Perry County becomes the 35th Kentucky community with a comprehensive anti-smoking ordinance; Hazard keeps partial ban

The Perry County Fiscal Court unanimously passed a comprehensive smoke-free ordinance on June 18, becoming the 35th community in Kentucky to do so.

The law, which took effect immediately, bans smoking, including the use of electronic cigarettes, in all places of employment and public buildings. It also prohibits smoking within 15 feet of any public door, window or ventilation system, as well as any public outdoor seating and recreational areas.

Perry County (Wikipedia map)

The county seat of Hazard will continue to operate its own smoke-free ordinance, which was implemented in 2016. The county ordinance "does not affect property within the City of Hazard," Katie Kelley of the Hazard Herald reports. The city's ban is considered only partial because it doesn't include all workplaces, says the Kentucky Center for Smoke-Free Policy.

The county ordinance will be enforced by the county Code Enforcement Board, with a possible fine  for violators of up to $50. Fines have also been set for business owners and employers who fail to comply with the ordinance. Business owners and employers are required to post "no smoking" signs.

At 28 percent, smokers are more prevalent in Perry County than the rest of the state, where that rate is 25%, but Emily Bennett with Hazard's WYMT-TV reports that most there are pleased with the ban.

Local diners at Frances' Diner, a restaurant that used to allow smoking, told Bennett that they are now able to eat without worrying about their health.

Matthew Combs, who works in Hazard, told her that he suffered from allergies and asthma and that being able to eat in a smoke-free environment is "wonderful."

One local health official pointed out the dangers of secondhand smoke, especially for employers who are exposed to it all day.

 "If it's a smoking venue, it is the equivalent to them having a pack a day habit themselves for a non-smoker having to work in a smoking environment where that is allowed," Scott Lockard, the public health director for the Kentucky River Regional Health Department, told Bennett.

Another told Bennett that such policies eventually create a "new norm."

Sherrie Stidham, a health educator, told Bennett, "We're wanting to set a new norm. We don't want children to get used to seeing everybody in these places and smoking and think it's an okay thing to do."

Kentucky opens first sober-living unit in a medium-security prison anywhere, with plans to open others across the state

By Melissa Patrick
Kentucky Health News

BURGIN, Ky. – Kentucky again leads in ways to deal with drug abuse, this time with a pilot program that provides aftercare for prisoners who have gone through drug treatment but are still serving time.

SOAR's logo was designed and painted by one of the program
participants. (Photo by Melissa Patrick, Kentucky Health News)

Supporting Others in Active Recovery (SOAR) allows inmates who have completed an addiction treatment program – and meet some other requirements – to live in a dorm that is committed to sober living while they complete their sentences.

"This is the best program I've been in," said Gevoyl Beauchamp, an inmate who has been in the program since it opened in April.

The six-month program at Northpoint Training Center, a medium-security prison near Burgin, has room for 88 participants. Inmates who have completed the program can request to stay in it.

"The important part of this is keeping them in that therapeutic community instead of being released back into the general [prison] population where there is less of a mindset for recovery," Northpoint Warden Brad Adams told Kentucky Health News.

Michael Reynolds, one of the participants, said being part of SOAR has allowed him to participate in programs that will help him live a sober life after he is released, such as those that teach life skills or employment "soft skills" and ones that focus on parenting or anger management.

"I'm looking for a change in my life," he said.

State Justice and Public Safety Secretary John Tilley told nearly 50 people at a July 9 news conference to announce the program that the plan is to "work the kinks out of it and take it to scale."

"It doesn't look at treatment as some 28-day program or some six-month program, or even a year-long program," Tilley said. "It looks at it like a life-long commitment to clean and sober living."

The pilot is funded in part by a $300,000 grant from the Kentucky Office of Drug Control Policy. Tilley said funding for the expansion of the program has not yet been secured.

"For every dollar we spend, the state recovers roughly three to four dollars," Tilley said. "So I'm going to continue to ask the legislature for more money. I'm going to continue to chase every federal grant dollar that we can chase, because this is a good use of taxpayer dollars. This is what will help us dig out of this."

