Ky. Rural Health Association meets in Bowling Green Sept. 17-18; major candidates for governor will speak back to back

The Kentucky Rural Health Association's annual conference will be held Sept. 17-18 in Bowling Green, with "a broader range of topics than ever before," KRHA says: "Whether you are a health-care provider, hospital or clinic administrator, community member, rural advocate, student, or simply curious about the rural healthcare landscape, we’ve got you covered."

KRHA says that at the end of the day-and-a-half meeting, attendees will be able to "build an overview of the state of rural health in Kentucky" and "become more skilled advocates for rural health at the local, regional and state levels," as well as explore opportunties for partnerships and collaboration.

A forum for the party nominees for governor will be held after the conclusion of the conference on Friday afternoon. Republican Matt Bevin is scheduled to speak and answer questions from 1:15 to 2 p.m., and Democratic Attorney General Jack Conway is scheduled to do likewise from 2:15 to 3 p.m. Bowling Green is on Central Time. The forum is co-sponsored by the Foundation for a Healthy Kentucky, the Friedell Committee, the Kentucky Academy of Family Physicians, the Kentucky Coalition of Nurse Practitioners & Nurse Midwives, the Kentucky Hospital Association, the Kentucky Medical Association, the Kentucky Primary Care Association and Kentucky Voices for Health. Before lunch, candidates for governor and other statewide offices will have a meet-and-greet session.

The conference and the forum will be held at Western Kentucky University's Knicely Center on Nashville Road, with lodging at the adjacent Staybridge Suites on Campbell Lane and the new Hyatt Place, next to the WKU campus on Center Street (with shuttle service). The registration fees until Sept. 3 are $125 for KRHA members, $200 for non-members and $45 for student members. For the draft agenda, registration form and hotel information, in a PDF, click here.

Ohio Gov. John Kasich, defending his Medicaid expansion as he runs for president, can point to lower-than-expected costs

John Kasich campaigned in Derry, N.H.
(Associated Press photo by Jim Cole)

By Al Cross
Kentucky Health News

Expanded eligibility for Medicaid, an issue in the Kentucky governor's race, is one of the major topics that separate Ohio Gov. John Kasich from his competition in the race for the Republican nomination for president. Like Democratic Gov. Steve Beshear, Kasich used the federal health-reform law to give Medicaid to households with annual income up to 138 percent of the poverty level.

Both states' enrollment of the newly eligible was higher than expected, adding to critics' concern that the expansions are a ticking time bomb for state budgets. States have to start paying 5 percent of the expansion cost in 2017, rising gradually to the law's limit of 10 percent in 2020. Advocates say increased tax revenue from a larger health-care industry will cover the cost, at least for a while.

Last week, Kasich's administration reported that Ohio's total Medicaid spending in the fiscal year that ended June 30 was 7.6 percent less than expected, despite the higher-than-expected enrollment. "Medicaid Director John McCarthy said savings have been achieved through expanded home-based care for seniors, shorter nursing-home stays, expanded managed care, capitated reimbursement policies — pay per patient rather than per patient visit — and other cost-controlling efforts," Catherine Candisky reports for The Columbus Dispatch.

Kentucky officials have pointed to capitated managed care, adopted statewide in November 2011, as the main reason Kentucky's Medicaid expenses have been lower than projected. However, health-care providers complain of slow payment, no payment and unfair treatment by managed-care companies.

Ohio's expansion added more than 500,000 people to the Medicaid rolls, bringing total enrollment to near 3 million. That is about 25 percent of the state's population of 11.6 million. Kentucky's expansion added about 430,000, currently about 400,000. About 1.2 million Kentuckians are on Medicaid, representing about 27 percent of the state's population of 4.4 million.

While Kasich and a few other Republican governors have used the reform law to expand Medicaid, he says that if elected president he would move to replace the law with something better. "The 'repeal' position is essential for Kasich," writes Chrissie Thompson of The Cincinnati Enquirer. "Kasich had to defend his Medicaid move in his first question in the prime-time debate" among top-tier GOP candidates.

