First day of open enrollment on federal health-insurance exchange got off to a rough start for some Kentuckians

The first day of open enrollment to sign up for health insurance on the federal health exchange, Nov. 1, got off to a rough start for some Kentuckians.

Sharon Bush, an application assister, told Lisa Gillespie of Louisville's WFPL that she had spent half an hour helping her 60-year-old client sign up for an e-mail account, which is required on HealthCare.gov if you don't want to call the federal help center to sign up. Then they spent another 45 minutes waiting because the website was down, before finally giving up and rescheduling for the following week.

“In southeastern Kentucky, there are a lot of people who don’t have and/or use technology,” Bush said, noting that it took longer to sign up for the e-mail account than she realized it would.

Bush works at Grace Community Health Center in Manchester. She’s a former Kynector, a person who helped people sign up for health care on Kynect, the state-based exchange, which has been dismantled. She is now trained an application assister for the federal exchange, HealthCare.gov.

Susie McConkey, vice president of business development for agent services at AgentLink, a company that acts as a go-between for insurance brokers and clients, told Gillespie that she had run into similar problems in Louisville. The agency will likely enroll 10,000 people before open enrollment ends Jan. 31, 2017, Gillespie reports.

More than 100,000 Kentuckians had signed up for health insurance on Kynect and must now re-enroll on HealthCare.gov because none of the enrollment information from Kynect was transferred.

McConkey said she was concerned some brokers might become frustrated and give up using the site.

“We anticipate, even though this is day one, some people are going to try and give up,” she said. “And the more difficulties, if the Healthcare.gov is down more, we need to be in a position to help them.”

Another challenge is that brokers and application assisters can no longer get into the system to enroll their clients as they could on Kynect. Instead, consumers have to do it themselves, or brokers can use purchased software that interfaces with HealthCare.gov that allows them to enroll people -- but the software is expensive, Gillespie reports.

McConkey also told Gillespie that limited doctor networks in insurance plans are also a big issue for people trying to enroll.

Residents in 59 of the state's 120 counties will have only one health insurance option this year, Anthem Health Plans of Kentucky. And many of its plans are health maintenance organization plans, which only pay for doctors in the network, Gillespie reports.

“The big issue is that you’re not covered outside the network," McConkey said. “In a PPO [preferred provider organization], you can go outside the network and it might cost more. The only thing offered in Jefferson County is an HMO,” or health maintenance organization, which generally doesn't pay for care outside its network of providers.

Open enrollment runs through through Jan. 31. For coverage starting Jan. 1, 2017, consumers must sign up by Dec. 15, 2016.

Noted heart surgeon found guilty of health care fraud; exaggerated patient conditions to get Medicare payments

UPDATE, July 11, 2018: A federal appeals court reinstated the conviction but left open the possibility of a new trial, Bill Estep reports for the Lexington Herald-Leader. (Earlier update: Judge Bunning overturned the conviction and the government appealed his ruling, Mike James reports for The Independent.)

Dr. Richard Paulus
(Ashland Independent photo)

In the latest judgment of health-care fraud in Kentucky, a well-respected cardiologist in Ashland was found guilty last week of performing unnecessary heart procedures on patients. From 2006 to 2012, Dr. Richard E. Paulus at King's Daughters Medical Center billed Medicare "for more heart procedures than any other cardiologist in Kentucky and was fifth in the nation in the amount paid by Medicare for stent procedures," Andrew Wolfson reports for The Courier-Journal.

"Attorneys for Paulus have asked U.S. District Judge David L. Bunning to acquit Paulus, arguing that, at most, the evidence showed only honest mistakes or disagreements among cardiologists," Rachel Adkins reports for The Independent of Ashland. If Bunning refuses, Paulus lawyer Robert Bennett of Washington, D.C., said they will appeal.

A Covington jury convicted Paulus "after a seven-week trial and four days of deliberations . . . of performing numerous invasive heart procedures on patients who did not need them from 2008 to 2013, and to justify the procedures, falsifying their medical records to exaggerate their medical condition so he could qualify for government payments," Wolfson writes. "Ten cardiologists testified on behalf of the United States, and Paulus was convicted on 11 counts and acquitted on five counts."