Secretary John Tilley talks to inmates at Northpoint Training
Center at the announcement. (Photo by Melissa Patrick)

The need for such programs in Kentucky is great, Tilley said, because Kentucky ranks in the top 10 states for per-capita incarceration, with 24,000 people in the system, and 48,000 on supervision.

Tilley added that prosecutors tell him that 95 percent of their cases are related to addiction. Further, he said that by some measures it is estimated that between 60 and 70 percent of people in the corrections system need substance-abuse treatment.

In 2017, 1,565 people died in Kentucky from a drug overdose. Tilley, saying he was speaking "cautiously," said he sees a light at the end of the tunnel because this number is coming down.

"The good news is that Kentucky is leading the way in drug policy," Tilley said. "We've had to be the leader. We've had to put political differences aside to innovate because the problem is so acute here."

Tilley noted that Kentucky was the first state to limit prescription opioids to three days for acute pain, and the first to mandate monitoring of prescriptions. It leads the nation in its number of syringe exchange programs, with 58 sites operating in 51 counties as of June 5.

The justice secretary has long called for a public-health approach, not a criminal-justice approach, when it comes to addiction, which has been proven to be a chronic brain disorder.

"But until policymakers build an infrastructure that allows us to do that in this country, in this state, we'll continue to have to give it our best effort in corrections – and this represents our best effort," he said. He added later, "This is a public-health epidemic; it is not a corrections epidemic. Its impact is in the criminal-justice system."

Tilley, a Democrat, was appointed justice secretary in December 2015 by Republican Gov. Matt Bevin. He had been a state representative from Hopkinsville and was instrumental in passing Kentucky's 2015 anti-heroin bill. Among other things, the bill created a system in which local officials could allow syringe exchanges; increased penalties for high-volume traffickers; allocated money for drug treatment; and let the Department of Corrections medicate inmates for opioid-use disorders.

If you're digging, using sharp tools or handling plants with sharp points, make sure your tetanus vaccination is up to date

Photo from MountainX.com

"Gardening this summer?" Medicare asks. "Did you know that gardeners can be prone to tetanus infections? Tetanus lives in the soil and enters the body through breaks in the skin, especially when using sharp tools, digging in the dirt, or handling plants with sharp points."

Medicare offers some advice that is useful for everyone, not just Medicare beneficiaries: "Make sure your tetanus, diphtheria, and pertussis (Tdap) vaccination is up-to-date. Use a good set of gardening gloves, which can help lower the risk for skin irritations and cuts."

Medicare says its prescription drug coverage (Part D) generally covers vaccinations needed to prevent illness. And for people not on Medicare, vaccinations are relatively inexpensive.

Registration open for free, day-long forum Sept. 23 on public-health policy considerations regarding medical marijuana

Registration is now open for a statewide forum on medical marijuana to be held September 23 in Lexington.

The forum is not intended to change minds about whether marijuana should be legalized for medical purposes, but to share facts to inform how best to promote health, well-being and safety as state lawmakers consider new policies around medical cannabis, said Ben Chandler, CEO of the Foundation for a Healthy Kentucky, which is sponsoring the forum, titled "Medical Marijuana Fact and Fiction: Practical Public Health Policy Considerations for Kentucky."

Photo from MedicalMarijuana.com

"Since 1996, 33 states and the District of Columbia have legalized medical marijuana, and public support for the idea is growing in Kentucky," Chandler said in a press release. "Yet, most policymakers and Kentucky residents haven't had the chance to learn how various regulatory restrictions have affected health outcomes for different population groups or what kinds of public health resources are needed when restrictions are reduced. This will be a balanced forum designed to answer a lot of questions about the issue, and give attendees the chance to engage with experts on all sides."

The event will be the latest edition of the foundation's Howard L. Bost Memorial Health Policy Forum. It will be held from 9 a.m. to 4:15 p.m. EDT Monday, Sept. 23, at the Marriott Griffin Gate Resort in Lexington. The forum is free and includes lunch, but advance registration is required.

