Journalists gather to hear why and how to cover health, get a myriad of story ideas, sources and approaches

SLADE, Ky. -- Kentucky journalists interested in covering health got plenty of information and hopefully some inspiration Friday at "Covering Health: A News Workshop" at Natural Bridge State Resort Park.

The workshop was presented by the University of Kentucky's Institute for Rural Journalism and Community Issues with support from the Foundation for a Healthy Kentucky, which funds the institute to produce Kentucky Health News.

Jennifer P. Brown, former editor of the Kentucky New Era,
discussed how a small daily newspaper can cover health topics.

Journalists heard a battery of reasons for covering health, and how to find and use local health data. They were urged to overcome reluctance to report bad news, and to publish special newspaper sections on health.

Institute Director Al Cross told the journalists that covering health is important because it is the most important issue facing the state, "and probably your community." He cited the state's dismal health statistics, including: No. 1 in cancer deaths, lung-cancer deaths, deaths related to smoking, heart disease, hepatitis C, overuse of antibiotics and preventable hospitalizations ."They take care of us and then we don’t take care of ourselves," Cross said.

He noted other poor rankings: Second in smoking, heart attacks, high cholesterol, poor physical health days, and insufficient sleep; third in percentage of deaths from drug overdoses, fourth in diabetes, physical inactivity and poor mental-health days; fifth in adult obesity, sixth in stroke and sixth in hypertension, or high blood pressure (one of 2 states where the rate rose last year).
Cross said the state's poor health status hurts all Kentuckians, through higher insurance premiums, state taxes that pay for Medicaid, jobs that don’t come (or leave) due to high health costs and drug use in the workforce. He said that if Kentucky could reduce its No. 1 health problem, our high rate of smoking (26.5 percent), just to the recent U.S. average (18 percent), we would save $1.7 billion on health care the next year, with the average Kentuckian saving $400.

Melissa Patrick, senior reporter for Kentucky Health News, showed the journalists how to gather and use local health data. She said the foundation's KentuckyHealthFacts.org site "is just the best one-stop shop for information."

Cross said the annual County Health Rankings from the University of Wisconsin provide an easy rundown of a county's health status, but many newspapers have never reported them, apparently reluctant to go out of their way to report information that reflects poorly on the community. "The worse your health ranking, the less likely you are to read about it in your local newspaper," he said. "The better your ranking is, the more likely you are to read about it."

He said that pattern didn't hold true in 2014, but recurred in 2015, albeit with a smaller sample. He said the ratings don't change much from year to year, so newspapers are less likely to report them, but should do so every year because of the impportance of community health.

Cross also urged the journalists to report the ratings of Medicaid managed-care companies, since Medicaid members can change their MCO through Dec. 16; and to follow county health boards, which under state law have responsibility for their county's health. For a copy of his PowerPoint presentation, click here.

Covering a local hospital can be difficult if it is privately owned, but if it is charitable, its report to the Internal Revenue Service is a public document that can provide useful information, said Jennifer P. Brown, former editor and opinion editor of the Kentucky New Era in Hopkinsville.

Sharon Burton, editor and publisher of the Adair County Community Voice in Columbia, spoke about her paper's success with special sections on health, which she said she always includes when publishing a sample-copy edition that is mailed to every postal address in the county. "It's the easiest sale," she said. "The wonderful thing about a health section is, it can be as much work or as little work as needed," because Kentucky Health News and other sources have plenty of stories to go between the ads. But she said every story needs a call to action for readers who think, "This resonates with me; now what do I do?"

The workshop also included sessions on smoking, cancer, obesity, vaccinations, drugs and syringe exchanges, the need to consider the health effects of government and institutuional policies, add a luncheon keynote speech by Van Ingram, director of the Kentucky Office of Drug Control Policy. A story on Ingram appears below; reports on other sessions and/or their PowerPoint presentations will be posted here soon.

State drug-control policy office's legislative package will include putting overdose incidents into prescription database

By Melissa Patrick
Kentucky Health News

SLADE, Ky. -- The executive director of the Kentucky Office of Drug Control Policy said Friday that his office is working on a legislative package that includes putting overdose incidents into the state's electronic prescription drug monitoring program, and offered a comprehensive overview of the problem, saying it will take 20 years to solve.

