will leave her position as a nursing professor and associate provost at Miami University in Ohio and become president of FNU on Aug. 1. She holds a Master of Science in Nursing and a Doctor of Nursing Practice degree from FNU. 

“We are thrilled that Dr. Flinders has accepted the offer to become the next president of Frontier Nursing University,” said FNU Board Chair Michael Carter.  “Dr. Flinders’ wealth of experience as an educator, practitioner, and administrator will be a tremendous asset to our students and to our faculty and staff who support them. We are extremely excited about the future of Frontier under Dr. Flinders’ leadership.”

Flinders will succeed Susan E. Stone, who was with the university for more than 30 years, the last 23 as president. Stone will be president emeritus and chair of midwifery and nursing on FNU's board.

Flinders obtained her Associate Degree of Science in Nursing (1994) and Bachelor of Science in Nursing (2003) degrees from Miami. In addition to acute care and community-based care experience as a registered nurse and full-scope practice as a certified nurse-midwife, Flinders has been a nurse educator, nursing department chair, and associate dean.

“I am proud and honored to accept the position of president of Frontier Nursing University,”  Flinders said. “My connection to Frontier extends nearly two full decades, and I am so proud to be one of its more than 9,000 graduates. . . .  I believe wholeheartedly in Frontier’s mission to provide accessible nurse-midwifery and nurse practitioner education that integrates the principles of diversity, equity, and inclusion, and I am excited to carry it forward.”

Flinders received the 2021 Distinguished Alumni Award from Miami's nurisng department, and in recognition of their service efforts during the Covid- pandemic, she and each of her nursing colleagues received the President’s Service Medallion. Flinders became a fellow of the American College of Nurse-Midwives in 2021, as a recognition of her demonstrated leadership, clinical excellence, scholarship, and professional achievement.

“As a proud graduate of Frontier School of Midwifery and Family Nursing and Frontier Nursing University, I am eager to build upon the amazingly strong foundation that already exists,” Flinders said. “Health-care provider shortages and the maternal mortality crisis plague our country. Frontier has a long history of finding unique solutions to complex problems, and we will continue to be a leader in identifying and implementing solutions by producing highly prepared nurse-midwives and nurse practitioners who have answered the call to serve.”

FNU was founded in 1939 as the Frontier Graduate School of Midwifery by the Frontier Nursing Service, a group of nurses and nurse-midwives who have served rural areas of Kentucky since 1925. Formerly located in Hyden, FNU completed its transition to Versailles in 2022 and is "one of the largest not for profit universities in the United States for advanced nursing and midwifery education, its website says.

Community event at church addresses health needs in Frankfort

A variety of health-focused vendors set up tables in the parking lot of First Baptist Church Frankfort on June 14 to share information and host activities with attendees. (UK photos by Lindsay Travis)

By Lindsay Travis
University of Kentucky

Coretta Scott King said, “The greatness of a community is most accurately measured by the compassionate actions of its members.”

On a warm Saturday in June, First Baptist Church Frankfort opened its doors to more than 500 individuals in the community to put an emphasis on their well-being. It was part of the fourth annual Dr. Rosby L. Glover Unity in the Community event — a day of fun, food, music and raising awareness.

The fruits of this effort are an extension of collaborations with key community partners, including Capital City Activity Center, Meals on Wheels Greater Frankfort, Kentucky State University Cooperative Extension and the University of Kentucky.

“The day is an effort to bring the whole community together, to not only just have fellowship, but to bring awareness to physical health, diabetes and other health issues,” said Bishop Tiangello Hill, senior pastor of the church. “It means that we're doing our job. It means that we are reaching beyond the four walls and being a help to all mankind.”

The event is held in honor of the church’s late pastor, the Rev. Dr. Rosby L. Glover, who made it his mission to be an advocate for the Frankfort community for children and families. His widow, Lady Kimberly Glover, said “This was a vision of ours, and I’m elated to see Frankfort continue my husband’s mission to serve the community and its families.”

The compassion for Frankfort is evident in talking to those behind the June 14 event, like Glover.

“People care about this event because when people get together, we're all just people,” she said. “No matter what race, what nationality, it’s bringing love for one another, showing how much we care. And just to know that the church is here to help anyone in need.”

In an effort to share important health information with the community, inside the church, guests could complete free health screenings. The Lions Club partnered for diabetes screenings and the Franklin County Health Department donated screening materials and time for blood pressure screenings.

UK's Refocus Project, aimed at African Americans, answered
questions about opioid overdoses. (UK Photo by Lindsay Travis)

Tents and tables lined the church parking lot and nearby Clinton Street showcasing the services provided by a variety of health-focused agencies. Among those tables were UK’s Sanders-Brown Center on Aging and its Engaged Aging Lab, the College of Health Sciences’ Physical Therapy program, the Research Examining Factors Associated with the Opioid Crisis among Underserved African Americans (REFOCUS) research team, and the Cooperative Extension Service.