Dr. Jeffrey Howard, Kentucky public health commissioner, will offer welcoming remarks. Other morning speakers include a keynote presentation from former Colorado "marijuana czar" Andrew Freedman, who will discuss the public health infrastructure put in place when that state legalized medical marijuana in 2000 and how public health has been affected since then, including when the state eased restrictions even further to allow recreational marijuana in 2007. (Twenty-six states have now legalized or decriminalized marijuana, not merely authorized its use for medical purposes.)

Dr. Shanna Babalonis of the University of Kentucky will provide an overview of how marijuana has changed in recent decades, and Brian Higgins, a Frost Brown Todd attorney, will share how marijuana is regulated across the country today. Following lunch, attendees will choose two of three panel discussions, each with three speakers and an opportunity for moderated audience discussion:

• Health Impacts on At-Risk and Underserved Populations, moderated by Miranda Sloan, Kentucky Psychiatric Medical Association
• Persons with Mental Health Disorders: Dr. Shanna Babalonis, University of Kentucky
• Accidents, poisonings and crime: Will Jones, Smart Approaches to Marijuana
• Infants/Children/Youth/Pregnant Women: Dr. Kathy Hager, Kentucky Nurses Association
• Revenues and Outlays, moderated by Dr. Brent Wright, University of Louisville
• Who can grow and sell products, what kinds of products and where: Evan Ogburn, Pharm-CBD
• Expected State Revenues and Expenses: Beau Whitney, New Frontier Data
• Testing and Quality Control: Lisa Gill, Consumer Reports
• Future of Cannabis Regulation, moderated by Anthony Zipple, Consultant and former CEO, Centerstone of Kentucky
• Regulation Considerations for Kentucky: Jaime Montalvo, Kentuckians for Medical Marijuana
• Prescriber, Distributer and Public Education: Dr. Danesh Mazloomdoost, Wellward Regenerative Medicine
• Cannabis and the Justice System: Ed Monahan, NAPD Fund for Justice

The full agenda and speaker biographies are available on the registration site.

After appeals-court arguments in case challenging Obamacare, Beshear calls it 'the future of rural health care'

"A panel of federal appeals court judges on Tuesday sounded likely to uphold a lower-court ruling that a central provision of the Affordable Care Act — the requirement that most people have health insurance — is unconstitutional," reports Abby Goodnough of The New York Times. "But it was harder to discern how the court might come down on a much bigger question: whether the rest of the sprawling health law must fall if the insurance mandate does."

The law "is the future of rural health care," said Andy Beshear, the Democratic nominee for governor and one of 21 Democratic attorneys general who intervened in the Texas lawsuit that led to a federal district court ruling that the entire 2010 law violates the Constitution.

Without the law and its expansion of Medicaid to people earning up to 138 percent of the federal poverty level, many more rural hospitals would be in trouble, Beshear told reporters, because they would not only get less revenue but have to write off the cost of care for people who wouldn't be able to afford health insurance.

Beshear is the son of former Gov. Steve Beshear, who expanded Medicaid under the reform law. His opponent is Republican Gov. Matt Bevin, who initially campaigned on repealing the expansion but now wants to require work or other "community engagement" from "able-bodied" people covered by the expansion. Most of them work, but Bevin has argued that the benefits keep some from working.

In Tuesday's oral arguments, "Two appellate judges appointed by Republican presidents peppered lawyers with blunt questions while the third judge, appointed by President Jimmy Carter, remained silent," Goodnough reports. "The two Republican appointees, Jennifer Walker Elrod, appointed by President George W. Bush in 2007, and Kurt Engelhardt, appointed by President Trump in 2018, seemed particularly skeptical of the Democratic defendants’ argument that Congress had fully intended to keep the rest of the law when it eliminated the penalty for going without insurance as part of its 2017 tax overhaul."

"Despite such pointed questioning, the hearing did not clearly foreshadow how the panel will rule," reports Amy Goldstein of The Washington Post. Beshear said he thought the argument "went well" and the judges will reverse the lower court.

Meanwhile, the Post reports that Senate Majority Leader Mitch McConnell of Kentucky refused to say whether he supports the lawsuit, but focused on coverage of pre-existing conditions, which has also been the focus of Beshear and most other Democrats. “I think the important thing for the public to know is there is nobody in the Senate not in favor of covering pre-existing conditions,” the Republican leader told reporters at the Capitol. “And if it were, under any of these scenarios, to go away, we would act quickly on a bipartisan basis to restore it.”

