Ky. Rural Health Assn. names state Auditor Adam Edelen "Rural Health Champion" for report on finances of rural hospitals

State Auditor Adam Edelen

The Kentucky Rural Health Association has named state Auditor Adam Edelen its first “Kentucky Rural Health Champion” for his special examination of the financial strength of 44 of the state’s 66 rural hospitals.

Edelen found that most of Kentucky’s rural hospitals were below the national average in financial strength. His report "emphasized the importance of rural hospitals, which provide healthcare to 45 percent of Kentuckians and serve a disproportionate share of low-income and elderly citizens," KRHA said in a news release. "In many rural communities, hospitals are the first or second largest employer."

“Auditor Edelen’s leadership sparked a statewide dialogue about the importance of rural hospitals, and provided policymakers with a baseline for monitoring the financial health of rural care centers in the future,” KRHA Executive Director Tina McCormick said. “He has proven himself a true advocate for rural health care.”

Bevin and Conway's running mate, state Rep. Sannie Overly, show sharp differences on health-care issues at forum

By Melissa Patrick
Kentucky Health News

The major-party campaigns for governor disagree on all of Kentucky's major health issues, sharply on such topics as the Medicaid expansion, the Kynect health-insurance exchange and a statewide smoking ban.

Those differences and others were explored Friday in Bowling Green, at a forum sponsored by the Kentucky Rural Health Association, by Republican candidate Matt Bevin and Democrat Sannie Overly, Attorney General Jack Conway's running mate for lieutenant governor.

The questions were composed from a list of questions from the audience, most of whom had attended the annual KRHA conference prior to the forum. Conway was scheduled to attend, but sent Overly, citing a scheduling conflict.

Medicaid

Overly, who spoke second, said on more than one occasion during the forum that the candidates' views on Medicaid expansion under federal health reform was their main difference on health care. Bevin says the expansion is unaffordable and he would replace it with a different program that he has yet to nail down. Conway says that would be premature.

"Jack and I are going to monitor our Medicaid expansion to make sure that we can continue to afford [it] moving forward," Overly said in her opening remarks. "But what we won't do, and what our opponents have said they would do, on video and in writing, is to kick nearly 500,000 Kentuckians off their health care. Our friends, our neighbors and our relatives. Folks in this room know just how damaging that idea can be."

The expansion of Medicaid eligibility, to people in households earning up to 138 percent of the poverty level, has added about 400,000 Kentuckians to the federal-state program. Overly cited the state-funded study by Deloitte Consulting that predicted the expansion would pay for itself, by bringing more people into the health-care system, creating jobs and tax revenue.

The study says the expansion would put $820 million into the state's economy through 2020, but would not pay for itself in 2021. Overly said, "We just simply believe that you don't throw 500,000 Kentuckians off their insurance today because of something that may or may not happen in six years," she said.

The federal government is paying the full cost of the expansion through next year. In 2017, the state would pay 5 percent, rising in annual steps to the law's limit of 10 percent in 2020.

Bevin, who spoke first, said he expects that states will have to pay more than the law now calls for because "the federal government is broke." He said Kentucky won't be able to afford the 10 percent, let alone a higher figure.

He said Gov. Steve Beshear spent $144,000 on the study "to delude us into thinking that we are actually making money from this." He added, "We are not. . . . You don't make money by spending other people's money."

Bevin declared, "We will not, and I can't be more clear about this,we will not continue to enroll or re-enroll people at 138 percent of the federal poverty level. We can't afford to. To do otherwise is to lie to them, is to mislead them, is to put too much cost on the taxpayer, to preclude us from being able to provide for those who most desperately need it."

Asked what would happen to the 400,000 Kentuckians covered by the expansion, he offered a lengthy explanation.

Bevin acknowledged that he would have no authority as governor to "oust" the "initial folks" from Medicaid and said that we needed to "come up with a way to provide health care to them." He acknowledged, "Nobody likes the idea of getting less than anything than they currently have."

He said he would apply to the Centers for Medicare and Medicaid Services (CMS) for waivers under Section 1115 of the Social Security Act "to customize something that allows us to provide for these same folks." In July, he said he would use examples from other states, such as Indiana, which requires Medicaid patients to make co-payments.

Bevin said people need to have "skin in the game," because "When you rob people of any vested interest in their own success you rob them of any reason to care."

