Feds reject Ohio's Medicaid proposal, which was a lot like Ky.'s; federal comment period for Kentucky plan runs through Oct. 8

By Melissa Patrick
Kentucky Health News

The Centers for Medicare and Medicaid Services rejected Ohio's new Medicaid plan Friday, saying it could lead to the state's low-income people losing health coverage -- a decision that should place Kentuckians on alert, since it has a lot of similarities to the one Gov. Matt Bevin has proposed.

Ohio's new plan would have required all non-disabled Medicaid beneficiaries, except pregnant women, to pay up to $8.25 per month, depending on income, into a health savings account, with a $99 annual limit. Beneficiaries who failed to make their payments within 60 days of the due date would have lost coverage and would have had to pay back all missed payments to re-enroll.

"CMS is concerned that these premiums would undermine access to coverage and the affordability of care, and do not support the objectives of the Medicaid program," acting CMS Administrator Andy Slavitt wrote in a letter to the state's Medicaid director.

Bevin's proposal would also require Medicaid members to pay premiums, between $1 and $15 per month, depending on income, except pregnant women, children and the medically frail. These amounts would be assessed on households, not individuals.

Kentucky's plan would also dis-enroll members for non-payment, but has different penalties for those above or below the federal poverty level. Non-payers under that line would be required to make co-payments and lose $25 from their health savings account, which would be suspended. Like Ohio, Kentucky would stop coverage for those above the poverty line.

Kentucky's plan, like Ohio's, would allow suspended individuals to re-enroll by making back payments. Kentucky's plan would also require them to participate in a financial or health literacy course.

Slavitt, of CMS, said Ohio's application indicated that more than 125,000 Ohioans would lose coverage each year because of these changes, and "We do not believe that this practice would support the objectives of the Medicaid program, because it could lead to a substantial population without access to affordable coverage."

Kentucky officials also forecast that their plan would decrease enrollment: by about 17,000 in the first years and by 85,000 in the fifth year.

Another challenge for approval that Kentucky's plan faces is its "community engagement" requirements, which requires all able-bodied adults who aren't primary caregivers to work or volunteer, eventually 20 hours a week. No plan has been approved so far with any work requirements.

Ohio had proposed to require that a workforce-development agency referral be offered to any of its members who worked fewer than 20 hours a week, while clearly stating that participation in any such program was not a condition of enrollment.

Why should Kentuckians care about what happens in Ohio?

While Bevin has said he would negotiate with federal officials, his plan says it constitutes the conditions under which Kentucky will continue the Medicaid expansion implemented by his Democratic predecessor, Steve Beshear. Thus, a failure of negotiations could take health insurance away from the more than 430,000 Kentuckians who qualified under the expansion of eligibility to households who earn up to 138 percent of the federal poverty level.

Ohio could not negotiate with CMS because its legislature wrote its plan into its two-year budget. Slavitt clearly stated in rejecting Ohio's plan that waivers allowing changes in Medicaid rules cannot be approved unless they "strengthen coverage of health outcomes for low-income individuals in the state, increase access to providers, or otherwise increase the efficiency and quality of care provided to Medicaid beneficiaries and other low-income populations in the state."

Kentucky's waiver comment period runs through 11 p.m Oct. 8. Click here to comment. Click here to see the proposal.

Sitting down? It could be killing you; how about a standup desk?

Increasing numbers of news reports about the dangers of sitting are prompting traditional offices to make their workstations healthier by ditching desk chairs. "The link between sitting jobs and deadly disease processes galvanized the rise of the adjustable desk and the decline of the cubicle world as we knew it," Steve Shaw reports for Insider Louisville.

Burger Boy owner Dan Borsch of Louisville at his standup desk
(Insider Louisville photo courtesy of Dan Borsch)

Louisville restaurateur Dan Borsch made the switch to a standup desk after suffering a back injury three years ago."It took about two weeks to get used to the standing aspect of it," Borsch told Shaw. "After that, I don't notice it all -- and I love it."

Borsch said he is pain-free, and attributes his back relief to the $1,000 desk, not his exercises. "I do believe that, because of the standing desk, my back has been better than it would have been otherwise -- without a doubt."

Prolonged or leisurely sitting contributes to metabolic syndrome, which the Mayo Clinic defines as "a cluster of conditions -- increased blood pressure, high blood sugar, excess body fat around the waist, and abnormal cholesterol or triglyceride levels -- that occur together, increasing your risk of heart disease, stroke and diabetes." The Mayo Clinic describes in more detail what happens:

"Red blood cells in your legs begin to clump together, thickening inside your vessels and slowing circulation. If, later, you notice a further drop in energy, it's because your body's insulin production is down. The sugars . . . linger in your bloodstream, rather than being ushered into your muscles for energy. Soon a key element responsible for vacuuming fat out of the blood deactivates. Small amounts of fat begin to accumulate in your blood; your body will store it in an easy-to-access central location — your gut."

