Ashland hospital lays off another 4 percent, citing lower revenue

King's Daughters Medical Center in Ashland is laying off another 4 percent of its payroll and closing satellite centers in Pikeville and Russell, citing lower numbers of patients and reduced federal and state reimbursements.

"It is the most recent in a series of layoffs for the medical center, which saw layoffs and shift reductions for more than 100 employees in 2010 and an undisclosed number of layoffs in 2012," reports Beth Hendricks of The Herald-Dispatch in Huntington, W.Va. "Most affected positions are in support, administration and supervisory areas, according to KDMC spokesman Tom Dearing. Staffing levels for direct patient care remain unchanged. Physicians at the closing family-care offices will be relocated to other centers."

Mike James of The Independent in Ashland reports, "Some workers had their hours cut from full time to part time, Dearing said. . . . CEO Fred Jackson ... said the cuts were part of a national slump in the health care business. . . . Jackson’s email blamed 'a perfect storm of a shifting business model, changing federal and state reimbursements, increasing demand for charity care, and a weak economy' and said the hospital would look to outpatient services and its community outreach centers for future growth."

Jackson has been under fire from the Service Employees International Union for his total compensation of $1.37 million in 2010, the figure reported on the not-for-profit hospital's most recent IRS Form 990. "By comparison, a CEO at a Huntington-based hospital earned $725,744," Hendricks reports. "Five additional KDMC senior management officials saw a combined $300,000 in increased wages over the same period."

Hendricks writes, "Ashland City Commissioner Kevin Gunderson said the layoffs Thursday, coupled by layoffs in recent years, raises questions about whether the board and management at King's Daughters have overspent on various outreach clinics, some of which are closing. 'They should have focused on their core medical center instead of building outreach centers in Pikeville, Prestonsburg, Flatwoods, Cannonsburg, Russell and South Shore and Jackson, Ironton, Burlington and a large one in Portsmouth,' Gunderson said. 'I just drove by there today, and they had people out planting shrubbery.' . . . This week's layoffs are the latest in a string of woes for the hospital, which lost its contract with Medicaid managed-care organization CoventryCares in late 2012. King's Daughters is also under a Department of Justice investigation into its cardiac program."

Effort for kids' dental health in Clark, started by volunteers and continued by health department with tax, earns national award

"A community effort to fight tooth decay in children in Clark County has been named a model for the nation," veteran journalist Al Smith reports in an op-ed for the Lexington Herald-Leader. The Clark County Dental Health Initiative received the award for model practice last month at the annual conference of the National Association of City and County Health Officials, and the county health board recently raised taxes to pay for it.

"Its five-year campaign for change by volunteer dentists, hygienists and engaged citizens should inspire all Kentuckians in a state further scandalized by its own Diane Sawyer in her '20/20' program on ABC in 2009 when she showed 11 million viewers shocking scenes of Appalachian kids with disfigured teeth called Mountain Dew Mouth," writes Smith, former federal co-chair of the Appalachian Regional Commission and co-founder of the University of Kentucky's Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News.

The Clark County program was inspired by Winchester dentist Rankin Skinner, after he and his wife, Ruthi, had started a preventive program for poor children in Ecuador, Smith writes: "He developed a similar plan for Clark County, became its unpaid director and persuaded all 16 other Winchester dentists and 116 volunteers to apply dental fluoride varnish to children in preschool through fifth grade. Every Winchester dentist donated service and staff to take the initiative inside the schools.

Five years later the decay rate in sixth graders has dropped to 11 percent, a decline of 78 percent since 2008 when Kentucky's decay rate for children was reported in national media to be a shameful 50 percent, the country's worst."

Smith notes that the effort was boosted by "a local banker who raised money with help from the Clark County Community Foundation and First Lady Jane Beshear, who urged Gov. Steve Beshear to use the Clark initiative as an example in organizing treatment for underserved children in Eastern Kentucky." The Beshears' permanent home is in Clark County.

Volunteerism only lasts so long, but the Clark County Health Department is now funding the program with a tax increase that will let it hire the state's first public-health dental hygienist. "With continued help from the local dentists and citizen volunteers, [it hopes to] eventually extend the program to students through high school," Smith reports.