He added, "There is nobody who is getting it that doesn't have some element of need. There is no question about that. But I grew up well below the poverty level, we never had access to it, I managed to turn out. That isn't to say that that is the answer, it is not. I know it is not easy. I know it is a struggle. But it is not as if these people will suddenly be destitute in the street if they don't have everything that they currently have today."

Bevin said getting federal Medicaid money in a block grant could allow the program to help people between 138 percent and 200 percent of the poverty level. "Maybe they have a health savings account where they get a certain allocation of CMS dollars through this 1115 waiver where they have their own account and so that they have some incentive, if they have prescriptions, to not get the $100 prescription if they can get the $20 generic, because they have power over that and they have an allocated amount of money that has been given to them.

"If we implement things like this, and we can and we should, then ultimately we are going to find that we are covering more people with better access and empowering them in ways that actually help them to streamline themselves back into society in ways that are good."

Kynect

Bevin said the Kynect exchange has been a success only because it was built on "other people's money," meaning federal grants, and reiterated that he plans to shut it down and move Kentuckians to the federal exchange because Kynect "is a level of redundancy frankly that does not serve us well."

He said that the argument that Kynect only costs insurers 1 percent, compared to the 3.5 percent charged by the federal exchange is like comparing "apples and oranges" because the 1 percent is a fee on all health-insurance policies sold in the state, while the federal exchange's 3.5 percent fee is levied only on policies sold through that exchange.

Overly reiterated that she and Conway plan to keep Kynect.

"We've been hailed as a national model for how to take the federal law and implement it here in Kentucky," she said. "That doesn't mean it's perfect, and we will continue to work with folks in this room as we need to make additional changes to continue to improve Kynect, but I think we've done a pretty job of implementing it to this point."

Smoking ban

Bevin says bans on smoking should be local decisions, though he does support government buildings being smoke-free.

Overly said, "Jack and I are supportive of a statewide smoking ban," noting that she had voted for it in the House during this last session.

Managed care

After many complaints from hospitals and other health-care providers, the Cabinet for Health and Family Services changed its contracts with managed-care organizations that oversee Medicaid patients' care.

Bevin said the changes have not gone far enough. "At a bare minimum, we need to ensure absolute strict compliance with streamlining this to the degree possible, but we would do well to simplify it even further," he said.

Overly said she and Conway want to make sure the contracts had enough "teeth" in them to allow the cabinet to ensure compliance."We have a ways to go before we get this right and we are committed to continue to work to make sure that we are providing health care delivery to Kentucky's rural citizens."

Tort reform and medical review panels

Bevin said he absolutely supports tort reform and would be "very intentional" about moving it forward if elected. "If this race comes down to nothing else in your minds, the odds that you will have any kind of tort reform in this state in the next four plus years if Jack Conway is the governor of this state is zero."

Bevin said he also supports medical review panels for malpractice and other lawsuits against health-care providers, but says they should be set up in a way to promote "thoughtful, intentional, self-evaluation" that doesn't create a situation where the information disclosed can be used against you.

Overly, like Conway a lawyer, said, "I very strongly believe that we must keep our court system open for each and every Kentuckian. Having said that, Jack Conway has said that he would consider some amendments to tort reform here in Kentucky. We would take those on a case by case basis and where they make sense we would be willing to look at implementing those."

Quality and quantity of health care

Bevin said to improve quality and quantity of health care, we must "sit down and have a modern, up-to-date, frank conversation about things like certificate of need, things like scope of practice, things like reimbursements and whether or not the number of MCOs we have is appropriate. . . . Everything should be on the table. . . . The heart of the answer to that question is the fact that we need to empower those at the point of contact."

Overly said, "We have put forward a jobs plan, we have put forward an education plan and a number of components of those plans are things that will improve the lives of rural Kentuckians," noting their commitment to bringing broadband to all of Kentucky. She also said that she and Conway would make sure rural health issues would "have someone at the table in Frankfort."

Republicans want Medicaid members to pay something

As state officials reviewed changes in the five Kentucky Medicaid managed-care organization contracts that went into effect July 1, one Republican lawmaker said the contracts don't go far enough and that he would like to see them include co-payments and deductibles for all recipients of these services.

