Health care is top-spending legislative lobby in Kentucky

Kentucky's health-care industry spent about $1.5 million, more than any other industry, to lobby state legislators in  in the first four months of the year.

"Health care spending was led by hospital operators, who spent about $300,000, including Kentucky Hospital Association ($56,000), Norton Healthcare ($44,631), Baptist Healthcare System ($42,800) and St. Elizabeth Healthcare ($28,182)," the Lexington Herald-Leader's Jack Brammer writes, from a report by the Kentucky Legislative Ethics Commission.

Pharmaceutical companies and pharmacies spent the second highest amount, about $281,000. That includes contributions from the Consumer Healthcare Products Association ($67,333), Pharmaceutical Research & Manufacturers of America/PhRMA ($23,362), Amgen ($19,389), Glaxo SmithKline ($18,500), American Pharmacy Cooperative ($18,000) and Pfizer ($15,000).

Other big spenders include the Kentucky Medical Association ($71,415); All Things Good, a Louisville-based chiropractic business ($65,000); Kentucky Optometric Association ($61,604); and Kentucky Academy of Eye Physicians & Surgeons ($26,000).

A total of about $7 million was spent on legislative lobbying in Kentucky in the first four months of 2011. About $6.5 million of that was spent by 660 employers of lobbyists and about $445,000 was spent by lobbyists themselves. The insurance industry, which is often related to the health industry, spent about $354,000. Energy and utility interests like coal and natural gas spent $516,000. Reports filed by employers and legislative agents are compiled on the Legislative Ethics Commission's website. For the Herald-Leader story, go here.

Watching 3-D movies may strain eyes but doesn't harm them and can help detect vision impairment, optometrists say

With summer blockbusters set to be released in the coming months, the Kentucky Optometric Association says watching 3-D movies is not harmful to eyes, but can cause eye strain and headaches.

To help with those conditions, the association recommends sitting farther back from the movie screen.

In some cases, some viewers won't be able to recognize 3-D pictures because they lack binocular vision. "Although this doesn't pose any problem viewing the screen, it serves as a vision screening that something is abnormal with the viewer's binocular vision," the association says in a news release used by the Journal-Enterprise of Providence.

"That means 3-D actually has a benefit," said Dr. Joe Ellis, an optometrist in Benton and president of the optometric association. "It can alert people to undetected vision disorders and eye diseases that, if caught early, are fully treatable."

Viewers might consider seeing an optometrist or ophthalmologist if they get headaches while watching 3-D, if they feel nauseous or dizzy after viewing or if it is difficult for their eyes to adjust back to normal after viewing. (Read more)

National system needed to battle pill abuse, newspaper says

Despite Georgia's recent move to implement a system that will track prescription pill use, a national system is needed to help prevent the problem flowing "to the next crack in the system," the Lexington Herald-Leader says in an editorial today.

"We know it's popular now to howl about big government," the paper says. "But if a national government has any legitimate use, it is certainly to stop something like the pill pipeline that operates across state lines. . . . "As long as even a few states don't have monitoring systems the market will move to those areas of opportunity."

The piece cites a story that ran in the Herald-Leader May 17. In it, reporter Bill Estep discussed Georgia's move to approve a tracking system, meant to prevent people from "doctor shopping," filling the resulting prescriptions and selling the pills illegally. "Florida has been the leading source of pills flowing into Kentucky from outside the state, but Georgia has been a growing source of concern," Estep reported.

While Georgia's monitoring system is approved, money is still needed to fund it. "We hope Georgia will get those grants. But we'd be more optimistic if funding weren't based on hope," the paper says. "There's every indication the rate of prescription drug abuse is outpacing the monitoring system."

The editorial notes that overdose deaths in Kentucky continue to rise, doubling from 403 in 2000 to 978 in 2009: "Confirmed overdose deaths in Floyd County jumped from 15 in 2009 to 43 in 2010, according to Brent Turner, the commonwealth's attorney there. Florida averages seven overdose deaths a day." (Read more)

More Americans are choosing health insurance with high deductibles, lower premiums; study says that strategy pays off

In order to pay lower premiums on their health insurance, Americans are opting for plans that have cheaper  monthly premiums but higher deductibles, USA Today's Kelly Kennedy reports.