The Clark County Board of Health voted this month to raise its tax rate to 4.6 cents per $100 of assessed property value from last year's 4 cents, to generate about $150,000 in additional revenue for the program. Public Health Director Scott Lockard "estimated that funding the program would take $127,531 per year, but the board wanted a cushion in the budget to help pay for dental care for students not covered by Medicaid, KCHIP or private insurance," Rachel Gilliam reports for The Winchester Sun. Lockard told the board, “I can think of nothing better to invest in other than our children.”

Aug. 28 webinar will help journalists understand health reform

Jennifer Tolbert

After The Rural Blog published an item (see below) yesterday that said 80 percent of people who could benefit from insurance exchanges being established under the Patient Protection and Affordable Care Act knew nothing about it, a reporter immediately emailed to say she and and a co-worker were trying to decipher the act for readers, and "I'm personally terrified."

So, how do reporters go about covering the changes? The Kaiser Family Foundation hopes to help, through a series of webinars for journalists that will "address key aspects of the law, the implications for consumers, and strategies for connecting the dots for different audiences," according to the foundation.

The first webinar is scheduled for 12:30 to 1:30 p.m. ET on Wednesday, Aug. 28, and "will be an overview of how health reform’s impact will vary for people in different circumstances, including those currently with employer coverage, those who buy their own insurance and those who are currently uninsured," the foundation says.

Karen Pollitz

The webinar will be hosted by the foundation's state health policy director, Jennifer Tolbert, and senior fellow Karen Pollitz, who will "explain the law’s individual mandate requiring most Americans to obtain coverage, as well as the law’s new coverage options, including new state insurance marketplaces, subsidies for people with low- and moderate incomes, and new rules prohibiting insurers from discriminating based on pre-existing conditions." They will also answer questions. For more information or to register click here.

Most who would benefit from insurance exchanges under health reform knew nothing about them last fall

The Patient Protection and Affordable Care Act will affect millions of Americans, especially those in rural areas. But many are not prepared for the coming changes, according to a survey by Enroll America, a non-profit group that calls itself "a nonpartisan organization whose mission is to maximize the number of uninsured Americans who enroll in health coverage made available by the Affordable Care Act" through online insurance marketplaces known as exchanges.

The survey "shows that nearly 80 percent of those who stand to benefit have no idea what an exchange is or how to get the health insurance subsidies they will offer," Christine Vestal reports for Stateline. There's no reason to think the percentage in Kentucky would have been much different at the time of the survey, taken early last fall. State government, which will open its exchange Oct. 1, has been using advertising and other means to inform people who could benefit from the exchange.

"When the exchanges open, anyone who does not already have employer-sponsored insurance will be able to comparison shop for coverage and find out whether they qualify for federal subsidies to help pay for their policies," Vestal notes. "Visitors to federally funded websites and call centers will also find out whether they qualify for Medicaid or the Children’s Health Insurance Program, and they’ll be able to sign up for that coverage immediately. Policies purchased on the exchange will take effect Jan. 1, 2014. The Obama administration is scheduled to announce Thursday how it will dole out $54 million in federal money to hire so-called 'navigators' who will help people actually sign up." (Read more)

Clearly, this subject needs more news coverage to inform people about it. To help reporters do that, the Kaiser Family Foundation is holding a series of free, one-hour webinars, beginning Wednesday, Aug. 28, from 12:30 to 1:30 p.m. ET. For details and registration, click here.

Federal report says many hospitals wouldn't keep critical-access designation if distance rules were strictly enforced

More than two dozen Kentucky communities still have hospitals because of the critical-access hospital program, in which small, isolated hospitals get higher Medicare and Medicaid reimbursements in return for limiting their size and services. Now federal officials appear to be considering a move that could cost the hospitals money and perhaps put them at risk of closing.

Most of the hospitals would not meet current location requirements if required to re-enroll to get reimbursements from Medicare, and the Centers for Medicare and Medicaid Services could realize substantial savings by revoking certification to some of these hospitals and reimbursing them at lower rates set by prospective payment systems and fee schedules rather than at 101 percent of costs, according to a report by the Department of Health and Human Services.