"What I am concerned about is that we still seem to be turning a blind eye to managing and encouraging good behavior on the recipient side," Rep. Robert Benvenuti, R-Lexingtion, said at the Sept. 16 meeting of the Medicaid Oversight and Advisory Committee.

"I am afraid with one-fourth of our population now in this program that the most vulnerable, the truly vulnerable, are going to fall through the cracks and are falling through the cracks and part of that is because a group of folks, especially through expanded Medicaid, who I don't consider truly vulnerable, are paying nothing and I just don't think that is at all sustainable or responsible."

Benvenuti said that he thought a co-payment should be mandated in the contracts because, "We've got to have folks to have skin in the game."

The five MCOs with contracts in Kentucky are Anthem, Humana, CoventryCares, WellCare and Passport.

Medicaid Commissioner Lisa Lee said that the main reason MCO's don't charge a co-payment is to assure that the providers get maximum payment for services under federal guidelines. For example, if the co-payment is built into the service billing, if the recipient doesn't pay their co-payment, then the provider loses that amount.

Benvenuti also suggested MCOs are hesitant to include co-payments on their own because it would make their plans less attractive to Medicaid clients, who choose their MCO. Certain services are exempted by federal law from any cost-sharing provisions, such as emergency services, family planning, pregnancy-related services, preventive services for children and others.

Lee agreed with Benvenuti that it was important to continue to explore ways to pay for the expansion of Medicaid under federal health reform. The state will have to start paying 5 percent of the expansion cost in 2017, rising to the law's limit of 10 percent in 2020.

"I think as a group we just need to come together and figure out what we can do to make this program sustainable going forward and look at every option on the table, put everything out there and try to see what we can do," Lee said. “And of course we know that we have a new administration coming in next year, and we’ll have opportunities to kind of look at the program and how to best move forward to make sure that we are providing services and being fiscally responsible.”

The "skin in the game" concept is one that gubernatorial candidate Matt Bevin supports, having said that this is one of the reasons he likes the Indiana model of Medicaid expansion as it requires people to be vested in their healthcare through co-payments.

"Having skin in the game is a big, big differentiator when it comes to whether or not a person has the dignity that comes with making decisions for themselves...," he said at a Kentucky Chamber of Commerce meeting in Louisville in July.

But Rep. Joni Jenkins, D-Shively, while saying all avenues should be explored, offered some caution on this idea, reminding the group that this was a complex issue.

“I think we need to remember what this population looks like and what the income requirements are to be eligible for that," she said. " I think we have to be very careful here that we are not dissuading people from seeking out health care."

Gov. Steve Beshear expanded Medicaid to include those up to 138 percent of the poverty line. For a family of four, that is $33,465. About 400,000 Kentuckians now have free health coverage because of this expansion. The total number of Medicaid members in Kentucky is 1,264,275, according to Lee's report.

Rep. David Watkins, D-Henderson, said that he was a "big proponent" of indirect charges to help promote healthier behavior, such as raising the prices of cigarettes and other tobacco products. He also stressed the importance of "educating our people when we provide these services to them."

Bevin letter says he will repeal Medicaid expansion; spokeswoman says he will find another solution

A mid-August fund-raising letter from gubernatorial candidate Matt Bevin says he would "repeal" the state's Medicaid expansion if elected, returning him to essentially the same stand he took early this year.

The Republican's campaign said he plans to replace the expansion with a different program approved by the federal government, but his vision of that appears to conflict with the federal health-reform law, which pays almost all the cost of the expansion only if states make eligible people with household incomes up to 138 percent of the federal poverty level.

“We will not continue to enroll people at 138 percent of the federal poverty level,” Bevin told Ronnie Ellis of CNHI News Service. “They will continue to be on it until we come up with a solution. But we are not going to re-enroll people at 138 percent.”

Bevin's newly named communications director, Jessica Ditto, issued a statement saying "Matt has been consistent on the issue of Medicaid expansion from day one. Kentucky simply can't afford to have a quarter or more of our citizens on Medicaid. What he has called for is repeal of Obama's Medicaid expansion by applying to CMS for 1115 waivers (as other states have successfully done) in order to better customize a solution to address the healthcare needs of the commonwealth."

The federal government pays the entire cost of the expansion through next year. In 2017, the state begins paying 5 percent, rising to the federal health-reform law's cap of 10 percent in 2020.