Plan to change how some rural hospitals are paid would hike pay to 39 in Ky., totaling $4 million a year, hospital association says

By Melissa Patrick
Kentucky Health News

A Trump administration plan to change the way Medicare pays hospitals, and perhaps keep some rural hospitals from closing, would give some rural Kentucky hospitals a financial boost.

A proposed rule would raise reimbursement rates, starting in October, for rural hospitals paid under the "inpatient prospective payment system" by reducing payment to the nation's better-off hospitals.

The Kentucky Hospital Association is in full support of the proposal, it said in a May 30 letter to the Centers for Medicare and Medicaid Services (CMS).

“Every Kentucky rural hospital paid under the inpatient prospective payment system would be helped. It would increase payments to those hospitals by $4 million a year," KHA President Nancy Galvagni told Kentucky Health News in an e-mail. "No payments to Kentucky urban hospitals would be cut. It is the high-cost hospitals in the Pacific and New England states whose payments would be lowered.”

KHA says 39 of the state's rural hospitals would benefit from this new payment model. The state has 127 hospitals.

Some critics of the plan note that it doesn't apply to critical-access hospitals, which comprise about half the rural hospitals in the country. Kentucky has 27 such hospitals, which are generally in rural areas and have 25 or fewer beds.

Currently, Medicare reimbursement rates for hospitals in the inpatient prospective payment system are calculated by first determining a base payment for each patient, based on their diagnosis and the severity of their illness. It then factors in a wage index for the labor-related share of the costs.

The index is based on how much a hospital pays its staff, so hospitals in areas with high living costs get higher reimbursements than areas that have low cost of living -- for the same services.

The wage index has shortchanged Kentucky hospitals; the proposed 2020 index ranks Kentucky 36th in rural wages, "and no rural or urban area in Kentucky has a wage index at or above 1.0," the lowest ranking in the index, the hospital association said in its letter to CMS.

Table from Kentucky Hospital Association letter endorsing changes in the Medicare wage index.

A labor market's wage index is the ratio of its average hourly wage to the national average hourly wage, according to CMS.

KHA says the wage-index disparities mean Kentucky's rural hospitals get approximately 26 percent less -- $1,800 per case -- than the state with the highest rural wage index. Kentucky's urban hospitals with the highest wage index get 40 percent less, $3,700 per case, than hospitals with the highest urban wage index "for providing the exact same level of care to Medicare beneficiaries," KHA says.

The lobbying group points out, "The wage index is a significant issue for Kentucky's hospitals because Medicare covers about one-half of all patients treated in hospitals."

The proposed rule would reduce the disparity in reimbursements by increasing the wage index for hospitals in the bottom fourth of payments and reducing the index of those in the top fourth, creating a budget-neutral shift of funds, a CMS news release said.

"This policy change is needed to improve the fairness of Medicare payments necessary to protect access to care for every American," KHA said in its letter.

But not everyone supports the proposal.

The American Hospital Association said in a letter to CMS that while it supports increasing the wage index for low-wage hospitals, "this should not be accomplished by penalizing other hospitals," especially because Medicare reimburses most hospitals "below the cost of care." It adds that there is no legal requirement for the adjustment to be budget-neutral.

The Office of Inspector General in the Department for Health and Human Services called for a complete overhaul of the system after it conducted a study that found, among other things, that the wage index often relies on inaccurate wage data and CMS lacks authority to penalize hospitals that submit inaccurate or incomplete data. The report estimated a total of $140.5 million in over-payments to 272 hospitals resulted from the inaccurate data between 2004 and 2017.

State could owe 58 hospitals 'hundreds of millions of dollars' if Ky. Supreme Court lets stand lower-court rulings on Medicaid rates

By Melissa Patrick
Kentucky Health News

For about nine years, the state Cabinet for Health and Family Services used a formula to reimburse hospitals for Medicaid that two Kentucky courts have said was not legal – and unless the state Supreme Court takes up the case and rules otherwise, the state could owe the 58 hospitals named in the case hundreds of millions of dollars, the cabinet said Friday.