Paulus, for whom the hospital's vascular center is named, is the third Kentucky cardiologist to be convicted of health-care fraud. Published reports say he earned $2.6 million in 2011 alone. He was specifically convicted for placing unnecessary coronary stents and performing unnecessary diagnostic catheterizations in patients, Wolfson writes, noting that stents "can save lives of heart-attack victims, but their use in stable patients has been disputed by medical researchers."

Hospital vascular center named for Paulus (Independent photo)

Paulus retired last summer. The hospital said in a statement: "Since the beginning, King’s Daughters has stood behind our cardiac program. Our heart program has continued to meet or exceed national performance standards. Independent experts have been reviewing our cases and agree that the heart care we provide is excellent."

In 2014 King's Daughters agreed to pay the federal government $40.9 million to settle civil allegations that it made millions of dollars by falsely billing federal health programs for performing heart procedures on patients who did not need them, Wolfson notes. He also recounts other recent health-care fraud cases.

Paulus faces a maximum of 20 years for health care fraud and up to five years for making false statements. His sentencing is scheduled for April 25. About 100 people attended a Sunday prayer service for Paulus, Adkins reports.

Opioid epidemic has increased number of grandparents raising grandchildren; 21 percent in U.S. are in poverty

An increasing number of grandparents are raising their grandchildren, largely because many of the children's parents are addicted to heroin or prescription drugs, both increasing problems in rural areas, Teresa Wiltz reports for Stateline. In 2015, 2.9 million kids were living with their grandparents, up from 2.5 million in 2005.

"Child welfare officials say drug addiction, especially to opioids, is behind much of the rise in the number of grandparents raising their grandchildren, just as it was during the crack cocaine epidemic of the 1980s and ’90s," Wiltz writes. That has led to a growing number of children being neglected or abandoned and for caseworkers to turn to grandparents for help, largely because the foster care system is already overcrowded with children of addicts.

"Federal law requires that states consider placing children with relatives in order to receive foster care and adoption assistance," Wiltz writes. "And grandmothers and grandfathers often are the first—and best—choice when state and local caseworkers have to take a child out of a home and find someone else to take custody, said Angela Sausser, executive director of the Public Children Services Association of Ohio, a coalition of public child-safety agencies in the state."

Generations United, a group that works to improve the lives of youth and older adults, says that grandparents and other relatives raising children save taxpayers $4 billion each year by keeping the children out of the foster care system, Wiltz reports. But some of those grandparents might not be equipped to handle raising a child. Generations United says that 21 percent of grandparents caring for grandchildren live below the poverty line, 39 percent are over 60 and 26 percent have a disability. "And because many are not licensed in the system, they are not eligible for the same services and financial support as licensed foster parents." (Read more)

Nationally, poisonings of youth from opioids rose 165% from 1997 to 2012, 205% among those aged 1 to 4

More than 13,000 Americans age 19 and under were hospitalized for opioid poisonings from 1997 to 2012, says a study at the Yale School of Medicine, published in JAMA Pediatrics. The incident rate rose from 1.4 per 100,000 people in 1997 to 3.7 per 100,000 in 2012, an increase of 165 percent. The study found that 176 of the victims died during hospitalization. (Yale graphic: Hospitalizations for opioid poisonings for people under 20 from 1997-2012)

The study, which analyzed U.S. pediatric hospital discharge records every three years from Jan. 1, 1997, through Dec. 31, 2012, found 13,052 instances of opioid poisoning for people between the ages of 1 to 19. Hospitalization rates were highest in older adolescents 15 to 19—they increased from 3.69 per 100,000 to 10.17 per 100,000—but the largest increase was among toddlers, with incidences among those 1 to 4 years old increasing 205 percent, from 0.86 to 2.62 per 100,000, for a total of 1,531.

Epidemiologist Julie R. Gaither, the study's lead author, said research points to the likelihood that the majority of incidences among those 1 to 4 were accidental, from children getting into drugs prescribed to their parents, Ariana Eunjung Cha reports for The Washington Post. There were few cases of poisonings among those 5 to 9, with researchers saying children at these ages were able to tell the difference between candy and a dangerous drug. But once children hit 10, incident rates began to climb, and are more likely attributed to suicide or self-inflicted injury, Gaither said.