Mayo adds, "You may also have hunger cravings, even though you haven’t moved. That’s because your appetite-regulating hormones leptin and ghrelin have gone off-kilter. Meanwhile . . . deep within your leg muscles, a gene critical for suppressing clotting and inflammation switches off. By the end of the day, even with a lunch break and trips to the water cooler, your good cholesterol and insulin sensitivity may have fallen 20 to 40 percent.”

Shaw writes, “Sitting disease may be even more concerning to women than men.” A study by Alpa Patel, an epidemiologist with the American Cancer Society, found that “men who spent six hours or more per day of their leisure time sitting had an overall death rate that was about 20 percent higher than men who sat for three hours or less. The death rate for women who sat more than six hours a day was about 40 percent higher.”

Patel writes that leisure-time sitting “has been associated with greater mortality, cardiovascular disease, type II diabetes mellitus, obesity, and some cancers . . . markers of chronic disease risk such as weight gain, high cholesterol, high fasting insulin levels, and other biomarkers.” She estimates that, on average, people who sit too much “shave years off their lives.”

Convinced that standing during his long workdays will improve his health, Borsch tells Shaw that it’s likely he’ll never sit at his desk again. “Once you make that two-week transition or maybe three weeks — or however long it takes somebody to make that initial adjustment — there’s no looking back.”

If buying a standup desk isn’t on your to-do-list, Bonnie Berkowitz and Patterson Clark from The Washington Post recommend “sitting on something wobbly, stretching the hip flexors, walking during breaks, alternating between sitting and stranding, and trying yoga poses.”

Open comment period begins today for Gov. Matt Bevin's Medicaid request to feds for Medicaid waiver; ends Oct. 8

By Melissa Patrick
Kentucky Health News

Kentuckians have 30 days to let the federal government know what it thinks about Gov. Matt Bevin's new Medicaid plan, starting today and ending at 11 p.m. Oct. 8.

Gov. Matt Bevin

“We look forward to the public input that will be received over the next 30 days,” the Republican governor said in a news release. He said the plan “will allow us to provide Medicaid coverage that ensures better health outcomes for Kentuckians in a fiscally responsible manner. Without it, there will be no expanded Medicaid in Kentucky, so we look forward to working with CMS to ensure this coverage continues.”

CMS is the Centers for Medicare and Medicaid Services. The plan is called Kentucky HEALTH, standing for Helping to Engage and Achieve Long-Term Health. It seeks a waiver from federal Medicaid rules, under a law allowing five-year demonstration programs.

Bevin continues to say that if this waiver is not approved, the state will no longer provide Medicaid coverage to the 430,000 Kentuckians who now qualify for the program under his Democratic predecessor's expansion of Medicaid under federal health reform to those who earn up to 138 percent of the federal poverty level.

But when Kentucky Health News asked him in August if he was willing to negotiate with Health and Human Services Secretary Sylvia Burwell, he said, "Absolutely. That's where we are in the process."

Burwell has indicated that the process could easily continue until after the November election, in which Republicans hope to take control of the state House and the White House. She told former Gov. Steve Beshear in a July 21 letter, "Medicaid waivers in other states have often taken between six to 12 months to negotiate."

The Bevin administration submitted the formal Medicaid plan to Burwell Aug. 24. In a statement, the Department of Health and Human Services said that opening the federal comment period only signifies the completeness of the application for an 1115 Medicaid expansion waiver.

“Application completeness is an early step in the waiver review process, and simply means that the waiver contains sufficient information to evaluate it," HHS Press Secretary Marjorie Connolly said in the statement. "After the comment period and review and consideration of public input, the waiver process usually involves significant additional dialogue between HHS and states."

The most controversial parts of the plan include requiring premiums to those with incomes below the poverty level that could prevent access to care and the work requirements for able-bodied adults who aren't primary caregivers, both conditions that Burwell has said she would not approve.

"We are prepared to continue working for as long as it takes to find a solution that builds on the historic progress Kentucky has made under Medicaid expansion and avoids moving backwards," Connolly said.

The proposal mainly targets able-bodied adults who qualify for Medicaid under the expansion and is designed to encourage participants to have a higher level of involvement in their health care. It does not affect children, pregnant women, the medically frail and adults who were eligible for Medicaid before the expansion.