"Kasich has insisted he wouldn’t cut back on the expansion of Medicaid to more low-income Americans," Thompson reports. "Instead, he says, he’d want to send the federal money back to states, with more freedoms on how to implement the program." Also, "He’s all but said he’d scrap the controversial (and, thus, delayed) mandate that businesses with at least 50 employees provide coverage for their full-time employees. . . . From there, it gets a little vague, except for Kasich’s clear discomfort with the idea of mandating just about anything." (Read more)

Improving Kentuckians' health will require education, fighting poverty; poor and less educated have poorer health, study shows

By Melissa Patrick
Kentucky Health News

Increased access to insurance is just one part of the equation to improve the health of Kentuckians, improving poverty and increasing education levels are disparities that must also be addressed if Kentucky ever hopes to improve the health of its citizens.

"We believe that health disparities can be eliminated, and that they must be eliminated," say the authors of a recently released report, Money Matters: Health Disparities in the Commonwealth - a Report on Socioeconomic status and health in Kentucky. "The first step towards eliminating health disparities is to understand and monitor where they exist."

The report was released by the Foundation for a Healthy Kentucky and the University of Kentucky College of Public Health.

Using 2011-12 data from the Kentucky Behavioral Risk Factor Surveillance System (the most recent data available), this report looked at the relationship between health, income and education and found that poverty and lower education levels are consistently associated with poorer health.

The data show that people who live in poverty and those with less education are more likely to be smokers. Smoking is a known cause of cancer, heart disease, stroke and other chronic conditions.

In 2011-13, the smoking rate in Kentucky was 28.6 percent, with almost one in three adults smoking. Of this group, almost half of the smokers (45.4 percent) were below poverty, while 20.9 percent were above poverty; and more than four in 10 (44.6 percent) had less than a high school education and about one in 10 (11.9 percent) were college graduates.

Obesity, which contributes to heart disease, stroke, type 2 diabetes and cancer, was also found to be more prevalent among the poor and uneducated.

The report found that 30.8 percent of Kentuckians were obese. Of this group, 38 percent lived below poverty and 30.9 percent lived above poverty; and 33.6 percent of those with less than a high school degree were obese, compared to 25.5 percent of college graduates.

Two-thirds of Kentuckians were considered overweight in the survey, and this was consistent across socioeconomic and education groups.

Poor, less educated Kentuckians in the survey also reported that they were less physically active and that they had increased activity limitations than those who lived above poverty and with more education.

Another health indicator among poor, less educated Kentuckians was that they were more likely to describe their health as fair or poor. Of the 23.1 percent of Kentuckians who described their health as fair or poor, 44.6 percent were below poverty and 17.6 percent were above poverty; and 45.2 percent of them had less than a high school education, while 9.1 percent of them were college graduates.

This finding was also true for people reporting poor physical health and poor mental health.

Of the 16.8 percent of Kentuckians who said they had poor physical health, 36.5 percent lived below poverty and 12.3 percent lived above poverty; and 30.8 percent had less than a high school education, while 7.4 percent were college graduates.

Of the 15.9 percent of Kentuckians who said they had poor mental health, 33.9 percent lived below poverty and 11.1 percent lived above poverty; and 28.2 percent had less than a high school degree, while 7.8 percent were college graduates.

Poorer, less educated people in Kentucky were also found to have increased levels of asthma and diabetes.

While the study also found that poorer Kentuckians have less access to health care, often forgo medical care due to the cost, and are less likely to have health insurance, it must be noted that this data was collected prior to the implementation of the Patient Protection and Affordable Care Act, which has since provided health coverage to more than 500,000 Kentuckians. The percentage of uninsured in Kentucky has dropped to 9 percent, compared to 20.4 percent in 2013, prior to the law's implementation.