It’s an intentional approach from researchers and clinicians at UK to address the specific needs of the Frankfort community. The city, at one time, had the nation’s second-highest prevalence of Alzheimer’s disease in African American adults among other health challenges.

The partnership is an important one to Elizabeth Rhodus, assistant professor at Sanders-Brown and the Department of Behavioral Science in the UK College of Medicine.

“We connected with Dr. Glover a few years ago to think about how we can help provide health care, access and resources to individuals in the community,” said Rhodus. “We are excited to see that partnership grow.”

Saturday’s event is an extension of Sanders-Brown’s partnership with First Baptist Church Frankfort. Researchers meet monthly with church members to help address the commumity's needs. It’s part of Rhodus’ Engaged Aging Lab, which takes lessons learned from research and clinical spaces out into the communities to address health gaps.

Rhodus and her team provide support and resources for Alzheimer’s disease and dementia through research which focuses on everyday activities that support healthy brain aging, caring for individuals with dementia and community-engaged research for health equity. They use practical methods and everyday items in ways to help people live healthy and reduce their risks for diseases.

“We focus on telling people about five main areas to try to reduce your risk for dementia: sleep, nutrition, exercise, novelty — or doing something new — and socializing, are the great things for your brain,” said Celeste Roberts, research program manager at the Engaged Aging Lab.

Oil timers can relax the mind and body through visual cues.

Roberts kept a bottle of lavender-scented lotion and an oil timer on the table. The items may be simple, but as Roberts explains, they can relax the mind and body through aromatherapy and visual cues.

She and Sanders-Brown’s April Stauffer answered questions from people stopping at their tables for hours. They handed out helpful flyers on a range of topics related to brain health.

“Having a conversation with people about what they can do every day on their own and giving them the tools they need to ask the right questions about their health is key,” said Roberts. “Unity in the Community gives us an opportunity to start that conversation.”

On Clinton Street in downtown Frankfort, physical therapy students looked like they were playing games with attendees who stopped by their table. In actuality, they were conducting fall risk and balance assessments they’d use in clinic — a four-square step test and a timed up-and-go test out of a chair.

“Depending on how they score we can tell them if they’re at an increased risk for falls or not and provide them with helpful information,” said Sheila Clemens, an assistant professor in the Department of Physical Therapy. “This community is potentially at risk for being underserved and they may not get this information elsewhere. We’re happy to offer this easy access.”

In the next booth, the focus was on engaging members of the Black community in research. It’s part of the REFOCUS project, led by Danelle Stevens-Watkins, acting dean and professor in the Department of Educational, School and Counseling Psychology in the College of Education.

“We came to this event to help educate the community about opioid overdoses,” said Mona Goggins, a research assistant with REFOCUS. While the number of overdose deaths in Kentucky declined 9.8% frpom 2022 to 2023, there was an 8% rise in overdose deaths among Black Kentuckians. “Our hope is people want to participate in our study so we can increase awareness and gather information that will improve treatment in the Black community.”

The project is primarily focused on Lexington and Louisville, but the REFOCUS representatives shared that guests were “getting what they needed from the table” from education to sharing stories to seeing themselves represented in research efforts.

“I think that when you try to look at treatment from just one lens, you miss out on so many different groups in the population. I think it's important to recognize what different cultural backgrounds and factors that influence people's lives in the way that they experience opioid use,” said De’Asia Beard, a REFOCUS mresearch assistant.

UK’s Cooperative Extension Service has been a long-time partner in this community initiative. Sanders-Brown works closely with Carla Carter, an extension agent for family and consumer sciences at the Franklin County Extension Office.

Carter, a long-time member of First Baptist Church Frankfort, helps coordinate monthly workshops at the church and was the emcee for the Dr. Rosby L. Glover Unity in the Community. She thanked Debora Bobbitt and Reverend Anna Jones for organizing the day.

The event took a holistic approach to community health, with pieces focused on the spectrum of age ranges represented. In addition to health screenings for older age groups, the church donated 65 bicycles to kids in the community — doubling their previous giveaway goal — to foster health and exercise.

It took a team of people to put on the event and a strong spirit of collaboration from the team at the church to make such an impact in the capital city.

Rhodus and her team know there’s a health need in this area that can benefit from targeted resources and outreach paired with different research approaches. The team shares a similar goal with First Baptist Church Frankfort:

“Let’s literally build unity within all of these communities to support every individual, wherever they’re at in their aging journey — childhood all the way throughout their older age,” said Rhodus. “Let’s tailor the health pieces that they need to support a healthy, active lifestyle.”

