Painkillers appear to increase risk of deaths other than overdoses, according to new study of Medicaid patients in Tennessee

"Accidental overdoses aren't the only deadly risk from using powerful prescription painkillers," The Associated Press reports. "The drugs may also contribute to heart-related deaths and other fatalities, new research suggests."

A study of of more than 45,000 Medicaid patients in Tennessee from 1999 to 2012 found that "those using opioid painkillers had a 64 percent higher risk of dying within six months of starting treatment compared to patients taking other prescription pain medicine," AP reports. "Unintentional overdoses accounted for about 18 percent of the deaths among opioid users, versus 8 percent of the other patients."

"As bad as people think the problem of opioid use is, it's probably worse," said Vanderbilt University professor Wayne Ray, the lead author of the study report. "They should be a last resort and particular care should be exercised for patients who are at cardiovascular risk."

The report in the Journal of the American Medical Association noted that opioids can slow breathing and worsen the disrupted breathing associated with sleep apnea, which could lead to irregular heartbeats, heart attacks or sudden death.

The patients in the study "were prescribed drugs for chronic pain not caused by cancer but from other ailments including persistent backaches and arthritis," AP reports. "Half received long-acting opioids including controlled-release oxycodone, methadone and fentanyl skin patches. . . . There were 185 deaths among opioid users, versus 87 among other patients. The researchers calculated that for every 145 patients on an opioid drug, there was one excess death versus deaths among those on other painkillers. The two groups were similar in age, medical conditions, risks for heart problems and other characteristics that could have contributed to the outcomes."

Court of Appeals orders Lexington abortion clinic closed for now

By Al Cross
Kentucky Health News

Reversing a lower court's ruling Wednesday, the Kentucky Court of Appeals said Lexington's only location for legal abortions must stop performing them pending a lawsuit by the state that seeks to require it to be licensed as an abortion facility.

Fayette Circuit Judge Ernesto Scorsone declined in March to issue an injunction to close EMW Women’s Clinic on Burt Road, saying that the state failed to show that it was likely to win its lawsuit and that allowing it to stay open in the meantime would cause any irreparable injury. He found that the clinic was operating legally, and closing it would be “against the public interest” because it is the only clinic that routinely provides abortion services in the eastern half of the state and the right to an abortion is constitutionally protected.

But the facility is licensed as a physician's office, not as an abortion clinic, and a three-judge panel of the Court of Appeals, all of them women, unanimously agreed with the administration of Gov. Matt Bevin that it needs the latter license to operate legally. The judges said Scorsone had misinterpreted the licensing requirements and didn't give proper weight to the evidence, which was that all the clinic does is perform abortions and related procedures.

The clinic's owner, Dr. Ernest Marshall of Louisville, testified that the Lexington business "originated as a doctor's office" but has narrowed its line of work in recent years, especially after his partner died in December 2013. He said it was a simple facility compared to his EMW Women's Surgical Center in Louisville, which is licensed as an abortion facility and performed 2,773 abortions last year compared to 411 at the Lexington facility, which does abortions only in the first 12 weeks of pregnancy.

Scorsone said Marshall "has a strong argument" that he didn't need an abortion license because the Cabinet for Health and Family Services reached that conclusion after its last previous inspection in 2006 and the clinic doesn't have $1.5 million worth of equipment, at which point an abortion-clinic license is required. But the appeals court pointed out that state law says an abortion facility is "any place in which an abortion is performed" and "We see no reason why an exemption determination should be determinative a decade later," after the nature of the facility had changed.

The appeals court said Scorsone also erred in saying denial of an injunction wouldn't cause irreparable injury, because the cabinet and the citizens would be harmed "if the cabinet is not allowed to correct the alleged violations of its licensing requirements." It said that is a legal presumption that Marshall could have rebutted but did not. It also cited the cabinet's latest inspection, which found "expired medications, defective equipment, [a] torn examination table and dust accumulation."

In granting the injunction prohibiting abortions at the facility, the court said "There is a substantial legal issue as to whether EMW Lexington qualifies as a private physician's office, where it performed only abortions in the last year."