That being said, "one-quarter of consumers who buy insurance on their own still have problems being able to afford needed care," according to a Families USA report.

"Simply having health insurance is no guarantee that consumers can afford to pay for health care," the report said. "Health insurance involves different types of costs that consumers must pay out of pocket—ranging from a health plan’s deductible to co-payments at a doctor’s office. These expenses add up, and research has shown that even nominal cost-sharing can deter people from getting needed care."

"Economic opportunity is the cornerstone of getting people jobs and employment. That then requires good education. Those two combined set the stage for people to pay more attention to their own health and the health of their community," Dr. William Hacker, former state health commissioner and current health chair of Shaping Our Appalachian Region, said at a recent advisory council meeting. SOAR is a bipartisan, nonprofit effort to improving the economy of Appalachian Kentucky.

The importance of getting families out of poverty was also noted by Dr. Terry Brooks, executive director of Kentucky Youth Advocates, in response to the 2014 Kids Count report, which ranked Kentucky 32nd in economic well-being.

"Here’s the bottom line from this year’s report: If we as a commonwealth want to get serious about improving the lives of our children, there is one overriding and persistent challenge: poverty," Brooks said. "You can’t talk education or health without talking family economics. And we can begin to tackle persistent poverty only when economic well-being policy stops being political and starts being about the common good."

Issues between managed care companies and Kentucky Medicaid providers still mar the state's implementation of the program

By Molly Burchett
Kentucky Health News

For many health care providers in the state, implementation of Kentucky’s Medicaid Managed Care system has been taxing, but Cabinet for Health and Family Services officials say the state is taking steps to resolve disputes between these medical providers and managed care organizations.

Despite previous attempts by state officials to address these issues, providers like Sen. Danny Carroll, chief executive officer of Easter Seals West Kentucky, an organization that provides care for disabled adults and youths, continue to complain about both delayed or denied Medicaid payments and burdensome bureaucratic hurdles, Kevin Wheatley reports for cn|2's Pure Politics.

Carroll, a Paducah Republican who chaired Thursday's legislative committee meeting, is not alone. Other nonprofits and providers serving the Medicaid population say they are still struggling to stay financially viable and deal with managed-care organizations that are not state-based and that have different rules.

“It’s very frustrating trying to navigate the rules of all the different MCOs and all the different requirements, and it’s taxing on staff, it costs more money,” Carroll said. “Being a nonprofit, we need those funds to operate, and we’re having to focus more and more on how to navigate the system to get prior authorizations approved. One MCO requires a prior authorization every 60 days. Some it’s longer, and the rules have changed fairly frequently over the last few years,” said Carroll.

Medicaid Commissioner Lisa Lee

Lisa Lee, commissioner of the Department for Medicaid Services, told the legislative panel that the state has attempted to resolve many of those criticisms in new MCO contracts that took effect July 1. These efforts included provisions like "requiring standardized forms for all five managed care groups, utilizing national uniform standards to credential health professionals and adding stiffer penalties for non-compliance," Wheatley reports.

Lee noted that Medicaid has 1.2 million members "and we have thousands of providers, and I know that we do have some issues and when we have those issues, they seem to be bigger than what they are. But we are able to do provide many services that were not provided by the traditional fee-for-service model," citing one MCO that sent a case worker to the emergency room at midnight to help one Kentuckian during a crisis situation.

Carroll and others on the committee complimented the cabinet for its work to resolve issues between providers and MCOs, but Carroll said he wished the state had greater oversight of MCOs.

He cited one Medicaid provider who has seen an increase in the percentage of Medicaid patients in his practice and has had to borrow money to make payroll: "So you tell me, is the system working under those circumstances?"



Such questions are part of the overall discussion of Medicaid expansion and the millions of dollars it may cost the state as the federal dollars decline, said Carroll. The state will begin paying a portion of expansion expenses in 2017, when the federal government will cover 95 percent, decreasing to the federal health reform law's floor of 90 percent in 2020.

