Doctor's rejection of the willfully obese makes exercise expert ask: Who's responsible for your health? Who should pay for it?

Bryant Stamford, professor and chairman of the Department of Kinesiology and Integrative Physiology at Hanover College in Indiana, wrote in his weekly exercise-and-health column Thursday's edition of The Courier-Journal:

"I caught an interesting news story on TV about a physician who refuses to treat obese patients. That was the headline. In truth, when she was interviewed she made it clear that she had a number of obese patients and she was treating them," if they were willing to lose weight. She referred the other obese patients to physicians who specialized in care of the overweight.

Stamford asked: "Is this approach the rationing of health care? It’s rationing it to those who take responsibility for themselves by managing their weight. . . . I don’t support withholding health care to anyone, and that includes the obese and smokers. But it does raise the issue of who is responsible for your health. We spend far more on health care than other industrialized countries, and we are bankrupting our health-care systems, including Medicare and Medicaid. Why? We follow a health-destroying lifestyle, then we expect to jump into the health-care system and have it perform miracles. And, more often than not, it does, but it costs a fortune for each patient. Does this make any sense?"

He points to ways in which some countries have decided in what order people get heart surgeries -- those who smoke are not first in line. What it could mean in the future for us?  "I believe the writing is on the wall. ... If you engage in health-destroying behaviors, you will be required to pay a lot more for health insurance. It’s the model for life insurance, and there already are rumblings around the country supporting a move in this direction. Stay tuned." Read the column here.

Board of Medical Licensure to amend pill-mill regulations to address concerns of doctors and some patients

The Kentucky Board of Medical Licensure wants to change some of the more controversial requirements for urine screenings and digital monitoring in the state’s new prescription-drug regulations under the law aimed at fighting doctor shopping and "pill mills" that dispense painkillers indiscriminately.

Mike Wynn of The Courier-Journal reports that Dr. Preston Nunnelley, the board’s president, told state lawmakers Wednesday that the board plans to submit amendments to the regulations by Nov. 1 to address the concerns of doctors that the new law is proving too burdensome, and because patients are being charged for urine tests that insurance companies are refusing to cover. Nunnelley said the amendments would provide more flexibility on when patients must receive those screenings. He said "chronic pain patients would not face regular screenings unless they are considered high risk for abuse or diversion," Wynn reports. "The amendments are also likely to exempt certain patients, such as children, from checks through the Kentucky All Schedule Prescription Electronic Reporting system, or KASPER, he said."

Nunnelley called the changes “tune-ups." “This is a new experience for the board of licensure,” he testified. “This is the first time we’ve done anything on this scale and obviously we didn’t do it perfect.” Or perfectly. (Read more)

Georgia doctor prescribes pills to help in school -- whether or not the ADHD shoe fits -- to level the playing field for the poor

Amanda Rocafort and her son, Quintn,
who takes Adderall for his ADHD.
(NYT photo by Bryan Meltz)

In light of last week's news that the number of poor children on Medicaid in Kentucky are being prescribed anti-psychotic drugs at alarming rates for such diagnoses as attention-deficit and hyperactivity disorder and depression, the New York Times reports that some doctors are making "no excuses" for prescribing psychostimulants in other locales for children of the poor.  Dr. Michael Anderson, a pediatrician in a poor county north of Atlanta, Ga., said he thinks ADHD is "made up" and "an excuse" to prescribe pills to treat what he "considers the children’s true ill -- poor academic performance in inadequate schools." Still, "I don’t have a whole lot of choice,' said Anderson. “We’ve decided as a society that it’s too expensive to modify the kid’s environment. So we have to modify the kid.'"

Dr. Anderson is one of the more outspoken proponents of an idea that is gaining some ground: Prescribe drugs to struggling students in schools not to treat ADHD, necessarily, but to boost their focus and impulse control.  Alan Schwarz reports that Anderson figures that he is arming them with the only tool he has because these children can't afford family therapy or tutoring or behavior-based counseling or any of those other tools that other children might have at their disposal to help them learn.