The agency found that "the program costs the government and Medicare beneficiaries up to a billion dollars a year more than the original parameters of the law allowed," Jenny Gold reports for Kaiser Health News. If forced to re-enroll, 849 of the 1,329 hospitals in the program would not meet the requirements -- having 25 or fewer beds and being at least 35 miles away from another facility (15 miles in mountainous terrain) in communities that would otherwise have limited access to health services.

"Until 2006, states were allowed to waive the distance requirement and designate small hospitals considered 'necessary providers' as critical access hospitals as well, even if they were close to other facilities," Gold reports. "The program grew quickly and now nearly one in four acute care hospitals are getting the extra payments. Congress got rid of the loophole in 2006, but hospitals that already had the exemption were grandfathered." (Read more)

Critical-access hospitals are located in Barbourville, Berea, Burkesville, Cadiz, Carlisle, Carrollton, Franklin, Greensburg, Hardinsburg, Hartford, Harrodsburg, Horse Cave, Irvine, Liberty, Martin, McDowell, Monticello, Morganfield, Owenton, Princeton, Russell Springs, Salem, Scottsville, Stanford, Versailles and Williamstown. For a detailed list, click here.

Smokers, take note: Chinese meditation technique offers hope

In 2010, Kentucky had the second highest rate of adult smokers in the U.S., with 24.8 percent of the adult population -- or 1.1 million adults -- smoking, according to statistics from the Cabinet for Health and Family Services. Only West Virginia, at 26.8 percent, had a higher percentage of adult smokers.

So, what can Kentuckians do to cut the cigarette habit?  A Chinese meditation technique may contain the answer. And the kicker is, smokers don't even need to focus on quitting smoking to be successful.

A study by Texas Tech University and the University of Oregon "looked at the effect of the mindfulness meditation known as Integrative Body-Mind Training on the pathways in the brain related to addiction and self-control, discovered that by practicing the meditation exercise, smokers curtailed their habit by 60 percent. The control group that received a relaxation regimen instead showed no reduction in their smoking," reports Newswise, a research-reporting service.

Yi-Yuan Tang, a co-author and director of Texas Tech’s Neuroimaging Institute, told Newswise, “We found that participants who received IBMT training also experienced a significant decrease in their craving for cigarettes. Because mindfulness meditation promotes personal control and has been shown to positively affect attention and an openness to internal and external experiences, we believe that meditation may be helpful for coping with symptoms of addiction.”

The study group consisted of 27 young-adult smokers who averaged 10 cigarettes a day. Fifteen participants received the meditation training over a two-week period. "After two and four weeks, five of the responding smokers whose smoking had been significantly reduced after IBMT reported that they were continuing to maintain the improvement," Newswise reports.

Researchers wrote that "the apparent ability to enhance self-control and reduce stress could make the practice useful in reducing smoking and craving 'even in those who have no intention to quit smoking'" as well as treating individuals with other addictions," Newswise reports. "The meditation regime, they wrote, 'does not force participants to resist craving or quit smoking; instead it focuses on improving self-control capacity to handle craving and smoking behavior.'” (Read more)

Congressman visits Telehealth Primary Care Clinic in Campton

U.S. Rep. Andy Barr

U.S. Rep. Andy Barr, a freshman Republican from the Sixth District, recently visited the Telehealth Primary Care Clinic in Campton. The clinic, one of two in Kentucky funded by federal telehealth grants, opened in August 2012, and "provides access to primary and specialty care for the community through network established by KentuckyOne Health, the largest health system in the Commonwealth," reports KyForward.

Shelley Neal of KentuckyOne told KyForward, “We established these clinics to make quality health care accessible to the communities in and surrounding Powell and Wolfe counties. If we are to be successful in our mission to create a healthier Kentucky, we must continue to implement new technologies and services to reach our state’s medically underserved communities.”

The clinics minimize "the need to travel to see a specialist therefore reducing the costs of care," KyForward writes. The newest addition is a social worker, who serves both clinics. Through the first six months of this year the social worker "helped 185 patients complete financial assistance paperwork to obtain drug assistance for 1,804 medication orders." During that same span, the clinic saw 1,417 patients from 34 counties. The clinics, which have specialists in cardiology and pulmonology, plan to add specialists in urology, obstetrics and gynecology, endocrinology, neurology and psychiatry. (Read more)

Free medical screenings, dental work for teens and adults available in Mayfield through Tuesday

West Kentuckians in need of health care can get free medical, dental and optical screenings through Tuesday, Aug. 13 at the old Morgan Haugh Clinic building at 220 W. Walnut St. in Mayfield from 9 a.m. to 7 p.m., including Saturday and Sunday.