Nonprofit grades hospitals on patient safety; the 52 ranked in Ky. improved slightly, but the state still ranks relatively low

By Traci Thomas
Kentucky Health News

A nonprofit group that rates hospitals released its patient-safety scores Monday, giving most Kentucky hospitals a 'B' or 'C'. The scores are similar to grades released in June, but the state improved its national rating from 40th to 35th.

The Leapfrog Group, a nonprofit group based in Washington, D.C., evaluated 2,633 hospitals nationwide, including 52 in Kentucky. Most of Kentucky's 129 hospitals were not rated because critical-access hospitals in rural areas don’t have to report their quality measures.

The grades are calculated using 30 publicly available safety-performance measures from the Centers for Medicare & Medicaid Services, the Leapfrog Hospital Survey, the Agency for Healthcare Research and Quality, the Centers for Disease Control and Prevention and the American Hospital Association’s Annual Survey.

The calculation gave an A to 12 of Kentucky's hospitals, or 21.3 percent, lower than the national average of 31.3 percent. Eighteen each, or 34.6 percent, earned a B or a C. Four hospitals, or 7.7 percent of those reviewed, got a D. That was down from six (11.5 percent) in the spring.

Three of the four Kentucky hospitals that got a D are in Louisville and owned or operated by KentuckyOne Health: Jewish Hospital, Sts. Mary and Elizabeth Hospital and University of Louisville Hospital. A state inspection of University Hospital this year found that shortcomings in nursing had endangered three patients, and nurses and doctors told inspectors that staff shortages put patients at risk.

The data used for the grades go back as far as July 2013 and are no more recent than June 2015.

"KentuckyOne Health said it has implemented programs and best practices to improve quality and safety across its facilities, including at U of L Hospital, which has been fraught with controversy this year," Darla Carter reports for The Courier-Journal.

Company spokesman David McArthur told the newspaper in a statement: "While these Leapfrog Hospital Safety Grades at some of our facilities may not reflect the culture of quality, safety and service instilled in recent years across KentuckyOne Health, we are confident that the commitment of nurses, physicians and employees at all our facilities will guide our improvement and the delivery of quality care."

The other hospital to get a D was Ephraim McDowell Regional Medical Center in Danville. St. Joseph Hospital and St. Joseph East in Lexington, also owned by KentuckyOne, received Cs this fall after getting Ds in the spring.

Among Leapfrog's top safety picks is Pikeville Medical Center, the only Kentucky hospital to get straight As since the rankings began in 2013. The two University of Kentucky hospitals got Bs after getting Cs last spring.

The grades include separate ratings for errors, injuries, accidents and infections. Click here for Kentucky's hospital safety scores.

The Leapfrog Group says its analysis was developed under the guidance of the nation's leading patient-safety experts. The report is peer-reviewed and published in the Journal of Patient Safety.

“In the fast-changing health care landscape, patients should be aware that hospitals are not all equally competent at protecting them from injuries and infections,” Leapfrog President and CEO Leah Binder said in the report. The group tweeted, "No hospital is perfectly safe."

Friedell Committee hears focus should be on prevention programs, community strategies and community partnerships

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. – Seventy percent of the influence on our health comes from our own behaviors and the environment. So, plans to improve Kentucky's low health status should focus on quality prevention programs, recognizing the importance of community determinants of health, and creating successful community partnerships.

Those were the main arguments from speakers Oct. 25 in Frankfort at the annual meeting of the Friedell Committee for Health, which focused on population health -- defined as "the health outcomes of a group of individuals including the distribution of such outcomes within the group."

Larry Cohen

Larry Cohen, founder and executive director of the Prevention Institute, said we must start demanding quality preventive care, just like we ask for quality health care.

"When people talk about health care, the expectation is for the highest quality, but with prevention we don't always emphasize quality," he said. "We have a lot of tools at our disposal, but they require a different set of strategies, they require a different kind of political will and then they require elements like funding."

Cohen gave several examples of the social and community determinants of health. In Cincinnati, he said, the health department and local hospital tracked asthma rates by location and were able to determine the housing areas that were most affected and the bus routes and truck routes that were causing the most asthma-causing pollutants.

"If we don't change the environment, don't change the norms, we can't change the behavior and the medical conditions are going to be predictable outcomes," Cohen said.

