Friday, March 18, 2011

Madisonville hospital earns national award for program that helps pregnant women maintain, improve oral health

For its work in improving oral health in prenatal patients, the Center for Women's Health at Trover Health System in Madisonville has received a national award.

The William J. Gies Award for Outstanding Innovation is given to individuals and organizations dedicated to improving dental education, research and leadership. Trover Health System's program "Centering Pregnancy Smiles" focuses on educating women about the importance of maintaining their oral health while pregnant.

"Women may mistakenly think they can skip dental care when pregnant. However, now more than ever, regular oral health check-ups are very important," said LeAnn Todd-Langston, director of the Center for Women's Health. "Pregnancy causes hormonal changes that put women at increased risk of dental disease. Some studies even suggest that infections in the mouth, including gingivitis and cavities, may increase the risk of delivering early. Additionally, some studies have shown that the bacteria responsible for tooth decay are passed from the mother to the baby. By incorporating oral health education into the care our prenatal patients receive, we have been able to reduce the number of preterm and low birth-weight births at Trover." (Read more)

Thursday, March 17, 2011

Judge rules Passport managed-care plan for Medicaid in Louisville region is subject to state Open Records Act

As Kentucky prepares to put more of its Medicaid program under a managed-care system to save money, a judge has ruled that the contractor running the program's only managed-care plan is a public agency subject to the state Open Records Act.

Ruling in a lawsuit filed by The Courier-Journal, Jefferson Circuit Judge Susan Schultz Gibson wrote, "Since Passport exists for the purpose of administering the Medicaid program on behalf of the Commonwealth, the sought records all appear to relate to Passport’s state-related operations."

Passport, which can appeal the ruling, declined to comment. A consortium of Louisville-area hospitals, physicians and other health care providers, it serves about 165,000 poor and disabled Medicaid patients in 16 counties in the Louisville region under a $740 million annual contract. The state administers the program but most of its money comes from the federal government.

"While it has been praised by lawmakers for providing good care and saving the state money, it came under fire last year after a critical audit by state Auditor Crit Luallen," Deborah Yetter writes for the Louisville newspaper. "The audit blasted Passport management for spending on meals, travel and lobbying, and it questioned the transfer of about $30 million in reserve funds to University Hospital and other physician groups and hospitals involved in Passport operations." (Read more)

Well-being index gives rankings for Kentucky's congressional districts and metropolitan areas; some are very bad

In keeping with its second-to-last state ranking in the 2010 Gallup-Healthways Well-Being Index, which assessed people's physical and emotional health across the country, one of Kentucky's congressional districts and its major metropolitan area have also ranked low.

Of 436 congressional districts nationwide, Kentucky's 5th District ranked 435th overall, and was dead last in the emotional-health and physical-health categories. The other districts' rankings were: 1st, 383rd; 2nd, 404th; 3rd, 312th; 4th, 415th and the 6th, 388th. Here's a table with breakouts and the 2009 rankings:


Of the 188 metropolitan areas assessed, Louisville ranked 170th, not much different from its 151st ranking in 2009. Lexington ranked 115th, way down from 15th. Among metro areas centered in other states, Cincinnati was 123rd; Clarksville, Tenn., was 162nd; Evansville was 172nd; and Huntington was 188th, dead last in the nation. It has scored poorly on several other health measurements.



The well-being index assessed respondents on their emotional health, physical health, life evaluation, work environment, healthy behaviors and basic access. Respondents answered a large spectrum of questions that pertained to their life now and how they expect it to be in five years. In the emotional-health category, for example, they were asked about how often they laugh, if they were treated with respect and if they experienced sadness, anger or depression. In the work-environment category, people were asked about how they are treated by their supervisor, if they are able to use their strengths while at work and if they're satisfied with their job.

Compared to the rest of the country, Kentucky as a whole ranked 49th, surpassing only West Virginia. Hawaii had the highest well-being index in the country.