Of course, Anderson is not without his critics. Many doctors, writes Schwarz, warn of the dangers of exposing children to the unwarranted physical and psychological risks of powerful drugs on everything from mood to blood pressure to the suppression of growth. (Read more)

Kentucky Spirit to terminate Medicaid contract with state early; Cabinet assures recipients no interruption in service

Kentucky Spirit, a Medicaid managed-care provider, will terminate its contract with the state's Cabinet for Health and Family Services a year earlier than scheduled, effective July 5, 2013. The company serves approximately 140,000 Medicaid recipients in 104 Kentucky counties. According to the CFHS, Kentuckians enrolled in Kentucky Spirit coverage "will continue to receive health care with no interruptions, and the Cabinet will ensure a smooth transition for those patients to another managed care organization in the coming months."

Kentucky Spirit said in a statement Wednesday that it is committed to helping its clients it serves transfer to one of Kentucky's three other Medicaid contractors. In addition, the move will cut some 200 jobs in Lexington, representing $12 million a year in wages and benefits.

The Courier-Journal's Tom Loftus writes that Kentucky Spirit has been in months of discussions with the Cabinet for Health and Family Services about its contract. The company also said it has filed a formal dispute with the cabinet for damages it has incurred throughout the process. Gov. Steve Beshear issued his own statement informing the company that the state "will hold this company accountable to its contractual commitments through whatever means necessary on behalf of both the members and the taxpayers.”

Overall, Kentucky’s transition to Medicaid managed care has not been smooth, explains the Lexington Herald-Leader's Beth Musgrave. Many doctors, hospitals and other providers have complained about late payments and cumbersome reimbursement processes; some of which have had to be resolved in court.

To see the Kentucky Spirit statement, go here.

Governor lauds HB 1 for closing 10 of the state's worst pain clinics, reducing the number of controlled-substance prescriptions

Gov. Steve Beshear gave credit this week to House Bill 1 for reducing the number of prescriptions written for frequently abused controlled substances and for closing the doors on 10 of the state's worst pain-management clinics. He also said the bill had promoted investigations into what he called "suspicious prescribing practices." Beshear, in a prepared statement, said: "We knew that this bill would have an immediate impact on thwarting the abuse and diversion of prescription drugs in our state, and the statistics over the last few months are already showing progress."

The governor also noted that Kentucky All Schedule Prescription Electronic Reporting (KASPER) accounts have increased from 7,911 in April to 21,542 in October. Account users are physicians, dentists, optometrists, advances practice nurses and podiatrists who then use those accounts to check on the drug records of patients daily. Beshear, responding to frequent criticism that the reporting of KASPER results is time-consuming, remarked that "the vast majority of those requests are processed in less than 15 seconds."
 
John Cheves of the Lexington Herald-Leader also reported that state regulators said this week that "they're working with private insurance companies and Medicaid managers to make sure health insurance plans help cover the cost of urine tests required under HB 1." Cheves had written earlier about consumer complaints that the costs of those tests, now required by the bill, were being borne by the patient. The
Kentucky Department of Insurance is communicating with insurers to guarantee that urine tests under HB 1 are classified as a medically necessary expense, Insurance Commissioner Sharon Clark told Cheves. The Kentucky Cabinet for Health and Family Services is doing the same for Medicaid clients.
(Read more)

Cigarette companies balking at Justice Dept's request for "confessional" advertising that they say goes too far

Calling them "forced public confessions," America's largest tobacco companies are asking a federal judge to reject the government's proposed corrective statements for cigarette advertising. Fred Frommer reports for the Associated Press that the Justice Department has responded by saying that such statements need to be strong enough to protect people from future false declarations made by cigarette makers. The statements that the tobacco industry views as "going too far" include admissions that the companies lied about the dangers of smoking, the addictiveness of nicotine, the lack of health benefits for "low-tar" and "light" cigarettes and the negative effect of second-hand smoke. U.S. District Judge Gladys Kessler, who is hearing the case, has already said "she wants the industry to pay for corrective statements in various types of ads," writes Frommer. (Associated Press photo)

Judge Kessler ruled in 2006 that America's largest cigarette makers had systematically concealed the dangers of smoking for decades and that, as assurance that the crime was not repeated, such statements as a requirement in tobacco advertising would be appropriate. An example of an advertising statement under consideration, as suggested by the Justice Dept.: "For decades, we denied that we controlled the level of nicotine delivered in cigarettes. Here's the truth: Cigarettes are a finely tuned nicotine delivery device designed to addict people." At Monday’s hearing, Kessler said she doesn’t have to take the government’s proposed statements word-for-word, and will come up with “modifications.” (Read more)

Open enrollment period for 2012 Medicare Part D continues now through Dec. 7

The open enrollment period for 2012 Medicare Part D began this week and will continue through Dec. 7. The open period is a time for seniors and persons with disabilities to take advantage of prescription drug benefits or, if they've been previously enrolled in the program, to modify their existing plans. The Part D program, now in its sixth year, was set up to assure those 65 and older, or those with disabilities, easy access to their medications.