Lee said the Medicaid expansion has put $2 billion into the state's economy and “has been very positive because we know that a dollar’s not spent once,” she said. “The Medicaid program pays the providers, the providers pay their employees, their employees go to the grocery store, they go spent that money in other ways out into our economy.”

However, if fewer providers are available to Medicaid patients because of managed care, regulatory requirements and low Medicaid reimbursements, critics say the Medicaid expansion won't give people the care they need and will be a continuing burden on hospital emergency rooms.

Scott County schools will have a smartphone app to let parents see cafeteria menus, look up nutritional content

For parents who have children with food allergies, it can be stressful not to know what will be served in the cafeteria. Scott County Nutrition Director Mitzi Marshall is researching two smart-phone apps that inform users of what will be served for breakfast and lunch each day at school, Dan Adkins reports for the Georgetown News-Graphic.

"Parents are on the go," Marshall told the school board. "If you're working, it's here at your fingertips." The app will also let parents single out certain food allergies and determine which dishes their children should not eat, Adkins writes. Marshall said the one app, NutriSlice, will also let parents look up nutritional content for each meal.

"Nutritionals automatically pop up, so this will help the nurses with carb counts, families . . . There are the sugars for diabetics, the carbs," Marshall said. She did not yet specify when a decision will be made about which app to implement.

Legislative freshmen's bipartisan bill, now law, lets tax refund to go to pediatric cancer research, or part of it to rape crisis centers

Gov. Steve Beshear held a ceremonial signing Aug. 12 of a bill that creates a option on individual state income-tax returns to divert refunds for the study and treatment of pediatric cancer. “Cancer is the second leading cause of death in children,” Beshear noted.

From 2008-2012, Kentucky had approximately 200 cases each year of cancer among people up to the age of 19, according to the National Cancer Institute.

“This legislation will fuel innovative pediatric cancer research being done here at the University of Kentucky and will directly benefit some of the sickest children in the Commonwealth,” said Dr. Michael Karpf, UK's executive vice president for health affairs. “Thanks to this bill, now all Kentuckians will have the opportunity to advance pediatric cancer research.”

The bill was sponsored by freshman Sen. Max Wise, R-Campbellsville, whose young son is a pediatric cancer survivor. It became law June 24. Wise said he dedicated the bill “to the families who have been affected or are dealing with pediatric cancer,” and called it a testament to legislative bipartisanship.

The bill also allows individuals to designate a portion of their tax refund to a new trust fund to support rape crisis centers, incorporating legislation sponsored by freshman Rep. Chris Harris, D-Forest Hills (Pike County).

Boone County Schools strategically implement healthy changes to lunch menu

Boone County Schools began serving healthier food and offering low-fat, low-sodium meals in their lunchrooms before the Healthy, Hunger-Free Kids Act was implemented in 2010, Amy Scalf reports for the Community Press.

"Whole grain is our largest issue," Food Service Director Barbara Kincaid told the weekly paper published by The Cincinnati Enquirer. "We work really hard on that because some students find these products unacceptable. . . . Sometimes we don't point out that items are whole-grain, but they are."

Dr. Randy Poe, superintendent, said nutrition education is important in the school environment: "A healthy child can make healthier choices, which leads to improved academic performance. So, it's beneficial to not only make sure our students are eating healthy but to make sure they understand the importance of eating healthy and how it affects their brain, body functions and growth."

Kincaid said introducing new foods is a little easier with younger students, and "adding unusual vegetables as a garnish can generate interest among students," Scalf reports. "The students get used to seeing them and begin to try them," Kincaid said. "Kids who say they don't like tomatoes may try them if they're offered as a garnish." They have been careful to make a few changes at a time. Boone County school cafeterias no longer serve foods with trans fats and high-fructose corn syrup.

