Groups try education to allay confusion about health reform

Though the Patient Protection and Affordable Care Act celebrates its first birthday today, most Americans admit they are still largely confused by what its provisions will mean for them. To help increase understanding, many organizations are launching or expanding their educational efforts.

Kentucky Voices for Health has put together a brief, right, to promote understanding, addressing a range of issues from pre-existing conditions to Medicare drug donut holes. It outlines what provisions will take effect when, answers other commonly asked questions, and looks at how the new law will benefit Kentuckians.

The group, which does not lobby but comprises organizations that do, has also issued statements on how the new law protects small business, seniors, patients' rights and protecting women.

The Health Foundation of Greater Cincinnati has launched a public education effort, FOX19's Matt Miller reports. "Sections of the Affordable Care Act have already begun to take effect and the community needs information," said Kate Keller, foundation senior program officer. "We want to help people understand changes coming and new benefits for which they may be eligible."

The foundation will distribute informational pamphlets through community organizations and will feature a website about the new law. (Read more)

Bullitt County health board votes to make county smoke-free; Fiscal Court wants a judge to decide if a board has that power

Bullitt County's board of health voted to enact a countywide smoking ban Tuesday evening, but the county's Fiscal Court wants a judge to decide if the board has that authority.

"This is not about the smoking ban," Judge-Executive Melanie Roberts told WAVE-TV's Connie Leonard. "This is about which agency can enact legislation." Health Department Director Swannie Jett said fighting the ban is "ludicrous if you just think about the health impacts."

The Bullitt County Board of Health is not the first in Kentucky to enact such a ban. Health boards in Woodford, Hopkins, Madison and Clark counties did likewise. The move in Hopkins County did result in a legal battle, but the judge sided with the health department. (Read more)

Meanwhile, in a story healdined, "Smoking-ban advocates find Southern Kentucky a hard sell," the Lexington Herald-Leader's Bill Estep explains how a multi-county agency such as the Lake Cumberland District Health Department can enact a smoking ordinance. "A county health department that stands alone can approve a smoke-free law by regulation," he reports. "Counties under a district health department board can't, however; the multi-county board would have to approve such a regulation for the entire district." (Read more)

St. Joseph Health System CEO is leaving for Texas

The chief executive of Saint Joseph Health System is leaving his post June 1 to join a health group in Dallas. Eugene Woods, right, will become executive vice president and chief operating officer of Christus Health, a system with facilities in 60 southern U.S. cities.

St. Joseph is best known for its two Lexington hospitals, but it also has hospitals in Bardstown, Berea, London, Martin, and Mount Sterling, and an ambulatory care center in Nicholasville. The Catholic system expanded under Woods's watch to 1,012 beds, 5,000 employees and 1,300 physicians.

The move comes in the midst of St. Joseph's negotiations for a merger with two hospitals in Louisville, Jewish Hospital and the University of Louisville. Woods said the merger discussions are going well, and St. Joseph's interim leadership will be announced in two or three weeks, the Lexington Herald-Leader's Linda Blackford reports.

Electronic health records are the new frontier in health care

By Tara Kaprowy
Kentucky Health News

Just two years ago, the acronym EHR didn't mean much to many people. But since Congress passed the health-care reform law last year, physicians and hospitals have become intimately acquainted with it — and patients may follow suit.

EHRs are electronic health records. They are quickly being adopted by hospitals and physicians as the federal government begins to pay out $19 billion in incentives: extra Medicare and Medicaid payments. Kentucky health care facilities and providers have been especially eager to sign up, perhaps because so few of the state's doctors had adopted EHRs. Kentucky doctors' offices were the least digitized in the nation last year, according to a national survey.

An EHR is a digitized copy of a person's health record, essentially replacing the file folder that has typically held handwritten information about a patient. It generally contains information about a patient's laboratory and radiology results, diagnoses, prescriptions and other treatment.

EHRs' advantage is their easier accessiblity. Rather than being locked in a doctor's office, the information, in theory, can be accessed by other health-care providers, regardless of which one the patient is seeing. "It's about the information always moving with you," said Nancy Szemraj, spokeswoman for the Office of the National Coordinator for Health Information Technology.

"That's like the pot of gold," said Jeff Brady, executive director of the Governor's Office of Electronic Health Information. "If you've been to six different hospitals and three different doctor's offices, literally all of that data can be viewed."