According to the Medicare Rx Access Network of Kentucky, nearly 11 million Americans over 65 gained comprehensive prescription drug coverage as a result of Medicare Part D's implementation including 63 percent of Kentucky’s seniors. Currently, more than 40 million people with Medicare -- 90 percent of all beneficiaries and 89 percent of Kentucky seniors – now have comprehensive prescription drug coverage.

For additional information on the Medicare Part D program, or to view and compare Medicare plans, go here.

Calorie counts on your Coke and Pepsi machines coming in 2013

Coca-Cola, PepsiCo and the Dr Pepper Snapple Group, for starters, will start displaying calorie counts on vending machines in an effort to encourage consumers to make lower-calorie choices, starting in 2013. The plan, explains Time magazine, falls in line with the Patient Protection and Affordable Care Act’s requirement that vending machines and restaurant chains with more than 20 locations display calorie information. The labels will be marked "Check Then Choose" or "Try A Low-Calorie Beverage." The industry initiative, called the Calories Count Vending program, will begin its launch in city buildings in Chicago and San Antonio, where government employees are participating in a “wellness challenge.” The nationwide rollout will begin next year.

Time reporter Olivia B. Waxman asked whether this move will make a difference in calorie consumption. Early research didn't hold much hold, but later studies were more promising, she reports: "Studies have found that calorie information, when presented clearly — and at the point of sale — does tend to sway people’s eating and drinking behaviors. In a December study published in the American Journal of Public Health, for example, researchers at Johns Hopkins went to corner stores in predominantly black neighborhoods and posted signs with calorie information about sugary drinks (sodas, fruit drinks, energy drinks and the like) on refrigerated beverage cases. Overall, the study found, black teens — a population that is more likely to consume sugary drinks and is at higher risk of obesity than other groups — were 40 percent less likely to buy soft drinks when they saw the calorie signs. They were even less likely to buy them when the calorie labels put information in context: for instance, by noting that it would take 50 minutes of running to burn off the calories in one sugary drink. Those signs reduced soda consumption by 50 percent." (Read more)

Kaiser study estimates how changing Medicare to a premium-support plan like Ryan's would cost differently by state and region

A Kaiser Family Foundation study has looked into what Medicare beneficiaries might pay under a "premium support" system that relies on competitive bidding, like the one proposed by House Budget Committee Chairman and Republican vice-presidential candidate Paul Ryan. Presidential nominee Mitt Romney has also supported a premium-support system, which allows beneficiaries to choose among competing plans.

Under such plans, if subscribers choose to enroll in a more costly plan, for whatever reason, they would pay the additional premiums. This differs from the current Medicare system, explains Kaiser, "in which beneficiaries generally pay the same Medicare premium regardless of where they live, whether they choose traditional Medicare or a private plan, or whether they live in a high-cost or low-cost area." Assuming full implementation of such a premium support system, and assuming current plan preferences among beneficiaries, the Kaiser study "estimates that:

• Nearly six in 10 Medicare beneficiaries nationally could face higher premiums, assuming current plan preferences, including more than half of the beneficiaries enrolled in traditional Medicare and almost nine in 10 Medicare Advantage. Even if as many as a fourth of all beneficiaries moved into a low-cost plan offered in their area, more than a third of all beneficiaries would still face higher premiums.
• Premiums for traditional Medicare would vary widely based on geography, with no increase for beneficiaries living in Alaska, Delaware, Hawaii, Wyoming, or Washington, D.C., but an average increase of at least $100 per month in California, Florida, Michigan, Nevada, New Jersey and New York. Such variations would exist even within a state, with traditional Medicare premiums remaining unchanged in California's San Francisco and Sacramento counties and rising by more than $200 per month in Los Angeles and Orange counties.
• At least nine in 10 Medicare beneficiaries in Connecticut, Florida, Massachusetts and New Jersey would face higher premiums to keep their current benefits.