It bears noting that the rankings are based on very narrow margins of difference, with many states' scores just a few tenths of 1 percentage point apart. While Kentucky's overall well-being index was 61.9 out of a possible 100 points, Hawaii, which ranked first in the country, had a score of 71. The 2010 score for the nation was 66.8. West Virginia's score was 61.7 points. Because the scores were so close together, precise rankings are uncertain. The ranges for congressional districts and cities are greater, but the error margins are larger.

The survey was based on random-digit dial telephone interviews with 352,840 adult Americans living in all 50 states and the District of Columbia. There were 5,881 Kentuckians who participated in the study. Of those, 1,046 live in the 5th Congressional District and 1,632 live in the Louisville area, which includes Jefferson County and the Indiana border. Interviews were conducted every day from January to December 2010.

The margin of sampling error for most states is plus or minus 1 to 2 percent, but is as high as plus or minus 4 percent for the smallest states. For results based on the total sample size, "one can say with 95 percent confidence that the maximum margin of sampling error is plus or minus 1 percentage point," says Elizabeth Mendes of Gallup.

Rogers, Florida colleague file measure to crack down on 'pill mills'

U.S. Rep. Harold "Hal" Rogers of Eastern Kentucky's 5th District continues to pressure the White House for more action to crack down on "crook doctors operating these pill mills," the Lexington Herald-Leader's Halimah Abdullah reports. (H-L photo by David Perry)

Along with U.S. Rep. Vern Buchanen, R-Fla., Rogers has filed a measure that would support state-based prescription drug monitoring efforts; use seized profits from the drug trade to support rehabilitation treatment; tighten prescription standards for some pain drugs; and make prison terms more lengthy and fines more expensive.

The Obama administration says it is doing its part and "is the first to publicly call the prescription abuse problem an epidemic," Abdullah reports. White House officials contend the administration has increased drug busts and has already poured millions into state-operated prescription monitoring programs. "We've been laser-focused on this issue since day one," said Rafael Lemaitre, a spokesman for the Office of National Drug Control Policy. (Read more)

Heavy smoking less common than 40 years ago

The percentage of people who smoked 20 or more cigarettes a day decreased significantly from 1965 to 2007 in the United States, according to a study in the March 16 issue of the Journal of the American Medical Association.

There was also a decline in the number of people who smoked 10 or more cigarettes a day. The declines were more significant in California than the rest of the country, in part due to the state's tough tobacco control programs, researchers concluded.

Before 1964, when the surgeon general first linked smoking and disease, Americans smoked an average of 1 pack — or 20 cigarettes — per day, the study shows. Researchers found that in 1965 "the prevalence of high intensity (20 or more cigarettes per day) of smoking among California adults did not differ from the remaining United States; prevalence of high-intensity smoking in California was 23.2 percent compared to 22.9 in the remaining United States, and these smokers represented 56 percent of all smokers," reports Newswise, a research-reporting service. By 2007, this prevalence was 2.6 percent in California and 7.2 percent in the rest of the country. As smoking rates have declined, so, too, have lung cancer death rates. (Read more)

Health Reform Source website answers questions about law

In time for the one-year anniversary of the enactment of the federal health-reform law, the Kaiser Family Foundation is advertising its Health Reform Source website, which offers comprehensive resources concerning the Patient Protection and Affordable Care Act.

The website answers questions about implementation, how reform can affect individual states, as well as research and analysis. It also features an official document finder and summaries of reports and studies.

Its latest addition is an interactive quiz, which allows visitors to test their knowledge about what is and what isn't in the new law. Take it!

Link found between kids watching food-based TV commercials and childhood obesity

Watching TV commercials, not the sedentary act of watching TV itself, contributes to obesity in children, according to a study published by the American Journal of Public Health.

The study found that the average child sees about 4,000 television commercials advertising food each year. During Saturday morning cartoons, kids see a food ad about every five minutes. Of that food advertised, about 95 percent of it is of poor nutritional value.