EHRs are expected to reduce unnecessary tests and treatment because they will list tests that have been performed, and to reduce the potential for medical errors, because they containing such cautionary information as the patient's allergies.

Protecting your information

One risk of electronic health records is the potential for the information being leaked, lost, altered or merely read by an unauthorized person. Leaks can be purposeful or by accident. In January, the private information of thousands of people who visited the Green River District Health Department in Owensboro was found online, where it had been mistakenly available for several months.

Brady acknowledged the danger of unauthorized access, but said safeguards have been taken to avoid it. Participating providers in the Kentucky Health Information Exchange, the state clearinghouse for EHRs, have to sign several agreements in which they attest the information they obtain will be used responsibly.

"The golden rule is this data will only be viewed by a provider who is providing care to a patient," Brady said. To make sure that is happening, he said, the software has an audit function, in which administrators are able to see who looks at a patient's data, when they did, from what computer and what piece of data they examined.

The national network will not be a database, and thus not in danger of being hacked, said Szemraj, of the national office. "It's simply a means to securely push and pull information as needed," she said, citing an example of a person traveling around the country and falling ill in New York City. "At that time, they would be able to tap into your medical record in your home base and say, 'I want to pull your medical information.' It's not literally sitting out there in a repository where anybody could hack into it."

To set up EHR systems, hospitals and doctors choose from a list of federally approved software. The programs don't "necessarily have to communicate with each other," Brady said, "but they do have to conform to certain standards that would allow them to communicate with a health information exchange."

The state's exchange has been operating in the pilot stage since April 2010. It will act as a "middleman" between hospitals and health care providers, Brady said. "We will be the hub and all information will flow from a provider, to us, back to another provider."

Under ideal circumstances, Brady said he hopes to see half of the state's hospitals and doctors' offices connected to the exchange by the end of the year, with the other half signed on by the end of 2012. That may be ambitious, since a recent survey showed Kentucky had the lowest percentage of doctors' offices that have adopted EHRs, just 38 percent, compared to 51 percent nationwide.

While Kentucky builds its exchange, other states are doing the same. Eventually, the goal is to create a National Health Information Network that will allow information to flow from state to state. That will be especially beneficial to Kentucky, Brady said, "because we have so many hospitals and medical facilities on our border. We're talking to Tennessee and Ohio about exchanging data with them. There's going to be a lot of development in the next 12 months."

But when will the state information exchange or national network be useable? Brady said no date has been set for the state exchange, and Szemraj said of the national network, "We are truly just beginning."

Cost savings?

The Obama administration and other supporters of the health-reform law say EHRs will save money. A 2005 study by the RAND Corp. indicated that implementing EHRs and networks could eventually save more than $81 billion per year by improving health care efficiency and safety, but that study was theoretical in nature and assumed 100 percent compliance, Drs. Jerome Groopman and Pamela Hartzband wrote in an op-ed piece in The Wall Street Journal.

Some data show EHRs do not necessarily improve patient care, the doctors wrote, pointing to a study published in the journal Circulation that reviewed the influence of EHRs on the quality of care received by more than 15,000 patients with heart failure. It concluded that "Current use of electronic health records results in little improvement in the quality of heart-failure care compared with paper-based systems."

Another study looked at the Department of Veterans Affairs' health information technology investments and estimated a potential value of $3.1 billion "in cumulative benefits net of investment costs." But Brandon Glenn of Medcity pointed out "the study's lead researcher stressed the dollar amount reflects only what's possible — not actual savings."

The prevailing opinion in the industry is that EHRs will save money, but no one is really sure how much. On the expectation of savings, the health-reform law calls for extra Medicare and Medicaid payments to providers as incentives to adopt the technology. Providers have until 2014 to adopt EHRs. If they don't, Medicare will start penalizing them by paying them less in Medicare payments.

A rural equalizer?

Since the Centers for Medicare and Medicaid Services started distributing EHR incentive payments in January, Kentucky hospitals and other health-care providers have received more than $18 million of about $38 million handed out nationwide so far. University of Kentucky Healthcare and Central Baptist Hospital, which together received $4.1 million, were the first facilities in the nation to receive the extra payments. In the next four years, Kentucky hospitals are expected to receive more than $100 million in incentives.

For a spreadsheet of incentives paid to Kentucky providers through last week, click here.