As for the availability of abortions in the eastern half of the state, the three judges said Marshall presented no evidence regarding "the location of the women EMW Lexington serves" and noted that it refers women past the 12th week of pregnancy to its Louisville facility. "As the cabinet points out, this case is not about a woman's right to an abortion," Judge Allison Jones wrote.  "The cabinet is not seeking to prevent women from obtaining abortions [but] to enforce its right to regulate the manner in which abortions are performed in this commonwealth." Judges Sara Combs and Debra Lambert joined in the opinion.

Forrest W. Calico, national leader in rural health care, dies at 75

Forrest W. Calico

Dr. Forrest W. Calico, a nationally recognized expert on rural health-care quality, died Monday at his home near Crab Orchard "after striving against multiple myeloma for several years," said his obituary in the Lexington Herald-Leader. He was 75.

A native of Garrard County, Calico received his medical degree from the University of Kentucky in 1966. He also held a master's degree in public health from Harvard University. In the U.S. Air Force, he was a flight surgeon at Area 51 in Nevada, a family physician, residency director and hospital administrator, earning the Bronze Star. He was president and CEO of Appalachian Regional Healthcare from 1993 to 1999, a health-systems adviser to the federal Office of Rural Health Policy and a senior quality adviser to the National Rural Health Association. In 2007 he was named a Rural Hero by the National Rural Assembly and in 2010 entered the UK College of Public Health Hall of Fame.

In retirement, Calico remained active at the state and local levels, serving on the boards of the Foundation for a Healthy Kentucky, the Friedell Committee for Health System Transformation and the Lincoln County Board of Health. In 2012 he published a memoir, Out of the Blue, with the subtitle "How open doors and unexpected paths set the course of my life."

Calico is survived by his wife Patricia Calico, their son Jefferson and wife Cari, daughter Tricia and husband Wes Cohron, his sister Helen Eden, a nephew and six grandchildren. A celebration of his life will be held Saturday, June 18, from 2 to 5 p.m., with a memorial service at 3 p.m., at The Church at Cedar Creek at 5787 US 150, east of Stanford. Memorial donations may go to The Friedell Committee, PO Box 910953, Lexington KY 40591, or the Dr. Patricia A. Calico Endowed Nursing Scholarship at UK, 315 College of Nursing Building, Lexington KY 40536.

Potent fentanyl, mixed with heroin, drives 14.7 percent increase in fatal drug overdoses in Kentucky from 2014 to 2015

The number of drug-overdose fatalities in Kentucky rose almost 15 percent in 2015, driven by a 247 percent jump in deaths involving fentanyl, a highly potent opioid that some traffickers are mixing with heroin, the Kentucky Office of Drug Control Policy said Tuesday.

The office counted 1,248 fatal overdoses in Kentucky last year, up 14.7 percent from the 1,088 reported in 2014. Fentanyl was a factor in more than a third: 420, up from 121.

"Heroin was detected in 28 percent of cases, consistent with the previous year," the Justice and Public Safety Cabinet said in a press release. "However, as a total, heroin-related deaths increased in 2015, largely because the drug is being laced with fentanyl."

“The introduction of illicit fentanyl into the heroin trade is producing devastating results,” Van Ingram, director of the office, said in the release. “Whether it’s manufactured to resemble heroin or a prescription pill, the cartels have made an already dangerous situation worse.”

Gov. Matt Bevin said, “I am heartbroken for the Commonwealth. More than three families a day are shattered by this epidemic of untimely death. This is unacceptable and will be vigorously addressed with every resource at our disposal.”

The report by Ingram's office listed the eight counties with the most fatal overdoses per person from 2012 to 2015. All were in Eastern Kentucky or Northern Kentucky. Here are the counties, with the number of deaths per 10,000 people: Leslie, 6.86; Bell, 6.12; Gallatin, 5.26; Knott, 4.87; Wolfe, 4.83; Floyd, 4.76; Campbell, 4.72 per 100,000 and Kenton, 4.63 per 10,000.