Bevin has said that the state cannot afford to have 1.32 million people, nearly 30 percent of the state's population, on Medicaid.

The proposal says it "is expected to save taxpayers $2.2 billion over the five-year waiver period," by reducing enrollment in the program, but only $331 million of that would be state tax money, because the federal government covers the bulk of Medicaid costs.

The federal government is paying the full cost of the expanded Medicaid population through this year. Next year the state will be responsible for 5 percent, rising in annual steps to the federal health-reform law's limit of 10 percent in 2020. The state pays about 30 percent of the cost of traditional Medicaid participants.

Click here and follow the prompts to submit your comments. Click here to see the full report.

Kentucky's first Health Hack-A-Thon, via SOAR, will brainstorm to find solutions to Eastern Kentucky's health challenges

By Melissa Patrick
Kentucky Health News

Registration is now open for the Appalachian Health Hack-A-Thon, an action-oriented event designed to create new solutions to the health challenges in Eastern Kentucky.

"A Hack-A-Thon is an event in which people with different backgrounds and expertise form teams, collaborate within a limited time frame, and focus on a specific problem or idea in health care to come up with innovative, disruptive ideas and solutions," says the website. "By bringing together diverse minds alike in their interest for solving healthcare’s biggest challenges, problems can be diagnosed from multiple different perspectives."

The event will be held Thursday through Saturday, Oct. 6-8 at the Center for Rural Development in Somerset.

Thursday's events include a series of "high-energy presentations" and is the only day that is open to the public.

Keynote speakers at the event include U.S. Rep. Hal Rogers of Somerset, chair of the House Appropriations Committee; Dr. Nora D. Volkow, director of the National Institute on Drug Abuse; and Dr. Douglas R. Lowy, acting director of the National Cancer Institute.

Teams will be formed on Friday after all of the problems have been pitched. These teams will be charged to create and develop innovative solutions to health problems in the region, with a focus on substance abuse, obesity and diabetes.

The teams will present their ideas on Saturday and a judge will the select winners, who will be recognized with prize money and special recognition.

The event needs both participants and mentors to apply. The website notes that eligible participants include: medical professionals, engineers, designers, business people, entrepreneurs, and students. While the event is free to participants, you must apply and be accepted to attend.

The website also describes specific attributes it is looking for in those who apply to be mentors, including someone who is "engaging and helpful, avoids tearing down teams ideas in a destructive way, and instead directs conversations in a constructive way."

The event is sponsored by Shaping Our Appalachian Region and MIT Hacking Medicine. Click here for more information or call Jenna Meyer at 606-766-1160.

Almost half of Ky. counties will have only one insurer to choose from on government exchange; open enrollment begins Nov. 1

Base chart from Insider Louisville

Anthem Health Plans of Kentucky will be the only health insurer offering coverage for next year to Kentuckians on the government exchange in 54 counties. That is a sharp decrease from last year, when Kentuckians in all counties had at least two insurers, and most had three.

"The diminishing competition on health-care exchanges is not a local issue—it’s a national one," Jean West, communications director for the state Cabinet for Health and Family Services, said in an e-mail. "As has been widely reported, insurers across the country have been losing hundreds of millions of dollars in the Obamacare exchanges and can no longer sustain such heavy financial losses. Insurers are left with the choice of increasing rates, reducing benefits or pulling out of the exchange markets altogether."

USA Today reports that "up to 2.1 million people nationwide will likely have to change plans for 2017 due to insurers leaving states' [Patient Protection and] Affordable Care Act marketplaces, up from more than 1.2 million who had to find new insurers last year."

West noted that the failure of the Kentucky Health Cooperative has added further burden to the remaining insurers on the exchange. Prior to its demise in 2015, the cooperative sold 75 percent of the policies on the state's health exchange, attracting many of the state's unhealthiest people. These clients have since had to find new insurers who now must assume their risk.

"While CHFS and the Department of Insurance will continue to work with insurance providers to increase their offerings, any such efforts will continue to be handcuffed by market forces created under Obamacare," West said.

Screenshot of part of The Wall Street Journal's interactive map of
exchange insurers. Light blue counties have one, medium blue two
and dark blue three or more. Click here for the map and county data.

Anthem is the only company offering statewide coverage on the exchange in 2017. Baptist Health, CareSource and Humana Health Plan will offer exchange plans in specific areas only.

In 2017, Baptist Health will offer exchange plans in 20 counties, up from 18 in 2016; CareSource will offer plans in 61 counties, up from 46 in 2016; and Humana will decrease the number of counties it serves to nine, down from 15 in 2016.