To receive the incentives, which can mean up to more than $60,000 for eligible professionals and millions for hospitals, applicants must prove their EHR systems are being used in a meaningful way. To show "meaningful use" in the first of three stages — the only stage that, so far, has been officially defined — eligible professionals must show "continuous quality improvement and ease of information exchange," according to regulations in the Federal Register. Professionals must meet 25 measures, hospitals 24, to prove meaningful use. One measure, for example, is the ability to send electronic data to the state's immunization registry.

The list of incentives already paid shows providers in the most rural to the most urban areas areas of Kentucky are switching over at equally rapid rates. In fact, two of the few hospitals already linked up to the Kentucky Health Information Exchange are Pikeville Medical Center and Murray-Calloway County Hospital, both outside metropolitan areas.

Brady said the Office of the National Coordinator for Health Information Technology "is very interested in rural areas, the critical-access hospitals, the very small but important hospitals . . . that typically get left out on technology. This an effort to bring them along and be the equalizer."

Second summit will shed light on health literacy

The second annual Kentucky Health Literacy Summit will be held in Bowling Green Thursday and Friday.

"The event will raise awareness about low health-literacy skills," The Courier-Journal's Darla Carter reports. "Skills include the ability to fill out forms, find health providers and services, and take medications correctly." It will also shed light on available resources, the patient perspective and practices at work.

Called "Health Literacy in Action," the event will run from noon Thursday to noon Friday at the Holiday Inn University Plaza. It is sponsored by Humana Inc., the University of Kentucky and Western Kentucky University. (Read more) The event's website is here.

Parents' insurance can now cover children up to age 26

Following the lead of the federal health-care law, Kentucky employers can now extend health coverage to their employees' adult children. The employees will not be subject to state taxes if they opt for the coverage, Business Insurance's Jerry Geisel reports.

Gov. Steve Beshear signed House Bill 255 last week. "The law requires employers to extend health care coverage to employee's adult children up to age 26," Geisel reports. "Under prior Kentucky law, an employee's child had to be younger than 19, or 24 if a full-time student, for the coverage to be provided on a tax-free basis."

Similar laws have been passed in Arizona and Maine this year. The extended coverage has been one of the most highlighted pieces of the Patient Protection and Affordable Care Act, which was signed into law a year ago tomorrow.

Near-unanimous House passes Medicaid plan; Senate mum

By an overwhelming margin of 94-4, the state House today passed a bipartisan bill to fix the state Medicaid budget, again putting the ball in the court of the Republicans who control the Senate. They declined to comment.

The House again adopted Democratic Gov. Steve Beshear's plan to transfer money from the second year of the budget amd make up the difference by instituting managed-care plans, but this time included what House Republican Leader Jeff Hoover called "triggered" cuts if Beshear falls short.

"Beshear would have to certify by Aug. 15 the amount he can save within Medicaid in the fiscal year that begins July 1," Beth Musgrave and Jack Brammer report for the Lexington Herald-Leader. "The bill also would let Beshear use about $23 million in one-time money to offset any shortfall if there are no savings in the Medicaid budget. Anything short of the remaining $116 million needed to balance the Medicaid budget would trigger cuts in most other parts of state government." The Courier-Journal's Tom Loftus and Deborah Yetter note, "Public schools, universities and a few other selected areas would be exempt." (Read more)

In a video interview posted via Facebook, Hoover said the bill is "a lot better" than the one the House passed 80-19 in the regular session. But he called it only "a first step" toward finding an agreement with the Senate, and said he expected the matter to again reach a House-Senate conference committee. He said House Republicans "want to move above the fray of the politics of this. . . . I hope and think that the Senate now recognizes that we're part of the process." Senate President David Williams was personally critical of the House GOP leader after Hoover rebuffed Williams' plan to make small cuts in basic school funding.

New website, www.SortingThroughTheSmoke.com, offers journalists local and state information on tobacco and health

Three Kentucky organizations are launching a website to serve as a one-stop shop for journalists covering tobacco and health issues in Kentucky, and for others interested in documenting the impact of Kentucky’s tobacco use on the health of the state's residents.

SortingThroughTheSmoke.com is administered by Kentucky Youth Advocates with assistance from the Institute for Rural Journalism and Community Issues and the Kentucky Center for Smoke-free Policy, both based at the University of Kentucky. The site provides state and county-level data, contact information for local and state experts, local and regional news coverage of the issues, and other resources to help tell the story behind tobacco and health in Kentucky.