Cohen said genetics influences 20 percent of our health, and health care influences it by 10 percent. Though the environment and our behaviors have a 70 percent influence, but only 3 percent of health resources are spent on prevention.

"In terms of our investment patterns and our prevention strategies, we have a systemic failure in investing in health," he said.

Cohen discussed several new ways to fund preventive health, including collaborative strategies that bring the money saved through prevention programs back to the programs; improved community benefit spending, which is a requirement or non-profit hospitals; and "wellness trusts," which work under the premise that savings from prevention initiatives, like a cigarette tax, is captured and re-invested back into "evidence-informed prevention strategies."

"What we are talking about is a paradigm shift with leadership from Kentucky . . . a different way of working, a different way of thinking, he said.

Community partnerships

Dr. Douglas Scutchfield

Dr. Douglas Scutchfield , the Peter Bosomworth Professor of Health Services Research and Policy at the University of Kentucky, told the group, "There is a paradigm shift. There is a growing realization that controlling the increase in health-care expenditure and improving the health of our nation's population requires major changes in the way we've been doing business."

Scutchfield discussed findings from a study that looked at characteristics of successful relationships between hospitals and health departments.

He said successful partnerships have common threads, including: being built on a basis of trust, with clear, agreed-upon missions and goals that are defined and measurable; having a designated body with a clearly defined charge; and having broad and diversified funding sources.

He said Kentucky has many organizations that have formed successful partnerships with the communities they serve, including Humana and several accredited health departments and their local hospitals.

Patty Dale Tye, a Humana vice-president, said the health-insurance company is working with seven communities, including Louisville, to improve community health by bringing like-minded people together to work on health initiatives specific to their communities, like behavioral health issues, obesity and diabetes and access to healthy foods.

"We can't expect people to be healthy simply by visiting their doctors or using a hospital," she said. "We have to meet them outside of those places, we have to meet them in their communities where they live."

Carrie Conia, accreditation coordinator for the Owensboro-based Green River Health Department, talked about the Green River Regional Health Council, which works to improve access to care, fight obesity and promote healthy lifestyles, offers education about tobacco and substance abuse, and an initiative to help young people make healthy choices.

Lynne Saddler, director of the Northern Kentucky Independent District Health Department, ticked off a long list of its successful community partnerships and said they have worked toward creating an action plan with measurable objectives, like a complete streets project, smoke-free policies, public-housing initiatives and their heroin impact response initiatives.

"Health departments need to change their thinking from controlling and owning the whole process of community health improvement and really think about facilitating and collaborating that," she said.

Judy Mattingly, director of the Franklin County Health Department, pointed out that one of the 10 essential public-health services is mobilizing community partnership. She said partnerships are even more necessary these days because of budget cuts in every aspect of health care, including health departments: "No one agency can do it alone."

State sues failed Kentucky Health Cooperative's former chief executive board and contractors, alleging mismanagement

By Melissa Patrick and Al Cross
Kentucky Health News

The former president and directors of the Kentucky Health Cooperative, created under federal health reform, are facing a lawsuit from the state as liquidator of the failed, not-for-profit health insurer.

“Years of mismanagement by co-op administrators and contractors forced the co-op into liquidation, leaving Kentucky’s citizens and their health-care providers in medically and financially vulnerable positions,” Insurance Commissioner Brian Maynard, liquidator of the cooperative, said in a news release Friday, Oct. 28. “The complaint filed today serves as a step toward justice for the tens of thousands of Kentuckians who have been impacted by the co-op’s failure.”

The suit in Franklin Circuit Court at Frankfort, in the name of deputy liquidator Jeff Gaither, claims gross negligence and breach of contract and fiduciary duties by the co-op’s former contractors and management, including President Janie Miller, Board Chairman Joe Smith and other directors; Beam Partners LLC and its principal, Terry S. Shilling of Atlanta; and CGI Technologies and Solutions.

Janie Miller (Associated Press photo)

The lawsuit says Miller failed to set premiums high enough to keep the co-op solvent, seeks an unspecified amount of damages for her "reckless conduct," and notes that the co-op paid Miller a $50,000 bonus "even as KYHC was losing millions of dollars," and seeks "disgorgement of funds," a legal term for refunding money gained by illegal or unethical actions. Miller was then-Gov. Steve Beshear's first health and family services secretary.