Where to find more information:

• Sanders-Brown offers a variety of resources for people with questions about brain health. You can get started online here.
• The Engaged Aging Lab is ready to help caregivers and community members. You can find those resources online here.
• Anyone with questions about the study REFOCUS and opioid use in the Black community can email REFOCUS@uky.edu.
• UK’s physical therapy program also offers clinics for the public. More information is available online here.
• The Cooperative Extension Service provides practical education to help people, businesses and communities solve problems, develop skills and build a better future. Find more about their services online here.
• The Kentucky State University Cooperative Extension Program strengthens underserved communities, families, farmers, individuals and youth to improve their quality of life with state-of-the-art, research-based educational programs. You can learn more about their services online here.

Bill to help Pikeville hospital turned into a law that will help other rural hospitals after UK saw it as a threat and rewrote the bill

State Sen. Phillip Wheeler discussed his SB 280
 on KET's "Kentucky Tonight." (Screenshot from KET)

By Melissa Patrick
Kentucky Health News

State Sen. Phillip Wheeler of Pikeville says one of the most consequential pieces of legislation passed by state lawmakers this year is a bill he sponsored to funnel more money to rural hospitals in Kentucky. 

Senate Bill 280 allows certain rural hospitals that get at least 35% of their revenue from Medicaid to get the same enhanced Medicaid reimbursement rate as the University of Kentucky or the University of Louisville. 

The hospitals are defined as those that have a trauma center and offer clinical rotations for doctors, nurses and other medical professionals who are in training.

"It kind of levels out that playing field," Wheeler told Kentucky Health News. "And it does this without placing any additional liability for matching funds on the General Fund by allowing local communities to assess a provider tax against the medical provider." Such taxes are applied to revenues of health-care facilities, typically to get more government matching money.

Asked if his bill will keep rural hospitals from closing, Wheeler said, "I wouldn't be so bold as to say that this is the only solution. I think you need to take a multifaceted approach and providing these hospitals with the ability to compete and the funding they need to develop this specialized care is one piece of the puzzle."

Wheeler, a Republican who represents Elliott, Johnson, Lawrence, Martin and Pike counties, said the higher reimbursements will allow rural hospitals to provide a higher level of care, especially when it comes to specialty services. And this, he said, will increase access to care for rural communities. 

"Not only does that make a huge difference to the patients being served, but it also will result in a much larger increase in investment in health care in those communities," he said. "And . . . especially in a lot of rural areas, including where I live in the 31st Senate District, health care has essentially become our largest industry. I mean, the largest employer in my district, by far, is Pikeville Medical Center with over 3,000 employees." 

Wheeler said he didn't think anyone would be harmed by this law, noting that he resolved concerns voiced by UK HealthCare, which has clinical rotations at King's Daughters Medical Center in Ashland, which it recently purchased.

Path to "good public policy" 

Mark Birdwhistell, UK HealthCare's vice president for health system administration and chief of staff, explained that UK and UofL receive enhanced Medicaid reimbursements because they are Level I trauma centers that agree to care for the "sickest of the sick" patients in the state and also house the state's primary educational programs for medicine and dentistry.

UK HealthCare VP Mark Birdwhistell

He said the impetus of SB 280 and its companion bill SB 281, which was not heard in committee, came about when UK bought King's Daughters, which allowed the Ashland hospital to get the higher Medicaid reimbursement. 

The original SB 280 would have given Level II trauma centers -- Pikeville has the only one in the state -- the same enhanced Medicaid rate as UK and UofL. SB 281 said UK and UofL could only take that enhanced Medicaid reimbursement in clinics or hospitals that operated in the county of the educational facility, limiting UK's enhancement to Lexington.

"Both of these had unintended consequences," Birdwhistell said, so UK could not support the bills in their original form. He said they would have left UK with lower Medicaid payments for services provided in any hospital that it has an agreement with to provide care, such as Hazard Appalachian Regional Healthcare. In addition, he said UK has practices in other counties, such as Bowling Green and Manchester, that get enhanced Medicaid payments.   

"That would have been devastating if that had come to fruition," said Birdwhistell, who was state health secretary in 2006-07. Later adding, "It would have significantly reduced funding and would have eventually compromised good patient care in the commonwealth."

That's because the state has to get ongoing approval from the federal government for the special Medicaid payment plans, one for public universities and another for private hospitals. And, he said, if these two pieces of legislation had passed in their original format, it would have triggered an amendment to the current plans, possibly putting them at risk. 

Driven by this concern, Birdwhistell said he suggested that the bill keep the existing enhanced Medicaid plans but have a different solution allowing a third way for hospitals to get the enhanced payments. 

"We moved it from a potential where we would not be able to get as much federal Medicaid money in the state to a new program that has the potential of pulling in additional reimbursement and an incentive to focus on access and improved outcomes, improved patient outcomes," he said. 

The revised bill that passed allows an opportunity for hospitals to get comparable reimbursement to what the universities get if they meet the criteria to do so, and Birdwhistell. And this, he said, accomplishes the goal of creating a more "level playing field."