In the study, Associations of Television Content Type and Obesity in Children, researchers followed children from 1997 to 2002 to observe how different types of television might affect obesity rates. They found "television advertising, rather than viewing per se, is associated with obesity." During the five-year period, children saw an increasing amount of commercials and a decreasing amount of non-commercial programming. (Read more)

Inspectors found 389 deficiencies in 66 Kentucky nursing homes in last quarter of 2010

Inspectors found 389 deficiencies at 66 Kentucky nursing homes in the last three months of 2010. Ten of the nursing homes inspected had 10 or more deficiencies. Two of them, one in Elizabethtown and one in Winchester, had none.

Kentuckians for Nursing Home Reform, a non-profit organization that advocates for nursing home residents, obtained the data through an open-records request to the Kentucky Cabinet for Health and Family Services.

On average, inspectors find six deficiencies in Kentucky's nursing homes, according to Medicare's nursing-home comparison data. A recent report by the state inspector general in the Cabinet for Health and Family Services shows 25 nursing homes had more than six deficiencies and 10 of them had 10 or more deficiencies.

Inspections assess a facility on the care of residents and how that care is administered; on how staff and residents interact; and on its environment. Certified nursing homes must meet more than 180 regulator standards.

Though several proposals were considered by the General Assembly this year to improve the care of and protect nursing home residents, none passed.

The nursing homes inspected in the last three months of 2010 that had 10 or more deficiencies were: Britthaven of Pineville (17 deficiencies); Signature Healthcare of Pikeville (14); Signature Healthcare of East Louisville (13); West Liberty Nursing & Rehabilitation Center (13); Golden Living Center-Camelot, Louisville (12); Kingsbrook Lifecare Center, Ashland (12); Life Care Center of Morehead (12); Knox County Hospital, Barbourville (11); Nim Henson Geriatric Center, Jackson (11), and Villaspring of Erlanger (10).

Nursing facilities inspected recently with no defiencies were at Hardin Memorial Hospital, Elizabethtown; and Clark Regional Medical Center, Winchester.

Sunday, March 13, 2011

Legislature passed few health-related bills; took small steps on child obesity, diabetes, elder abuse

There were proposals to combat childhood obesity, fight methamphetamine production, impose a statewide smoking ban and protect nursing home residents, but Kentucky lawmakers were reluctant to make changes through health-related legislation this year, with one big exception. Some small strides were made, but in large part much-heralded bills did not get much farther than committees.

The major exception was Senate Bill 110, sponsored by Senate Republican Floor Leader Robert Stivers of Manchester, left, which flew through the General Assembly at eyebrow-raising speed. The bill greatly expands the scope of care optometrists can provide to their patients, including a corrective laser procedure that optometrists can now do only in Oklahoma. Normally, that procedure can only be performed by ophthalmologists, who are trained medical doctors. The bill also allows optometrists to prescribe certain drugs and lets the state Board of Optometric Examiners define what procedures optometrists can legally perform, a more fundamental policy change.

The bill was cause for controversy also because of the amount of campaign contributions, totaling almost $400,000, that optometrists made to all but one legislator and Gov. Steve Beshear in the past two years.

One of the first bills to make headlines was House Bill 193, a proposal by state Rep. Susan Westrom, D-Lexington, left, to ban smoking statewide in public spaces and workplaces. Though hopes were never high it would pass, advocates said the time was right to introduce the idea to the General Assembly and educate legislators about the importance of a comprehensive law that would protect all employees, including restaurant and nightclub workers, from second-hand smoke. "Here's what's important: We don't want to settle for a half-baked law," said Amy Barkley, a director for the Campaign for Tobacco-Free Kids.

At the dawn of the session, state Rep. Addia Wuchner, R-Florence, right, introduced a pack of bills designed to fight childhood obesity. One would have required the assessment of elementary school children's body mass indices, or weight-to-height ratios. Another would have required that elementary school children receive 30 minutes of physical education a day. Neither of these proposals were able to gain traction, but Wuchner did win passage of House Concurrent Resolution 13 creating a legislative task force on childhood obesity. By examining child-care facilities, before-and after-school programs, physical education in schools and higher school nutrition standards, members will come up with strategies to get children eating more healthily and exercising more frequently.

