Rural hospital coalition urges Congress to spare Medicare programs that shore up rural health care

A coalition of rural hospitals are lobbying Congress to keep two Medicare programs that the National Rural Health Association says are vital to keep hundreds of smaller hospitals going. The Medicare Dependent Hospital designation and the Low-Volume Hospital Adjuster, which date to the 1980s, help keep low-volume rural hospitals' doors open with the Medicare payment adjustments they provide, according to the NRHA.

Both programs could end Oct. 1 without Congressional action. "Rural facilities do not have the financial background to weather all of these cuts," said Lance Keilers, NRHA president and administrator of Ballinger Memorial Hospital in San Angelo, Tex., told Brendon Nafziger of DOTmed News, an online magazine serving the medical and medical equipment industry.

More than 200 hospitals have the Medicare Dependent designation. To qualify, a hospital must have fewer than 100 beds and Medicare patients must make up 60 percent of its inpatient days or discharges. Low-volume hospitals must be at least 15 miles from another hospital and provide care for fewer than 1,600 Medicare beneficiaries a year. (Read more)

Next phase of health reform: New and renewed insurance policies will have to cover birth control, other preventive care for women

Even though the decision was widely expected, as part of health care reform, the news is still what Julie Rovner of National Public Radio termed "a pretty big deal." Earlier this week, she reports, the Department of Health and Human Services adopted in full the women's health recommendations issued two weeks ago by the independent Institute of Medicine. "Since birth control is the most common drug prescribed to women ages 18-44, insurance plans should cover it," said HHS Secretary Kathleen Sebelius in a press briefing. "Not doing it would be like not covering flu shots, or any of the other basic preventive services that millions of other Americans count on every day."

The upshot: Starting a year from now, most new health insurance policies, and eventually almost every policy, will have to offer a comprehensive list of women's preventive health services with no co-pay or deductible, including all forms of prescription contraception approved by the Food and Drug Administration. These services include: Screening for gestational diabetes; counseling about sexually-transmitted infections; support for breast-feeding, including supplies and counseling; and domestic violence screening and counseling.

Rovner reports that "The new rules do take into account the complaints from some conservative and religious groups, by allowing religious organizations that provide health insurance to refrain from offering contraceptive coverage 'if that is inconsistent with their tenets.' HHS says that part of its proposal is modeled on the most common exemption used by the 28 states that already require contraceptive coverage to be offered in health insurance policies. The department, however, is specifically asking the public to comment on that portion of the rules, 'as we work to strike the balance between providing access to proven prevention and respecting religious beliefs.' Already the reactions are pouring in. Some people object to the religious exemption." (Read more)

Smoke Free Kentucky Coalition's multi-city tour launches push for statewide smoking ban in 2013 legislature

Backers of an effort to ban smoking in all public places in Kentucky took their message on the road this week in hopes of getting legislation passed in the 2013 General Assembly. The Smoke Free Kentucky Coalition swept through the state's largest cities to gather support for a final punch to be delivered at the annual Fancy Farm Picnic in Graves County on Saturday. Beth Musgrave of the Lexington Herald-Leader reports that one of the week's first stops was at the Kentucky Chamber of Commerce, a longtime supporter of the statewide smoking ban. "We know that a majority of Kentuckians support a smoke-free Kentucky," said Amy Barkley, chairwoman of the coalition. (KRT graphic)

Rep. Susan Westrom, D-Lexington, has sponsored a statewide smoking ban for several years. During the 2012 legislative session, the House Health and Welfare Committee passed the measure, but the full House did not vote on it. Westrom told the Herald-Leader that said she did not aggressively pursue the matter during the 2012 session because all 100 members of the House are up for re-election in November. "But we've had several members who have said that they will be co-sponsors" next year, she said.