The suit claims CGI failed to provide "adequately trained personnel," did not pay claims timely, overpaid claims and failed to properly process enrollments of policyholders, and should refund the millions of dollars in fees that it collected.

The suit alleges Beam recommended CGI as the co-op's third-party administrator though it lacked adequate experience; recruiting directors without proper backgrounds to oversee a health-insurance company, and failing to "adequately train and orient" them; and failing to "monitor or supervise the performance of the individuals and entities it selected or recommended." It says Shilling was a co-op board member while his company "negotiated a contract under which it was paid hundreds of thousands of dollars."

The suit claims former co-op board chair Joseph E. Smith of Frankfort and other unnamed directors kept premiums "woefully inadequate" though they knew that would make the co-op insolvent, and kept paying bonuses to co-op executives.

It seeks an unspecified amount of damages, including punitive damages, from the directors, Miller and the contractors for their "wanton and reckless conduct," as well as attorneys' fees. The suit was signed by attorney Paul Harnice of the Frankfort office of the Lexington-based firm of Stoll Keenon Ogden.

Kentucky's co-op was established under the Patient Protection and Affordable Care Act to compete with insurance companies and hold down premium costs. It was one of 23 created under the law, but only six remain, according to healthinsurance.org.

Before it closed in October 2015, Kentucky's co-op sold 75 percent of the policies bought through the state health-insurance exchange and covered about 51,000 people through the end of 2015. The co-op said it had attracted business from the sickest population in the state and had to pay more claims than expected.

The co-op said it had turned things around and could have stayed afloat if Congress had provided sufficient "risk corridor" payments to insurers with disproportionately sick policyholders. Republicans inserted limits on those payments in the December 2014 budget deal, and the Obama administration was unable to make up the difference. The co-op, which had a deficit of $50 million in 2014, was expecting a risk-corridor payment of $77 million, but got only $9.7 million.

Click here for a copy of the complaint, with exhibits. Claims made in filing a lawsuit give only one side of a case.

Cost of employer-based health insurance grew more slowly after 2010 reform law, but not for single-person plans in Kentucky

By Melissa Patrick
Kentucky Health News

The growth in premiums and deductibles for employer-based health insurance has slowed since federal health reform was enacted, but workers probably haven't noticed because incomes haven't kept up with the cost of health care, a new study says.

Kentucky Health News graphic, based on data from Commonwealth Fund report

Kentucky families covered through employers spent, on average, 10.4 percent of their incomes on health insurance in 2015, slightly above the national average of 10.1 percent, according to an analysis by The Commonwealth Fund, a New York-based research foundation. In 2006, the national average was 6.4 percent, just under Kentucky's figure a decade earlier, Kentucky's median family income is less than the national average; in 2015, it was $50,000.

"They’re still facing a bigger burden today even though growth has slowed. . . . because wages have remained largely flat over the last few years,” David Radley, co-author of the report, said during a teleconference.

The study looked at about 154 million Americans under 65 who get health insurance through their employers, using data from the Medical Expenditure Panel Survey and the Current Population Survey.

Critics of the law say it has caused higher premiums on employer plans, but Radley said the research shows otherwise. The study found that annual rates of premium growth for single-person plans have slowed in 33 states and the District of Columbia since 2010, compared to earlier years.

But that wasn't so in Kentucky, where single-person premiums grew at a faster rate between 2010-15 than the rest of the nation: 5 percent, compared to 3.8 percent respectively. That put it in the top eight states for increases.

The report also found that after the passage of the law, employee premium contributions for single-person plans grew more slowly in 31 states, including Kentucky.

Again, Kentucky's costs were slightly higher. A single-person premium contribution in Kentucky grew 4.7 percent annually after 2010, compared to 6.4 percent before 2010. The national rates were 4.2 percent and 6.7 percent, respectively.

Family plans and deductibles

Employee premium contributions for family plans after passage of the law grew more slowly in 30 states and the District of Columbia, says the report. In Kentucky, this rate was about the same before and after 2010: 5.5 percent and 5.4 percent, respectively. The national rates were 6.5 percent and 4.8 percent, respectively.