WCPO.com photo

"The hospitals claim they are entitled to hundreds of millions of dollars for the years between 2007 and 2015," cabinet spokesman Jordan Rowe said in an e-mail.

Rowe said the cabinet filed a motion for discretionary review with the Supreme Court July 5, the last day to do so.

The state Court of Appeals said in its ruling, "Neither the correct amounts of reimbursements nor any award of interest or other damages have been determined, and the remaining rate appeals have been remanded for further administrative proceedings." It adds that the court's findings will have "real economic consequences."

The possible need for extra cash comes as the administration of Gov Matt Bevin has bemoaned the cost of Medicaid, especially for for the nearly 450,000 Kentuckians who have it through its expansion  to people who earn up to 138% of the federal poverty line, under the Patient Protection and Affordable Care Act. States are responsible for 7 percent of the expansion cost in 2019, rising to the law's cap of 10 percent in 2020.

The Court of Appeals upheld a 2016 ruling of Franklin Circuit Judge Phillip Shepherd. In its appeal, the cabinet had asked the three appeals judges to determine three things: if Shepherd had erred in his finding that the cabinet's rate-setting method was "facially invalid and arbitrary;" whether he erred in his finding that hospitals are entitled to administrative process; and whether the hospitals' underlying claims are moot because the offending regulation has since been repealed.

The Court of Appeals' March 29 ruling said, "After careful review, we discern no error." The cabinet filed a petition for a rehearing of the case on April 18, which the Court of Appeals denied on June 5.

What's it all about?

Under then-Gov. Steve Beshear, the cabinet applied a "budget neutrality adjustment" to its Medicaid payments that essentially reduced hospital Medicaid reimbursements to 70 percent of hospitals' costs.

The hospitals said that did not comply with state or federal requirements that Medicaid payments be based on the actual cost of care, and that they be "reasonable and adequate."

The hospitals tried to go through a regulatory process to resolve the dispute, but in 2013, the cabinet said the hospitals had no administrative appeal rights on the issue and dismissed their request "without administrative evidentiary hearings or further due process," the appeals court said.

On the same day it sent its dismissal letters to the hospitals, the cabinet filed a lawsuit seeking a court declaration that its reimbursement methodology was legal. Judge Shepherd found that the rate-setting method was invalid and told the cabinet to hold hearings.

The cabinet appealed, but the Court of Appeals upheld Shepherd, saying "The hospitals may seek monetary damages for past underpayment from the cabinet," including interest and other damages.

The Cabinet has asked for a discretionary review by the Supreme Court.

Study shows a link between frequent exposure to insecticides and a higher risk of depression and anxiety in Ecuadorian teenagers

Teenagers with frequent exposure to the most widely form of insecticide may have an increased risk of depression, according to a study published in the International Journal of Hygiene and Environmental Health.

The study was conducted in Ecuador by Dr. Jose Suarez-Lopez, an assistant professor at the University of California-San Diego. He and colleagues "have been tracking the development of children living near agriculture in the Ecuadorian Andes since 2008," a university press release said. "Ecuador is the world’s third-largest exporter of roses, with much of the flower production located near the homes of participants. Like many other agricultural crops, flowers are routinely sprayed with organophosphate insecticides, which are known to affect the human cholinergic system, a key system in the function of the brain and nervous system."

Researchers measured blood levels in 11- to 17-year-olds of an enzyme that is inhibited by organophosphates. Studies in mice had shown that reduced levels of the enzyme were linked to "behaviors of anxiety and depression in mice, and a few existing studies in humans have also suggested such a link," the release says. "However, pesticide exposure assessment in past studies had been only established by self-report of exposure and not using biological measures."

The study found that teens who had reduced enzyme levels, suggesting greater exposure to , showed higher-than-normal symptoms of depression. "The association was stronger for girls, who comprised half of all participants, and for teens younger than 14," the release says. It quotes Suarez-Lopez:  “Agricultural workers and people in these communities have long offered anecdotal reports of a rise in adolescent depression and suicidal tendencies. This is the first study to provide empirical data establishing that link using a biological marker of exposure, and it points to a need for further study.”