Diabetes, which is often preceded by obesity, was also addressed in the form of Senate Bill 63, which charges several state offices, including the Department for Public Health, to try to reduce the incidence of the disease in the state and improve diabetes care, and Senate Bill 71, which establishes the Kentucky Board of Licensed Diabetes Educators and defines diabetes education.

The "meds-for-meth" bill, which would have required prescriptions for three popular decongestants used to make methamphetamine, drew a lot of attention — and pro and con advertising dollars — this year, but was not able to make headway after clearing the Senate Judiciary Committee 6-4 on Feb. 3. The sponsor, Sen. Tom Jensen, R-London, right, promised to broach the issue again next year. "We're waiting for something very terrible to happen by not acting on this," he said. "A tragedy's gonna happen here and then we're all really gonna feel bad."

After several stories about elder abuse and nursing home neglect ran in the Lexington Herald-Leader and The Courier-Journal late last year, two bills were on the table to provide protection for those potentially in harm's way. But neither — whether that be requiring coroners to investigate nursing home deaths or making nursing home workers be subject to a background check — made any headway. House Bill 52, intended to prevent elder abuse by prohibiting a convicted adult abuser from inheriting from the victim after he or she dies, did pass.

Other health-related bills that passed:

House Bill 121, which bans methylenedioxypyrovalerone, the primary ingredient on products marketed as "bath salts." The product is sold in stores and online under names like Cloud Nine, Red Dove, Blue Silk and Ivory Wave, and, if used inappropriately, can cause paranoia, hallucinations and violent behavior.

House Bill 311, which allows physicians to submit electronic or faxed prescriptions for methamphetamine and Schedule II controlled substances. Previously, the prescriptions could only be written.

House Bill 12, which allows mental health professionals to perform an examination using telehealth services. One of its amendments requires health care facilities to report data on health-facility acquired infections and to implement infection prevention programs.

House Bill 362, which establishes licensing requirements for ginseng dealers.

Senate Bill 40, which allows pharmacists to give flu shots to children 9 to 13.

House Concurrent Resolution 138, which urges Congress to provide more resources to treating veterans and military personnel for post-traumatic stress disorder.

Senate Bill 112, which limits the amount of a copayment or coinsurance that must be paid for services rendered by a physical therapist or occupational therapist to 20 percent of the total charge of the service.

Thursday, March 10, 2011

Most Kentuckians want to treat drug offenders, not jail them

Days after a bill was passed that will reduce prison time for the state's low-risk, non-violent drug offenders, the 2010 Kentucky Health Issues Poll shows that seven in 10 Kentuckians favor replacing prison sentences with mandatory drug treatment and probation for people who commit non-violent crimes.

The poll also showed 71 percent of Kentuckians are in favor of doing the same for non-violent offenders who commit crimes under the influence of alcohol.

The results were released today, just days after Gov. Steve Beshear signed House Bill 463, probably the most important piece of legislation passed in the Gereal Assembly's just-ended session. The legislation is, in part, meant to help curb overcrowding in jail and prison populations. Kentucky's prison population has increased by 45 percent since 2000.

About 25 percent of inmates in federal, state and local jails and prison are incarcerated because of drug violations, National Center on Addiction and Substance Abuse data show. Another 4 percent are incarcerated because of alcohol law violations. These violations include drug/alcohol possession or use; substance trafficking; driving under the influence; drunkenness, vagrancy or disorderly conduct; and liquor law violations.

The poll was conducted Dec. 3-22 and Dec. 27-28 by the Institute for Policy Research at the University of Cincinnati. It interviewed a random sample of 1,677 adults, 1,469 by landline phones and 208 via cell phones. The poll was funded by the Foundation for a Healthy Kentucky and The Health Foundation of Greater Cincinnati. In 95 of 100 cases, the estimates are accurate within a 2.4 percent margin of error.