The report also found that average deductible growth in single-person plans slowed in Kentucky and 26 other states since 2010, though deductible growth remained high in 22 states and the District of Columbia. In Kentucky, deductible growth was 7.9 percent since 2010, compared to 12.5 percent before 2010. In 2015, Kentuckians paid an average of $1,543 for their deductibles, compared to $659 in 2006. Click here for the Kentucky data.

The report came as the federal government announced increases averaging close to 25 percent for premiums on its insurance exchange, which serves about 10 million people who don't have employer health coverage. Kentucky's Cabinet for Health and Family Services has said Kentucky's exchange plans are increasing by an average of 20 percent. Most people on the exchange will also get an increase in government subsidies, which will ease the impact.

Sara Collins, lead author of the report, said some exchange premium increases likely stem from the fact that the exchange is a much smaller and newer market than employer-based markets and that they are still working to understand their risk pools.

The Patient Protection and Affordable Care Act has several provisions that affect employer-sponsored coverage, such as requiring larger employers to provide health insurance to full-time employees, allowing parents to cover their children up to age 26, and covering preventive services with no cost-sharing. Early predictions were that these requirements would cause many employers to stop offering health insurance, but they haven't.

"We just have not seen that," Collins said. "There just hasn't been large-scale disruption in the employer group market."

"There has been little change in the number of people with employer-sponsored coverage since the law's passage in 2010," Radley added.

The authors attribute the slowdown in health-insurance premiums and deductibles to the slowdown in health-care costs since the implementation of the reform law. Commonwealth Fund President David Blumenthal said, “It would help if employers designed health plans that help their workers afford timely care. But since employer health insurance costs are driven by overall health-care costs, it is also crucial to implement provider payment reform and quality improvement initiatives that keep health-care costs down while improving patient outcomes.”

Medicaid participants can change their managed-care organization through Dec. 16; there are five to choose from

Kentuckians with Medicaid coverage can switch to a different managed-care organization though Dec. 16. Switching is voluntary and coverage with a newly chosen MCO will start Jan. 1.

Kentuckians can apply for Medicaid benefits at any time during the year through the state Department for Community Based Services. Upon initial enrollment, Medicaid participants must choose a MCO, but have a 90-day window to change for any reason.

After the window closes, Kentucky Medicaid members can change to a new MCO only during the yearly open enrollment period, which started Oct. 24 and runs through Dec. 16. Once a person is enrolled in the new MCO, they have a 90-day window to make a change.

There are a few exceptions to this rule, which fall under "disenrollment for cause," which includes things like poor quality of care, lack of access to services covered under the MCO contract, and lack of specialty providers to deal with the member's health care needs, to name a few. Members must submit a written or oral request for disenrollment to DCBS or the MCO.

Kentucky has five MCOs to choose from: Aetna Better Health of Kentucky, Anthem Blue Cross and Blue Shield Medicaid, Humana-CareSource, Passport Health Plan and WellCare of Kentucky. Click here for more information on each plan. Click here for Medicaid managed-care updates.

The National Committee for Quality Assurance recently rated Passport Health Plan at 4 on a 5-point scale. WellCare was rated 3.5, Aetna, 3; Humana, 2.5; and Anthem, 2. The annual ratings are based on measures of consumer satisfaction, treatment and prevention. Click here for more details on the ratings.

Eligible members can change MCOs by calling 855-446-1245, Monday through Friday from 8 a.m. to 5 p.m. Eastern Time.

Kentucky ranked No. 1 in the percentage of cancer deaths that were related to smoking in 2014

Kentucky has long ranked No. 1 in cancer deaths, and in deaths from lung cancer, so it seems only natural that it rank first in deaths from smoking. It did in a study by the American Cancer Society, published in JAMA Internal Medicine, that ranked every state for percentage of cancer deaths in 2014 that were related to smoking.

In Kentucky, 34 percent of cancer deaths were related to smoking. The other top states were all in the South: Arkansas (33.5 percent), Tennessee (32.9), West Virginia (32.6) and Louisiana (32.6). Then came Alaska (31.4), Missouri (31.3), Alabama (31.3), Oklahoma (31.1) and Nevada (30.9), rounding out the top 10. (Map shows numerical rank and quartile of each state)

The study looked at 12 cancers: acute myeloid leukemia and cancers of the oral cavity and pharynx; esophagus; stomach; colorectum; liver; pancreas; larynx; trachea, lung, and bronchus; cervix uteri; kidney and renal pelvis; and urinary bladder. Among the 167,133 deaths in 2014 from those cancers, 28.6 percent were attributed to smoking.