In 2007, about 4.5 million people opted for high-deductible plans. By 2010 that number had more than doubled to 10 million, an America's Health Insurance Plans survey found. Having high deductibles saves $85 to $100 a month on premiums, but runs the risk of paying more when services are used. It's important for purchasers to understand that lower premiums can mean higher doctors' bills, said Karen Ignagni, president of the industry group.

However, a RAND Corp. study found that people on high-deductible plans pay considerably less than people on traditional plans. "RAND researchers also found that people on high-deductible plans — no matter their income level — received less preventive care: fewer annual exams, fewer cervical cancer screenings and fewer colonoscopies," Kennedy reports. The federal health reform law is preventing some of that from happening, however. Now, most high-deductible plans have to include basic preventive care like colonoscopies.

High-deductible plans are expected to become more common, especially since 47 percent of people who are insured through their employers have high-deductible plans. "Employers like the plans because it's cheaper to insure an employee — about $133 less per family at companies that offer only the high-deductible plans, according to a study in the American Journal of Managed Care," Kennedy reports. (Read more)

Teenager set to return to Haiti after Louisville docs fix her heart

After Louisville doctors performed a life-saving operation on her failing heart, a 16-year-old girl is set to return to her native Haiti. Stephanie Privert, left, came to Kentucky after she became ill following the deadly 7.0-magnitude earthquake that devastated the country, The Courier-Journal's Chris Kenning reports. (C-J photo by Pam Spaulding)

"We hate to see that she's obliged to return to a tough situation, but we can't keep her here forever," said Dr. Erle Austin, the lead heart surgeon during Privert's operation. "She's so much better than when she arrived."

Privert was watching her mother cook soup when the earthquake struck. Her family was able to escape, but her home near Port-au-Prince was destroyed. Privert's health quickly deteriorated and she was brought to a clinic run by American doctors from Medical Teams International. Deciding she could not be treated in hospitals in Haiti or neighboring Dominican Republic, the doctors got in touch with non-profit group Healing the Children, which has a chapter in Louisville. Its members helped her fly to Kentucky. She arrived weighing just 70 pounds.

Doctors determined she had a leaking heart valve, which was causing severe pulmonary hypertension and lung problems, Kenning reports. In August, doctors at Kosair Children's Hospital decided to repair the valve, rather than replace it with a mechanical one, which would require expensive anti-rejection drugs, or a pig valve that would wear out more quickly.

Since, she has been recovering, staying with host families, learning English and attending school. The Haitian Christian Outreach has raised money needed to start rebuilding Privert's family home in Haiti. (Read more)

Rural Training Track programs get more health professionals to rural areas, but live 'on the edge' of funding and personnel

By Tara Kaprowy
Kentucky Health News

With the Obama administration offering more funding to improve rural health care, Rural Training Track programs to steer medical students to rural areas are hoping to expand, a move that would benefit underserved areas of Kentucky.

"Over 62 million Americans live in rural America and there is a significant crisis in terms of having access to care for these people," said Amy Elizondo, vice president of program services at the National Rural Health Association. "There is a very uneven distribution of health care professionals and an acute shortage of primary care physicians in rural areas. If we can recruit and retain physicians to serve rural areas, we improve access for rural America." (University of Washington map; click for larger version)

RTT programs aim to educate family physician residents in rural environments with the hope they will continue to practice there, Candi Helseth reports in a deailed article for the Rural Assistance Center. "These residency programs are a proven model for addressing rural family physician workforce shortages, with more than 70 percent of graduates praticing in rural areas," Helseth reports. The first such program started in Colville, Wash., in 1985. There are 25 RTTs in 17 states, including one in Morehead by the University of Kentucky and St. Claire Regional Medical Center. Eight physicians have graduated from the program there since it was established in 2000, five of whom are practicing in Kentucky. Of those five, three have joined the SCR medical staff.