Respondents were asked more than 50 questions that covered a range of health-related topics, including financial stresses related to health care; characteristics of their neighborhood (examples: Is it easy to buy fresh produce or ride a bicycle?); degree of civic engagement, such as donation of blood, work on a community project or attendance at political meeting or rally; using cell phones while driving; health insurance coverage; the new health care law; and smoking policy.

Wednesday, March 9, 2011

Kentuckians among least happy and least healthy in U.S.

Kentuckians are among the least happy and healthy citizens in the country, with the state ranking second lowest in a survey that rates the emotional and physical health of Americans.

Only West Virginia had a lower well-being score, according to the 2010 Gallup-Healthways Well-Being Index. West Virginia ranked lowest in three of six measured categories, while Hawaii got the highest well-being scores in three of the six categories.

Kentucky ranked lowest in the country in the "healthy behaviors" category, which measures smoking rates, weekly consumption of fruit and vegetables and frequency of exercise. Of course, people who engage in unhealthy behaviors may not necessarily be unhappy.

The other categories include life evaluation, emotional health, work environment, physical health and basic access. Respondents answered a large spectrum of questions that pertained to their life now and how they expect it to be in five years. In the emotional-health category, for example, they were asked about how often they laugh, if they were treated with respect and if they experienced sadness, anger or depression. In the category of work environment, people were asked about how they are treated by their supervisor, if they are able to use their strengths while at work and if they're satisfied with their job.

The survey was based on random-digit-dial telephone interviews with 352,840 adult Americans living in all 50 states and in the District of Columbia. Interviews were conducted every day from January to December 2010. The margin of sampling error for most states is plus or minus 1 to 2 percent, but is as high as plus or minus 4 percent for the smallest states. For results based on the total sample size, "one can say with 95 percent confidence that the maximum margin of sampling error is plus or minus 1 percentage point," says Elizabeth Mendes of Gallup.

The range of scores was less than 10 points, and many states were close together, so precise rankings are uncertain. Kentucky's well-being score was 61.9 out of a possible 100 points. The 2010 score for the nation was 66.8. West Virginia's score was 61.7 points; Hawaii's was 71. Results for congressional districts and major cities will be released later this month. (Read more)

Senate blows the whistle on the session, leaving Medicaid at an impasse; Beshear says a special session will start Monday

By Al Cross
Institute for Rural Journalism and Community Issues

The state Senate is forcing an early end to the Kentucky General Assembly's regular session today, without fixing the budget gap in the Medicaid program for the poor and disabled. Even as legislators were still meeting, Gov. Steve Beshear said he would call a special session for Monday on the issue, and said Medicaid providers would get letters warning them that their Medicaid reimbursements could be cut 30 percent.

Thus did the Democratic governor raise the ante in a game where the stakes had already been raised by his likely opponent in the general election, Senate President David Williams, R-Burkesville. Doctors are major campaign contributors, but tend to give to Republicans, and they can be a potent lobbying force.

Beshear wants to move money from next year's Medicaid budget to this year's, which would pick up extra federal matching funds, and institute managed-care plans to save money in the fiscal year that begins July 1. Williams says Beshear has not proven that enough can be saved, and warns that the governor's plan will leave the state in much bigger budget trouble a year from now, early in the next gubernatorial term.

Williams, with two opponents in the May 17 Republican primary who have questioned his history on taxes, spending and debt, wants to meet the Medicaid deficit by with across-the-board cuts that would affect education -- a spending area that Beshear has left virtually untouched during a series of budget cuts.

Williams has often been a friend to education, but is at odds with the state and Jefferson County teachers' unions. Those groups are Kentucky's most powerful public-employee unions, a sector that Republicans in several other states have targeted in efforts to cut spending. For years, Williams has tried to change the state pension system from a defined-benefits plan to a defined-contribution plan.

Williams says ending the session early, without a recess and return to reconsider any bills vetoed by Beshear, will save hundreds of thousands of dollars, more than the likely cost of a special session. For coverage from the Lexington Herald-Leader, click here; from The Courier-Journal, here.