Counties with big percentage increases in fatal overdoses from 2014 to 2015 included Bell, from 11 to 20; Boyd, from 13 to 24; Butler, from none to eight; Harlan, from six to 10; Kenton, from 71 to 112; and Rowan, from five to 12.

Counties with large decreases included Bullitt, from 22 to 11; Grant, 13 to 6; Russell, from 13 to 7; Laurel, 18 to 10; Leslie, from nine to five; McCracken, 20 to 10; and Marshall, from 12 to fewer than five. The report does not list specific numbers for a county in years when the county had fewer than five fatal overdoses.

The figures above are based on where the death occurred. Based on the residence of the overdose victim, some counties ranked higher; for example, Powell County had 5.84 overdose deaths per 10,000 people, and Russell County had 4.95. This map shows rates based on the county where the overdose victims resided; note that it shows the death rate per 100,000 people, not 10,000 (a figure closer to the population of most counties). Click on the image for a larger version.

Wellness coalition in Perry County, where life expectancy is state's lowest, gets funding from Foundation for a Healthy Ky.

The Foundation for a Healthy Kentucky has funded the Perry County Wellness Coalition's three-year plan to encourage fitness and better nutrition in school-age children, "Kids on the Move!"

The wellness coalition will receive $144,450 from the foundation this year, matched by $124,944 from the community, to increase access to physical activity and provide healthier food options and nutrition education. Perry County has the lowest life expectancy in Kentucky.

"Our children are the most valuable resource we have," said Gerry Roll, executive director of the Foundation for Appalachian Kentucky, which is serving as fiscal agent for the coalition. "It's the best investment we can make as a community partner."

The health coalition will work with local schools to implement physical activity and nutrition-policy changes, collaborate with local farmers' markets for a strong farm-to-school component, and coordinate with other community agencies to create a lasting and collective impact.

The project also will implement best-practices nutrition and exercise programs in schools, support community gardens, summer feeding programs, and a "Farmacy" program to increase the purchase of healthier produce at farmers' markets and local grocery stores, among other changes to be coordinated by the agencies in the coalition.

The Appalachian Regional Healthcare hospital in Hazard will be the administrative hub for the coalition, providing leadership and sharing its expertise in promoting community health. "We have already begun these efforts by providing fitness fairs and health screenings to over 20 schools in our service area and reaching a little more than 2,500 middle school and high school age kids this year alone," said Hazard ARH Community CEO Dan Stone said.

The coalition is among seven Kentucky communities funded by the foundation's "Investing in Kentucky's Future" initiative, which is spending $3 million over five years to fund communities working to improve the health of their school-aged children. The other groups are in Breathitt, Clinton, Grant, Jefferson and McLean counties, and in Boyd and Greenup counties. Perry County was in the original announcement and recently completed its detailed plan. It shares with Breathitt and Wolfe counties the state's lowest life expectancy, 70 years.

Doctors trying to reverse course on opioid prescriptions can find it difficult because of addiction, shortage of good alternatives

The epidemic of opioid overdoses, 60 percent of which are blamed on abuse or misuse, "is changing prescribing habits, but there's still a lack of other pain medications, access to alternative therapies and knowledge among primary-care providers about multidisciplinary approaches to pain management," Modern Healthcare reports.

"The medical community turned to opioid prescriptions to address a condition many believed had been ignored or undertreated," Steven Ross Johnson writes. "And the dependence on fee-for-service payments also made it easier for providers to whip out their prescription pads rather than spend the time to help patients find alternatives. But experts now say the over-reliance on opioids for chronic pain, despite a lack of evidence on their efficacy and impact, was misguided and has distorted the public's concept of what pain is and what it means to be treated."

But reversing course can be difficult because many patients "have built up resistance to opioids and seek treatment while addicted or at risk of addiction," Johnson reports. He quotes Dr. Neel Mehta, medical director of Weill Cornell Medical College's Pain Medicine Center, which specializes in treating long-term pain as saying many come there because their doctor won't write them another prescription: “So we're sort of left with them expecting to get prescribed an opioid and we have to then calmly redirect that.”