A Deloitte Consulting study, funded by the state, says that the expansion will pay for itself throiugh 2020 by adding regular patients to the system, expanding jobs in health care and increasing income taxes paid by those workers. Bevin has called this report "nonsense."

At the Kentucky Chamber of Commerce's Business Summit and Annual Meeting in July, Bevin said he would not immediately end the expansion, contrary to what he said for months. “That’s not what I’m calling for, at all,” he said, adding that he favors a modified plan based on the experience of other states like Indiana, which received federal waivers to create a program in which Medicaid beneficiaries have co-payments, can pay premiums for better benefits and get partial refunds if they don't use the benefits.

Bevin told the Chamber that it was important for consumers to have some "skin in the game" when asked why he liked the Indiana plan, describing his belief that it is important for clients to have a "sense of ownership" in their healthcare and that charging them a co-payment is a way to treat people with "dignity and respect, and giving them the belief that they have control over their own situation and people are seizing that."

The Kentucky Center for Economic Policy disagrees and says that the Indiana model "could prevent low-income people from getting the care they need, making health problems costlier down the road and creating barriers to sustaining the health coverage gains Kentucky has made in recent years, " Ashley Spalding writes for the center.

In a Sept. 15 debate, Bevin said he would "tweak" the program, "largely gliding past his February declaration that he would end the expansion 'immediately'," Lexington Herald-Leader political reporter Sam Youngman notes, adding that the letter is "a far cry from a 'tweak,' and the closer we get to Election Day, the less clear Bevin's position on the issue has become. But the assumption that most voters will check out the facts and look closely at the veracity of what was said is a fool's bet, and Bevin's apparent strategy of trying to muddy the waters on the issue might help him survive his many contradictions."

First-of-its-kind conference in Lexington Oct. 2-4 will look at the role of pharmacists in public health

By Melissa Patrick
Kentucky Health News

The Advances in Pharmacy Practice 2015 Fall Conference, "Discussing the Role of the Pharmacist in Public Health," will be held Oct. 2-4 in Lexington and is open to pharmacists and public-health professionals.

The conference will offer a broad overview of public health issues and the role of the pharmacist in addressing them.

"To my knowledge, there has not been a conference like this before," Patricia Freeman, director of the Center for the Advancement of Pharmacy Practice at the University of Kentucky, told Kentucky Health News.

Freeman said that there is a real push right now by national organizations to recognize the role pharmacists play as active partners in public health.

"In Kentucky we lead the nation in many public-health issues," Freeman said. "Pharmacist, I think, have a responsibility to understand how they can contribute as part of the public health team to address these issues that have negatively impacted the citizens of Kentucky."

One of the speakers at the conference, Cmdr. Lori Hall of the federal Centers for Disease Control and Prevention, will talk about the overlap between CDC health priorities and pharmacy practice.

Freeman noted that the CDC has laid out a federal plan on how pharmacists should be utilized to improve the nations public health and said, " If they are saying that at the federal level, then we should be saying that same thing and exploring those opportunities at the state level."

Kentucky pharmacists play an active role in several public health initiatives: they provide immunizations, help the state with emergency preparedness through the mobile pharmacy, and can now, because of Senate Bill 192, dispense Naloxone for patients who are at risk for opioid overdose. Both topics will be addressed at the conference.

"The pharmacist is such an underutilized health care professional," Freeman, who is also president-elect of the Kentucky Pharmacists Association, said. "They are so accessible in all of these different communities, we've really started . . . some additional public health activities that the pharmacists could be fulfilling in a more active role."

The conference will be held at the Griffin Gate Marriott Resort in Lexington. Registration fees vary depending on the sessions chosen. Go to www.cecentral.com and click on "live events" for details.

Kentucky had the largest decrease, from 2013 to 2014, in percentage of residents without health insurance

By Melissa Patrick
Kentucky Health News

Kentucky led the nation in the largest drop in the percentage of residents without health insurance from 2013 to 2014, according to a report released Sept. 16 by the U.S. Census Bureau.

The percentage of uninsured Kentuckians dropped to 8.5 percent in 2014 from 14.3 percent in 2013. The drop of 5.8 percentage points was double the national decrease of 2.9 percent. The report says 366,000 Kentuckians were uninsured in 2014, down 250,000 from 616,000 in 2013.