"We hope to be releasing a 2017 plan very shortly," Van Ingram said at "Covering Health: A News Workshop," sponsored at Natural Bridge State Resort Park by the Institute for Rural Journalism and Community Issues and the Foundation for a Healthy Kentucky.

Ingram's PowerPoint presentation had many such
charts and graphs. For a copy of it, click here.

In 2015, 1297 Kentuckians died from a drug overdose. This was up from 1,087 in 2014 and up from 246 in 2000.

Ingram said approximately 28 percent of the 2015 overdose deaths had heroin in their system and approximately 34 percent had fentanyl, and most of them had a combination of drugs in their system.

 "Almost every time you've got heroin, you've got a benzodiazepine also," he said. "What a person generally dies of is drug toxicity."

He added that 56 percent of the people who died from an overdose in 2015 had an opioid prescription written in the prior 6 months to their death, 33 percent had a current opiod prescription and 21 percent had an overlapping opioid or bezodiazepine prescription at the time of their death.

"They really need to know whether or not that person has had an overdose incident," Ingram said of his offices plans to include this data in KASPER to better help physicians in their prescribing. Ingram said that while there has been some decrease in heroin seizures in the state, fentanyl is on the rise.

"And that's a trend that I predict will continue," he said, noting that the "profit margin is amazing" for this drug, with dealers making up to $1.6 million dollars for a $6,000 investment or up to $6 million if they have the ability to create fake pills.

"This is a business model that is not going anywhere," he said.

DEMAND, SUPPLY AND TREATMENT

Ingram said that while the United States has only 5 percent of the worlds population, it uses 99.3 percent of all hydrocodone combination products and 82 percent of the oxycodone.

"We lose 129 people in this country every day. That's a small commuter airplane crashing every day. If we had a plane crashing every day, do you think we'd figure it out? . . . Of course we wouldn't have anyone lobbying to keep plane crashes going. There are people lobbying to keep this number here. And they are a powerful lobby," Ingram said. "If we don't change these numbers nothing in this country changes and this opiod epidemic goes nowhere. We'll just keep throwing Band-Aids on it."

Ingram noted that the Centers for Disease Control and Prevention recommends that providers only prescribe a three to seven day supply of pain pills after a procedure. He also said we need to start using opioids as a last resort for pain, that reimbursement rates must change to allow providers more time for evaluation and that reimbursement rates must also include alternative treatments for pain. And just as importantly, he said that we as a society have to stop wanting a quick fix for pain.

Ingram said the federal government has finally taken notice of this problem, but that he wished they had paid attention to Hal Rogers back in 2004 when "he was running up and down the halls telling everybody, but nobody would listen." We need to "lay groundwork with good policy" that will make an impact over time, it took 20 some years to create this problem and it will likely take 20 more to solve it, he said.

Ingram pointed out that the solution to the opioid epidemic is greater than just saying, "Why don't these people quit?" He explained that because of how opioids affect the brain, people who are addicted to them need the drug, just like we need food and water. And because of this, we need every available resource to treat it, including: medication assisted treatment, peer led recovery, intensive outpatient treatment and residential treatment.

"We need it all," he said.

HISTORY

Ingram said it is important to recognize that conditions leading up to this "perfect storm" of opoid abuse have been in the making for the last 20 years. He pointed out that it began with Purdue Pharma's marketing campaign for OxyContin, which was heavily marketed in Appalachia. He noted that Appalachia had eight of the top ten zipcodes for the highest number of opioid prescriptions between 1998 and 2000.

"Appalachia was ground zero for this entire epidemic," he said.

Ingram said the increase in lobbyists pushing for increased treatment of pain;The Joint Commission's decision to establish pain as the fifth vital sign; and the decision to tie hospital reimbursements to patient satisfaction surveys, which asks patients if their pain has been adequately addressed, also contributed to the current problem.

In addition, he extended the blame to individuals wanting quick fixes for their pain; physicians who over-prescribed them; and the health insurance industries poor reimbursement policies for alternative treatments to pain.