Musgrave notes that even Westrom is unsure how the the Republican-led Senate will vote. Senate President David Williams has said he supports the idea of a statewide smoking ban, while opponents of the proposal have said it represents an overreach of government power. "There are personal property rights that are being trampled," Rep. Ben Waide, R-Madisonville, said when he voted against a statewide smoking ban in March.

You can do this, too: Lexington church's fresh food program reaches out to lower income neighbors with deep discount

Rick Courtney loads tomatoes into a crate bound
for Fresh Stop (Herald-Leader photo by Charles Bertram)

Fresh produce comes to the church-goers of Fresh Presbyterian Church of Lexington every Sunday through Fresh Stop, a community-supported agriculture program. But it's not your typical CSA program; this one comes with a charitable twist. Sure, members sign up to receive fresh produce weekly during the summer growing season but, writes Mary Meehan of the Lexington Herald-Leader, here 25 percent of the members pay a nominal amount because they live in a "food desert," where fresh food is hard to come by, and have lower incomes. To cover the difference, explains Meehan, the other 75 percent of members pay slightly more than a CSA normally would cost. "That's the key," said Libby Iverson, a church member and Fresh Stop member. "We need to share. That's very important."

The farm-to-table non-profit supplies tomatoes and cabbage, sweet peppers and onions that fill a table last Sunday were literally gleaming with freshness. All were picked from farmer Rick Courtney's Harrison County field just the day before, Meehan notes. It was all the brainchild of student Julia Hofmeister, who, armed with a major in sustainable agriculture at the University of Kentucky and having been part of the local Community Farm Alliance, set out in 2009 to find a farmer. Courtney was a tobacco farmer in Cynthiana, now a section of his farm on the South Fork of the Licking River is filled with vegetables.

Many of the low-income families served by the program are referred by Habitat for Humanity and Kentucky Refugee Ministries. Wheeler said one of the biggest concerns in expanding the program is that families often don't know what to do with all the produce they receive. Hofmeister thinks the program can be made to work elsewhere. "It is so transferrable," she said. (Read more)

Research suggests dental therapists could provide care to Medicaid-eligible kids at terrific savings

The recent revitalization of the Kentucky Oral Health Coalition was a reminder that our state ranks 49th in dental health, behind only West Virginia. So was the news then Tuesday from the University of Connecticut, where research suggests that adding a new kind of health provider -- dental therapists -- to clinics known as federally qualified health centers could significantly expand the availability of care for millions of American children. (Pew Center photo)

The white paper from the Pew Children's Dental Campaign of the Pew Center on the States notes that, "In particular, by including dental therapists as providers in school-based programs operated by FQHCs, the researchers estimated states could provide access to care for 6.7 million Medicaid-eligible children, nationwide." The analysis also suggests that this significant increase in access could be realized for a cost of approximately $1.8 billion or just one half of 1 percent of combined state and federal 2009 Medicaid spending. To read the full Pew report, go here.

Nationwide, 830,000 emergency room visits in 2009 were due to preventable dental problems, according to the center, many of those in rural areas. Most of the children lacking care don't have insurance, live in areas without enough dentists or can't find doctors who accept Medicaid. Problems accessing dentists could grow in 2014, when 5 million more children are expected to get dental insurance under the federal healthcare reform law.

Despite the undisputed need, not everyone is behind the concept. The American Dental Association argues that dental therapists lack the training and education needed to perform irreversible surgical procedures and to identify patients' other medical problems, writes Anna Gorman in the Los Angeles Times. Therapists would be properly educated and would help close vast gaps in care that can lead to costly emergency room visits for dental problems, said Shelly Gehshan, director of the Children's Dental Campaign. In 2005, Alaska became the first state to try out the new dental care model, when therapists began treating native populations. Minnesota authorized the new tier of practitioner in 2009, and the first graduates of dental therapy programs began practicing last year. 