Providers, advocates and academics file court briefs against work rules in Medicaid; only supporting entity is Ky. Hospital Assn.

"Dozens of provider groups, advocates and academics are urging a federal appeals court to rule against" Gov. Matt Bevin's plan to require work or other "community engagement" from "able-bodied" Medicaid beneficiaries in Kentucky, James Romoser reports for Inside Health Policy.

In five friend-of-the-court briefs, "a diverse array of organizations and prominent health-care scholars weighed in on the side of beneficiaries who are challenging the legality" of the plan and a similar one in Arkansas, Romoser writes.

U.S. District Judge James Boasberg

U.S. District Judge James Boasberg of Washington, D.C., has blocked the plans, saying they are not allowed by the 1965 law that created Medicaid as a national program also funded by the states. The Trump administration has appealed to the U.S. Court of Appeals for the District of Columbia Circuit.

The briefs agree with Boasberg, and argue that work rules "undermine the purpose of Medicaid, make people sicker, and disproportionately harm beneficiaries in vulnerable populations," Romoser reports. "Several of the briefs rely on a recently released Harvard study finding that Arkansas’ work requirements failed to boost employment during the initial months when they were in effect."

The Arkansas Hospital Association joined with nine other organizations in a brief criticizing the plan in that state, contrary to the Kentucky Hospital Association, which filed a brief in May, urging the court to uphold the Kentucky plan, Romoser notes. He adds that KHA "is the only entity that filed an amicus brief in support of work requirements — a marked contrast with the roughly 80 individuals and organizations that have signed one of the amicus briefs opposing work requirements."

The KHA brief called the plan a "reasonable experiment" to test whether "linking Medicaid benefits to work-sponsored commercial insurance, may encourage beneficiaries to maintain, and use, health-care coverage even while healthy," Andy Davis reports in a long story for the Arkansas Democrat & Gazette.

The Arkansas hospitals joined a brief with the American Medical Association, the American Academy of Pediatrics, the National Alliance on Mental Illness and other groups, arguing that the Arkansas plan would cause mass disenrollment from Medicaid, make beneficiaries sicker "and will possibly lead to premature deaths," Romoser reports. "The AMA and other national provider groups also filed a similar brief arguing that the Kentucky waiver will have the same negative health consequences."

Another brief, by organizations that represent seniors and people with disabilities or chronic conditions, argues that Kentucky's work requirements would “devastate older adults and people with disabilities or chronic conditions.” Kentucky’s plan applies to people up to 64; Arkansas' program goes to 49.

"The organizations take issue with CMS’ contention that work requirements apply only to beneficiaries who are capable of working," Romoser reports. "Many beneficiaries who are deemed able-bodied may have chronic conditions and need significant care, the brief says." CMS is the Centers for Medicare and Medicaid Services.

A date for oral arguments in the case has not been set, "but likely will occur in the fall," Romoser writes. Bevin is up for re-election on Nov. 5, but has said he expects the issue to go to the U.S. Supreme Court.

Ky.-based Infection-control activist calls for screening all patients, isolating infected ones, making hospital risk ratings more reliable

An infection-control activist says every hospital patient in the U.S. should be screened for a certain type of staph infection that can be deadly, citing data that shows this is the best way to decrease the spread of such infections.

Dr. Kevin Kavanagh of Somerset, chair of Health Watch USA, made several assertions and recommendations in a commentary published in the medical journal Antimicrobial Resistance & Infection Control, and also wrote an op-ed about the issue for BioMed Central. 

The commentary was prompted by new data from the federal Centers for Disease Control and Prevention showing that more than 119,000 people in America had a staph infection in 2017, and nearly 20,000 of them died from it.

These numbers reflect rates for all Staphylococcus aureus infections, including methicillin-resistant Staphylococcus aureus, or MRSA, and methicillin-susceptible Staphylococcus aureus, or MSSA.