In March the federal Centers for Disease Control and Prevention "recommended doctors prescribe alternative treatments such as over-the-counter medications, cognitive behavioral therapy and exercise before resorting to opioids. Weeks later, the Joint Commission [which accredits health-care facilities] clarified its 2001 standards for pain management and treatment to stress that opioid use was neither required nor specified for treating pain."

Other alternative treatments chiropractic care and the use of anti-inflammatory and neuropathic medications and even vitamin supplements, Johnson notes. "The problem is that few carry the punch or, for some, the pleasure of opioids. . . . The use of medical marijuana, meanwhile, has increased in several parts of the country. It's approved in 38 states and the District of Columbia for patients with illnesses such as cancer and HIV. But only some of those states allow the use of marijuana to relieve chronic pain." Kentucky does not.

Health ranking of Kentucky seniors moves up, but they are still last in health outcomes, says America's Health Rankings

By Melissa Patrick and Al Cross
Kentucky Health News

Kentucky moved up three spots, from 48th to 45th, in the fourth annual Senior America's Health Rankings Report. But the state ranked last in health outcomes and 44th in determiners of those outcomes, so it remains one of the least healthy places in the nation for seniors to live.

Among negative measures, Kentucky seniors ranked first in preventable hospitalizations, second in tooth extractions and premature death; and third in physical inactivity and hospital re-admissions within 30 days of discharge.

Among positive measures, the state also ranked poorly: for example, 46th in the percentage (34%) of seniors who reported that their health status was good or excellent and 48th in the percentage (56.9%) who reported having no disability.

The state's best ranking was No. 3 in influenza vaccinations, reflecting an increase to 70 percent from 62 percent of seniors vaccinated in the past two years. It was No. 8 in the percentage of seniors with arthritis who self-report arthritis or joint pain does not limit their usual activities. It tied for 10th in the percentage of seniors with a "creditable prescription-drug plan" and was 17th in the percentage of senior who reported having a mammogram or a colonoscopy or similar screening.

Kentucky ranked low in volunteer activity by seniors (45th) and nursing home quality (43rd) but has fewer people in nursing homes who perhaps shouldn't be there. Only 7 percent of its nursing-home residents, the No. 7 ranking, were considered "low care" and thus candidates for living in less restrictive environments. However, it was 46th in the number of personal-care and home-health aides per 1,000 adults aged 75 or older.

The state tied for 44th in the percentage (32.1) of seniors who reported falling in the previous 12 months. It was 44th in the percentage (42.8) of seniors who were enrolled in hospice during the last six months of life after being diagnosed with a condition that carried high probability of death.

It was also 44th in a related measure, the percentage (16.6) of seniors who spent seven or more days in an intensive- or critical-care unit during their last six months. Generally, use of an ICU correlates with the number of ICU beds, which "could indicate a supply-induced remand," the report says. "Overusing the critical care system often goes against the wishes of dying patients and is costly. Research indicates many patients receive care they would not choose in their final days."

The rankings are based on 35 measures of health, as well as supplemental measures such as education and mental health. Combined, they paint a picture of how individual behavior, our communities and their environments, health policy and access to care influence health.

One area that Kentucky consistently ranks low in is government support for seniors in poverty. It was 45th again this year, spending $382 per senior when federal, state and local funds were all counted. Massachusetts, which ranked first in overall senior health this year, spends $4,053 per senior in this category, more than any other state but Alaska, which has many rural elderly. The national average, which has been declining, is $811.

Kentucky leads the nation in smoking, so it's no surprise that its seniors also rank in the bottom five states for this negative category (47th). Kentucky seniors' smoking rate is 12.4 percent; the national average is 8.8 percent. Both have declined about 40 percent in the last 15 years.

Smoking is the leading cause of preventable death in the United States," says the report. "Cessation, even in older smokers, can have profound benefits on current health status as well as improve long-term outcomes."

Kentucky was fifth from the bottom in dental visits by seniors, but the good news is that the share of seniors having such visits rose to 57 percent from 53 percent last year.