West confirmed that Kentuckians who sign up for health insurance through the exchange will enroll on Healthcare.gov this year, instead of Kynect, the state's health insurance exchange. Open enrollment begins Nov. 1 and goes through Jan. 31.

United HealthCare, WellCare, and Aetna, which offered plans on the exchange in 2016, will not offer any state exchange plans in 2017. United will continue to offer small group plans outside the exchange and Aetna will continue to offer plans off the exchange, which means they will not be eligible for federal tax subsidies.

United, which offered plans in all 120 counties in 2016, announced in April that it would no longer participate in Kentucky's exchange, citing unsustainable losses. A Kaiser Family Foundation analysis said that the effects of United's departure would be "modest" in states where it did not offer low-cost "silver" plans. United did not offer such plans in Kentucky, where 60 percent of those who signed up through the exchange chose a silver plan in 2016.

Aetna withdrew from Kentucky's exchange in August, also citing unsustainable losses. Its withdrawal affects 10 counties in three major metropolitan areas: Boone, Campbell, Kenton, Fayette, Madison, Jefferson, Oldham, Trimble, Henry and Owen counties.

WellCare's withdrawal from the exchange will affect 12 counties: Boone, Bullitt, Campbell, Clay, Fayette, Harlan, Jefferson, Jessamine, Kenton, Laurel, Leslie and Warren counties.

USA Today notes, "Insurers need healthy people to buy insurance to offset the cost of covering the sicker ones," but current premiums are too high for many healthy consumers to afford, especially if they don't qualify for a subsidy.

Insider Louisville reports that Kevin Lucia, a senior research fellow and project director at the Center on Health Insurance Reforms at Georgetown University’s Health Policy Institute, said that before Obamacare "insurers made money by discriminating against sick people. Now, insurers have to make money with a diverse pool of customers, including some with very high risks for health services, and some are still figuring out how to properly price their policies."

“It’s a totally different situation,” Lucia said. “We are just at the beginning” of health reform, he said. “This is a marathon.”

Teacher learns food literacy is more than teaching about healthy food; it's also about geographic and socioeconomic challenges

Cooking Club, part of Fern Creek's Food
Literacy class (Photo by Joe Franzen)

A "food literacy" class that began as a way to teach high-school students to eat healthier has turned into a social-justice exploration through the shared language of food preparation and eating, Joe Franzen writes in a "Classroom Connection" piece for The Courier-Journal.

Franzen, a food and sustainability educator at Fern Creek High School in Jefferson County, said he showed up to his first food-literacy class at FCHS with plans to teach about "healthy" foods, new and improved cooking techniques and how to grow a garden.

"My students balked," he wrote, saying they pushed back on his curriculum with real-world issues that screamed of the geographic and socioeconomic realities that often segregate people into those who can afford to eat "healthy" and have access to fresh, healthy foods and those who can't and don't.

"They complained of not having the tools to cook at home or the ability to purchase ingredients on a budget.They explained how apartments don’t have yards to dig up.They talked about how junk food tastes good," he wrote.

So Franzen said he shifted the focus of the class, realizing that it would have to deal with the "dynamic realities" of his students.

Franzen noted that one of the first changes he implemented was to ask his students: "What is your food reality? What is your definition of 'good' food? What are the recipes that your family values? What are the boundaries that you face in eating well?"

Which, he said, led to "student-written food narratives, lessons in food discourse and debate, class cookbooks, 30-student potlucks, and conversations about what people deserve, what is just and right -- all while using our city as a classroom, textbook, and laboratory to explore and critically engage."

And all of this led to "talking about socioeconomic status, income inequality, privilege, race, religion, gender, and ethnicity," he wrote. "All I started out wanting to do was teach a couple of recipes, encourage less soda consumption, and show how to put a plant in a hole."

Franzen said he was "glad that students sent back the first version of 'food literacy' and that the new curriculum now formally "looks like Food Lit., a food-themed pre-AP English course, Cooking Club, Food Sociology, Global Issues, and Environmental Club."

"Through this process, I realized what good teaching should be: responding to the needs and curiosities of the students to help them critically engage and question the world in a way that allows them to improve themselves and the community around them," he wrote.

In conclusion, Franzen challenged all of us to find common ground around the table, to build a relationship over sharing a meal, and "to engage the world around us in a meaningful, sustaining, and compassionate way," and to come back for seconds.

He wrote: Food literacy "isn’t just about eating “healthy” or learning to cook, it is about building community and building resiliency within ourselves and together during such divisive times."