"The information from the U.S. Census Bureau is yet another independent, unbiased confirmation that Kentucky is on the path to make transformational changes in the lives and health of our commonwealth and the hundreds of thousands of Kentuckians who have qualified for health care coverage through Kynect since Jan. 1, 2014,” said Gov. Steve Beshear, who created the state health-insurance exchange where Kentuckians enroll in Medicaid or private insurance subsidized by the Patient Protection and Affordable Care Act.

This report confirms other public and private surveys that have shown a significant decrease in the number of Kentuckians without insurance since implementation of the ACA, which took full effect Jan. 1, 2014. The survey results differ slightly due to methodology.

The Gallup Organization reported in August that Kentucky's uninsured rate dropped to 9 percent during the first half of 2015, compared to 20.4 percent in 2013.

The surveys show that states that expanded Medicaid eligibility, to people in households with incomes up to 138 percent of the federal poverty line, saw the greatest reductions of their uninsured populations. In Kentucky the expansion covers about 400,000 people.

Census data show that the Fifth Congressional District, Kentucky's poorest, had the greatest drop in uninsured residents, going from 17.1 percent to 8.4 percent. Other decreases by district, according to Ron Crouch of the Kentucky Education and Workforce Development Cabinet: First, 15.9 to 9.3 percent; Second, 13 to 8.2 percent; Third, 13.4 to 7.8 percent; Fourth, 12.4 to 7.9 percent; Sixth, 14.1 to 9.2 percent.

"This is important to not just for making the population and workforce healthier with access to health care insurance but also the potential to create jobs across Kentucky, needed additional training and education for many of those jobs creating higher pay, and new tax revenue to pay for Kynect and Medicaid expansion as well as other needs in Kentucky," said Crouch, the cabinet's director of research and statistics.

The figures are based on continuing Census surveys, which do not provide enough data for reilable estimates in most counties. Last year, the state gave rough estimates for the uninsured population in each county:

$3.5 million in grants allocated across state to treat heroin and prescription drug addiction and neonatal abstinence syndrome

As part of the heroin legislation passed this year, community mental health centers and residential treatment facilities across the state will receive more than $3.5 million in grants to help treat prescription drug and heroin abuse, and address neonatal abstinence syndrome in Kentucky, according to a state press release.

“Substance abuse continues to be one of the most stubborn, damaging public health and safety issues facing our Commonwealth,” Gov. Steve Beshear said in the release. "This grant funding will help us reach more people and get them the treatment they need to overcome their addiction.”

This funding is part of a larger allocation of funds attached to Senate Bill 192 and will go to centers that provide behavioral and medication assisted therapy services for people in treatment for addiction, and to residential treatment services for pregnant women battling substance abuse.

In Fiscal Year 2015, which ended June 30, community mental health centers served 15,709 individuals with substance use disorders, or about 5 percent of the population in Kentucky estimated to have a substance use disorder, Beshear said.

The community mental health centers receiving funding are: Pathways, Ashland, $320,000; Communicare, Elizabethtown, $320,000; North Key, Northern Kentucky, $320,000; River Valley, Owensboro, $193,000; Bluegrass, Lexington area, $308,300; Kentucky River, Jackson area, $320,000; Pennyroyal, Hopkinsville area, $292,200; Seven Counties, Louisville area, $247,400; and Mountain Comp Care, Prestonsburg area, $244,000.

Four additional programs providing residential treatment for pregnant women also will receive grant awards. They include: Transitions Inc., Northern Kentucky, $219,600; Mountain Comprehensive Care, Prestonsburg, $250,000; Chrysalis House, Lexington, $250,000; and Volunteers of America, Louisville, $249,300.

"The goal of the program is to serve adults diagnosed with a substance abuse disorder or a co-occurring mental illness with a substance abuse diagnosis," the release said. "Awardees must demonstrate a commitment to ensuring individuals have access to evidence-based services and supports that include outpatient, medication-assisted, individuals, group, family, intensive outpatient, crisis, case management, residential treatment and recovery support services."

Medicaid expansion brings increased revenue to hospitals, but has also created different financial challenges

Kentucky's hospitals have seen a $1 billion increase in revenues since the expansion of Medicaid and the launch of Kynect, the state's health insurance exchange program, but the influx of so many new Medicaid patients into the health system has created a new set of financial challenges, Josh Shepherd reports for The Lane Report.