Centers for Disease Control and Prevention chart; click on it for a larger version

After dropping by an average of 17 percent a year between 2005 and 2012, the rate of decline for hospital-onset MRSA has stalled. The report notes that the U.S. is not on track to meet its goal of 50% reduction by 2020.

Department of Veterans Affairs hospitals had a much larger decrease in MRSA infections, as opposed MSSA, since 2005: 55% and 12%, respectively.

Kavanagh says the difference is that the VA has universal MRSA surveillance and isolates all MRSA carriers, and those results mirror the results in the United Kingdom's National Health Service, which has similar infection-control practices.

"These findings support the contention that the marked decline in hospital-onset MRSA infections observed in these studies is due to interventions which are specifically targeted towards MRSA," he writes.

Kavanagh argues that because MRSA is regularly found in 2% of hospital patients, all U.S. hospitals should screen all patients for MRSA when admitted.

He says hospitals have moved away from early identification and isolation of MRSA carriers as a first line of intervention, to strategies that are based on poorly designed studies — perhaps as a reaction to patient-advocacy groups' push to mandate MRSA testing and isolation, which is costly.

Kavanagh further argues that daily bathing with the antiseptic chlorhexidine, a common practice in U.S. hospitals, is not supported by solid research. He says one study supporting it has data interpretations that have been questioned, and has "apparent conflicts of interest." He also argues that random, controlled trials haven't demonstrated uniform effectiveness of chlorhexidine bathing.

Kavanagh also points out instances where facilities have asked for "risk adjustments" to be made for their rates of hospital-acquired infections, such as adjusting the numbers to allow for high rates of infection among opioid users. He holds firm that this should not be allowed.

He argues that instead of adjusting numbers to make the problem seem less than it really is, hospitals should follow a standard of care that includes not only screening and isolation, but decolonization, which means getting rid of the MRSA virus in people who carry it in their nose or on their skin even though they are not sick with a MRSA infection.

Kavanagh says some of Kentucky's major hospitals have the highest numbers of MRSA infections in the U.S., but after manipulating the data for "risk adjustment" they are designated "no different from national benchmark."

He calls for a different way of thinking about MRSA in the U.S. that includes increased transparency; making surveillance, isolation and decolonization a standard of care that is fully funded; and a more comprehensive tracking system.

He concludes, "Until these reforms are universally enacted in the United States health-care facilities, I have grave reservations that the epidemic of drug-resistant bacteria will be brought under control."

Caregiving costs aren't just for the elderly, health columnist says

By Trudy Lieberman, Rural Health News Service

Is the U.S. ready for a discussion about paying for caregiving, an increasingly vexing and costly problem for a growing number of Americans?

The answer may be “yes.” It has become obvious that long-term-care insurance is not the answer to paying for nursing home and other kinds of care for the elderly. Sales for this product have been declining, the result of sky-high premiums, rate increases, and the difficulty of qualifying for a policy if you’re sick.

But the elderly are not the only Americans needing care. At the other end of the age spectrum, paying for childcare is becoming harder and harder except for families with the fattest salaries.

In between are middle-aged women, many of whom have left the workforce to become caregivers for elderly parents. Not only do they not get paid for the care they give, but they jeopardize their own income security and health care when they reach retirement age because they have quit paying into Social Security.

The need for financial help is clear and growing. Among those turning 65 today, 70 percent will eventually need help with one activity of daily living such as eating and bathing. Fifty-two percent will need significant long-term services and supports for two activities of daily living. Among those needing such supports now, 40 percent are working-age adults, many of whom need lifetime care, according to the National Academy of Social Insurance, a non-profit, nonpartisan Washington-based organization, which fosters the understanding of America’s social insurance programs: Social Security and Medicare.

But what if there were a program where Americans paid a little bit each month through their entire working life just as they do now to qualify for Social Security and Medicare benefits? Over a lifetime, a person would be entitled to a benefit just as paying into Social Security entitles them to receive disability benefits and their surviving spouse or children to receive survivors’ benefits should the person die.

In the last 20 or 30 years policy proposals in this area didn’t match the magnitude of the problem, says Marc Cohen, a co-director of the LeadingAge LTSS Center at UMass, Boston. But now a more far-reaching proposal has surfaced.