The site is funded by the American Legacy Foundation, created with money from the 1998 settlement between states and cigarette manufacturers. It carries the same name as a series of 2009 workshops funded by the foundation and conducted by the Institute for Rural Journalism and Community Issues for Kentucky Youth Advocates. On the hot topic of smoking bans, it includes links to information from supporters of regulation and those who favor a libertarian, free-market approach.

New law on diabetes educators is only one of its kind in U.S.

The new Kentucky law requiring that diabetes educators be licensed is the only one of its kind in the country. The American Association of Diabetes Educators says the law will "enhance consumer protection and increase professional recognition," The Courier-Journal's Laura Ungar reports. The group would like to see similar license requirements in every state in the nation.

Senate Bill 71 was sponsored by state Sen. Alice Forgy Kerr, left, R-Lexington. It was signed by Gov. Steve Beshear earlier this week. It is one of two bills that passed this session that addresses diabetes, a growing problem in Kentucky. In 2009, Kentucky had the nation's fourth highest rate of diagnosed diabetes, state officials say. Senate Bill 63 charges several state agencies, including the Department of Public Health, with the responsibility of trying to reduce the incidence ofdiabetes in the state and improve diabetes care.

Diabetes educators, who can be nurses, dieticians, physicians or other health-care professionals, counsel patients about nutrition and physical activity, educate them about their medications and teach them how to monitor their blood glucose. (Read more)

Drink bottles, cans must now show calorie content on front

In an effort to educate people about how many calories they're sucking back, the front labels of packaged beverages in bottles or cans of 20 ounces or less must now show the total number of calories they contain.

"Beverage containers traditionally 'hid' the nutritional content at the back in a small square with small print and cleverly listed just calorie content per serving," said Dr. Jessica Bartfield, part of a physician-led team with Loyola University Health System that is trying to help people change behaviors that lead to them being overweight. "Unbeknownst to those who are happily guzzling their favorite cola or fruit drink, most packaged beverages contain multiple servings, and most Americans fail to do the math on the total calorie count."

In terms of caloric consumption when it comes to fruit and soft drinks, Bartfield shared some troubling statistics, which research research-reporting service Newswise listed:

• The average American consumes 22.5 teaspoons of added sugar each day. Half of that amount comes from soda and drinks, the National Health and Nutrition Examination Survey (1999-2004) showed.

• One in 10 overweight adults "consume 450 calories of sugar sweetened beverages per day, which is three times that of an average American. Cutting 450 calories per day would lead to about a 1 pound per week weight loss, close to 50 pounds in one year," Bartfield said. (Read more)

Maine gets health-reform exemption that Kentucky also wants

Maine has been granted an exemption that Kentucky is also seeking — one that will exclude it from being subject to the health reform's medical-care ratio rules.

The ratio requirement "mandates that at least 80 cents out of every premium dollar go toward patient care and quality improvement, rather than administrative costs and plan profits," Amednews.com's David Glendinning reports. Under the exemption, which has been granted until 2013, Maine insurers will only have to spend 65 percent of premiums on care.

The Department of Health and Human Services contends the Maine insurance market could not bear the impact of the new regulation. The state is only served by three major insurers, one of which threatened to pull out if the regulation stood. Kentucky, Florida, Nevada and New Hampshire have applied for similar exemptions. (Read more)

Forum on health-reform law to be held in Lexington March 21

In time for the one-year anniversary of the passage of the Patient Protection and Affordable Care Act, a forum will be held in Lexington to review the ins and outs of the law.

"This is not a debate about reform, but it is a chance for interested parties to get better educated by some of the top professionals in the field," said Mark Johnson, health equity team leader with the Lexington-Fayette County Health Department.

The forum will be held from 5 to 7 p.m. March 21 at the Lyric Theatre and Cultural Arts Center, 300 E. Third St. in Lexington. Speakers will include Jodi Mitchell, executive director of the Kentucky Voices for Health; the Rev. Marian M. Taylor, executive director of the Kentucky Council of Churches; and Anton J. Gunn, regional director of Region IV of the U.S. Department of Health and Human Services.

Other speakers will include Lexington Mayor Jim Gray; Councilman Chris Ford; the Rev. Troy Thomas, chair of the Black Church Coalition; and Dr. Rice Leach, acitng county health commissioner and former state health commissioner.

The event is sponsored by the health department, Kentucky Voices for Health and the Black Church Coalition. For more information, call Mark Johnson at 859-288-2391.