The study also ranked states by smoking-caused cancer deaths among men (103,609) and women (63,524). Nine of the top 10 states for men and six of the top 10 states for women were in the South. Arkansas led in deaths among men, with 39.5 percent. Utah was the only state under 30 percent, at 21.8. Among women, Kentucky had the highest share, 29 percent. Utah had the lowest, at 11. Only Utah, California and Hawaii were under 20 percent. (Read more)

Feds give UK $19.8 million second-round grant to bring health research into communities in Kentucky and Central Appalachia

By Al Cross and Traci Thomas
Kentucky Health News

A four-year, $19.8 million research grant to the University of Kentucky will bring better health care for people in Kentucky and Central Appalachia, U.S. Sen. Mitch McConnell said at Thursday's announcement of the grant. "It's great news for the entire commonwealth," said McConnell, the Senate majority leader.

The grant is the second multi-year award for UK's Center for Clinical and Translational Science, which was established with another grant in 2011 after years of effort. There are 64 such centers, funded by the National Institutes of Health, which McConnell lobbied for the money. The grants "support innovative solutions to improve the efficiency, quality, and impact of translating scientific discoveries into interventions or applications that improve the health of individuals and communities," a UK news release said.

L-R: CCTS Director Phillip Kern, grant-funded diabetes screener Brittany Martin, U.S. Rep.
Andy Barr, UK Health VP Michael Karpf, President Eli Capilouto, U.S. Sen. Mitch McConnell,
UK Research VP Lisa Cassis, UK College of Medicine Dean Robert DiPaola. (UK photo)

Most but not all of the centers that applied for this round of funding received money, according to Dr. Phillip Kern, director of the center. UK President Eli Capilouto complimented Kern and others who worked on the application but said McConnell was "another reason we got across the finish line."

Capilouto said that the grant positions the university "to recruit the brightest scientific minds of our generation," but the heart of its impact is on communities. McConnell noted that Kentucky has the nation's highest rate of deaths from cancer, and Eastern Kentucky has many great health disparities. The UK center is the translational-science hub for Central Appalachia.

Kern cited several examples of useful research done under the previous grant, including a collaboration that found disruptive behavior and hearing loss among Appalachian children are related.

Brittany Martin, coordinator of the Big Sandy Diabetes Coalition, told how the center had helped her personally screen more than 800 people in five far-eastern counties. She is a graduate of the center's Community Leadership Institute of Kentucky, which provides research and training in health for community leaders.

Dr. Michael Karpf, UK's executive vice president for health affairs, said "Developing new treatments and diagnostics, and training top-notch physicians and researchers who can carry on the processes of discovery" will provide the most advanced care for Kentuckians. "Our focused efforts and investment in translational team science mean we have more clinical trials available to our patients, and we’re able to bring the best and most innovative science to their care," he said.

Part of UK's grant goes to Marshall University in Huntington, W.Va., for work in the Mountain State. Marshall is part of the Appalachian Translational Research Network founded by UK, along with West Virginia University in Morgantown, Ohio University in Athens, The Ohio State University in Columbus, the University of Cincinnati and East Tennessee State University in Johnson City.

Health commissioner leaves political correctness at the door, talks about getting governor to back anti-smoking measures

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. - State health officials didn't shy away from saying that smoking was one of Kentucky's top health issues at a recent meeting about population health, and Health Commissioner Hiram Polk went so far as to say they need to find a way to get Gov. Matt Bevin, who says smoking bans are a local issue, to adjust his policy.

Dr. Hiram Polk

"We've got to find some kind of landmark we can use there that would be acceptable to the governor and get through the legislature," Polk told the Friedell Committee for Health Oct. 25 in Frankfort.

Polk called smoking a "political issue" and said solutions include higher cigarette taxes and enforcement of smoke-free areas. He also said he has been talking to Ben Chandler, the new director of the Foundation for a Healthy Kentucky, about ways to get the governor to adjust his stance on this issue.