Kentucky is one of only 2 states where adult obesity rose last year; now we're fifth in the nation; state diabetes rate highest ever

By Melissa Patrick
Kentucky Health News

We're fat, and getting fatter. And that's making us sicker.

More than one-third of Kentucky adults are obese, placing the state fifth in the country in obesity, a big jump from 12th the year before. Kentucky was one of only two states where obesity rates increased from 2014 to 2015, according to the latest State of Obesity report.

Graphics are from the State of Obesity report

Kentucky's adult obesity rate increased to 34.6 percent in 2015, up from 31.6 percent in 2014. In 1990, only 12.7 percent of Kentucky adults were obese. Get the adult obesity rate in your county at KentuckyHealthFacts.org.

“Obesity remains one of the most significant epidemics our country has faced, contributing to millions of preventable illnesses and billions of dollars in avoidable health care costs,” Richard Hamburg, interim president and CEO for Trust for America's Health, said in a news release.


"Obesity continued to put millions of Americans at increased risk for a range of chronic diseases, such as diabetes and heart disease, and costs the country between $147 billion and $210 billion each year," says the release.

The report, "The State of Obesity: Better Policies for a Healthier America," is conducted by Trust for America's Health and the Robert Wood Johnson Foundation and is based on data from the federal Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System, a continuous national poll.

Most obese Kentuckians fall between the ages of 26 and 64, with 36.8 percent of those aged 26-44 obese and 40.5 percent of those aged 45 to 64 obese, says the report.

The report found that black Kentucky adults were the most likely to be obese, at almost 43 percent, followed by whites (32.9 percent) and Latinos (24.3 percent). There was little difference between men and women.

The report also measured obesity-related health issues, such as diabetes and high blood pressure.

Kentucky's reported diabetes rate is at its highest ever, 13.4 percent, which places it fourth in the nation. This is up from 12.5 percent in 2014 and 10.6 percent in 2013. The report projects that almost 600,000 Kentuckians will have diabetes in 2030.

"Diabetes is the seventh leading cause of death in the United States, accounting for around $245 billion in medical costs and lost productivity each year," says the report.

The state's high-blood-pressure rate, at 39 percent, is about the same as the year before. The state ranks sixth in this measure. The report projects that 1,175,750 Kentuckians will have high blood pressure in 2030.

"Approximately 30 percent of hypertension cases may be attributable to obesity, and the figure may be as high as 60 percent in men under age 45," the report says. "People who are overweight are more likely to have high blood pressure, high levels of blood fats and high LDL (bad cholesterol), which are all risk factors for heart disease and stroke."

The report also updated high-school obesity rates and found that Kentucky's 18.5 percent was about the same as the last time such data were gathered in 2013. But because some other states' rates went up, Kentucky no longer ranks first in the nation. We're third.

The report notes that Kentucky adults fall into the top 10 states for the highest rates of physical inactivity (32.5 percent); states with the highest rates of obese 10- to 17-year olds (19.7 percent); and states with the highest rates of obesity among 2- to 4-year-olds (15.5 percent).

Kansas and Kentucky were the only two states to see obesity increases in 2015. Most remained steady, and four states saw a drop: Minnesota, Montana, New York and Ohio.

Nine of the 11 most obese states are in the South, and 22 of the top 25 are in the South and Midwest. Louisiana has the highest obesity rate, 36.2 percent.

More than half the states have obesity rates at or above 30 percent, with four above 35 percent. Obesity rates are above 20 percent in every state; in 1991, no state had a rate above 20 percent.

The authors outline a set of policy recommendations to combat obesity, including: investment in obesity prevention; focusing on early-childhood and school-based policies and programs that support healthier meals, physical activity and less screen time; prioritizing active transportation planning and access to healthy foods in communities; and covering a full range of obesity prevention, treatment and management services under all public and private health plans.

“These new data suggest that we are making some progress but there’s more yet to do. Across the country, we need to fully adopt the high-impact strategies recommended by numerous experts," Hamburg said. "Improving nutrition and increasing activity in early childhood, making healthy choices easier in people’s daily lives and targeting the startling inequities are all key approaches we need to ramp up."

CDC doesn't deliver on reported promise to probe health effects of surface coal mining, but other federal agencies are tackling it

When Shaping Our Appalachian Region was formed to help improve and diversify the economy of Appalachian Kentucky, one of the 10 working groups on issues was about health, which is not good in the region.

As the working group held 16 meetings around the region, it heard repeated concerns about the health impacts of surface coal mining, which has evolved from small contour-strip mines around hillsides to huge mines that take the tops off of mountains.