"Nationwide, there's a 15 percent reduction of kids eating school lunches," Kincaid said. "In the past four years, there has been a 7 percent reduction in Boone schools. That's significant, and it's still troublesome to me because those are kids we're not feeding, and I want to feed all of them."

Ashland teachers will incorporate physical activity into lessons

Teachers from Ashland Independent Schools attended a Take 10 workshop to learn how to incorporate physical activity into the classroom, Adam Black reports for The Independent: "The program, which has been provided . . . through a grant, encourages teachers to give students 10 minutes twice a day in physical activities while learning core curriculum subjects."

The workshop included colorful scarves, stress balls and Chinese jump ropes. Teachers said the alphabet backwards while jumping rope and used scarves to write out letters. John Smith, educational consultant for Flaghouse Inc., said, "There is a 42 percent obesity rate in the Ashland area." Smith told teachers who attended the workshop that the Take 10 program could positively affect their schools. "Kids get better test scores after physical activity," he said.

Smith demonstrated activities students could do even in a small classroom and shared some analogies and stories with the group. "Imagine you are a car, and you fill your tank up, drive around the block and fill up again. Eventually you will explode since you're not burning it all off," he said, Black writes.

"They are really practical activities that don't require a lot of prep time," said Oakview Elementary School music teacher Braun Ream.

UK doctors use remote ultrasound program to care for at-risk expectant mothers in rural areas

Sonographer Laura Bates moved a camera in Manchester
while a doctor at UK talked with patient Mary Sizemore.
(Lexington Herald-Leader photo by Andrea Noell)

"Care often is best delivered close to home," Dr. John O'Brien, director of maternal fetal medicine at UK HealthCare, told Mary Meehan of the Lexington Herald-Leader. That's why he and other UK doctors are providing remote care for at-risk mothers in rural areas through the Blue Angels program.

Finding money and transportation to travel to Lexington, and navigating the campus, can be challenging and stressful, especially for mothers who are concerned about the trip's potential impact on their unborn children. Instead, "O'Brien reviews ultrasounds in real time via an Internet connecting using a specially designed portable ultrasound machine with a specially trained sonographer," Meehan reports. 

Patient portals at Leitchfield hospital are breached in cyber attack; officials say it did not involve any data in state system

By Melissa Patrick
Kentucky Health News

Twin Lakes Regional Medical Center's patient portals were the target of a sophisticated cyber attack earlier this year, which may have breached protected patient health information, reports The Record, a Leitchfield newspaper.

The cyber attack was made on one of the Kentucky Health Information Exchange's patient portal vendors, NoMoreClipboard. KHIE patient portals are secure, online websites that give patients access to their personal health information.

"The NoMoreClipboard breach only affected one hospital, Twin Lakes," Beth Fisher, spokeswoman for the Cabinet for Health and Family Services, said in an e-mail. "The breach affected the patient portal maintained by NoMoreClipboard, not KHIE. No information from KHIE was breached or accessed."

KHIE provides a common electronic information infrastructure that supports the exchange of electronic health information among healthcare providers and organizations throughout Kentucky. It contracts with many different vendors to provide this service.

The security notice from NoMoreClipbard said the data that might have been compromised are: an individuals’ name, home address, Social Security number, username, password, spousal information (name and potentially date of birth), security question and answer, email address, date of birth, health information, and health insurance policy information. The newspaper says that no financial or credit card information was compromised because this information is not collected or stored.

The hospital made the announcement on July 27 and asked patients to not call the hospital "since the breach did not involve any information stored by the hospital or by any local doctor's office," the newspaper writes.

As of July 30, the hospital could not determine the number of people affected by the breach, but said "It should be kept to a minimum since the system was only recently put into place," the newspaper reports.

NoMoreClipboard began contacting affected individuals on June 2, according to the online security notice. It has also established a confidential, toll-free hotline to answer any questions. The hotline is available Monday through Friday, 8 a.m. to 8 p.m. CDT and can be reached at 866-328-1987.