National Breastfeeding Week, Aug. 1-7, focuses attention on need for supportive families, friends and employers

World Breastfeeding Week is Aug. 1-7, so the state Department for Public Health is pointing out the importance of providing support for breastfeeding families. “We encourage mothers to breastfeed to ensure that infants are getting the nutrition they need to grow and thrive,” said Health and Family Services Cabinet Secretary Audrey Haynes. “Even the most committed mothers can struggle to successfully breastfeed when they don’t have the kind of support system they need at home, at the workplace and in the community. If we want to send the message that breastfeeding is important and improve our breastfeeding rates, we need to support mothers who choose to breastfeed.”

The World Health Organization, the American Academy of Pediatrics and other medical organizations recommend that babies be exclusively breastfed for the first six months of life, and continue to be breastfed, along with other food sources, for at least a year. The cabinet and the department want fathers, other family members, friends, employers and others to know that, and the importance of support for breatfeeding mothers, especially in the workplace. “Continuing breastfeeding after returning to work is a tremendous challenge,” said Fran Hawkins, director of the state's Women, Infants and Children nutrition program. Public health officials stress that continuing breastfeeding after returning to work is often necessary to meet the recommendations for optimal infant nutrition.

The state says four steps help make workplaces more conducive to breastfeeding: support from managers and coworkers; flexible time to express milk (10 to 15 minutes three times per day); education for employees about how to combine breastfeeding and work; and a designated space to breastfeed or express milk in privacy. Kentucky law protects women who wish to breastfeed their babies in public. This law permits a mother to breastfeed her baby or express breast milk in any public or private location. This law also requires that breastfeeding not be considered an act of public indecency or indecent exposure. For more information, contact Marlene Goodlett at (502) 564-3827 ext. 3612 or marlene.goodlett@ky.gov. Information on breastfeeding can be found here.

What it's like to lack health insurance, and how health reform is changing that: It's a story for every county, with local data

The Kentucky Standard's Randy Patrick deftly shows how the federal health-care reform law is having an effect at the individual level by telling the story of Bonnie Varnell, a Nelson County resident who is uninsured and is more than $65,000 in debt due to her fight against cancer.

For 18 years, Varnell worked at a daycare that didn't offer health insurance. She wasn't able to buy individual coverage because she had pre-exisiting conditions as a result of surgeries. She is only 59, so does not qualify for Medicare, and she didn't qualify for the federal law known as COBRA, which "allows workers to keep their company group health insurance benefits for up to 18 months after leaving their jobs, as long as they pay the entire premium," Patrick explains.

As a result, the bills kept mounting, despite hospitals giving the Varnells reduced rates through charity care. "I've been trying to pay something on every one," Varnell's husband Ed said of the bills he receives and has to delay paying in full. "It's really frustrating. We had never been late a day in our lives."

Now, Varnell has health insurance through a program created under the Patient Protection and Affordable Care Act. "It costs her $315 a month and covers most of her costs after the deductible is met, but the law stipulates that a person with a pre-existing condition must be uninsured for at least six months before she or he can be eligible," Patrick reports.

Varnell's fear now is the program will be taken away if the Affordable Care Act is repealed after the November election. Patrick gives opponents of the law their say. (Read more)

There are stories like Varnell's in every county. Patrick, who recently joined the Bardstown thrice-weekly after editing papers in Nicholasville and Winchester, sets the bar high for how to tell such stories.

Varnell is among the estimated 15 percent of people in Nelson County who didn't have health insurance in 2009, the last year for which estimates are available. Statewide, the census estimate was 16.5 percent. For a list of all Kentucky county estimates, click here. For the Census Bureau website that is the source of the data, go here. 

New health law and aging baby boomers' anticipated strain on the system is about to make chronic doctor shortage worse

Kentucky's persistent physician shortage is hardly new. Almost a century ago, the Frontier Nursing Service came to Hyden on the presumption that doctors wouldn't. A report from the Health Resources and Services Administration in 2005 found that 81 of 120 of the commonwealth's counties were officially health professional shortage areas. Now comes news that areas in the United States with growing and dense urban populations are feeling the considerable pinch of also not having enough doctors to provide care.