Further, he said SB 280 allows the opportunity for additional Medicaid payments for care provided by other health-care workers, such as advance-practice registered nurses, dentists and social workers. It also says that pediatric teaching hospitals are able to get the additional Medicaid reimbursements for services to patients under 18. 

"So I think we ended up with good public policy that has the potential of improving access and  patient outcomes for the Medicaid population," Birdwhistell said.

He added later, "I think it is transformative because it has the potential of aligning people's incentives around an increased increased physician workforce, opening up additional access, appointment availability. And thirdly, aligning around access and quality." 

Birdwhistell said six or seven hospitals will likely qualify for the enhanced Medicaid payments in the first wave of hospitals. He said the goal is to get the plan submitted to the Centers for Medicaid and Medicare Services by Aug. 1 and for payments to be approved by January 2025. 

A news release from the governor's office said it estimates that 43 Kentucky hospitals meet the requirements of the new plan, dubbed the Kentucky Medicaid Assistance Program. The plan is contingent upon approval from CMS. Wheeler said they have "very good indicators" that it will be approved. 

Why SB 280 is important

Donavan Blackburn, president and chief executive officer of Pikeville Medical Center, said he'd been working on this bill for the last year and a half "to address the inequality and disparity between us and urban hospitals," which have a greater share of patients with commercial insurance, which pays higher rates. 

He pointed out that his Level II trauma hospital accepts patients from 48 other hospitals in the region who need a higher level of care and that 77% of them are either on Medicaid or Medicare. He said Pikeville Medical Center "serves the sickest of the sick and the most financially challenged in the nation." 

And while he said his hospital could be likened to UK or UofL when it comes to the services it provides, it is not a state-owned hospital or a teaching hospital. The hospital has an agreement with the University of Pikeville and four nursing schools to provide clinical rotations. 

In particular, he said it's his mix of payers that makes SB 280 so important because this extra money will allow the high level of care provided by the hospital to continue. 

"And what that extra payment means is, is that programs like our children's hospital, like our trauma center, like our specialties and subspecialties, endocrinology, rheumatology, all those different specialties that we're able to offer here in our community can stay in our community," he said. "Which means that not only people have access to care, but it prevents a diagnosis that if it goes untreated, becomes advanced, which costs actually the state and federal government even more."

Further, he said it will allow the hospital to retain jobs in health care, which is the top economic driver in the region. 

Blackburn said the success of SB 280 will be evident if they are able to "keep those service lines open and to keep making investments and advancements and to be able to keep up with all the other markets. . . . It's about advancement and sustainability." 

Today is World No Tobacco Day; youth group coordinated by UK pharmacy student aims for tobacco-free future for Kentucky

Members of the #iCANendthetrend Youth Advistory Board and

and UK coordinator Griffin Nemeth pose with Gov. Andy Beshear

outside the state Capitol. (UK College of Pharmacy photo)

By Rosa Mejia-Cruz

University of Kentucky

On this World No Tobacco Day, May 31, the importance of educating and engaging youth in tobacco use prevention cannot be overstated. The theme of this year's observance, "Protecting children from tobacco industry interference," emphasizes the vital role young people play in promoting healthier lifestyles and positive community change.

According to the World Health Organization, an estimated 37 million youths aged 13–15 use tobacco globally, with children surpassing adults in elecgtronic-cigarette usage in all regions. 

Griffin Nemeth, a student at the University of Kentucky College of Pharmacy and coordinator for the #iCANendthetrend Youth Advisory Board, exemplifies the significant impact young people and pharmacists can have in this public-health mission.

Nemeth's involvement in tobacco prevention began his sophomore year of undergraduate studies through his role as a college facilitator with #iCANendthetrend, a youth e-cigarette prevention and empowerment initiative. Project Director Melinda Ickes, a professor in the UK College of Education, worked with students to bring a near-peer prevention approach to decrease initiation of tobacco use by youth, support those who are already dependent on tobacco, and ensure that student voices are at the forefront of prevention and policy advocacy.

Since 2019, the team has reached more than 20,000 Kentucky youth. The advisory board, a group of 10 high school advocates from across Kentucky, fosters a generation of changemakers dedicated to educating peers, community members and policymakers about the negative health outcomes of vaping and tobacco use.

“I am thrilled to see young people engage in something they traditionally haven't been involved in, especially in the policy sphere,” said Nemeth. “Witnessing our Youth Advisory Board advocate for their communities and interacting with local leadership is immensely rewarding."

A key element of Nemeth's work is the comprehensive, yearlong training program he helps coordinate for younger Kentuckians. Each summer, new members of the Youth Advisory Board gather at UK for an in-person training session, followed by bimonthly virtual meetings throughout the year. This training includes online modules, skill-building opportunities and sessions led by near peers who are part of #iCANendthetrend. Each year, the Youth Advisory Board selects a project to work collaboratively on throughout the year to equip them with the knowledge, skills and confidence to effectively support their goals.