There are similar success stories across the country. In Caldwell, Idaho, 95 percent of graduates have chosen to practice in rural areas over the past 16 years. "We heavily recruit residents who are rural-oriented," said Dr. Samantha Portenier, a practicing physician and director of the Caldwell RTT. "We've had some who were not and we converted them. Part of it was that they really saw where the training we give them and the skills they learn are so needed in rural areas. I emphasize that in rural areas you can specialize in areas that particularly interest you."

Despite the success, 10 RTT programs have closed in the past 10 years. "Every RTT lives on the edge in terms of funding," said Dr. Randall Longenecker, who is project director of Rural Training Track Assistance Demonstration Project. "In general RTTs are small, have limited faculty and are vulnerable to personnel changes, a bad year for recruiting, loss of funding and many other factors beyond their control."

Morehead's RTT is funded by St. Claire. Residents spend their first year at the UK College of Medicine in Lexington and their second and third years at St. Claire, which is accredited by the Accreditation Council for Graduate Education. Carla Terry, St. Claire's graduate medical education coordinator, acknowledged the difficulty in maintaining an RTT program. "The reason why the RTTs are in jeopardy is that all the faculty that teach them are voluntary," she told Kentucky Health News. "They are not paid to teach, they still have to keep their patient load. If it were a university program, all the faculty would be paid."

But St. Claire physicians believe strongly in rural-based education and also see how they can benefit from their investment. "We actually had a physician that when he came here he was interested in starting a residency because he wanted to use that as future recruitment," she said. "We look at it as training future partners."

Now, RTTs are under a federal microscope. The health care reform law created the Rural Training Track Assistance Demonstration Project, a three-year pilot program that plans to "collect comprehensive information to better understand the collective forces challenging RTT models and develop solutions that will strengthen existing RTTs and encourage development of new RTTs," Helseth reports.

The time is ripe, given that more medical students are choosing to be family medicine physicians, up by 11 percent last year and 8 percent the year before. "We have a real opportunity here to redefine the importance of primary care being foundational in rural workforces," Dr. Ted Epperly, past president and past board chairman of the American Academy of Family Physicians, told Helseth. "Right now, only 9 percent of physicians are choosing to practice in rural areas while 20 percent of the population lives there. RTTs offer a way to give family physicians a broad scope of practice, which they need practicing in a rural area, and to get them to stay in those rural areas." (Read more)

Fight is on against mosquitoes, West Nile virus after flooding

The fight is on to rid Western Kentucky of a mosquito infestation  worsened by recent flooding. Treatment to kill adult mosquitoes began Wednesday night, The Gleaner of Henderson reports.

The effort is partly to prevent the spread of the West Nile virus, a potentially serious illness. Mild infection can result in fever, headache, body ache and a skin rash. Severe infection, which affects about 1 in 150 infected people, can lead to high fever, disorientation, sleepiness and even coma, paralysis and death. Mosquitoes can transmit the infection to humans with a bite. (Centers for Disease Control and Prevention diagram)

The state's plan is a two-part process, killing adult mosquitoes and their larvae. It uses aerial spraying over 700,000 acres in Western Kentucky, concentrating on areas along or near waterways where flooding was most problematic. Planes will spray from dusk until after midnight until treatment is complete. Afterward, ground crews with the Transportation Cabinet will treat against mosquito larvae in standing water. The state Department of Agriculture will also spray ditch lines along roads. Chemicals used in the treatments are only harmful to mosquitoes, gnats and black flies, a state press release reads. It is safe for humans, pets and livestock.

Residents are asked to eliminate standing water in containers on their property and wear insect repellent and long-sleeved clothing. (Read more)

Bidders to manage Medicaid unknown; contracts July 1?

