University Hospital files suit saying it is not public; could affect merger, open records

 Attorney General Jack Conway may have ruled it a public entity and thus subject to open-records laws, but University Hospital officials are insisting that's not the case and have filed a lawsuit saying it should not have to turn over documents to, among others, The Courier-Journal.

The implications go beyond the records issue and could affect the merger between University Hospital, Saint Joseph Health System and Jewish Hospital & St. Mary's HealthCare. A public governmental entity cannot favor one religion over another, under the state constitution. But if the merger goes through, all three health systems would be subject to certain Catholic health directives, such as those pertaining to sterilization, because Saint Joseph is owned by Catholic Health Initiatives.

"A ruling in the public-records case that University Hospital is a public entity will bolster the arguments of those opposed to the merger, while a ruling that it isn't a public entity will favor merger supporters," reports Dan Klepal of The Courier-Journal.

The lawsuit argues that University Hospital is a private, nonprofit corporation "because it is controlled by a board of directors, not the University of Louisville," Klepal reports. U of L board members also cannot constitute a majority at any board or committee meetings; the hospital selects its own CEO; and manages its own finances and daily operations.

The suit further points to the fact that former Attorney General Greg Stumbo ruled it was not a public entity in 2006. "But that ruling was made when two private companies, Norton Healthcare and Jewish & St. Mary's, were still partners with U of L in governing the facility. The following year, Norton and Jewish withdrew, leaving U of L as the hospital's only overseer," Klepal reports. (Read more)

Louisville hospital merger would be just one of dozens across the country, driven by economic and regulatory concerns

Hospitals are banding together to create organizations better able to withstand the changing tides of the economy and health-care policy. The proposed merger of Louisville's Jewish Hospital & St. Mary's HealthCare, Lexington-based Saint Joseph Health System and University Hospital at the University of Louisville is just one of many examples.

"The small, community hospital is soon to go the way of the dinosaurs," said Angela Mattie, associate professor of health-care management of Connecticut's Quinnipiac University, told Laura Ungar of The Courier-Journal.

Through September, 2011 had seen 71 mergers nationwide involving 132 hospitals worth $6.9 billion, plus another four deals in October. In all of last year, there were 74 mergers involving 126 hospitals and $5.8 billion, Ungar reports.

The poor economy is part of the reason for hospital systems merging because "people don't use hospitals as often; even those with insurance sometimes forego care to avoid co-pays," Ungar reports. In a tight economy, credit is more difficult to obtain, but bigger, richer systems have less trouble. Finances are a major impetus behind the big Louisville merger, with officials at University Hospital and Jewish arguing "if they don't merge they'll lack the money to make improvements going forward, partly because of economic pressures such as rising levels of indigent care," Ungar reports.

Catholic Health Initiatives, which owns the Saint Joseph Health System, plans to invest $320 million "to launch the merged network and strengthen its balance sheet," said CHI spokeswoman Mary Elise Biegert. Of another $300 million that would be generated by operations, two-thirds would be invested in Louisville's academic health center and $100 million would help pay for a switch to electronic health records.

Experts also say big systems have more bargaining power with health insurers, nd the federal health-care reform law means "It makes sense to enlarge a hospital system to capture as many as possible of the 30 million Americans expected to eventually be newly insured under the new law," Ungar writes.

Mergers also allow hospitals to consolidate and save costs, "by having one human resource or finance department instead of three," Ungar reports. (Read more) For another story on what has been termed "merger mania," click here.

Beshear appoints panel to identify docs with suspicious prescribing practices

Gov. Steve Beshear has appointed a panel that will help identify the state's health providers who are prescribing a suspicious amount of pain pills. The move is to help combat the prescription-pill abuse in Kentucky.

"The panel is made up of four practicing physicians, including a psychiatrist, a pain-management specialist and an oncologist; three pharmacists; an advance-practice registered nurse; a dentist; a substance-abuse and mental-health professional from the University of Kentucky faculty; and a representative of community mental-health centers, which provide drug treatment," reports Bill Estep of the Lexington Herald-Leader.

The inclusion of an APRN is in keeping with a request from the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. "We believe that the addition of APRNs who are prescribing controlled substances for different populations will be very helpful ... in creating guidelines for generally accepted practices," said Julianne Ewen, president of the 2,049-member coalition.