"Poor oral health is associated with such chronic diseases as diabetes and cardiovascular disease, and can have a large impact on quality of life resulting in pain and affecting the ability to chew or speak," says the report.

Kentucky improved its senior obesity ranking, another negative measurement, to 24th from 41st. About two out of every seven Kentucky seniors are obese, or 27.5 percent, the same as the national average. Last year the rate was 29.6 percent.

"Obese seniors experience more hospitalizations, emergency department visits, and use of outpatient health services than non-obese seniors, leading to higher health care costs," says the report. "Physical activity, healthy diet, supportive communities and social networks, and an environment that encourages exercise all play a role in reducing obesity in older adults."

The report says that between 1999 and 2014, Kentucky's middle-aged population (50-64) saw a 34 percent increase in in obesity and a 68 percent increase in diabetes. These findings were similar across the nation.

The report says Kentucky's senior population is expected to increase 44 percent by 2030. "Over the next 15 years, the health of this population will be challenged by large numbers of new people becoming seniors and the additional health challenges, such as diabetes, that this groups brings with them," it says."These higher rates of diabetes and obesity are expected to put significant strains on the Medicare program and the overall health-care system."

The report, sponsored by the United Health Foundation, is a call to action for states, offering specific benchmarks that can be changed to improve health.

Louisiana again ranked last for overall senior health, followed by Oklahoma. Kentucky, West Virginia, Arkansas and Mississippi had similar scores. The top six states for overall senior health are Massachusetts, Vermont, New Hampshire, Minnesota, Hawaii and Utah. Click here for the full report. (Click on chart for another version that may be clearer)

UK pays big to settle a health-care debacle but keeps almost all details under wraps; Herald-Leader says trustees should worry

"The University of Kentucky has spent more than $5 million in the last year to fix federal billing issues involving a Hazard cardiology practice it acquired three years ago, but UK officials have declined to provide documents detailing problems that led to the payments," including an audit of the Appalachian Heart Center that UK calls "preliminary" though the issue has been resolved, Linda Blackford reports for the Lexington Herald-Leader.

Most of the money went to Medicare and Medicaid, but $1 million went to a Washington lawyer whose billing records the university largely refused to release, citing attorney-client privilege. The university's trustees were told about the matter at a dinner meeting, which the Herald-Leader said it didn't cover because the agenda for the meeting did not include the matter. UK says no minutes were taken at the meeting, normally a social event that precedes formal meetings the next day.

The Herald-Leader said it would file an appeal with the attorney general, whose decisions in open-records and open-meetings matters have the force of law unless a court rules to the contrary. “We have strong concerns about the overall lack of transparency by the university in this case,” Editor Peter Baniak said. “Records about the issues involving this clinic should be public, as should the information presented and discussion that took place in an open meeting of the board of trustees.”

In an editorial, the newspaper attacked UK officials' secrecy about the case and other health-care issues, such as appealing an AG's decision that that the Kentucky Medical Services Foundation isn't a public agency. "Their imaginative legal arguments and bizarrely incomplete responses to requests for information by the Office of the Attorney General, this newspaper and a private individual should embarrass and trouble the trustees," it said, noting that a UK official said the university paid back "more than what was required."

"Who pays an attorney $1 million to settle a dispute by paying more than was owed?" the editorial asked. "If this were a one-off we might think that UK HealthCare and KMSF, which handles billing for UK physicians, are just muddling around to avoid admitting their deal went bad. But it’s only the latest in a series of stories that indicate a pattern of secretiveness in UK’s vast health-care empire."

Ashland hospital expands into wellness and prevention programs

By Judi Kanne
Kentucky Health News

Hospitals’ basic business is taking care of the sick and injured, not keeping people from getting sick. But more and more of them are getting into wellness and prevention, not only to help their communities but to make money.

King's Daughters Heart and Vascular Center

One of those is King’s Daughters Medical Center in Ashland, which has developed an innovative strategy for building relationships with local employers to help their employees live healthier lives.

King’s Daughters began by focusing on self-insured employers, who can get the most direct benefit from reduced health-care expenses. It used one-to-one employer outreach activities such as a farm-to-table employer lunch, to which more than 126 local employers were invited.