The screenings are a program of the Delta Regional Authority and the Department of Defense. Anyone is eligible to receive the free services, which do not include emergency or obstetrical treatments. For adults and children age two and up, medical screenings, non-emergency medical treatment, minor lab tests, prescription assistance and optometry exams are available. For adults and children 13 and up, dental exams, extractions and fillings are also available.

Services will be provided by 152 medical personnel from the U.S. Army Reserve and the Army National Guard. Other current clinic sites are in Blytheville, Ark., Hayti, Mo., and Dyersburg, Tenn. Earlier clinics were held in Martin, Tenn., Helena-West Helena, Ark., and four communities in western Mississippi.

Petition drive from parents asks UK Healthcare to release mortality rates for cardiothoracic surgeries on children

More than 250 people have signed a petition asking the University of Kentucky hospital "to make public the mortality rates for pediatric cardiothoracic surgery patients from 2010, 2011 and 2012," Linda Blackford reports for the Lexington Herald-Leader. "All pediatric cardiothoracic surgeries were suspended at UK last fall amid an internal review." UK spokesman Jay Blanton said Monday the investigation is not complete.

"In May, the state attorney general's office issued an opinion that said UK must release mortality rates and other data about the cardiothoracic surgery program to WUKY, the university-owned radio station," Blackford reports. "UK has acknowledged that it calculated mortality rates for the program as part of its investigation, but has refused to release them, citing patient confidentiality laws." The Herald-Leader also requested the information under the Kentucky Open Records Act.

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

The three-year span includes the tenure of ardiothoracic surgeon Dr. Mark Plunkett, who no longer works at UK. Jennifer Allen, whose one-year-old daughter died after having three surgeries performed by Dr. Plunkett, wrote on the petition, "We deserve to know this information, we CAN understand and comprehend this information. It is our right to know and the right of the public!" Allen's daughter suffered from hypoplastic left heart syndrome, where the left side of the heart is underdeveloped and can't pump blood properly. Allen told Blackford she finds it "very suspicious" that UK won't release the information. UK says there were so few surgeries at times that patients' identities could be deduced.

Tabitha Rainey, whose son survived cardiothoracic surgery at UK, before being moved to another hospital, started the petition after being interviewed by CNN, which reported on the issue over the weekend and updated its story today with news of the petition. She said she doesn't accept UK's response that publicly releasing mortality rates would somehow harm patient confidentiality, telling Blackford, "There are no names and no dates, just the data on how many have passed on." (Read more)

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy

Read more here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpReadmore here: http://www.kentucky.com/2013/08/05/2751040/parents-push-petition-urging-uk.html#storylink=cpy, wrto

Thursday morning webinar will explain health reform law

UPDATE: The webinar is archived here.

Amid much speculation and misinformation about the Patient Protection and Affordable Care Act, Kentucky Voices for Health will hold a webinar this week to explain it, and to help participants explain it to others.

"Get Covered Kentucky: Understanding the Affordable Care Act" will be held Thursday, Aug. 8, from 10 to 10:45 a.m. Eastern Time. The webinar is designed for health educators, health-care employees, community members, and journalists in Kentucky who want to improve their understanding of, and ability to talk to the public about, the health reform law, expansion of Medicaid and the new health benefit exchange branded as Kynect, where health insurance and subsides will be offered.

Kentucky Voices for Health, a coalition of health lobbying groups, said in its news release, "By the end of the webinar, participants should be able to:
• Explain to a lay audience the most important provisions of the Affordable Care Act;
• Understand the general timeline for implementation of the ACA, specifically when Kentucky's exchange and Medicaid expansion go into effect;
• Discuss how the ACA affects the health insurance responsibilities of employers and private individuals in Kentucky;
• Educate others about Kynect and its function;
• Inform community members about their eligibility for federal tax credits for purchasing insurance via Kynect;
• Inform community members about their eligibility for enrollment in Medicaid, as a result of its expansion;
• Debunk myths and misunderstandings about the ACA which may hamper implementation; and
• Communicate knowledge about the ACA to Kentuckians in a culturally appropriate manner."