New York Times reporters Annie Lowrey and Robert Pear report that with the expansion of insurance coverage and aging baby boomers driving up demand, we shouldn't expect the shortage to get better anywhere before it gets worse everywhere. (NYT chart)


"The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. That number will more than double by 2025," report Lowrey and Pear. "Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000." In addition, Medicare officials predict their enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year because of the baby boomer demographic hitting their golden years. “Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement. (Read more)

State insurance exchanges are good for farmers and other rural residents, farmers union president writes

Farmers and rural Americans have much to gain from state health-insurance exchanges under federal health reform, since "Rural residents often have the hardest time getting health insurance," the president of the Wisconsin Farmers Union argues in an op-ed piece in Madison's Capital Times.

People who live in rural areas "are predominantly self-employed and run small businesses, with insurance costs too high because of small risk pools," Darin Von Ruden points out. "They often pay way too much for terrible coverage. Some are uninsurable because of the high-risk nature of farming. Many can't pay high premiums for the current system of individual and family coverage." Insurance exchanges will "broaden risk pools" and bring down the overall cost, he argues. 

Wisconsin has been one of the firmest states against implementing federal health-care reforms, including the exchanges, which will be marketplaces where people can choose from a variety of state-approved health-insurance plans. This month, Republican Gov. Scott Walker said he would not take any action to implement the law until after the November elections. After the U.S. Supreme Court upheld the law, Democratic Gov. Steve Beshear of Kentucky issued an executive order creating a Kentucky exchange. States have the option to run their own exchange or let the federal government do it for them.

Von Ruden said exchanges are "critical" for Wisconsin's farmers and rural communities. "It's disappointing, to say the least, that our legislative majority would be dragging their feet on getting this done," he writes. "I can't imagine why any of them would want to wait on this. Creating our own state exchanges keeps the control in Wisconsin." He concludes, "Every American deserves health care that is comprehensive, affordable and accessible, regardless of occupation or geographic area." (Read more)

Reports show impact of health-care industry in each of Kentucky's 120 counties

It's not often that such detailed data is broken down to the county level, but a new report looks at the economic impact of the local health-care system in each of Kentucky's 120 counties.

The reports, compiled at the University of Kentucky, look at the number of health-care jobs, as well as the revenue and income generated by the local health-care system. In many rural counties, the authors note, health care is the second largest industry, second only to local government.

The most important economic role of the health-care sector is to "keep local health-care dollars at home," the report says. If private insurance, consumer out-of-pocket payments and Medicare and Medicaid transfer payments aren't kept local, an outmigration of health-care services can take place. "This bypass of local health care remains an important issue for many rural health care providers and rural communities."

Conversely, if the local health-care sector can attract patients from outside the area, health care "can act as an export industry," the authors note. Because doctors and other providers can help improve the health and productivity of the local workforce, the health-care sector can also help an area recruit new and retain existing business.

The county reports include a comparison of household income with the state and nation, and indicates how that income is earned. In Boyle County, for example, 55.6 percent was earned through place-of-work earnings, while 22.6 percent was from transfer payments, such as those from Social Security, Medicare and Medicaid. The reports also break down how much income is generated according to industry type, from 2000 to 2008.

Income earned by Boyle County residents working in the health-care sector increased 42 percent in those years, one of the largest areas of gains in the county. In all, health care accounted for 13 percent of industry in Boyle and generated more than $322 million in sales, more than $151 million in labor income and nearly 3,500 jobs in the area.

The report, available here, was compiled by Dr. Alison Davis, director of the Community and Ecomomic Development Initiative in Kentucky, part of UK's College of Agriculture. It was funded by the Foundation for a Healthy Kentucky.

Lyme disease in Ky. probably more common than reported

Nearly anyone who has spent considerable time in the woods this summer has later discovered they carried a visitor back with them — one the size of a freckle who latches on for dear life. Ticks are not uncommon in Kentucky, though Lyme disease, which is spread through the bite of a black-legged deer tick, is not commonly seen in the state.