The first question for employers, said Matt Ebaugh, vice president and chief strategy officer at King’s Daughters, is “Do you understand what is driving the cost for your employees?” because “Self-funded employers do not always have the analytics or tools needed to understand where those costs come from.”

King’s Daughters used Strategic Health Services of Alpharetta, Ga., to create a portal for health risk assessment, biometric screening results, claims analytics and personal health profiles of employees.

While the program is aimed at wellness, it also finds new cases for the hospital. “We knew if we did a smart thing for local employers, demonstrated value, and coupled it with good customer service, then when employees needed a higher level of care, they would come to us,” Ebaugh said.

By means of screenings for diabetes, cholesterol, and body mass index, employees become patients.

Diabetes screening can be critical. About 86 million American adults are pre-diabetic, but nine out of 10 people who are don’t know it, according to the federal Centers for Disease Control and Prevention. That can be detected with health-risk assessment lifestyle questionnaires.

Beyond individual screenings, hospitals can examine the emerging risks in a population using claims data. That can also help them show employers what’s driving up their costs. Claims also indicate which employees are most likely to use hospital and pharmacy services.

“We need to find innovative ways to motivate individuals to change old and dangerous patterns,” Ebaugh said, because simple lifestyle changes can dramatically cut the risk for developing diabetes.

But getting healthy may require offering financial and other incentives to get people to participate in wellness programs. The Ashland hospital plans to try gamification, incorporating into the workday a set of programmed games and activities that remind sedentary employees to get up, stretch, and move around.

The idea is to make health and fitness fun, a social experience and accessible to as many members as possible. Gamification programs include computer notifications or other reminders that stimulate sedentary disruption and track activity. In some cases, motivation includes team competition in which employees win points by stopping to stretch.

Ebaugh said such programs have been shown to work and are critical in some cases, because a pre-diabetic employee may not be motivated enough to change eating and exercise patterns. “Knowing is not enough,” he said. “We anticipate the energy and participation with gamification will increase as a result of more engaging activities.”

The hospital first started a wellness program for its own employees, and plans to add gamification to it, Ebaugh said: “It’s important our model work well to show our employers the success we are having with our internal employees.”

Judi Kanne, a registered nurse and freelance writer, combines her nursing and journalism backgrounds to write about public health. She lives in Atlanta.

Kynectors, health advocates ask state to maintain staffing and other resources in new health-insurance enrollment system

As the administration of Gov. Matt Bevin works toward dismantling Kynect, the state's health insurance exchange, health advocates say they worry that the transition is going too quickly to be smooth, risking a loss of coverage for some Kentuckians.

Kentucky Voices for Health, a coalition of groups supporting health-care reform, said June 9 that the administration needs to "keep, hire and train adequate staff," make eligibility decisions quickly, "dedicate enough resources to educate the public on how to enroll," publish its plan and allow time for comment, and "create an online dashboard to measure how well the system is functioning."

The group also wants the administration to extend the transition period, saying that no state has made such a transition so quickly.

“To be successful, we need to take our time and make absolutely sure we’re protecting consumers from gaps in coverage," KVH Executive Director Emily Beauregard said. "By . . . taking more time to complete the transition, Kentucky can keep more of its people covered with access to essential care."

Whitney Allen, coordinator of community development and outreach for the Kentucky Primary Care Association, said in the KVH news release, “These recommendations are key to fostering a culture of continuous improvement focused on the consumer experience.”

Keeping a campaign promise, Bevin decided to shift Kentuckians enrolling in private, federally subsidized health insurance via Kynect to the federal exchange, www.healthcare.gov, and Medicaid recipients to Benefind, the state's new one-stop website for state benefits, by Nov. 1.

This new model for subsidized insurance is a federally supported but state-based marketplace, in which the federal government will handle consumers' eligibility appeals but the state will handle insurance-company grievances and still review insurance plans. The federal government will certify the plans but it will "strongly rely" on state recommendations, Health Secretary Vickie Glisson said in March. Consumer grievances will be handled by a state-federal partnership.