Mike Rust, CEO of the Kentucky Hospital Association, told Shepherd, that "many healthcare systems have seen an overall improvement in their financial position," but Elizabeth Cobb, KHA vice president of health policy, told him that this increase in revenue varies greatly among hospitals and that "some of them are still struggling to keep their doors open despite increasing numbers of payers and a reduction in uncompensated care statewide."

Kentucky leads the nation in reducing its uninsured population, which Health Secretary Audrey Tayse Haynes told Shepherd that the Cabinet for Health and Family Services estimates has "introduced about $2.2 billion in new revenue into the healthcare industry, $1 billion of which has been shared among the state’s hospitals." and that the "ACA influence is credited also with the creation of 11,900 new jobs in the professional healthcare and social work sectors."

Kentucky's uninsured rate is currently at 9 percent, compared to the nation's rate of 11.7 percent, according to the latest data from The Gallup Organization.

But this reduction has caused a "major payer-mix shift," Shepherd writes.

“When it’s said that revenues are up, it’s a relative term,” Carl Herde, chief financial officer for the Baptist Health system, told Shepherd. “We are seeing more patients, doing more services and certainly our charges are up. But we are also experiencing a significant shift in our payer mix. If you are caring for the same or more patients but not getting the same (amount of revenue) as you used to get for services, it creates an operational challenge.”

Medicaid expansion changes"payer mix," creating new financial challenge

Payer mix, loosely defined as "the ratio of patients with commercial insurance coverage, Medicaid/Medicare or other forms of government reimbursement, and those few who still self-pay," varies per community demographic and is a "critical variable" used to assess hospital revenues, Sheila Currans, CEO of Harrison Memorial Hospital in Cynthiana, told Shepherd..

Cobb explained that even if hospitals are seeing more patients and performing more services, if most of the patients are on Medicaid, the revenue gained from these patients will not cover the cost of treatment because "Medicaid doesn't cover 100 percent of the costs of care." Medicaid reimburses between 70 and 80 percent of charges.

Currans from Harrison Memorial and Herde from Baptist Health told Shepherd that they have seen a shift in their payer mix to more Medicaid patients.

Currans told Shepherd that rural hospitals are affected more than urban ones because they have a proportionately larger Medicaid/Medicare patient population, but Herde said he had not seen "much difference" in this among the hospitals he monitors.

Medicaid expansion has provided free health coverage to more than 400,000 Kentuckians.

Shepherd also writes that there has been speculation that "the influx of Medicaid patients may include low-income individuals and families formerly covered by commercial insurance through an employer," but also notes that this has not been proven.

High-deductible plans and bad debt

A KHA report to CHFS earlier this year showed "dramatic improvement in 2014 in the rate of uncompensated care," because of Medicaid expansion and the influence of Kynect, but Shepherd also writes that the "incidence of bad-deb accounts for hospitals actually is on the rise."

"The ACA’s intent to make healthcare more affordable to a greater number of people is happening, Rust said, but an issue of “under-insured” individuals remains," Shepherd writes.

"This typically involves people who opt for cheaper health insurance plans with high deductibles, which they then can’t pay when they receive care." Shepherd writes.

This is a challenge for hospitals, but is preferable to treating uninsured patients, which still accounts for nearly 10 percent of Kentucky's population, Shepherd writes.

“It’s a lot better for both the patient and hospital to try and work out a payment plan to cover a $5,000 deductible than writing off debts of over $100,000 in cases of injury or a catastrophic illness,” Haynes told Shepherd. Rust agreed: “At least a portion of that debt is getting paid.”

ER overuse and other fiscal pains

Most hospitals are working to decrease the overuse of emergency rooms. Some are working on the development of advance triage units to assess, prioritize and treat critical cases; Baptist Health has opened medical clinics and urgent treatment centers during off-hours; Harrison Memorial is considering adding a clinic next to its ER; and KentuckyOne Health is utilizing telehealth to address this problem, Shepherd reports.

How Kentucky will pay for the expansion continues to be a topic of debate.

The federal government is currently paying 100 percent of the cost, but that will decrease to 95 percent in 2017, 94 percent in 2018, 93 percent in 2019, and then 90 percent thereafter.