To register for the webinar, click here.

Adair County Hospital District files Chapter 9 bankruptcy

In a move perhaps unprecedented in Kentucky, the Adair County Hospital District has voted to file for protection under Chapter 9 of the federal bankruptcy code, the same chapter used by bankrupt cities such as Detroit.

The district has a $20 million debt, creditors demanding payment, and no clear way to pay them. "The Chapter 9 filing will allow the hospital district to reorganize by extending the timeline to repay debt, refinance debt, or reduce debt by different means. It does not liquidate the taxing district nor does it close down operations" of Westlake Regional Hospital in Columbia, reports Sharon Burton of the Adair County Community Voice.

David Cantor, an attorney with Seiller Waterman LLC in Louisville, told Burton the filing is “incredibly rare” and perhaps the first in the state. “We cannot find any published cases of a Chapter 9 in the Commonwealth of Kentucky,” he said.

Farmers National Bank of Danville has sued in state court, seeking to force the  district board to levy a local property tax to pay its debt. "The federal court will, however, now likely decide the local taxation issue," Burton reports. "The hospital board voted to establish a tax but it is stalled until at least the 2014 general election after a group of citizens successfully filed a recall petition."

Only part of the Community Voice story is online, but a 7 MB PDF of its three pages with hospital news can be downloaded here.

Auditor Edelen says Medicaid providers 8 percent fewer under managed care; cabinet says report is limited, outdated

The number of people relaying on Medicaid will increase dramatically in 2014, as Kentucky expands it to include people with incomes up to 138 percent of the federal poverty level, but there is more concern than ever about the availability of health-care providers to treat them.

A review released Wednesday said the number of Medicaid providers in Kentucky declined 8 percent in the first six months of a managed-care system that has been unpopular with providers. Roger Alford of The Associated Press reports that some hospitals in border states have already stopped accepting Kentucky Medicaid, which went to managed care in November 2011.

After the Patient Protection and Affordable Care Act goes into effect Jan. 1, an additional 300,000 Kentuckians may be added to a program that already serves nearly 800,000. State Auditor Adam Edelen raised concerns whether Kentucky's rural hospitals could continue to deal with Medicaid's slow reimbursements under managed care. He said, "Managed care is designed to save taxpayer dollars, but it can't be at the expense of the health of our citizens."

A clinic on Main Street in Frankfort recently joined Medicaid.

State Cabinet for Health and Family Services spokeswoman Jill Midkiff told Alford the auditor's review was "limited and somewhat outdated" and said it "doesn't fully and accurately reflect" the status of the managed-care system.

Edelen told Kentucky Health News that the audit ran only through May 2012 because his office typically deals with fiscal years. State fiscal years end June 30. He said he believes the trends have continued.

Midkiff said "The overall number of Medicaid providers has actually grown under the managed care program," Alford reports. "She cited a 20 percent increase in dentists, a 150 percent increase in certified nurse practitioners, and a 300 percent increase in physician assistants." She said, "The cabinet firmly supports managed care as the best way to deliver needed medical services to a vulnerable population while also providing good value to Kentucky's taxpayers."

She also said, "The move to managed care was not simple or painless, but our records show evidence of health-care providers and managed care organizations working together to adapt to the new Medicaid system and that Medicaid members are receiving prompt, effective medical services with measurable improvements in health outcomes." (Read more)

"Midkiff said Tuesday other issues cited in Edelen’s report are not the result of managed care because they existed before its implementation, including the adequacy of medical providers in Kentucky, and it does not belie the need to expand Medicaid services, Ronnie Ellis of CNHI News reports.

Edelen made several recommendations, including:
• Establishing a formal advisory panel of members and stakeholders
• Requirements for retaining claims records
• Establishment of an approval process for subcontracts with MCOs, including third party providers for dental, vision and behavioral health services
• Improved monitoring of MCO accounts payable
• Establishing a way to estimate the cost savings of managed care for the state.