Kentucky Voices for Health said it wants "to ensure that any enrollment system that will replace Kynect works as well or better to ensure all Kentuckians have access to coverage without interruption or barriers."

Bevin's office replied to the KVH release with this statement: "Throughout the process, we have updated stakeholders and listened to their feedback. We appreciate the continued interest, input and cooperation of advocates as they are an important component of our communications and outreach strategy during the transition from Kynect to healthcare.gov. We are pleased to report that Kentucky has met all milestones and deliverables, some ahead of schedule, that were established by the [federal] team in order to proceed with the transition to healthcare.gov."

KVH continued to emphasize the importance of Kynectors, a blanket term used for those who help Kentuckians apply for and enroll in coverage. The state has about 600 Kynectors, but their fate is uncertain.

“Research indicates that Kentucky consumers find insurance overwhelming and confusing, and value the face-to-face assistance they have received to navigate the system,” Dr. Susan Buchino of the Commonwealth Institute of Kentucky, said in the KVH release. The institute, part of the University of Louisville School of Public Health and Information Sciences, calls itself a "transdisciplinary collaborative for population health improvement, policy and analytics."

KVH said the Bevin administration recently agreed to its request to have a diverse, multi-stakeholder advisory committee like the one that helped create Kynect.

The group said its recommendations came from Kynectors and health advocates, "many of whom have hands-on experience with enrollment and consumer assistance." Click here for the full report.

Forbes magazine contributor Josh Archambault wrote June 7 that Bevin is right to end Kynect because it serves mainly as a funnel to the Medicaid program and is funded by a fee on all health-insurance policies sold in Kentucky.

At least part of the fee will remain in place to help pay transition costs, fund the Kentucky Health Information Exchange and cover remaining claims to the high-risk insurance pool for which the fee was originally established. It was transformed into Kynect funding by an executive order from then-Gov. Steve Beshear.

"Kynect’s website will actually be active until the end of 2017, as the site also services small-business plans which have no set open-enrollment season," Archambault notes.

Nonprofit says most of the 52 Kentucky hospitals it grades on patient safety got Bs and Cs, and KentuckyOne got five Ds

Kentucky Health News

A nonprofit group that rates hospitals recently doled out its hospital safety scores and found that most Kentucky hospitals scored a 'B' or 'C' in overall patient safety, and that five of the six Kentucky hospitals that got Ds are owned by the same hospital system.

The Leapfrog Group, a non-profit organization that rates hospitals, evaluated more than 2,500 hospitals nationwide, including 52 in Kentucky. Most of Kentucky's hospitals were not rated because rural critical-access hospitals don’t have to report their quality measures.

It found that 21.2 percent (11) of Kentucky's hospitals got As, which was much lower than the national average of 31 percent, while 11.5 percent (6) got Ds, more than the national average of 6.3 percent. Additionally, 23 percent (12) got Bs and 44 percent (23) got Cs.

"Once again Kentucky had fewer 'A'-rated hospitals than the national median and more hospitals rated near the bottom with increasing numbers of 'D's. More troublesome is the observation that five of the six hospitals receiving a 'D' are in the same hospital system," Dr. Peter Hasselbacher, emeritus professor of medicine at the University of Louisville, wrote in an op-ed for the Kentucky Health Policy Institute blog.

Except Lake Cumberland Regional Hospital, the Kentucky hospitals that got a D are owned or operated by KentuckyOne Health: Jewish Hospital, Sts. Mary and Elizabeth Hospital and University Hospital in Louisville; and St. Joseph Hospital and St. Joseph East in Lexington.

Richardson

Staffing cuts at the U of L Hospital have made it “unsafe” for seriously ill and injured patients, Dr. J. David Richardson, vice chair of surgery and president of the American College of Surgeons, told the university's top health officials in an email on June 7. He said the public hospital has “never been worse in the 34 years that I have been heavily involved with it,” reports Andrew Wolfson of The Courier-Journal.