An advocacy group, Caring Across Generations, has just released a document outlining options for a long-term care benefit for states to consider. The work is the result of panel convened by the National Academy of Social Insurance.

For too long, policy makers and the media have avoided discussing the reality of the caregiving problem, although it has surfaced in the presidential campaign with a nod to the challenges of paying for childcare.

“Universal family care is a more comprehensive approach to the care crisis,” says Dr. Benjamin Veghte, research director at Caring Across Generations who led the NASI study panel. “This is very feasible. We know how to do this.”

The study panel lays out a number of options for the states to consider. For example, should there be only modest benefits, or should there be more generous benefits that would cost more? Should a program cover just workers, or should it be more universal?

Another decision, Veghte says, might be deciding to finance the benefits exclusively through worker contributions or include some general revenues. Medicare Part B, and Part D, which provides the drug benefit, are heavily funded with general tax revenues.

This spring Washington state passed a law, the first of its kind in the country, that establishes a social insurance program for long-term care. All residents will pay 58 cents on every $100 of income into a state trust fund. That’s estimated to cost the average worker about $18 per month. When they become eligible for services, they can receive benefits of $100 a day up to a lifetime cap of $36,500.

Those receiving care can choose what kind of services they want or need. They can even use it for financial support for family caregivers.

You might be thinking the plan is not very generous considering that the average price of a semi-private room in a nursing home is about $7,400 per month, but it’s a start.

It’s more than just a start, though. It’s a huge step forward to solve what has become a growing and seemingly intractable problem for Americans. Washington state is thinking outside the box. Time will tell if others do, too.

What problems have you had paying for long-term care? Write to trudy.lieberman@gmail.com.

Ky. Hospital Assn. gets grant for emergency-room software that tracks patient histories from other sites; could thwart 'ER hopping'

By Melissa Patrick
Kentucky Health News

The Kentucky Hospital Association has been awarded a $250,000 grant to equip Kentucky's emergency departments with software designed to help physicians have access to patient information from multiple sources in real time.

The grant for the software, called EDie, came from Anthem Foundation, the philanthropic arm of Anthem Inc., a major health insurer.

“Information is a powerful tool in medicine, especially emergency medicine when life and death decisions must be made quickly,” Harold C. Warman, president of Highlands Regional Medical Center in Prestonsburg, the first hospital in Kentucky to go live with the software, said in a news release. “EDie instantly consolidates information from multiple sources that would otherwise take hours to obtain, and lets emergency physicians make faster, more informed clinical decisions.”

EDie works by collecting data from thousands of hospitals, urgent cares, clinics and health plans and then packages the data and delivers it to emergency room physicians in real time.

"In one concise report, the ED team can see patient history, visit summaries, medical providers, security events, and even care recommendations like preferred language and drug allergies," says the release.

The grant funds, combined with discounts from Collective Medical Technologies, a Salt Lake City firm that developed the software, will cover one year's costs for nearly every hospital in the state, said Ginger Dreyer, director of communications for the hospital association.

"There are also separate grants to pay the cost for small, rural hospitals to have access to the EDie solution," Dreyer said.

The release says 10 Kentucky hospitals have adopted the technology and 28 others are in the process of installing it.

Dreyer said six five of the 10 that have adopted the program are actively using it, In addition to Highlands Regional, they are Breckinridge Memorial Hospital in Hardinsburg; Hardin Memorial Health in Elizabethtown; Wayne County Hospital in Monticello; and St. Claire Regional Medical Center in Morehead. ; and Twin Lakes Regional Medical Center in Leitchfield.

The release notes that this software will help hospitals identify and support high-risk patients across care settings, with the goal of reducing avoidable readmissions and further enabling statewide efforts to address the opioid epidemic,

“One particularly powerful application of this technology is in fighting Kentucky’s opioid epidemic,” KHA President Nancy Galvagni, said in the release. “Emergency-room hopping is a serious obstacle in helping people suffering from addiction and this software can tell a treating physician if the patient has a history of ER visits for pain treatment. EDie can be the difference between enabling addiction and treating it.”