At every meeting, someone brought up the West Virginia University research that showed a correlation between poor health and surface mining, such as increased rates of cancer and birth defects, according to Dr. Nikki Stone, a University of Kentucky dentist in Hazard.

Dr. Nikki Stone (Photo by Mimi Pickering, Appalshop)

“It was something that people were afraid to talk about, but it came up over and over, and it ended up at the top of our list,” along with a coordinated health program in schools, Stone told Benny Becker of West Virginia Public Broadcasting. "In its final report, the working group advised that SOAR should ask a federal agency for help studying the issue," Becker notes.

But when SOAR published the working groups' ideas a few weeks later, it listed only the "shortest-term recommendations" and did not include the mining study. At the health session of SOAR's "Strategy Summit" in May 2015, Dee Davis of the Whitesburg-based Center for Rural Strategies asked the moderator/presenter, Jennifer "Jenna" Seymour of the federal Centers for Disease Control and Prevention, what if anything was being done about the recommendation. Seymour replied that she wasn't aware of it. But when questioned about it, she said that she had heard about it.

Davis told Becker that CDC Director Thomas Frieden told the working group when it presented its recommendations that if they made a request the CDC would investigate. "Davis said that as far as he knows, that was the last time anybody from the CDC acknowledged the request. The CDC recently confirmed that the agency is not engaged in any such research," Becker reports. "It’s not clear where exactly things got stalled, but SOAR Executive Director Jared Arnett said there’s a reason why the group tends to steer clear of environmental issues."

“It’s about uniting, and a lot of things that may not be a part of SOAR that people want to be a part of SOAR are very divisive,” Arnett told Becker. He said earlier that the group would focus its health efforts on substance abuse, obesity and diabetes.

Davis told Becker, “If we want our talent to be part of what turns our region around, then it’s not really going to help us to sweep big questions about cancer and birth defects under the rug. . . . It’s about building an economy in a place,” Davis said, “and part of that is making sure that our communities are places people want to live.”

But while CDC hasn't acted, two other federal agencies have. At the request of the state of West Virginia, the federal Office of Surface Mining Reclamation and Enforcement gave the National Academy of Sciences $1 million to examine existing research, primarily done by Indiana University's Michael Hendryx when he was at West Virginia University. "Another study, from the National Institute of Environmental Health Sciences, was announced last year, and has already produced a draft," Becker reports. "NIEHS Director Linda Birnbaum recently visited eastern Kentucky and said she expects that study will be released within the year."

New health chief says drug crisis takes up most of his time; wants to guide kids to make better choices about tobacco, drugs, alcohol

Dr. Hiram Polk

By Melissa Patrick
Kentucky Health News

One of new Public Health Commissioner Hiram Polk's top priorities is to create an early-childhood education program to help Kentucky's children become healthy, drug-free adults. But when it comes to smoking bans, not so much.

"I have been on this job for eight to 10 weeks, and I've spent more effort on the drug thing than I have on anything else," he said. "The big-picture issue is to take a long-term look at tobacco, drug and alcohol use and find a way through education to make kids more likely to be immune to that when they grow up."

Health Secretary Vickie Yates Brown Glisson appointed Polk, 80, of Louisville, after searching for months for a doctor who would take the job. State law requires the commissioner to be a medical doctor.

Polk said he first declined the position, but changed his mind, then told Glisson he would stay only through the 2017 legislative session. However, he said he has since hired a driver, and that this "crucial" decision could very well influence his decision to stay longer.

"What has turned out is that this is a wonderful job," he said.

His stance on some issues

Polk said that one of the first things he would like to accomplish as health commissioner is to create an education program to teach young children how to live healthy, drug-free lives, and then find a way to set up and fund a foundation to research the outcomes of the program in 10 to 20 years.

"If there is a secret to drug, tobacco and alcohol addiction, it is through very early childhood education. I believe that," he said.

When asked if he would be willing to promote a statewide smoking ban, which Gov. Matt Bevin opposes, he said he probably wouldn't.

"I would be willing," he said, "but it doesn't have anything like the emotional appeal of some of these other things, like the drug addiction does."

Also, "I have an idea about drug addiction, but I don't have an idea of how to do better with tobacco," Polk said. "If somebody walked in here with a good idea, I'd listen and probably try to implement it, but I just don't see that happening."

Smoke-free advocates would likely say they have already offered up a "good idea" to decrease the smoking rate in the state, improve the health of the state's citizens and save the state an enormous amount of money: a statewide ban on smoking in workplaces.