"In an interview, Richardson said the problems are so great that the only solution is to 'unwind' the 2013 agreement in which the state turned over day-to-day management of the hospital to Catholic Health Initiatives," Wolfson reports. He said the letter understated the problems, which are making it impossible to conduct academic research at the hospital.

The two University of Kentucky hospitals got Cs from The Leapfrog Report. Pikeville Medical Center is the only Kentucky hospital evaluated that has had straight As since 2013, when the study began. Click here for Kentucky's Hospital Safety Scores.

KentuckyOne Health issued a statement saying University "is an excellent hospital with a dedicated and talented team of professionals that is staffed to meet the patient’s needs. Our focus has always been on quality, safety and patient experience."

On Sunday, June 12, KentuckyOne and the university ran a full-page ad in The Courier-Journal saying they are "committed to ensuring safe and effective patient care" and "Safety and quality are our top priorities." They said they take Richardson's concerns "seriously, and we are committed to reviewing and addressing the issues noted."

In 2012, when management of most of the hospital was given to KentuckyOne, "Officials said it would pump $1.4 billion into U of L health operations over 20 years. But the company has had financial troubles ever since, and in February 2014 announced it was laying off 500 employees in Kentucky," Wolfson notes.

The Leapfrog Group's analysis was developed under the guidance of the nation's leading patient safety experts and the scores were based on 30 measures of publicly available hospital safety data. The ratings are issued twice a year, for errors, injuries, accidents and infections. The report is peer-reviewed and published in the Journal of Patient Safety.

Hasselbacher noted legislation in Congress that would protect some hospitals from Medicare payment cuts if they serve more than average numbers of indigent and poor people.

"Care must be taken that this initiative, lobbied heavily by hospital organizations and their partners in academic medicine, is not interpreted to imply that is it acceptable to provide medical care of lower quality to poor people or in teaching hospitals," he wrote. "The fact that this protection is being considered at all is a tacit admission that our current methods of measuring quality and safety are flawed."

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Media at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Salmonella outbreak in 35 states linked to live poultry; 21 cases reported in Kentucky; here are some tips to avoid infection

U.S. Centers for Disease Control and Prevention photo

Poultry specialists from the University of Kentucky are urging Kentuckians who raise chickens or ducks to take extra precautions against salmonella infection, since 21 cases have been reported in the state.

“Any contact with live poultry puts you at risk for salmonella infection,” Jacqueline Jacob, UK poultry extension project manager for the College of Agriculture, Food and Environment, said in a news release. “Salmonella germs can be in the birds’ droppings and on their bodies and also on their cages, coops, hay, plants and the soil where they live and roam.”

Salmonella is a bacteria that makes people sick. Symptoms usually develop 12 to 72 hours after exposure and include diarrhea, fever and abdominal cramps. The illness usually lasts four to seven days. Children under 5, adults older than 65 and those with weakened immune systems are at the greatest risk of being severely affected.

These infections are part of a seven-state salmonella outbreak that have all been linked to contact with life poultry from multiple hatcheries. Jacob cautioned that any chicken can carry salmonella, even if it looks clean and healthy.

So far, more than 300 people have been infected, with more than one-fourth of those children aged 5 or younger, according to the federal Centers for Disease Control and Prevention.

“Many of the cases in the current outbreak are linked to backyard flocks, so we want to remind folks of simple things they can do to protect themselves," Jacob said.

Tips to avoid infection:

• Wash hands thoroughly with soap and water immediately after touching live poultry or anything in the area where they live.
• Do not let live poultry inside the house, or around areas where food or drink is located.
• Do not let children younger than 5 handle or touch live poultry without supervision.
• Adults should supervise the handwashing of young children.
• Keep poultry away from your nose, mouth and eyes.
• Wash your hands with sanitizer that has a 99 percent or higher bacteria kill rate after handling poultry at shows and fairs.

“It’s also a good practice to be careful when you wash equipment or eggs in the kitchen sink,” Jacob said. “You don’t want to cross contaminate food. Always use a good disinfectant to clean up in the kitchen when you’re finished.”

Click here for more advice from the CDC for backyard flock owners.