Further, Ingram said the problem has been exacerbated by the introduction of abuse deterant formulas for pain pills; an increase in intravenous drug use; the increased awareness of prescribers; and the drug cartels recognition and response to the demand.

"All these things come together to form the perfect storm that we have today," he said.

ADDITIONAL DETAIL

Age of Decedents from overdose deaths in 2015

Ingram also pointed out that most people who overdosed in 2015 were between the ages of 45 and 54 (372), followed by 35-44 (341) and then 25-34 (288).

"This is not just a young person disease," he said. "These are people who have probably had an opioid use disorder for a decade or longer."

Ingram noted that the 2015 anti-heroin bill increased access to treatment, enhanced penalties for major drug traffickers and increased access to Naloxone.

He said the "Good Samaratin" provision of the law, which allows a person to seek medical help for an overdose victim and stay with them without being charged, was already "making an difference," noting that the first months of 2016 were looking "a lot better than they did last year."

"My early prediction on this is that this is making an impact," he said, "I think more people are calling"

He also said that since the state has increased access to Naloxone, 1200 pharmacist are now trained to dispense it and that there are 300 locations dispensing it across the state. He added that the ODCP has recently launched an interactive website that connects zipcodes and counties with the closest places to get it.

Ingram recognized that syringe exchanges remain controversial, but said that after learning about them, he now considers himself the "poster boy for syringe exchange." He pointed out that a lot more happens at needle exchanges than just the exchange of dirty needles for clean ones, including, medical treatment, HIV and hepatitis C testing and counseling.

Annual Great American Smokeout is Thursday, Nov. 17

If you're one of the approximately 1 million Kentucky adults who smoke, and are in the majority who say they'd like to quit, the Great American Smokeout may be for you. It is Thursday, Nov. 17.

The annual event, promoted by the American Cancer Society, doesn't necessarily ask smokers to quit on that day. It encourages them to make a plan to quit, and quit smoking on a certain day. "Getting effective help through counseling and medications can increase the chances of quitting by as much as threefold," says the federal Centers for Disease Control and Prevention.

The cancer society says, "Encourage someone you know to use the date to make a plan to quit, or plan in advance and then quit smoking that day. By quitting – even for 1 day – smokers will be taking an important step toward a healthier life and reducing their cancer risk."

"In the more than 50 years since the surgeon general’s first report on smoking and health, cigarette smoking among U.S. adults has been reduced by approximately half," the CDC reports. "However, since 1964, an estimated 20 million persons have died because of smoking, which remains the leading preventable cause of disease, disability, and death in the United States. About two out of three adult smokers want to quit smoking cigarettes, and approximately half of smokers made a quit attempt in the preceding year."

Additional information and support for quitting smoking is available at 800-QUIT-NOW(784-8669). The CDC’s "Tips From Former Smokers" campaign offers additional resources for quitting at http://www.cdc.gov/tips.

Kentucky has the nation's second highest smoking rate, 26.5 percent of adults.

1 in 9 in Ky. have been diagnosed with diabetes, and you could have it and not know it; here are symptoms and risk factors

KentuckyHealthFacts.org map with latest available data, adapted
by Kentucky Health News; click on map to view a larger version

One of nine people have diabetes in Kentucky, which has "all the social ills that cause diabetes to fester," Laura Ungar and Darla Carter report for The Courier-Journal. "Chief among them is poverty, which makes it tough to eat well, find safe places to exercise or get to the doctor and avoid complications such as blindness and amputations."

Dr. John Buse, diabetes center director at the University of North Carolina, told the Louisville newspaper that a colleague once told him: “Diabetes is a death sentence for the poor and a nuisance for the wealthy.” One in five Kentuckians live below the federal poverty line, third among the states. Other major risk factors include obesity (35 percent of Kentuckians are obese, fifth in the nation) and physical in activity (fourth in the nation).

Diabetes in the state "has skyrocketed in the last two decades and shows no sign of slowing," the reporters write. "Kentucky’s rate of diagnosed diabetes shot up from 4.3 percent in 1994 to 11.3 percent in 2014, ranking the state sixth worst in a nation that has seen diabetes double over that time." The disease "takes thousands of lives each year and the American Diabetes Association estimates related medical costs and lost productivity total around $3.85 billion in Kentucky."