The council will use the state's prescription-monitoring system — known as KASPER — that is already in place and will work with the state's health-care licensing boards and law enforcement to establish acceptable prescribing practices. "For instance, it may be routine for a cancer doctor to write 50 prescriptions for pain pills in a month, but that would be very high for a dentist," Estep reports.

The work of the panel could be used by the Cabinet for Health and Family Services to track unusual activity through KASPER. The cabinet would then notify the applicable licensing boards of the activity. (Read more)

Prescription pill abuse has been a growing concern in Kentucky and nationwide, with the Centers for Disease Control and Prevention recently calling the problem "an epidemic." On Friday, police arrested three people that were allegedly part of a larger drug ring that trucked more than 50,000 pain pills into Pike County alone last year. The pills came from Michigan. "Many people in Eastern Kentucky have relatives in Michigan because people moved from Appalachia decades ago to look for work in Midwest factories," Estep reports. "People work through those family connections to bring drugs to Kentucky after obtaining pills in Michigan through large-scale 'doctor shopping.'" (Read more)

Ky. premature births declining, but still above national average

Giving birth to a baby before it has been brought to full term has become less common in the U.S. and Kentucky, but the nation still only received a C, and the state a D, in the 2011 Premature Birth Report Cards compiled by the March of Dimes. Each year, nearly half a million babies are born prematurely.

In Kentucky, 13.6 percent of women gave birth to babies prematurely in 2009, down by 0.4 percentage points over 2008. Only Vermont was given an A, with a pre-term birth rate of 9.3 percent, reports Bonnie Rochman of Time Healthland. Three states and Puerto Rico got Fs; 19 got Cs and 11, as well as the District of Columbia, got a D.

Data from 2006 to 2009 were analyzed. In 2009, the preliminary preterm birth rate was 12.2 percent, compared to 12.8 percent in 2006. The March of Dimes wants that number to drop to 9.6 percent by 2020. Pre-term birth is the leading cause of newborn death in the U.S.

The study analyzed three factors that can contribute to pre-term birth, including the percentage of uninsured women in each state and the percentage of women who smoke. Late pre-term birth, which occurs when a baby is born between 34 to 36 weeks gestation, was also considered, as it "has been linked to rising rates of early induction of labor and C-sections," the study says.

In Kentucky, the percentage of uninsured women has remained the same at 22.8 percent from 2006 to 2009. The smoking rate has dropped from 30.5 percent to 27.3 percent, as has the late pre-term birth rate, down to 9.7 percent from 10.2 percent. (For other states, click on the map above, then click on the state in the larger image.)

The pre-term birth rate was calculated by looking at the percentage of all live births in which the babies had reached 37 weeks gestation or less.

March of Dimes President Dr. Jennifer Howse called the study results positive, "given that for the past 30 years, the rate of preterm birth has been increasing."

"It's not a lot, and the rate is still too high, but the good news is some things are starting to work," she said. (Read more)

Prescription drug abuse is an epidemic nationwide and in Ky.

Prescription pain medicine overdoses now kill more people in the U.S. than heroin and cocaine combined, with 40 Americans dying every day from painkiller abuse.

"This stems from a few irresponsible doctors," said Thomas Frieden, director of the Centers for Disease Control and Prevention. "The problem is more from them than from drug pushers on street corners." One California study found 3 percent of doctors wrote 62 percent of painkiller prescriptions, reports Daniel J. DeNoon of WebMD Health News.

Prescription-drug abuse has tripled since 1999, with 1 in 20 U.S. adults admitting to taking the drugs for pleasure rather than need. According to the CDC, the drugs most abused are Vicodin (hydrocodone), OxyContin (oxycodone), Opana (oxymorphone) and methadone. In 2010, pharmacies sold enough of those drugs, and ones similar to them, "to give everyone in the U.S. a typical 5-milligram dose of hydrocodone every four hours for one month," DeNoon reports.

Abuse is more common in men than women; in rural than urban areas; in non-Hispanic whites than in other races or ethnicities; and in middle-age adults than younger or older adults.