It is not known who bid on taking over the work, but Kentucky is advancing plans to turn Medicaid over to managed-care organizations. The move, which will allow the organizations to take over the day-to-day operations of Medicaid in the state, is meant to improve efficiency and save money, The Courier-Journal's Deborah Yetter reports.

"The proposed changes will dramatically reshape the program for more than 500,000 of the roughly 800,000 Kentuckians who depend on Medicaid for health care," Yetter writes. "It will not affect those in nursing homes or in certain programs that serve individuals with mental disabilities."

Gov. Steve Beshear promised the move earlier this year in his proposal to fill a $166 million gap in Medicaid funding, which comes mainly from the federal government. His administration believes moving to managed can save about $139 million in Medicaid costs next year. There are concerns about the plan, not the least of which how to make a smooth transition for patients. "We want to make sure people are able to access their doctors and access to care is not threatened," said Jodi Mitchell, executive director of Kentucky Voices for Health.

Rural pharmacists are also worried about the impact, since legislators "have not ruled out allowing mail-order prescriptions for maintenance drugs, such as blood pressure pills," Yetter reports. If mail-order is allowed, pharmacists are concerned there would be less contact with patients and that rural, independently-owned pharmacies would be threatened. "With mail order you are taking revenue out of the state," said Clay Rhodes, president of the Kentucky Pharmacists' Association. "Mail order can survive on the thinnest of margins and your rural pharmacy more than likely can't."

The bidding process is a complicated one, Yetter reports, and it is unclear how Passport Health Plan, a managed-care organization that already takes care of 30 percent of the state's Medicaid recipients in the 16-county Louisville region, fits in. Bidders are asked to submit bids "for the Passport region alone, another for the whole state and the other for the entire state except for Passport," Yetter reports.

Contracts will be awarded July 1. Yetter confirmed Humana Inc. has chosen not to bid. (Read more)

World No Tobacco Day to be observed Tuesday

World No Tobacco Day 2011 will be observed Tuesday, with goals of encouraging tobacco abstinence for a 24-hour period, as well as drawing attention to the dangers of tobacco use.

The observance, created by the World Health Organization in 1987, occurs each May 31. This year's theme is WHO's Framework Convention on Tobacco Control, a treaty that "reaffirms the right of all people to the highest standard of health and provides new legal dimensions for cooperation in tobacco control," said a WHO press release.

The 2005 treaty has been embraced by 170 parties. It protects public health policies from companies with vested interests in the tobacco industry; regulates tobacco products; adopts price and tax measures for tobacco products; regulates packaging and labeling of tobacco products; bans tobacco advertising; bans sales to minor; and supports alternatives to tobacco farming. The key message of the day will be "that countries must fully implement the treaty to protect present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke," a press release reads.

In recognition of World No Tobacco Day, the Foundation for a Healthy Kentucky has noted latest smoking-related data for the state.

Among Adult Kentuckians, 26 percent are smokers. Fayette County has the lowest rate (17 percent) and Breathitt, Owsley, Perry and Wolfe counties are tied for highest at 36 percent. The data were collected from the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System for the years 2007 to 2009. Smoking rates for every county are available by clicking here.

This year, more than 5 million people will die from a tobacco-related heart attack, stroke, cancer, lung ailment or other disease, according to the WHO press release. It said more than 600,000 people, more than a quarter of whom are children, will die from second-hand smoke. (Read more)

Bowling Green American Legion post tests smoking ban, is fined

An American Legion post in Bowling Green has been fined $25 for violating the city's no-smoking ordinance. The Bowling Green Code Enforcement Board decided unanimously Tuesday to uphold the citation that Post 23 received April 28 after two plainclothed police officers went into the facility during bingo night and found people smoking inside, Justin Story of the Bowling Green Daily News reports.

Officers Tammy Britt and Rebecca Robins testified they bought two sheets of bingo cards and a soda at the facility. They said they were not asked at any point if they were members of the Post. The city's smoking ordinance "defines private organizations as establishments that are exempt from federal income taxes, are not profit-oriented, maintain a selective membership that operates the organization and does not sell food, drinks, entertainment or lodging to anyone who is not a member or a member's guest," Story reports.