The #iCANendthetrend program's efforts have earned significant recognition. The Campaign for Tobacco-Free Kids named the board the 2024 Group Advocates of the Year, highlighting the critical contributions of youth in tobacco prevention and the necessity for ongoing support.

Pharmacists are uniquely positioned to support tobacco cessation efforts. With most people in the U.S. living within five miles of a pharmacy, trained pharmacists can bridge the gap in treatment resources, particularly in rural areas.

"Even if patients are unsure they want to begin treatment, pharmacists can ask, advise and refer, which can make a significant difference for a patient who might otherwise continue to smoke for years until a severe health condition develops,” Nemeth said. “Pharmacists can play a crucial role in early intervention.”

As Nemeth advances in his pharmacy studies, he remains committed to advocacy. He envisions a future where his role as a pharmacist intersects with his passion for public health. "There's a significant health disparity in tobacco prevention and use, especially in Kentucky. Learning about the science and treatment in pharmacy school has further prepared me as an advocate," Nemeth explained.

For those looking to reduce or quit tobacco use, pharmacists offer invaluable support. Many pharmacies provide resources and counseling for smoking cessation, including nicotine replacement therapies and other medications to manage withdrawal symptoms. Pharmacists can also offer personalized advice and support, making it easier for individuals to navigate their cessation journey.

World No Tobacco Day 2024 is a call to action for health care providers, communities and individuals to support tobacco prevention and cessation efforts. By combining the power of youth advocacy, the accessibility of pharmacists and the collaboration of health-care providers, educators, policymakers and community leaders, Kentucky can move toward a tobacco-free future. This comprehensive approach, which includes prevention, education, policy advocacy and accessible treatment resources, is essential for ensuring healthier lives for generations to come.

UK has a new group to research infectious diseases, including treatment and prevention through community engagement

By Lindsay Travis
University of Kentucky

A new partnership between researchers at the University of Kentucky will combat the threat of infectious diseases through research directed at prevention and treatment.

The CURE-KY team: Front row left to right: Vincent Venditto,

Steven Van Lanen, Ilhem Messaoudi, Rebecca Dutch. Back

row: Feng Li, David Burgess, Beth Garvy, Richard Greenberg.

Not pictured: Krystle Kuhs. (UK photo by Jeremy Blackburn)

The Consortium for Understanding and Reducing Infectious Diseases in Kentucky (CURE-KY) will foster multidisciplinary collaborations to address the burden of infectious diseases in the state and beyond.

“I am thrilled by the boundless possibilities our collaborative efforts promise at the University of Kentucky,” said Ilhem Messaoudi, founder of CURE-KY and chair of the Department of Microbiology, Immunology, and Molecular Genetics in the College of Medicine. “With a steadfast commitment to advancing knowledge and fostering transdisciplinary alliances, we aim to propel infectious-disease research to new heights, creating a healthier Kentucky and nurturing future scientific leaders.”

She added, “We have an excellent team of scientists here at UK and on our leadership team. Together we can tackle infectious diseases from an array of perspectives to make a difference in the health of our community.”

CURE-KY grew from, and took most of its acronym from, UK’s Covid-19 Unified Research Experts Alliance. It has experts from the College of Medicine, College of Public Health, College of Pharmacy, Martin-Gatton College of Agriculture, Food and Environment and the Markey Cancer Center.

It will focus on research in five areas: microbial pathogenesis; vaccines, therapeutics and antimicrobial resistance; public health and community engagement; animal health; and engineering and systems. IT will also work to address vaccine hesitancy and misinformation to foster trust between Kentuckians and the scientific community.

“From studying prevention, control and understanding transmission dynamics to assessing risk, promoting health equity and engaging communities in disease-control efforts, this work is critical toward our goal of creating a healthier Kentucky,” said Public Health Dean Heather Bush.

Dr. B. Mark Evers, Markey director, said “Kentucky is home to the highest cancer rates in the country, including several cancers caused by infectious diseases such as HPV and hepatitis C. . . . By better understanding and combating diseases that can lead to cancer, CURE-KY will contribute to this mission and make progress toward our ultimate goal of conquering cancer in the commonwealth.”

More information about CURE-KY and upcoming events is on on its website.

Food-as-medicine effort at UK gets a boost from new endowment

Alison Gustafson (UK photo by Sabrina Hounshell)

By Christopher Carney

University of Kentucky

One of the first two Gatton Foundation endowed professors at the University of Kentucky is Alison Gustafson, who directs the Food as Health Alliance. The endowment, from a $100 million gift by the late Bill Gatton, will provide funds to developing and expanding food-as-medicine programs across the state.

The money will help build capacity for health-care providers to get key services for diet-sensitive patients who are at risk of food insecurity. Gustafson is also developing and expanding community partnerships, offering approved food-as-medicine programs to those who qualify, and building a referral and network hub that will give patients a connection to services regardless of location. 