Because those figures are based on poll questions asking people if a doctor has ever told then they have diabetes, the actual numbers are larger because many people have diabetes and don't know it. The C-J reports, "You may notice no symptoms at all, but here are some common ones, according to the American Diabetes Association:

• Frequent urination
• Feeling very thirsty 
• Feeling very hungry - even though you are eating
• Extreme fatigue
• Blurry vision
• Cuts or bruises that are slow to heal
• Weight loss, even though you are eating more (Type 1)
• Tingling, pain or numbness in the hands or feet (Type 2)

"Anyone 45 years or older should consider getting tested for diabetes, especially if you are overweight," the reporters write. "If you are younger than 45 but are overweight and have one or more additional risk factors, consider getting tested. They include: 

• Having a parent, brother or sister with diabetes
• Being African American, American Indian, Asian American, Pacific Islander or Hispanic American/Latino heritage
• Having a prior history of gestational diabetes or birth of at least one baby weighing more than 9 pounds
• Having high blood pressure measuring 140/90 or higher
• Having abnormal cholesterol with HDL ("good") cholesterol of 35 or lower, or a triglyceride level of 250 or higher
• Being physically inactive (exercising less than three times a week)

In wake of Trump's election, Bevin administration says it will keep negotiating with Obama officials about Medicaid waiver request

Donald Trump and President Obama met Thursday.
(Photo: Michael Reynolds, European Pressphoto Agency)

By Al Cross
Kentucky Health News

The administration of Gov. Matt Bevin says it will continue negotiations with federal officials about its requested waiver of some Medicaid rules despite the election of Republican Donald Trump, who vowed in his campaign to "repeal Obamacare" but now says he will keep parts of it.

“Until changes occur at the federal level, the Bevin administration will continue to work within the confines of federal law as written,” said Doug Hogan, spokesman for the Kentucky Cabinet for Health and Family Services. “To that end, the Bevin administration will continue to negotiate in good faith with the U.S. Department of Health and Human Services."

It remains unclear what effect the election might have on HHS officials, who have often cited Kentucky as an Obamacare success story and might be motivated to preserve as much of it as possible. But the election may create a better negotiating position for the Republican governor, who has said he is ready to end his Democratic predecessor's expansion of Medicaid to about 440,000 people.

Bevin's waiver request asks for permission to require premiums to those with incomes below the poverty level and require work or training for able-bodied adults who aren't primary caregivers, both conditions that HHS Secretary Sylvia Burwell has said she would not approve.

Trump will take office Jan. 20. Hogan said that when things change at the federal level, "We will respond accordingly."

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

Republicans have long proposed that Medicaid funding change to block grants, which would give the states certain amounts of money and more flexibility to write rules. That seems likely to be a part of any replacement of the 2010 Patient Protection and Affordable Care Act. But that will be a complicated task.

“It’s anybody’s guess what President Trump and a Republican Congress will do. Just repealing the Affordable Care Act is not a serious option unless they have something to replace it with,” former 6th District U.S. Rep. Ben Chandler, who voted against the law and now heads the Foundation for a Healthy Kentucky, told John Cheves of the Lexington Herald-Leader.

“The reality on the ground is that Gov. Bevin won his election in Kentucky and Donald Trump has now won his election nationally,” Chandler said. “It is incumbent on the rest of us to work with them in any way that we can to see that whatever they propose will hopefully make our people healthier. And I’ve got to believe that they want that same result.”

Trump reiterated Friday that he wants to keep the part of the law that prevents insurance companies for denying coverage because of pre-existing conditions. "But the insurance industry has long said it would have a hard time abiding by this rule unless virtually all Americans are required to have insurance," reports Amy Goldstein of The Washington Post.

Post business reporter and columnist Steven Pearlstein explains,  "To guarantee that people with pre-existing conditions can get affordable health insurance, you need to have rules requiring guaranteed issue and community rating," charging roughly the same prices in a geographical area. "To keep insurance companies in business because of guaranteed issue and community rating, you need to have an individual mandate" for everyone to buy insurance. "And because poor people can’t afford health insurance, you need subsidies. Combine all three, and what you have, in a nutshell, is ... Obamacare.