"This analysis does not attempt to model all aspects of any specific premium-support proposal, which would require more details than are currently available and assumptions about shifts in demographics, spending, and enrollment," Kaiser says. "The analysis also differs from Chairman Ryan's most recent proposal by assuming full implementation in 2010 (rather than a phased-in implementation starting in 2023) and by not exempting everyone who is at least 55 years old now." (Read more) To read the full report, go here.

Health reform expected to hurt recruitment of rural doctors

Recruiting doctors to rural hospitals will get harder in the next few years as the Patient Protection and Affordable Care Act reaches full implementation and the demand for healthcare services increases, a new report suggests. An Association of Staff Physician Recruiters report, "In-House Physician Recruitment Benchmarking," says interview-to-hire ratios in rural areas are much higher than in urban, and rural recruiting officers are often responsible for several things, not just hiring new doctors, making them overworked. Both factors make it harder for rural hospitals to recruit, the authors concluded.

ASPR Benchmarking Committee Chair Shelly Tudor told John Commins of HealthLeaders Media that the cost of recruitment is rising, making it hard for rural hospitals to compete with their urban counterparts. "In lots of respects, the process favors urban providers. Physicians are coming to urban areas and they are looking for jobs, whereas rural providers have to go out and target physicians that are likely to come to their area," Tudor said. Rural recruiters have to "filter through a lot of people to find the right one who is willing to come in and even look at the opportunity," she said. (Read more)

Studies show that preteen girls who get the HPV vaccination are not more inclined toward promiscuity than those who don't

An electron micrograph of the
human papilloma virus.
(National Cancer Institute photo)

 

The most recent study of preteen girls who received the vaccine for the human papilloma virus (HPV) found that they were no more likely than unvaccinated girls to get pregnant, develop sexually transmitted infections or seek birth-control counseling. The findings in Monday's issue of Pediatrics are in line with recent studies on British teens, which also dismissed concerns that getting the vaccination might encourage promiscuity.  USA Today reporter Michael Healy writes that while the latest results were based on parental or self-reporting, the reports were corroborated by medical tests, clinical markers of sexual activity and other behavior markers.

Robert Bednarczyk, a clinical investigator with the Kaiser Permanente Center for Health Research-Southeast and an epidemiologist at Emory University in Atlanta., queried 1,398 girls, aged 11 and 12, and analyzed their medical records. He and colleagues divided the girls into two groups and followed them for three years. "One group of 493 girls received at least one dose of the HPV vaccine Gardasil, along with other recommended vaccines for tetanus and meningitis. A comparison group of 905 girls received the tetanus and meningitis vaccines, but not HPV," Healy writes. "There was a very similar rate of testing, diagnosis and counseling between both groups," with no increase in pregnancies, STIs or birth-control counseling, Bednarczyk reported. Fewer than 1 percent of all girls tested positively for a sexually transmitted infection, and fewer than 1 percent had a positive pregnancy test.  (Read more)

Home-health agency for Madison, Estill and Powell counties says it has to cut staff because of issues with Medicaid and Medicare

Declining reimbursements from Medicaid and Medicare are behind the Madison County Health Department's layoff of seven home-health employees last week. Director Nancy Crew said the cuts should not mean a reduction in care but that cuts were being made because "we've done all we can do without involuntary layoffs," Bill Robinson of the Richmond Register reports. The department's MEPCO subsidiary, which has offered home-health services in Madison, Estill and Powell counties since 1974, has been under financial pressure for two years despite cutting costs and not filling eight now-vacant positions. It had a deficit last year of $610,000.

Only about 15 percent of MEPCO's revenue comes from private insurance, said David Reed, the health department's financial director. That leaves MEPCO with a disproportionate number of Medicaid patients at a time when those re-reimbursements often are denied by managed-care companies, Reed said. Challenging those denials is a complicated process, sometimes requiring going to court to recover costs. The problem is not all with Medicaid. MEPCO’s Medicare reimbursements began a steep decline from nearly $3.24 million in 2008 to $2.55 million in 2012.  (Read more)