The problem has grown to epidemic proportions in Kentucky, with more people dying from prescription drug overdoses than car accidents, The Courier-Journal reported in February. Much of the problem stems from Florida, which until September did not have a drug-monitoring system in place. Dealers from Kentucky would drive down to the Sunshine State and obtain prescriptions from several doctors at a time. They would then return to Kentucky to sell their haul. While a tracking system is now in place, there continues to be loopholes in Florida's law and the fear is pill mill operators will move to other states.

Frieden said states need to monitor who is prescribing the drugs; prevent doctor shopping; make prescriptions available for just three days of use at a time; and have doctors resort to narcotics only as a the last measure to control pain. "We are in an epidemic of prescription drug abuse," Frieden said. "This epidemic can be stopped."

In Kentucky, an effort has been launched to target "drug dealers in white coats" and involves a plan designed to root out doctors with suspicious prescription practices and pass legislation to better track prescriptions.

U.S. "drug czar" Gil Kerlikowske, director of the Office of National Drug Control Policy, said the White House has a goal of cutting down on prescription drug abuse by 15 percent by 2015. Kerlikowske visited Kentucky and adjoining states in February to assess the problem. (Read more)

Study finds doctors often overestimate how well they communicate in English as a second langauge

A study appearing in Health Services Research shows physicians who speak English as a second language, an increasing phenomenon in the U.S. and parts of Kentucky, often overrate how well they are communicating with patients.

The finding is the result of a language scale adopted by the Palo Alto Medical Foundation, which rates language proficiency in five levels: poor, fair, good, very good and excellent.

After the new scale was introduced in 2009, out of four of physicians who participated changed their rating. Of the 258 participants, 31 who had considered themselves "fluent" downgraded to "good" or "fair." Just 11 percent deemed their proficiency "excellent." "Seventeen percent used 'very good' and 38 percent said they were 'fair,'" reports Glenda Fauntleroy of research-reporting service Newswise. "Being 'fair' was defined as 'can get the gist of most everyday conversations but has difficulty communicating about health care concepts.'"

"This is a very tricky area as this demonstrates how many providers overestimate their proficiency in another language," said Joseph Betancourt, director of the Disparities Solutions Center at Massachusetts General Hospital in Boston. "This can lead to miscommunication and even medical errors." (Read more)

UK surgeons first to do life-saving lung procedures in tandem

Surgeons at the University of Kentucky are the first in medical history to perform two procedures in tandem to bridge a lung transplantation. The procedures were performed first on Wanda Craig, 68, who is now the oldest person to be "bridged to transplant using an artificial lung device, also known as an extracorporeal membrane oxygenation," reports research-reporting service Newswise. (Photo of Wanda Craig and Dr. Enrique Diaz by Julia Meador)

Craig, of Lexington, had chronic obstructive pulmonary disease and emphysema for which she has been treated for the past 10 years. In November 2010, she took a turn for the worse. "I was so out of breath from walking to the kitchen ... I didn't have enough energy to even scoop ice cream out of the carton," she said. Pulmonary hypertension, from which she also suffered, had caused the right half of her heart to fail, which prevented blood from going through the lungs to fill the left side of the heart, explained Dr. Charles Hoopes, director of UK's heart and lung transplant program.

To fix the problem, Hoopes and Dr. Enrique Diaz, the program's medical director, performed a procedure called an atrial septostomy, in which a small hole is created between the upper two chambers of the heart. This procedure, along with the extracorporeal membrane oxygenation procedure, saved Craig's life, the news release says. "These procedures are novel in terms of a bridge to transplantation, and the use of an artificial lung together with an atrial septostomy for cases of respiratory and right ventricular failure have not been performed together until now," Diaz said.

Three days later, Craig underwent a double lung transplant, and has been healing since. "More than anything I am looking forward to doing those normal everyday things like going to the grocery store and watching my grandson's T-ball games," she said. "And scooping my own ice cream." (Read more)

Smokeless tobacco can help you quit cigarettes, Owensboro-area residents are told (partly with tobacco money)

"Switch and quit" is the theme of an advertising campaign being promoted by a prominent cancer center in Kentucky, in which smokers are advised to lay off the cigarettes in favor of smokeless tobacco such as chew or snuff. "Supporters say smokers who switch are more likely to give up cigarettes than those who use other methods such as nicotine patches, and that smokeless tobacco carries less risk of disease than cigarettes do," The Associated Press reports.