"Yes, it’s a bit more complicated than that, but not much. It’s possible to allow insurance companies charge twice or three times as much, to people who are older or sicker. You can let healthy people buy somewhat more bare-bones 'catastrophic' policies to satisfying their obligation under the individual mandate. You could even avoid community rating by sending sick people into 'high risk pools' where their premiums would be subsidized by a tax on everyone else’s health care premiums.

"But at the end of the day, once you decide that everyone, regardless of age or medical condition, should be able to buy health insurance at an affordable price, you have essentially bought into the idea that young and healthy people have an obligation to subsidize the older and sicker people in some fashion. And once you do that, it’s sort of inevitable you end up where every health reform plan has ended up since the days of Richard Nixon. You end up with some variation on Obamacare."

McConnell wants to pass bill to spur medical research before Congress adjourns; measure has big supporters and critics

Senate Majority Leader Mitch McConnell says he has two main priorities as Congress wraps up its business: funding the government and passing a bill called the 21st Century Cures Act, which would boost funding of research at the National Institutes of Health.

"You haven't heard much about it yet, but it's extremely important, McConnell said at his post-election news conference in Louisville. "We need to take advantage of today's technology to really jump-start the medical field."

McConnell said President Obama and Vice President Biden, who will leave office Jan. 20, want to get the bill passed because "The president's particularly interest in precision medicine," and Biden wants more cancer research because his son, Delaware Attorney General Beau Biden, died of cancer last year.

"I'm interested in regenerative medicine," McConnell said. "Unless you can get in a clinical trial, you can't get stem cells from your own body to treat another part of your body. He said he was motivated by the experience of a Tennessee man whose blindness was cured by stem-cell treatment.

The NIH budget has stagnated because of automatic budget cuts known as sequestration. A study published last year in Health Affairs concluded that most transformative drugs come from federally funded research, not from drug manufacturers, which cite research costs as a reason they need to make their higher profits than most other industries.

Still, makers of drugs and medical devices are strong supporters of the bill, because it would expedite regulatory approval of them new drugs and medical devices. That has drawn criticism from the industry's lobbying adversaries.

The consumer lobby Public Citizen says the House-passed bill would "undermine the FDA's ability to ensure the safety and efficacy of medical devices ... effectively lower FDA approval standards for antibiotics and antifungals ... weaken reporting requirements of the Physician Payment Sunshine Act, allowing for secret influence by pharmaceutical and medical-device companies ... hasten the rise of resistant superbugs by giving hospitals incentives to use new antibiotics rather than conserving them for appropriate use" and bar generic entry of medicines into the market for longer periods."

Randy Gooch named deputy health commissioner

Gooch, right, with Jessamine County Judge-Executive David West

Randy Gooch, public health director in Jessamine County for the last four years, is the new deputy commissioner of the state Department for Public Health. Gooch says one of his main tasks will be to improve relations between the department and county and district health departments.

"While in Jessamine County Gooch implemented a needle exchange program, supported the development of a trails network, helped to secure funding for a bike and pedestrian path, and modernized the health department’s website," the Lexington Herald-Leader reports.

Read more here: http://www.kentucky.com/news/local/counties/jessamine-county/article113037523.html#storylink=cpy

3 ET Monday is deadline to register for Covering Health: A News Workshop, to be held Friday, Nov. 11, at Natural Bridge; it's FREE

Natural Bridge State Resort Park is near the Mountain Parkway.

Kentucky faces many unique health challenges, but they don't get enough news coverage, which hamstrings the state and its communities from fully addressing their health problems. These challenges and how to tackle them from a news perspective will be addressed at Covering Health: A News Workshop, Friday, Nov. 11 at Natural Bridge State Resort Park at Slade.

The conference is free, but registration is required; the deadline is noon 3 p.m. Eastern Time Monday, Nov. 7. To register for the workshop, complete this registration form.

The workshop is open to any Kentucky journalist, from those who are just starting to cover health issues to those with years of experience in the subject matter, and it offers something for everyone: reporters, editors, news directors, publishers, photojournalists and everyone in between. The workshop is sponsored by the Institute for Rural Journalism and Community Issues, which publishes Kentucky Health News, and the Foundation for a Healthy Kentucky.