"It is really rare for somebody in this position to say publicly that 'I want to try to change the governor's mind'," Al Cross, director of the Institute for Rural Journalism and Community Issues, publisher of Kentucky Health News and Friedell Committee member, told the group as he summarized the day. Cross said the 80-year-old Polk, a noted surgeon, is a "guy who speaks his mind."

Tim Feeley, deputy secretary of the Cabinet for Health and Family Services, noted that Kentucky has some of the highest smoking rates in the nation, along with obesity, cancer and opioid abuse. He called for more smoking and nutrition education.

Drug issues

Polk said since taking office his "time has been overwhelmed with the issues of IV drug abuse." And that after attending many meetings on the topic, "There are no good ideas about what to do with drug addiction."

He said the cabinet is working on three opioid initiatives: one that centers around a "healthy living" early childhood educational program, which he hopes to have set up in at least five school districts by fall 2017; a program to increase access to medication-assisted treatments; and beginning this week, a program involving the state's mobile pharmacy, which will travel around the state upon invitation and share educational literature, pass out free Narcan (naloxone), accept outdated drugs and operate a one-for-one syringe exchange.

There was some question about the state's requirement that syringe exchanges be one for one. Feeley said, "As of right now, Governor Bevin has endorsed the needle exchange on a local-option basis. He has also stated that he is in favor of a one-for-one needle exchange. . . . We want to do a needle exchange that encourages the individuals to come in and to get into treatment. . . . Some of the thought is that a one-to-one exchange is the best way to do that."

Cross said the administration's stance seems to be that only exchanges funded by state grants will have to be a one-for-one exchange. He said this strategy might work to appease the legislators who don't understand that this is a public health program designed to prevent the spread of HIV and hepatitis C. "We'll find out during the General Assembly," he said.

Polk also pointed out the increased health disparities among the state's African American population and those living in the Appalachian region, though he emphasized the problems in Appalachia.

"The situation in Appalachia is just appalling," he said. "I think again, Appalachia is more discriminated against than African Americans. If you look at anything. It needs the most help for everything."

Cross said that while Polk "is not politically correct," this is "largely a good thing" because public officials often "don't say what they believe to be fact and try to avoid confrontation. Hiram Polk is not conflict-averse, and we should be thankful for that."

And as for finding health solutions, Polk boldly reminded those in the room that many health decisions are selfishly motivated.

"We've got conflicting and selfish interests of people all over health care, many of which are represented in this room," he said. The perfect example of this, he said, is the pharmaceutical industry, which successfully lobbied to protect its "massive profits" under the Patient Protection and Affordable Care Act. He also said that the "larcenous nature" of this industry is sure to demand "$1,000 for every single treatment" of the newly developed medication assisted treatment drugs, which the state hopes to promote.

Cross said drug makers argue that their profits finance cutting-edge drug research, but also comprise a powerful lobby that knows how to influence the political system. He said the Kentucky Farm Bureau Federation is likewise a powerful lobby, "which I believe is the primary device by which Kentucky's tobacco heritage remains in control of tobacco policy in this state. . . . If you can change Farm Bureau, you can change the game."

Medicaid boss speaks

Medicaid Commissioner Steve Miller briefly reviewed the governor's proposals for the program and said the cost of the current plan is not sustainable. He said the plan "may not be all the answers . . . [but] what we have been doing, and the way we have been doing it, needs to change." After the meeting, Miller told Cross that state and federal officials have entered into negotiations about it.

Miller told the committee his agency is working to hold Medicaid managed-care organizations accountable to their contracts, but said they haven't changed their behaviors.

Providers still struggle with MCOs paying them on a timely basis, if at all. They also struggle with the administrative burden of dealing with five different MCOs. Scott Lockard, public health director in Clark County, asked if the state had considered contracting with only one MCO. Miller said the state wasn't ready to go that far, but averred, "We don't need to have five. I think we need to have more than two."

Raynor Mullins, professor emeritus at the University of Kentucky College of Dentistry, said it is clearly understood that Kentucky's financial woes are "substantial" and  asked, "When are we going to get serious and start to talk about tax reform?"

Miller said he would leave tax policy to others, but added, "The revenue stream as it exist today is not adequate enough to cover the Medicaid expenditures and other things that need to be done. . . . It is not sustainable as we are doing it today."