To this suggestion, Polk reflected on the difficulties in enforcing such a ban, noting that while government property and buildings are now smoke-free in the state, smokers still stand outside.

"I'm not saying it's not important," he said. "I think it's important. It's vitally important, but there are an awful lot of smart people who have taken a run at that and have failed and I might not try it."

Kentucky's smoking rate is 26 percent, second highest in the nation. The national rate is 18 percent. A recent study said that if the state could cut its rate to the national one, it would save an estimated $1.7 billion on health care the following year. Smoking bans and smoke-free policies have been proven to decrease the smoking rate and to protect workers from secondhand smoke. The latest Kentucky Health Issues Poll found that 66 percent of Kentucky adults favor a statewide smoking ban.

When asked if his department would support local health departments in efforts to get local governments to pass smoking bans, he shifted the conversation and said his first priority for local health departments is to re-establish a positive working relationship with them. He said he has recommended the hiring of a new deputy commissioner to work solely on this effort.

"I want to make those local health departments feel like they are connected to us, that we are their friends and they can call on us anytime, any place for help," he said.

As for mandating the human papilloma virus vaccination, which has been proven to prevent cervical cancer and genital warts, Polk said he supports Gov. Matt Bevin's stance on minimizing mandates.

"I would try to find every way you can to softly encourage the uniform use of that vaccine," he said. "But I wouldn't start requiring something."

Polk noted that he was very much aware of the state's rural health issues, having started the first rural surgical education program in America in 1972. But he also said he was surprised by the number of disparities that still exist in Eastern Kentucky.

"I'm surprised by how really under-served and deprived some of the things in Appalachia still are," he said. "I thought all of these Appalachian programs by now would have had some success, but they are still behind the curve on virtually everything . . . poverty, lack of education, misconduct. It is terrible. There are some problems that aren't going to be easily solved."

A new line of work

Polk praised the abilities and the passion of those who work in the Cabinet for Health and Family Services several times during the interview, suggesting they made his job easier.

"I am absolutely amazed at the quality of people who work in the trenches.They are the most altruistic, unselfish people I have ever seen," he said. Later adding, "The quality of the people and their commitment to the organization, their belief in what they are doing is fairly amazing."

Polk is an internationally renowned surgeon, but has little background in public health. He described himself as having "always been pretty busy."

He is a graduate of Harvard Medical School and was chairman and professor of surgery at the University of Louisville from 1971 to 2005, where he trained more than 330 surgical residents and started one of the world's first hand-transplant programs. He remains a professor emeritus and the surgery department is named for him.

Polk is widely published. He served as editor-in-chief of the American Journal of Surgery for 16 years and was chair of the accrediting body for Surgery in America for seven. He has served as Kentucky chair of the American Cancer Society and serves as a director of the Biomedical Research Foundation, which funds research on veterans' health. He is a director of the Thoroughbred Owners and Breeders Association and a steward of The Jockey Club.

Attorney general, stiffed again by UK's refusal to let it examine heart-clinic records, says university violated Open Records Act

Attorney General Andy Beshear has ruled that the University of Kentucky violated the state Open Records Act by not giving the Lexington Herald-Leader records about a Hazard heart clinic that proved to be a financial debacle.

"The Herald-Leader asked UK for a copy of a presentation made May 2 to the UK Board of Trustees by lawyer David Douglass regarding the Appalachian Heart Center in Hazard," the newspaper's John Cheves reports. "The newspaper also asked for records showing money paid to Douglass’ law firm and for copies of audits of the cardiology practice, which separated from UK after questions were raised about its billing."

UK gave the paper on a few documents, "citing five separate legal exemptions under the records law, including executive privilege, attorney-client privilege and the confidentiality required by the federal Health Insurance Portability and Accountability Act," Cheves writes. The paper appealed to Beshear's office, which asked to examine the records in camera, or confidentially, but the university refused, as it has in a string of cases.

“Given that UK refused to provide any of the disputed records for in camera review, we can only find that UK failed to meet its burden to establish any of its claims of exemptions,” Assistant Attorney General James wrote in his decision, signed by Beshear and issued Wednesday. “We are not prepared to accept, without independent confirmation, that all of the responsive documents are shielded from public inspection.”

James dismissed all the exemptions cited by UK. "Regarding the patient confidentiality required by HIPAA, James said, UK can redact identifying information about patients from documents that contain them, but it cannot use that law to justify withholding all records related to a medical facility," Cheves reports.

Attorney general's opinions in open-records matters are decisions that have the force of law unless overturned by a court. UK seems likely to do so in this case; it has more than one such lawsuit pending.