Specific health topics will include oral health, smoking, obesity and cancer, where to find information on these issues and how to localize it for your audience. Building revenue and delivering health information to under-served populations through special health sections will also be addressed.

Several guest speakers will discuss their areas of specialization. Van Ingram, of the Kentucky Office of Drug Control Policy, and Kentucky Health News Senior Reporter Melissa Patrick will talk about how to cover one of Kentucky’s biggest, most complicated problems: opioid dependency and the consequences that follow.

Al Cross, director of the Institute for Rural Journalism and Community Issues, will discuss several topics, including proposed Medicaid changes and their implications for your readers, as well as the basics of managed care organizations that handle Medicaid for the state.

Jennifer P. Brown of the Kentucky New Era in Hopkinsville and Sharon Burton of the Adair County Community Voice in Columbia will discuss, respectively, how a small newspaper can cover health and how newspapers can use health sections to gain revenue and serve readers who need more health information.

Cynthia Lamberth of the Kentucky Population Health Institute will talk about how to look for health policy in all stories. The workshop will conclude with a roundtable session to discuss story ideas, sources and approaches.

Questions about the workshop can be directed to Danielle Ray at dnray2@g.uky.edu.

One pediatrician says vaccines are the most important thing she does; another says providers' recommendations are key

By Melissa Patrick
Kentucky Health News

One of the most important things a provider can do to get children vaccinated is to offer clear recommendations for their parents.

Dr. Ari Brown

So said Dr. Ari Brown, a pediatrician and author of the "411" parenting book series, in Lexington on Nov. 3, the second day of the 2016 Kentucky Immunization Conference.

"The number one reason why (vaccinators) chose to vaccinate is because they trusted their health-care provider," Brown said, citing a study that asked parents who chose to vaccinate why they did so.

Brown said parents need to depend on reliable sources for immunization information when they are making the decision to vaccinate their child, like cdc.gov; immunize.org; healthychildren.org; vaccine.chop.edu; or baby411.com. And that providers need to actively direct parents to these sources.

Brown listed several myths that are perpetuated on websites with unreliable sources.

"There is no link between vaccinations and autism," she said, noting that the study that is often cited linking the measles-mumps-rubella vaccine to autism has been proven false and "should have never been published." She noted that the study has been removed from medical literature and the author, Dr. Andrew Wakefield, has lost his medical license.

She also pointed out that thimerosal, a mercury-based preservative that some think causes autism, was removed from vaccines in 2001, but autism rates are still rising.

She said risk factors for autism include genetics, mature parents, closely spaced pregnancies, obesity in pregnancy, taking certain medications during pregnancy, having flu during pregnancy, not enough folic acid, and extreme prematurity.

Brown, who is also a spokeswoman for the American Academy of Pediatrics, said there is no "alternative" vaccination schedule; there is either a recommended schedule or a delayed schedule, and studies show there is no benefit to delay.

"You are delaying your child's vaccine protection. And when you delay shots, you are leaving the most vulnerable children at risk. If your child is under six months of age and they get whooping cough, that is pretty serious," she said. "You are not going to wait to put your child in a car seat for the first six months of life, so why would you wait to protect yourself against these diseases."

Infants are recommended to receive their first dose of pertussis vaccine, in combination with diphtheria and tetanus, at 2 months, 4 months ,6 months and 15 months of age. Another dose is recommended between 4 and 6 years of age. New recommendations call for mothers to get the vaccine during pregnancy, which offers protection to the child until it is old enough to be vaccinated.

Pertussis, or whooping cough, is a highly contagious respiratory disease caused by bacteria transmitted by droplets from sneezing, coughing or close contact. Infected people are most contagious up to about two weeks after the cough begins.

Margaret Jones, manager of the Kentucky Immunization Program, said the state has had 430 confirmed or probable cases of pertussis this year, 150 percent more than all of last year.

Dr. Rebecca Bakke

Also at the conference, Dr. Rebecca Bakke, a pediatrician at Sanford Health in Fargo, N.D., shared her story of infecting her 5-week-old daughter with whooping cough, and spoke of the fear she had for her child because she knew that between 1 and 2 percent of babies infected with the disease die. Her baby survived and is now six.