But those numbers are likely under-reported, Keiara Carr reports for The Courier-Journal, in part because "Current medical guidelines say the disease is so rare in Kentucky that doctors should look for alternative causes for symptoms that might suggest Lyme disease."

Only five cases were reported in Kentucky in each of the past two years and there was just one case in 2009. But it's likely cases went under-reported because doctors don't give the blood test that diagnoses Lyme. They just don't feel it's necessary given the rarity of the disease in the area, Carr reports.

But Mike Gatton of Louisville knows all too well that it's possible. He got bitten by a tick while mowing his lawn two years ago. He developed a rash on his leg but when he went to the doctor he was tested for a variety of diseases, including West Nile, multiple sclerosis and Lou Gehrig disease, but not Lyme. "I was feeling more and more fatigued. I was having severe headaches. I was really concerned," he said.

When he got another tick bite a year ago and had the same reaction he had to the first bite, he put the tick in a vial and brought it to his doctor, who still dismissed the possibility of Lyme. He is now being treated with antibiotics he takes intravenously.

Symptoms of Lyme disease include fever, headache and fatigue. Sometimes, a rash that looks like a bull's eye around the tick bite can develop. Usually, people get better with large doses of antibiotics. If left untreated, "the infection can be painful and debilitating, causing arthritis or spreading to the heart and nervous system," Carr reports.

Guidelines by the Infectious Disease Society of America "to help doctors decide if a patient is eligible for treatment say the patient should have received the tick bite in an 'endemic area," Carr reports, which makes sense according to Paul Mead, a consulting physician for the Centers for Disease Control and Prevention. "For example, a physician in Africa evaluating a child for fever should have malaria at the top of his list; a physician in Kentucky should not," he said. (Read more)

Children's health and education improves in Kentucky, but one in four kids lives in poverty, report shows

New data show one in four Kentucky children live in poverty, a sharp increase since 2005, but the state is improving when it comes to children's health and education. These were the latest findings in the influential Kids Count report by the Annie E. Casey Foundation, as assessment of children's overall well-being in the country.

Compared to national averages, fewer Kentucky children go without health insurance (6 percent compared to the nation's 8 percent) and there are fewer teens who abuse alcohol or drugs (6 percent in Kentucky; 7 percent nationwide).

Though it remains higher than the national average, Kentucky's rate of child and teen deaths decreased considerably from 2005 to 2009 (41 per 100,000 to 32 per 100,000). And the number of babies who are born underweight dropped slightly in Kentucky from 2005 to 2009 (9.1 percent to 8.9 percent), though the number remains higher than the country as a whole (8.2 percent).

These were some of the 16 factors, shown below, that the report used to assess overall child well-being. The factors fell into four main groups: economic well-being, family and community, education and health. Kentucky ranked a somewhat dismal 35th among the 50 states in overall well-being of children. But in education, it was 28th, and in health, 25th.

The report shows the share of Kentucky children living in poverty grew by 18 percent from 2005 to 2010, meaning they lived at or below the federal poverty line. In 2010, that meant "an annual income of less than $22,113 for a family of two adults and two children," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

The Courier-Journal's Jessie Halladay points out that more children have access to health insurance in part because of a statewide push to get more children enrolled in the federally funded Kentucky Children's Health Program, known more commonly as KCHIP. Now, about 65,000 children are enrolled. "We are clearly making a difference in easing the difficulty these tough economic conditions put on our families," said Gov. Steve Beshear, who launched the effort.

But much work remains to be done, points out Terry Brooks, executive director of Kentucky Youth Advocates. He referred to the fact that while more fourth-graders are proficient in reading than they were in 2005, a whopping 65 percent of them were still not considered reading proficient in 2010. "At one level you want to celebrate us doing well compared to other states, but you can't celebrate too much," Brooks told Halladay. (Read more)