Haynes told Shepherd that "she believes the program is capable of sustaining itself in the long-run and that staying the course long term will result in a healthier Kentucky population and a more vigorous economic engine moving the state’s collective private and public healthcare enterprises forward."

Surgeon general says Americans need to walk more, and U.S. needs more walkable neighborhoods

Americans should spend more time walking, and communities should be equipped with walking areas to make that possible, U.S. Surgeon General Vivek Murthy said in a report released on Wednesday.

"Maybe this sounds like obvious advice, a health tip right up there with admonitions to eat right and wear sunblock," Emily Badger writes for The Washington Post. "But for much of the last century, the federal government has backed a different idea—cars running on cheap fuel and fast asphalt should carry us everywhere—that has largely proved incompatible with walking." (Library of Congress photo: Thomas Circle in Washington, D.C., in 1920, when most of the traffic was pedestrian)

The University of Virginia's Peter Norton, who has studied the history of transportation, told Badger, "If the surgeon general had called for people to exercise more, that would be just another predictable announcement. But he called for walking. That puts him up against a long history of official discouragement of walking."

One of the main problems is that nearly one-third of Americans live in neighborhoods that lack sidewalks, Badger writes. "The federal government subsidized the construction of postwar suburban subdivisions so heavily dependent on the car they had little use for sidewalks. The government paved the highways that enabled people to live there, and kept low the gas taxes that made commuting 30 miles a day affordable. Government engineers came, over time, to think of roads as the domain solely of automobiles—and of pedestrians as an impediment to them."

Another problem is that many people live far enough away from work, grocery stores and other conveniences that walking is not possible, Badger writes. Also, narrow rural roads can discourage walkers. In an age where cars take people everywhere they need to go, many people have grown out of the habit of having to walk much more than 300 to 400 feet to get anywhere.

Murthy told reporters, "In the last few decades we have lost touch with physical activity." Badger writes, "This is true in many ways, in school days that no longer include recess, or in jobs that no longer demand physical labor. But it is primarily true in how we've built (or rebuilt) the world around us. And research is starting to show the health consequences. Communities designed around more compact, walkable street grids—places that have what the surgeon general calls 'connectivity'—have been correlated in research with reduced rates of obesity, high blood pressure and heart disease (they also have fewer fatal car crashes, another public health problem). One study of a million residents in Toronto found that people in less walkable neighborhoods were more likely to develop diabetes."

New cancer treatment for late stage lung cancer that was developed at UK is approved for clinical trials

Researchers at the University of Kentucky have pioneered a new medical device for the treatment of late stage lung cancer, which has now been approved for clinical trials by the U.S. Food and Drug Administration at UK, auniversity news release says.

The medical device, called "Exatherm Total Body Hyperthermia System (Exatherm-TBH)," is used in a treatment that heats a patient's blood to about 107 degrees. The procedure takes approximately four hours under general anesthetic.

“Cancer cells are more susceptible to damage from heat than normal tissue, so the development of a safe method to deliver heat throughout the body may be a key step forward for advanced lung cancer patients,” Jeremiah Martin, surgical director of the UK Markey Cancer Center’s Multidisciplinary Lung Cancer Clinic and part of the research team, said in the release.

Because this treatment "attacks cancer cells throughout the body all at once, the research team hopes the project will lead to a new and safe method for treating patients whose cancer has metastasized through the body," says the release.

To learn more or to find out if you are eligible for this study visit UKClinicalResearch.com or call 859-323-6494.

The device was developed through a public-private partnership with Exatherm Inc. and the project is supported by a grant from the National Institutes of Health.

State-property smoking ban seems to cut share of smokers in Executive Branch, more than other employees in state health plan

By Melissa Patrick
Kentucky Health News

State-government moves against smoking have reduced it among Executive Branch employees at a greater rate than among state employees who were not affected by Gov. Steve Beshear's order that banned smoking on state property, according to the Department of Employee Insurance.

Beshear's executive order on Nov. 20, 2014 banned all tobacco products and e-cigarettes in state-owned or state-leased buildings, in state-owned vehicles and on state property. This order was aimed at helping achieve his kyhealthnow goal of reducing smoking rates by 10 percent by 2019.