NoMoreClipboard is offering credit monitoring and identity protection services to affected individuals, free of charge, for the next 24 months. Click here to see the security notice sent to its clients.

Kentucky's uninsured rate continues to drop; now 9 percent

The share of Kentuckians who have no health coverage has dropped to 9 percent, according to the latest data from The Gallup Organization. That makes Kentucky second, following Arkansas, among the states in the percentage of formerly uninsured who now have insurance, either with private insurance or the federal-state Medicaid program.

In 2013, prior to implementation of the Patient Protection and Affordable Care Act, Kentucky's uninsured rate was 20.4 percent. The rate dropped to 9.8 percent in 2014 and even further to 9 percent during the first half of 2015, according to the poll. Nationally, the uninsured rate fell from 17.3 percent in 2013 to 11.7 percent in the first half of 2015.

Most of the states with the highest reduction in their percentage of uninsured rates were states that chose to expand Medicaid, establish a state-based marketplace exchange or state-federal partnership, according to the poll results. States that enacted both of these reforms saw a 44 percent reduction in their uninsured rates since 2013, compared to a 28 percent reduction in states that did one of these reforms, or neither.

Kentucky did both, creating its own state-based exchange, Kynect, and expanding Medicaid to those making up to 138 percent of the federal poverty rate. More than 521,000 people obtained health insurance coverage through Kynect in 2014, either through a private plan or Medicaid.

A recent Gallup poll released in July found that almost equal numbers of Americans approve and disapprove of the eeform law. This is a huge shift from last year when 37 percent said they approved of the law and 56 said they disapproved. Differences continue to be defined by political party lines, with 83 percent of Democrats and 14 percent of Republicans saying they approved of the law in this most recent poll. The error margin in this poll is plus or minus 3 percentage points.

"This is happening as uninsured rates for most states have continued to decline," the report notes.

For the 2013 poll in Kentucky, the sample size was 2,755, for an error margin of plus or minus 1.87 percentage points. For the first half of 2015, the sample size was 1,350, for an error margin of plus or minus 2.67 percentage points.

New combination vaccine for children, researched at U of L, could reduce number of children's shots if approved by FDA

A new combination vaccine, awaiting its approval by the federal Food and Drug Administration, may reduce the number injections a child in the U.S. must get in order to be fully immunized, according to a University of Louisville news release.

“Hopefully, this vaccine combination will improve coverage rates," Gary S. Marshall, lead author of the study and professor of pediatrics, said in the release. "Studies show that when you use combination vaccines, more kids get vaccinated on time and by two years of age more are fully protected. When you make it easier, you get better coverage.”

The vaccine protects against six childhood diseases: diphtheria, tetanus, pertussis, polio, Haemophilus influenza type b, and hepatitis B. It could mean an infant receives one to four fewer injections, depending on which vaccine combinations are used, says the release.

"A similar hexavalent vaccine has been available in Europe for more than a decade and has resulted in more timely immunizations," says the release.

U of L, led by Marshall, coordinated the multi-center trials for the vaccine, which included nearly 1,500 children across the U.S. Results from these trials are published in the August 2015 issue of Pediatrics.

The research determined the drug to be "effective, safe and well-tolerated," says the release. The Pediatrics report said that the new vaccine provided equal immunity to the existing immunization regimen; children who were given the combination vaccine reported "a slightly higher rate of redness at the injection site and slightly higher rate of self-limited fever following the injections, as compared with the established regimen"; and no adverse health events were reported in either group for six months following the final dose.

“Once it is licensed, we can take pride in having brought this new vaccine to the pediatric community and having done our part to simplify the routine immunization schedule,” Marshall said.

FINANCIAL DISCLOSURE: Dr. Marshall has been an investigator on clinical trials funded by GlaxoSmithKline, Merck, Novartis, Pfizer and Sanofi Pasteur, and he also has received honoraria from these companies for service on advisory boards.