Bakke, who is also a member of the American Board of Pediatrics and a Fellow of the American Academy of Pediatrics, said she has taken care of a child that has almost died of chicken pox; cared for several children who now have severe brain damage from meningitis; bagged air into the exhausted bodies of babies with pertussis; and cared for many children in the ICU battling the flu. And said that though most children are resilient, "Not all stories have a happy ending."

"I vaccinate children every single day in my office and I know without a shadow of a doubt that it is the most important thing that I do at work. It has the most impact," Bakke said. "Vaccines matter."

Nursing homes say Ky. has highest malpractice insurance costs and needs lawsuit review panels to keep providers and facilities

By Melissa Patrick
Kentucky Health News

The state's nursing-home lobby is renewing its effort to get legislative insulation from lawsuits, a prospect that could improve if Republicans control the state House after Tuesday's election.

Kentucky needs medical liability reform to stay competitive with its surrounding states, all of which have enacted some form of it, representatives of the Kentucky Association of Health Care Facilities told a legislative committee.

"It makes us not a friendly state to operate long-term care services," Betsy Johnson, president of the association, said at the Nov. 2 meeting of the Interim Joint Committee on Health and Welfare, held during the association's annual meeting in Louisville. "Providers are leaving Kentucky and new companies will not even consider locating in our commonwealth because of the high cost of health-care liability."

Kentucky has at least one nursing home in every county, with a total of 281 nursing homes and 88 personal care homes. Combined, these facilities care for over 36,000 people, provide over 30,000 jobs and provide $200 million in state and local taxes, the group said.

Graphic Aon 2015 Long Term Care report

Citing a recent study, Johnson said Kentucky's long-term care providers are paying $9,350 per bed in liability insurance, the highest of any state. The study found Kentucky paid over $400,000 per claim in 2015, "the highest claims severity of all the states profiled in the Aon study," Johnson said. Aon Risk Solutions is a risk-management and insurance company.

Kentucky also had the highest loss rate of Medicaid dollars in the study, which means that "14.66 percent of Medicaid reimbursement dollars that facilities receive end up going back out to cover losses," Johnson said. "That is money that is not being used to provide care to the residents that we are committed to serving."

Aon said in a statement, "Kentucky's high cost of liability may be related to its lack of restrictions on tort actions. The state constitution prohibits limits on non-economic damages and there are no statutes concerning qualifications of expert witnesses, certificates of merit, pre-trial alternative dispute resolution or limits on attorney's fees."

For several years, nursing homes have been trying to get the legislature to require that medical-malpractice lawsuits be reviewed by a three-person panel to determine if a case has merit before the suit could proceed. Panel findings would be admissible in court, but not legally binding. The legislation has passed the Republican-led Senate, but has not been heard in the Democrat-led House.

Sen. Ralph Alvarado, R-Winchester, a physician, said after the meeting that he will likely introduce the bill again, pointing out that 43 other states have some sort of tort reform.

"The motivation for me to run for office to begin with was tort reform," he said. "It is kind of what has gotten me here. So this is the big white whale that I am chasing and if I harpoon it and I get voted out of office, I can leave with a smile on my face. So, I am really hoping to get this accomplished."

Another Senate bill, sponsored by Sen. Danny Carroll, R-Paducah, called the "truth in advertising" bill, would require advertisements of nursing-home inspection results to prominently include the date the deficiencies were found, the plan to correct them and whether they were corrected. It too passed the Senate, but was not heard in the House.

Such bills are opposed by the Kentucky Justice Association, formerly the Kentucky Academy of Trial Attorneys, a group comprised mainly of plaintiffs' lawyers.

Maresa Fawns, CEO of the group, said in an email, "Restrictions on free speech that inform the public of negligence aren’t in the public's interest. Neither is restricting the rights of individuals and businesses to seek redress in the courts. Both are protected by our constitution. The heart of the matter is that less negligence through higher standards will result in fewer lawsuits. An ounce of prevention is worth a pound of cure and the solution is better staffing, better care, and less harm to our seniors."