“Our team will be conducting expansion efforts for screening and referral, capacity building among community groups, outreach, UK Cooperative Extension training and research projects to better serve Kentuckians experiencing food insecurity,” Gustafson said. 

Gustafson is a professor in the Department of Dietetics and Human Nutrition in the Martin-Gatton College of Agriculture, Food and Environment and the College of Nursing. Under terms of the gift from the Bill Gatton Foundation, distinguished faculty get resources to continue meaningful research, extension and instructional programs related to advancing UK’s land-grant mission. 

The Food as Health Alliance was launched at UK in 2023 to boost health and well-being in the state through the combined application of agricultural, medical, and nutritional resources. Gustafson works to bring together clinical and community research to address the dual challenges of food insecurity and diet-related chronic diseases that many Kentuckians face.

Gustafson earned a doctoral degree in nutrition epidemiology from the University of North Carolina and a master's degree in public health from Boston University. As a master's student, she spent a year in Zimbabwe working with AIDS orphans. She has worked in local and state health departments, focusing on community health for disadvantaged populations. 

The other Gatton endowed chair, Tiffany Messer, will get support for student training and success, water-quality needs assessments, and low-cost water-quality treatment options. She is an associate professor of biosystems and agricultural engineering in the college.

May is Bladder Cancer Awareness Month, and Kentucky ranks high; UK doctor explains it, and how to detect and manage it

Illustration by irkus Creative, iStock/Getty Images Plus

By Dr. Zin W. Myint

University of Kentucky

Kentucky has one of the highest rates of new cancers in the U.S., with bladder cancer in the top 10 list of new diagnoses. Understanding the signs, risk factors and preventive measures is important for early detection and management.

What are the symptoms and signs? The most common symptom of bladder cancer is the presence of painless blood in urine. If you notice blood in your urine, don't ignore it and go to your doctor right away. Other signs to look out for are more frequent urination and an increased urge to urinate, especially accompanied by pain or discomfort. Persistent pain in the lower back or pelvic region that only gets worse over time is also a symptom.

What can increase the risk of developing bladder cancer?

• Smoking is the biggest risk factor. Tobacco smoke contains many harmful chemicals that can damage the bladder lining, increasing the risk of developing cancer.
• Exposure to certain industrial chemicals such as paint, dye, metal processing and petroleum products.
• Family history and genetics. If your family has a history of bladder cancer, you should be tested if you notice any of the symptoms above.
• Some chemotherapy drugs and medications are linked to bladder cancer increased because they can irritate the bladder.
• Environmental factors, including drinking water contaminated with arsenic.
• Chronic urinary tract infections may contribute to bladder cancer development as chronic inflammation causes damage to the protective layer of cells lining the bladder.
• A personal history of bladder cancer is also a risk factor, due to its high recurrence rate.
• Other risk factors include chronic indwelling urinary catheter or history of radiation to the pelvic area.

Is there a screening for bladder cancer? We do not screen for bladder cancer in the general population because current studies do not show sufficient benefit.

How can you reduce risks? Reducing the risk of bladder cancer stars with adopting healthy lifestyle choices and minimizing exposure to known risk factors:

• Quitting smoking is one of the most effective ways to reduce the risk of bladder cancer, creating a healthy bladder lining. We highly advocate for smoking cessation, and individuals who smoke should be actively encouraged to pursue cessation treatments, which may include medication and counseling. It is advisable to engage in discussions with your healthcare provider to explore effective methods for quitting smoking and receive personalized support tailored to your needs.
• Minimize or avoid chemical exposure and take safety precautions when working with chemicals that are known to be harmful. For instance, remember to wear gloves while using potent cleaning agents at home as numerous chemicals can permeate the skin. If you’re employed in a refinery setting, prioritize the use of protective gear. Similarly, if you’re a painter, ensure to work within well-ventilated areas to minimize exposure to potentially harmful substances.
• Stay hydrated. Drinking plenty of water throughout the day is vital for maintaining bladder health, reducing the risk of urinary tract infections, and facilitating the swift elimination of toxins from your system.

Zin W. Myint, M.D., is a medical oncologist at UK Markey Cancer Center.

UK colleges launch program to train more public-health nurses by getting nursing and public-health degrees in four and a half years

A University of Kentucky nursing class (UK photo)

By Jonathan Greene
University of Kentucky

One of the greatest challenges facing the state and the nation is the current and growing shortage of health professionals, particularly nurses.

A combined program from the University of Kentucky College of Public Health and the UK College of Nursing offers students a new pathway to make a difference in communities.

Through the Public Health Nursing Scholars program, students will earn two degrees – Bachelor of Public Health (BPH) and Bachelor of Science in Nursing (BSN) – in just four and a half years.