More members started to smoke after Jim Manley, the Post's chief finance officer, told the crowd they were free to do so. "He said that if a citation were issued it would be to (the post) and not the individual, and after that more people started smoking," Britt said. The citation indicates the facility violated three provisions of the ordinance: allowing smoking in a building/enclosed area; failure to remove ashtrays; and failure of owner or person in control to ensure compliance.

Malcolm Cherry, an officer of Post 23, "said that he wanted it to be cited by allowing smoking during charitable gaming on April 28 in an effort to prove it was exempt," Story reports. "Our whole intention was for the officers to be there and have the citation issue to us personally," Cherry said. City Attorney Gene Harmon argued the post does not meet all the criteria to be considered a private club, in part because it sells bingo cards and refreshments during bingo night. The board agreed. (Read more)

Cervical cancer initiative launched to promote education, vaccination, screening, prevention and treatment

The Cervical Cancer-Free America initiative launched earlier this month, bringing together six states, including Kentucky, and more than 75 organizations to help eradicate the disease. Promoting education, vaccination and effective screening are the cornerstones of the effort.

"Cervical cancer is a preventable and, if found early, a curable disease," said Dr. Baretta R. Casey, director of Cervical Cancer-Free Kentucky. "Education of every woman, young and old, is important."

Though it is largely preventable, nearly 400 Kentucky women develop cervical cancer each year, and 66 die of it. Kentucky has one of the highest incidence rates and mortality rates of cervical cancer in the country, mostly affecting rural, white women.

CCFA will bring together public health professionals, foundations, private partners and cancer survivors like Marissa Winokur, right, to build a public health campaign. "The goal of making the United States free of cervical cancer is ambitious but eminently achievable. Just like the polio vaccine nearly eradicated polio globally during the 20th century, we now have the opportunity to nearly eradicate cervical cancer collectively through screening, vaccination and treatment," CCFA Director Jennifer S. Smith said.

Cervical cancer is caused by various types of the human papillomavirus, which three of four adults contract at some point in their lives. A vaccine against two types of this virus, which are responsible for 70 percent of all cervical cancers, is available for girls and young women ages 11 to 26. But only a fourth of them have received all three doses of the vaccine.

The vaccine does not protect against all types of cervical cancer, so screening is still needed. The Pap test, which is generally performed annually, can detect cervical cancer when it is still treatable. At least half of all cervical cancer deaths are due to lack of regular screening. (Read more)

Tooth varnish saving smiles in Clark County

To protect about 3,000 Clark County children from tooth decay, local dentists and volunteers headed to schools to apply a fluoride varnish earlier this month. "We knew this material worked, although it was a new material, and there wasn't a lot of research on it at the time," dentist Rankin Skinner told The Winchester Sun's Rachel Parsons.

Skinner became concerned after learning that Kentucky children have more tooth decay than anywhere else in the country, a fact he gleaned from a Christmas Eve 2007 article in The New York Times. The same day, one of Skinner's friends read the article by Ian Urbina and called him to come up with a plan. "Skinner had recently completed a study on tooth decay in Ecuador, and the participating dentists had seen great improvement in oral health using a material new to the market at that time called amorphous calcium phosphate," Parsons reports.

Local dentists and the Clark County Community Foundation, of which Skinner's friend was a member, got together to get the varnish in Clark County. Twice a year, the dentists go to elementary and pre-schools to apply it on students' teeth, such as those of Emily Havens (above, Sun photo by James Mann). "We wanted to get the material on there as soon as the teeth came in," Skinner said. "There's just too much decay out there to be fixed. We knew we needed a preventative program."

Dentists found evidence of tooth decay in half the students the first year, but noted an 11 percent drop in decay in sixth-grade students after the first year. They track progress annually and conduct full exams on sixth-grade students to check for cavities. If any are found, parents are informed. Students are also given tooth brushes at the beginning of each school year. (Read more)