10 Ky. health departments nationally accredited, 30 in pipeline

By Melissa Patrick
Kentucky Health News

Ten Kentucky health departments are now nationally accredited, with about 30 more in the pipeline, placing Kentucky third in the country for the number of health departments to have earned this status.

The Public Health Accreditation Board accredited Louisville Metro Public Health and Wellness on Aug. 17, making it the 10th in the state.

What does it means for a health department to be accredited? "It means that it is one of the finest health departments in the nation, and that it can assure its citizens that it has the capacity to meet any of the public health problems that that community might address," said PHAB Chair Dr. Douglas Scutchfield, the Peter Bosomworth Professor of Health Services Research and Policy at the University of Kentucky.

Kentucky has led the way in getting its health departments accredited. In 2013, Franklin County Health Department in Frankfort, Three Rivers District Health Department in Owenton and the Northern Kentucky Independent District Health Department were among the first 11 health departments in the nation to be accredited.

Since then, the Barren River District Health Department in Bowling Green, Bullitt County Health Department in Shepherdsville, Christian County Health Department in Hopkinsville, Green River District Health Department in Owensboro, Madison County Health Department in Richmond and the Lexington-Fayette County Health Department have been added.

Health departments are accredited for five years, and must re-apply for accreditation.

New state Health Commissioner Hiram Polk, who served seven years as the chair of the accrediting body for Surgery of America, emphasized the importance of accreditation, saying he plans to make sure the state Department for Public Health is accredited during his tenure, and encouraged all of Kentucky's local health departments to do the same.

"The accreditation process is hugely valuable," he said in an interview. "The process makes you better."

Scott Lockard, director of the Clark County Health Department, which plans to apply for its accreditation in January, agreed.

"We have already benefited from the process of preparing for accreditation," he said, because the process has created a "culture of quality improvement" in his organization. He said that because of the application process, which requires a community health assessment, his department now looks at programs based on what the community needs and the expected outcomes, instead of simply whether the funding is available to provide a service.

"Accreditation assures the public that there is a base level of professionalism that they can expect," Lockard said. "[And] feel confident that the health department in their community is serving them with high quality programs."

Scutchfield said engaging community partners in the community health assessment and community health improvement plan, which are both early accreditation requirements, often re-establishes relationships in the community that have been lost.

"Frequently people are unaware of the capacity and the activities of their local health department," he said. By engaging them in the process, it allows the health department to collaborate with others, like local hospitals, non-profits, fire-departments and schools, to help them with their missions, he said.

Scutchfield also noted that becoming accredited improves a health departments performance, governance and management systems, promotes quality improvements, helps departments better identify strengths and weaknesses, and helps boards and departments better provide their required 10 essential public health services. It also assures that certain plans and programs are in place to respond to both emergent and non-emergent situations.

"It provides credibility and accountability to the community. The community knows and can believe that its health department has met the rigorous standards of now some 150 health departments, out of the 2,600 in the United States," he said. "This is an important thing for health departments to do."

State health officials warn of looming 'public health crisis from dangerous drugs,' including heroin laced with potent Fentanyl

Kentucky health officials are warning that a "public health crisis involving dangerous drugs" looms over the state, and could hit this weekend, the Department for Public Health said in a press release.

“There is a public health crisis brewing – much like a tornado forming – with a new supply of heroin and other drugs coming into this area,” said Dr. Hiram Polk, the state health commissioner. “This is a serious public health threat tied to a number of overdoses, hospitalizations and deaths across the county and needs public attention now.”

Polk said officials expect a rise in recreational drug use on the Labor Day weekend, so they felt a warning was needed. “Recent law-enforcement reports cite a new supply of heroin laced with the drug Fentanyl coming into the state – especially Louisville,” Polk said. “These drugs are much more toxic and can cause respiratory failure and death. Over the coming days, DPH is asking hospitals and facilities to prepare for increases in drug overdoses so that individuals can be properly treated, deaths prevented and we are better informed about the prevalence and nature of these occurrences.”

The state is asking hospitals to expand emergency-room and intensive-care staff, have pharmacies stock up on Naloxone, the “antidote” to heroin and other drug overdoses. to assist patients who may need long term drug treatment.

“It can take as much as three times the amount of Naloxone to reverse a given overdose with these mixed drugs as it would normally,” Polk said.

Assistance is available by calling the health department at 1-888-9REPORT (973-7678) or the Kentucky Emergency Management System at (502) 607-1638 or 800-255-2587. “Many of these services are available 24 hours a day,” Polk said.