“Having these two programs together shows how important it is to try to fix health issues on the front side as much as possible before people end up in the hospital. We need to intervene much sooner and try to make our communities healthier,” said Andrea Flinchum, manager of the Healthcare-Associated Infection/Antibiotic Resistance Prevention Program at the state Department for Public Health. “I love that I can impact a large group or a population with my knowledge and skills. This program is taking nursing to a larger scale, rather than one or two patients. Nurses play a key role in public health.”

Public-health nurses play key roles in preventing disease while promoting public safety and well-being. Public-health nurses promote better health and safety in communities and help prepare them for and recover from public health incidents, such as natural disasters and disease outbreaks.

“Public health is faced with existing and emerging complex health challenges: chronic conditions, infectious diseases and pandemics, traumatic injuries, and environmental hazards," said Heather Bush, dean of the College of Public Health.

“Effective solutions require bringing people, skills and expertise together. The Public Health Nursing Scholars Program is such a partnership,” Bush said. “Training at the intersection of our two colleges equips graduates to tackle emerging health needs on two fronts: delivering high-quality care to individuals while addressing upstream factors impacting health outcomes to ultimately build a more resilient health-care system.”

Rosalie Mainous, dean of the College of Nursing, said “Public health is the cornerstone of the work of the baccalaureate-prepared registered nurse. A partnership with the College of Public Health will now prepare practitioners that are uniquely qualified to blend the practice degree with one that is steeped in the evidence in genetics, the environment, and health policy to support healthy outcomes.”

A variety of agencies and industries are looking to hire people with a public-health nursing background.

Government and other public agencies hire public-health nurses, and job opportunities are available with agencies and organizations that serve the health needs of a community. Public-health nurses might work for a school system to educate students and their parents about hygiene and nutrition or work for a community clinic caring for individuals and promoting disease prevention.

Public-health nurses also work with nonprofit organizations like the Red Cross or smaller grassroots groups concerned about health, social justice, and education.

The Kentucky Nurses Association predicted a potential need for 20,000 nurses in the state by 2025. Across the country, the need for nurses is only continuing to grow with more than 300,000 additional nursing jobs expected by 2032. The median salary for nurses is $37.28 per hour or $77,500 per year.

University of Kentucky will buy St. Claire Hospital in Morehead

University of Kentucky trustees Friday approved buying St. Claire HealthCare in Morehead. (UK photo)

The University of Kentucky Board of Trustees voted Friday to approve plans to acquire St. Claire HealthCare in Morehead. The targeted date for UK's takeover is July 1. 

The move will expand clinical and academic programs and provide more access to high-quality patient care for more Kentuckians, UK said in a news release.  

“UK is committed to growing clinical services in the Morehead area as well as expanding programs in many clinical areas to grow the future health care workforce for Kentucky,” President Eli Capilouto said in the release.  

St. Claire is one of the largest employers in the Morehead region, with more than 1,300 employees, including over 50 physicians and nearly 50 advanced-practice professionals in more than 20 medical specialties.

St. Claire has partnered with UK on a number of academic and clinical programs since the 1960s, co-developing the Rural Physician Leadership Program along with Morehead State University and establishing a training and residency site for UK's colleges of Medicine, Pharmacy and Health Sciences. It is also home to the College of Health Sciences's Physician Assistant Program.

St. Claire President and CEO Donald H. Lloyd II, who will remain in that position, said in the release that "UK identified as the natural partner that could carry forward the previous work and ongoing investment while growing the health-care workforce."

He added, “In an ever-changing health care landscape, both St. Claire and UK are deeply committed to accessible and high-quality patient care and strategic collaborations that will enhance services to benefit Kentuckians throughout northeastern Kentucky for many decades to come.”

According to the release, St. Claire HealthCare includes a hospital with 139 licensed beds and seven primary-care clinics in five counties, a multi-specialty medical pavilion, two urgent-care centers, a pediatrics clinic, a retail pharmacy, a counseling center, an outpatient center and a medical equipment and supply store. St. Claire also provides home health and hospice services in eight counties.

This is UK's second major foray into hospital care in northeastern Kentucky in recent years. In 2021, the university created a joint venture with King's Daughters Memorial Hospital in Ashland in which UK holds the assets and manages the hospital system.

UK professor Alex Elswick overcame opioid addiction to work with others in recovery and start a community organization to aid them

By Grace Sowards
University of Kentucky

Alex Elswick grew up with everything he needed. With two great parents, a roof over his head and good grades in school, he was a young person who wouldn’t lead people to believe drug addiction would be in his future.

Elswick stands in front of the wall of hope at Voices of Hope,

The board is full of reasons to persevere through addiction,

and messages of gratitude. (UK photo by Sabrina Hounshell)

“I come from a really privileged background,” said Elswick. “My dad is a doctor, I grew up in the suburbs and kind of had every advantage. That mattered; it mattered in terms of my addiction and my recovery.”