AP reports the program is partly funded with grants from the tobacco industry, though program director Brad Rodu, a University of Louisville professor of medicine, said the industry has "absolutely no influence whatsoever." Smokeless tobacco has been linked to oral cancer.

"We need something that works better than what we have," said Dr. Donald Miller, an oncologist and director of the James Graham Brown Cancer Center, which is co-sponsoring the campaign with the university. "This is as reasonable a scientific hypothesis as anybody has come up with and it needs to be tried."

The campaign is being pushed in Owensboro using print, radio, billboard and other advertising. Residents of Owensboro and the surrounding area reportedly consume about 3 million cigarettes a week. "That amounts to well over a pack for every man, woman and child in the community of about 115,000 people," AP reports.

"The worst that you can say about smokeless tobacco is that it's the lesser of two evils," said Dr. Randall Thomas, an oncologist at the Owensboro Medical Health System. "I don't think we have any problem in telling a person that drinks a six-pack a day that if they could cut it back to two beers a day or two drinks a day that their health risks are greatly reduced ... Finding a way to let people have their nicotine that carries less risk, it's the realistic solution."

But there are opponents to the program, including Matthew Myers, president of the Campaign for Tobacco-Free Kids, who called it "a giant experiment with the people of Owensboro without rules or guidance designed to protect individuals from experimental medicine." The theme of the program does seem to run counter to warnings by the Centers for Disease Control and the National Cancer Institute at the National Institutes of Health, whose websites say the use of all varieties of tobacco products "should be strongly discouraged" and that there is "no scientific evidence that using smokeless tobacco can help a person quit."

Owensboro is an old tobacco town, and in the face of falling cigarette sales, tobacco companies are marketing more smokeless tobacco and other cigarette alternatives. (Read more)

Health Care Transparency and Patient Advocacy Conference to be held Nov. 11 in Lexington

Focusing on issues like hospital- and health care-acquired infections, the impact of medical errors and infections on patients, and the importance of transparency, the Health Care Transparency and Patient Advocacy Conference will be held Nov. 11 in Lexington.

Speakers include John Santa, director of the Health Ratings Center for Consumer Reports, who will discuss the principles of transparency; author Maryn McKenna, who will present the history of MRSA; Dr. Keith Sinclair, medical director of Bluegrass Oakwood in Somerset, who will speak of how transparency has nearly eliminated pressure sores at his institution; and Frances Griffin, a faculty member at the Institute for Healthcare Improvement, who will present on the IHI global trigger tool.

The gathering is from 8:30 a.m. to 5 p.m. at Embassy Suites in Lexington. Registration is $50 and includes a box lunch. Physicians, physician assistants, nurse practitioners, nurses, physical therapists and human resource managers attending the conference will receive 6.5 hours of continuing education credits. To register, click here.

Rural children face more health risks; most parents say their kids are healthy

Children in rural areas face more health challenges than those in urban parts of the country, and are more likely to be poor, more vulnerable to death from injuries, and more likely to use tobacco. Rural families also have more difficulty in gaining access to health care. But the majority of parents, regardless of whether they live in urban or rural communities, say their kids are healthy.

These findings are from a report entitled "The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation 2007," compiled by the U.S. Department of Health and Human Services' Health Resources and Services Administration. The report's results are based on the National Survey of Children's Health, conducted in 2007.

The survey classified children as living in an urban area, a large or well-populated rural area or a small or isolated rural area. Large rural areas include large towns with populations of 10,000 to 49,999. Small rural areas include small towns with populations of 2,500 to 9,999. Survey results were not broken down by state.

The report found children's overall health status does not vary substantially according to location. Four-fifths of parents said their children are in excellent or very good health, regardless of where they live.

But the analysis found rural children, as a whole, face more health risks than their urban counterparts. Only 67.6 percent of children in large rural areas and 69.8 percent in small rural areas are breast-fed, compared to 77 percent of urban children. (About 59 percent of new mothers breast-feed in Kentucky, compared to 75 percent nationwide.)

Rural children are also more likely to be overweight or obese — 34.6 percent of children in large rural areas and 35.2 percent in small rural areas compared to 30.9 percent of urban children. Rural children are also more likely to live with someone who smokes — one in three children in large rural areas and 35 percent in small rural areas do. Only one in five urban children do.