Medicaid approval delays

Johnson also said the association is working with the Cabinet for Health and Family Services and its Department of Community Based Services to get nursing-home patients approved for Medicaid more quickly. If a person hasn't already qualified for Medicaid, they can't apply for it until they have been admitted and because Medicaid will not pay for services until a resident has completed a 30-day stay, they will not process the application until the 31st day, she said in an e-mail. In addition, she added that it is "extremely difficult" to discharge a patient from a nursing home for "any reason, including non-payment" without an appropriate and safe discharge plan. The group said application approvals often take more than 90 days, with some taking more than a year.

As a result, nursing homes are caring for patients without being paid. This has amounted to an average balance of $170,093 per facility in September of 2016, according to a KAHCF survey for cases over 90 days. This problem is so bad that the survey found that a few facilities have stopped admitting Medicaid patients altogether and many more are considering it, Johnson said. The problem escalated in 2014 as a result of legislation that shifted the workflow to a centralized system, instead of the local DCBS offices, though that issue has recently been rectified, Johnson said.

State settles dispute with former Medicaid managed-care company, will get $7.5 million from former actuarial firm

The state and St. Louis-based Centene Corp. have settled their lawsuits and other disputes stemming from the 2013 departure of Centene's Kentucky Spirit Health Plan from the state Medicaid managed-care program.

Centene said in a press release, "Kentucky Spirit will receive an immaterial cash payment from the Commonwealth's actuarial firm and each party will dismiss all claims related to the litigation with prejudice," meaning that it cannot be refiled.

The amount of the payment was not disclosed. It will come from PriceWaterhouse Coopers, which was the state's Medicaid actuary until 2014. The state will get $7.5 million from the firm in return for dismissing its claims against it, said Doug Hogan, spokesman for the state Cabinet for Health and Family Services.

Last year, the cabinet "ruled that the insurer owed the commonwealth $40 million plus prejudgment interest," Erica Teichert reports for Modern Healthcare. Kentucky Spirit had made $110 million in claims against the state, Hogan wroite.

"So, the Commonwealth will get out of this litigation receiving $7.5 million and without making any payment to any party as a result of the settlement," he wrote. "This settlement will save the Commonwealth hundreds of thousands of dollars in attorney fees and expenses.  Based on the potential liability in this case and potential burden to taxpayers, and the significant litigation expenses associated with this case, this is an excellent outcome for the Commonwealth of Kentucky."

The Centene release added, "In addition, the parties agree that neither party acted in bad faith, that they took reasonable positions in light of the applicable contractual language and that the parties acted in good faith in attempting to address a difficult situation."

The release thanked Gov. Matt Bevin "for taking the initiative to resolve this longstanding issue."

Increasing Kentucky's cigarette tax by $1.50 a pack would decrease youth smoking, Cancer Society lobbyist writes

To decrease youth smoking in the state, the Kentucky director of the American Cancer Society Cancer Action Network is calling for an increase of $1.50 per pack of cigarettes and all other tobacco products, which would raise the 60-cent tax on each pack to $2.10.

"In the first full year following an increase in the tax by $1.50 per pack, it’s estimated that youth smoking would be reduced by about 17 percent and nearly 38,000 kids would never become adult smokers because most would never start," Erica Palmer Smith, said in a statement.

She noted that research finds that the increase in the price of tobacco products must be high enough to deter use and that tax increases of less than a dollar a pack are easily absorbed by the tobacco industry through things like discount programs.

Kentucky has the third highest youth smoking rate in the nation, with 17 percent of its high school students smoking. Palmer Smith, who is an aunt to four high schoolers, writes that an estimated 3,200 of Kentucky's youth under the age of 18 will become daily smokers.

"Almost all people who become lifetime tobacco users begin before graduating high school," she said. "And, almost nobody tries smoking for the first time after the age of 18."

A $1.50 increase "would convince approximately 45,000 current adult smokers to quit, generate more than $327 million in new revenue and save an estimated $9.28 million in Medicaid costs over a five-year period," she writes. "Tobacco remains the number one cause of preventable death in Kentucky. . . . The best way to reduce death and disease caused by tobacco use is to keep kids from ever starting to smoke in the first place."

Kentucky’s tobacco tax hasn’t been raised since 2009. The tax ranks 43rd among the states; the average tax is $1.65 per pack.