Today, Elswick is an assistant extension professor in the University of Kentucky's School of Human Environmental Sciences. He has master’s and doctoral degrees from the Martin-Gatton College of Agriculture, Food and Environment, which includes the school. His work focuses on substance-use prevention and recovery across the state. He is a founding member of Lexington’s Voices of Hope, a substance-use disorder community center focused on research-based recovery treatment.

Elswick’s passion for recovery education did not initially blossom from research. For many, addiction can start before an individual ever touches a substance. At age 18, he underwent wisdom-tooth surgery and was prescribed opioid painkillers. Risk factors, such as family history or mental illness, can seriously increase one’s likelihood for addiction. Elswick faced both.

“I took it exactly as it was prescribed by my provider, but with all those risk factors, I got addicted,” Elswick said. “Two years later, I woke up and I had a $200-a-day opioid addiction.”

Elswick describes his addiction in the years following his surgery as ‘nothing special.’ He experienced homelessness, unemployment and isolation. Finally, after checking into a treatment shelter in Dayton, Ohio, Elswick was able to get and stay sober for six months.

While his sobriety was an exciting milestone, Elswick confrontd barriers and questions that many people face when leaving addiction treatment. Where could he go for housing? How would he find employment? This is where his connections to the UK community made him luckier than most.

“I told everybody I was going to do tobacco research, but really I was just digging holes,” Elswick chuckled. “It was such a great job for me early in my recovery. I got to be outside, working with my hands.”

For Elswick there was a sense of healing in this work. Through it, he discovered his own healing wasn’t the whole story; he wanted to work in drug and alcohol counseling. One afternoon, colleague Kenny Hunter asked him if he had put any thought into his future. Elswick shared his new dream of working in recovery, and it opened a door he didn’t even know was there.

Hunter’s wife is Jennifer Hunter, an extension professor and director of the School of Human Environmental Sciences. She and Elswick were introduced, and it wasn’t long before he returned to the classroom.

With the support of Hunter and other UK faculty, Elswick used his own experience with addiction to address needs he noticed in his community.

“We looked at all of the help I had in my recovery,” Elswick said. “With my employment, education, mental and physical health—you could go down the list of everything I had access to that put me in a better position to recover. But 99% of folks who have addictions in our community don’t have access to most of those resources.”

Elswick knew they needed to create a one-stop-shop for recovery. This model already exists in recovery community organizations. After researching as much as they could on the topic, Elswick and his colleagues traveled to see some RCOs making real change in their communities.

Thus was Voices of Hope born. An RCO in the heart of Lexington working to prove to those struggling that change can be made at any stage. The Voices team upholds the unique approach of supporting other pathways of recovery besides complete sobriety, or abstinence. Voices of Hope supports individuals who want to practice abstinence and provides programming from organizations like Alcoholics Anonymous for those interested. However, the team of coaches at Voices encourage any and all steps toward recovery, no matter the pace.

“If you think about any other kind of behavior change, people typically don’t change all at once,” said Elswick. “If I want to lose weight, it’s usually a process. Even if I have 50 pounds to lose, if I go to my doctor and say I’m only willing to lose 10, he or she will not kick me out of their office. It’s an improvement in your health, and at Voices, we recognize that by meeting you where you are.”

Voices of Hope began in 2014 as a group that provided access to naloxone (brand name Narcan), the drug that reverses drug overdoses, when it was very stigmatized and difficult to find. Now, they are a fully operational RCO with two Lexington locations and thousands served.

It provides servics to the deaf and hard-of-hearing, has a partnership with the state Department of Corrections to place recovery coaches in prisons, and has created mobile recovery units to provide resources in hard-to-reach areas of Louisville and Lexington. Those are just a few of the major projects Voices has achieved in the last few years.

Today, Elswick continues to be motivated by the same community that lifted him out of his substance use disorder and into his life of service. This includes his family and those at UK who encouraged him to work and do research in the substance use disorder space.

“It’s a cliché, I suppose, to say I wouldn’t be here without them, but I think it’s literally true,” said Elswick. “There’s no single job on the planet better suited for me than exactly the job that I have, and I believe strongly that if it weren’t for Kenny and Dr. Hunter advocating for me, I would not be where I am now.”

In his college, Elswick teaches the course Addiction is a Chronic Disease and has taught classes on Substance Use, Family and Society, Family Resource Management. Working with students and inspiring change is something he’s immensely grateful for.

“The University of Kentucky, from the beginning, supported me and supported recovery,” Elswick said. “I never experienced stigma and I never experienced shame from the university. I always heard university leadership saying ‘this is an issue that we want to get behind.’”

For more information on Voices of Hope, visit https://voicesofhopelex.org.

Elswick stands outside Voices of Hope at 644 N. Broadway in Lexington. (UK photo by Sabrina Hounshell)