Though about 90 percent of children surveyed had health insurance, those in rural areas were more likely to have public coverage like Medicaid or CHIP. Urban children were more likely to have private insurance. Access to health care also remains a factor. Of the 2,052 non-metropolitan counties identified in 2010, 704 were designated as health professional shortage areas. Of those, 467 had shortages for dental care and 521 lacked adequate mental health services. To find if a Kentucky county is in a health professional shortage area, click here.

There are some advantages for rural children, however. They tend to be better protected and more connected to their families and communities. More than half of children in small rural areas shared a meal with their families every day in the past week. Children in small rural areas are also more likely to get physical activity every day (34.7 percent), though they are less likely to have access to community centers, parks or playgrounds. However, rural children are more likely to spend more than an hour each weekday watching television or videos — 60.9 percent of children in large rural areas did so, compared to 53 percent in small rural areas and 53.9 percent of urban children.

The data for the National Survey of Children's Health was generated using a random telephone survey, in which 2.8 million telephone numbers were randomly generated. After non-working and non-residential numbers were eliminated, the remaining numbers were called and surveyors spoke to respondents to see if children less than 18 years of age lived in the household. From each of those households, one child was randomly selected to be the focus of the interview and parents responded to the survey questions. Surveys were conducted in English, Spanish, Mandarin, Cantonese, Vietnamese and Korean.

Hike in health insurance premiums due to rising health costs, not reform law, FactCheck.org concludes

Health insurance premiums for employer-sponsored family plans shot up by 9 percent from 2010 to 2011, but the bulk of the hike is due to the increase in health care costs, not the federal health-care reform law, non-partisan FactCheck.org has found.

The law is responsible for about 1 to 3 percent of the increase, however, in large part because the law requires an increase in benefits, including: covering preventive care without co-pays or deductibles; allowing adult children to stay on parents' policies until age 26; increasing annual coverage limits; and covering children regardless of preexisting conditions.

"On the other hand, the fact that the law caused any increase at all casts more doubt on Obama's promise that the law 'could save families $2,500 in the comings years.' We've been calling that claim into question for several years now," Factcheck.org stares. "The plan fact is that — so far — the law has caused an increase in premiums, though not so large an increase as some Republicans claim." (Read more)

Haven't quit smoking, lost weight? Pay more for health insurance, more companies say

In an effort to keep health-care costs down, companies across the country, including Walmart, are opting to charge workers who smoke or are obese higher premiums than their more healthy colleagues. (Reuters photo by Lucas Jackson)

The move is the follow-up to a strategy many companies have already tried: to encourage workers to take better care of their health by offering benefits like weight-loss programs or smoking-cessation classes. But with few signs of the health-care landscape changing, "They're replacing the carrot with a stick and raising costs for workers who can't seem to lower their cholesterol or tackle obesity," reports Jillian Mincer of Reuters.

One example is Walmart, which in 2012 will start charging its smoking workers higher premiums. It will also offer cessation classes. A company spokesman said people who use tobacco use about 25 percent more health-care services than people who don't: "These decisions aren't easy, but we need to balance costs and provide quality coverage."

Critics say the move will limiting people's freedoms, create employee resentment and hut the lowest-paid workers hardest. "It's not inherently wrong to hold people responsible," said Lewis Maltby, president of the National Workrights Institute. "But it's a dangerous precedent."

Though well-intentioned, these policies can create bitterness. Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine, said having a colleague call to ask about a person's weight loss can be seen as intrusive. That's part of the reason why the janitors at the school participate, but "the professors on campus consider it a privacy tax, so we don't get some stranger calling us about how much we weigh."

Nevertheless, many companies are moving forward with the option. In 2012, almost 40 percent of large and mid-size companies will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009, an October survey by consulting firm Towers Watson and the National Business Group on Health shows. "Nothing else has worked to control health trends," said NBGH Vice President LuAnn Heinen. "A financial incentive reduces that procrastination."

Cleveland Clinic, with a staff of 40,000, has implemented a comprehensive program and seen its health-care costs grown just 2 percent this year. "The effort began several years ago when it banned smoking at the medical center and then refused to hire smokers," Mincer writes. "It later recognized that having a gym and weight -oss classes wasn't enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it." Paul Terpeluk, medical director of occupational health at the clinic, said employers have to develop a program and change the culture: "You don't do this overnight." (Read more)