Employment Insurance Commissioner Joe Cowles compared a control group – all the self-reported smokers in the Kentucky Employees Health Plan, which includes the executive branch, school boards, retirees and quasi-groups, a total of 265,000 people – to the Executive Branch, which makes up about 20 percent of the total and was the only one affected by the order.

The study found that from fiscal year 2014 to fiscal year 2015, the number of smokers in the health plan's population decreased 13 percent while the number of smokers in the Executive Branch population fell 16 percent.

"So what we found here is two-fold," Cowles said at at the Aug. 5 kyhealthnow oversight meeting in Frankfort. "The self-reported smokers actually decreased from '14 to '15, which is good . . .  but it decreased more in the Executive Branch. We are not ready to take the trophy and have a parade on Main Street, but I think as we talk about the trends, early trends, with it eight to 10 months in, we are there."

The study also found, suggesting a trend, that more of the Executive Branch population got smoking-cessation prescriptions (40 percent) than everyone in the plan (31 percent).

The plan and policies under the Patient Protection and Affordable Care Act provide for free smoking cessation programs and nicotine-replacement therapy.

"It is very easy to see that the Executive Branch is moving much more rapidly to smoking cessation and we are spending more money on them to do that, which is exactly what the purpose [of the executive order] was," Cowles said.

The study also found that smokers were more likely to file claims on their health insurance. Their claims costs increased by 7 percent while non-smokers' fell 10.7 percent. Claims for the Executive Branch decreased 13 percent.

Newspapers across the state are reporting about school lunch and nutrition programs, of great interest to readers with students

Kentucky newspapers are writing about school meals, against the backdrop of controversy about federal nutrition guidelines, and these are stories with a high level of interest among a key demographic - readers with children of school age.

The Glasgow Daily Times  recently reported that a new deli-style option at Barren County High School has more than doubled its sales of this grab-and-go option since it has been offered this year, compared to the old grab-and-go option that was pre-assembled and served in a bag. The article noted that this new option has been well-received by both the students and staff, all while staying within the new federal nutrition guidelines.

The Hickman County Gazette reported that the county schools have increased breakfast participation to 68 percent, up from 23 percent last year and lunch participation to 95 percent, compared to 77 percent the same time last year. (This story is behind a paywall.)

Schools Nutrition Director Lynsi Barnhill told the newspaper that the increase can be attributed to the nutrition staff working with the students through surveys to create a menu that they like, but still stays within the federal nutrition guidelines; and that the school district is now classified as a Community Eligibility Provision school district, which allows schools to offer breakfast and lunch at no cost to all of its students.

The Independent in Ashland reported on a campaign, called "No Soda September,"  to encourage families in Boyd and Greenup counties to drink more water and less sugary beverages throughout the month. This effort is a partnership between The Appalachian Partnership for Positive Living and Eating and the local Boyd and Greenup counties middle and elementary schools.

"Classes that returned signed pledges received free color-changing water bottles and water trackers for students and teachers. More than 2,300 water bottles have been distributed," Adam Black writes.
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This idea was spurred by the health department's 5-2-1-0 APPLE program, which is funded by a grant from the AstraZeneca HeathCare Foundation’s Connections for Cardiovascular Health, that suggest kids get: • 5 servings of fruit or vegetables • 2 hours or less of screen time • 1 hour of physical activity • 0 sugar-added beverages. 

"The consumption of sugary beverages, especially among young children who drink more than one beverage a day, leads to a higher risk of being overweight or obese and children with obesity issues are more likely to suffer from health problems such as asthma, headaches, depression and type 2 diabetes," according to the health department, Black reports.

"Officials also report the consumption of sugary beverages can lead to many dental issues, including cavities that can cause pain, infection, tooth loss and in severe cases, death," he writes.

The News-Graphic in Georgetown reported on how several schools  in Scott County, like many across the state, are conducting food drives to support its "Send Out Snacks Backpack" program to make sure kids don't go hungry over the weekend.

Becky McDonald, the family resources coordinator at Garth and Eastern elementary schools told Kayla Pickrell of the News-Graphic that the backpack program helps children who are on free or reduced lunch have food over the weekend by giving them backpacks with enough easy to prepare breakfast, lunch and snack foods to last until they come back to school on Monday. 

 “We have families who struggle to feed their kids over the weekend” because they are used to the free or reduced lunch during the week, McDonald said. “It helps out the parents a lot.” (This story is behind a paywall.)