Hike in health insurance premiums due to rising health costs, not reform law, FactCheck.org concludes

Health insurance premiums for employer-sponsored family plans shot up by 9 percent from 2010 to 2011, but the bulk of the hike is due to the increase in health care costs, not the federal health-care reform law, non-partisan FactCheck.org has found.

The law is responsible for about 1 to 3 percent of the increase, however, in large part because the law requires an increase in benefits, including: covering preventive care without co-pays or deductibles; allowing adult children to stay on parents' policies until age 26; increasing annual coverage limits; and covering children regardless of preexisting conditions.

"On the other hand, the fact that the law caused any increase at all casts more doubt on Obama's promise that the law 'could save families $2,500 in the comings years.' We've been calling that claim into question for several years now," Factcheck.org stares. "The plan fact is that — so far — the law has caused an increase in premiums, though not so large an increase as some Republicans claim." (Read more)

Haven't quit smoking, lost weight? Pay more for health insurance, more companies say

In an effort to keep health-care costs down, companies across the country, including Walmart, are opting to charge workers who smoke or are obese higher premiums than their more healthy colleagues. (Reuters photo by Lucas Jackson)

The move is the follow-up to a strategy many companies have already tried: to encourage workers to take better care of their health by offering benefits like weight-loss programs or smoking-cessation classes. But with few signs of the health-care landscape changing, "They're replacing the carrot with a stick and raising costs for workers who can't seem to lower their cholesterol or tackle obesity," reports Jillian Mincer of Reuters.

One example is Walmart, which in 2012 will start charging its smoking workers higher premiums. It will also offer cessation classes. A company spokesman said people who use tobacco use about 25 percent more health-care services than people who don't: "These decisions aren't easy, but we need to balance costs and provide quality coverage."

Critics say the move will limiting people's freedoms, create employee resentment and hut the lowest-paid workers hardest. "It's not inherently wrong to hold people responsible," said Lewis Maltby, president of the National Workrights Institute. "But it's a dangerous precedent."

Though well-intentioned, these policies can create bitterness. Mark A. Rothstein, a lawyer and professor at the University of Louisville School of Medicine, said having a colleague call to ask about a person's weight loss can be seen as intrusive. That's part of the reason why the janitors at the school participate, but "the professors on campus consider it a privacy tax, so we don't get some stranger calling us about how much we weigh."

Nevertheless, many companies are moving forward with the option. In 2012, almost 40 percent of large and mid-size companies will start using penalties to control unhealthy behavior. That's up from 19 percent this year and just 8 percent in 2009, an October survey by consulting firm Towers Watson and the National Business Group on Health shows. "Nothing else has worked to control health trends," said NBGH Vice President LuAnn Heinen. "A financial incentive reduces that procrastination."

Cleveland Clinic, with a staff of 40,000, has implemented a comprehensive program and seen its health-care costs grown just 2 percent this year. "The effort began several years ago when it banned smoking at the medical center and then refused to hire smokers," Mincer writes. "It later recognized that having a gym and weight -oss classes wasn't enough to get people to participate. It made these facilities and programs free and provided lower premiums to workers who maintained their health or improved it." Paul Terpeluk, medical director of occupational health at the clinic, said employers have to develop a program and change the culture: "You don't do this overnight." (Read more)

State's Medicaid program will be handled by managed care companies starting tomorrow

Update, Nov. 1: Kentucky Voices for Health, a coalition of more than 250 health care organizations, individuals and advocates, released its views on the move to managed care, which they said must be as much about improving the quality of health care as it is about saving money. "We want Medicaid managed care to be a positive move for both the fiscal health of Kentucky and the health of Kentuckians, so we must continually strive to ensure that all who are eligible have access to high-quality, affordable, effective health care regardless of poverty status or disability," said Dr. Rev. Marian McClure Taylor, KVH board member and executive director of the Kentucky Council of Churches.

The transition must also run smoothly, said Jody Mitchell, KVH executive director. "Our priority is ensuring that the 540,000 Medicaid members affected continue to receive the best health care possible, without interruption." (Read more)

About 560,000 Kentuckians on Medicaid will have a new way of getting health care starting tomorrow when the state switches to managed care.

So far, 68 acute-care hospitals, including some out-of-state facilities, have signed on to at least one of three of the managed care organizations chosen earlier this year by the state to run the program, reports Beth Musgrave of the Lexington Herald-Leader. Excluding the Louisville area, which has long been and will continue to be served by the Passport managed-care organization, there are 96 acute-care hospitals in Kentucky.

"A significant number of hospitals have signed in the last couple of weeks, and we anticipate that these numbers will continue to grow," said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services. The state had delayed the switch to managed care, which had been scheduled to begin Oct. 1, by one month to give providers time to sign contracts.

Gov. Steve Beshear said today the federal Centers for Medicaid and Medicare Services have approved the transition. "We have worked hard to make the transition as seamless as possible, and I appreciate the collaborative efforts that allowed us to reach this goal under aggressive deadlines."

Switching to managed care has been Beshear's answer to overcoming a Medicaid budget deficit. The program will be run by four managed care companies, which will be paid a predetermined per-patient, per-month amount regardless of what care is needed. Because they won't be paid using a fee-for-service model — believed to be more costly — and will try to streamline care, Beshear (right, photo by H-L's Pablo Alcala) said the move will save $1.3 billion in the next three years.

Delaying the move by another month could have cost the state $9.2 million in savings, Musgrave reports. (Read more)

Most beverage companies targeting kids, teens even more to sell sugary drinks, despite pledges; Pepsi an exception

A study analyzing the marketing practices for 600 products made by 14 companies found there is more advertising of sugary drinks to children, despite industry pledges to the contrary.

Child and teen exposure to TV ads for full-calorie soda doubled from 2008 to 2010. "This increase was driven by Coca-Cola and Dr. Pepper Snapple Group. Children were exposed to nearly twice as many TV ads for sugary drinks from these companies," the report by the Yale Rudd Center for Food Policy and Obesity reads. "In contrast, children were exposed to 22 percent fewer ads for PepsiCo sugary drink products." PepsiCo makes Mountain Dew, so sugary and popular among youth in Eastern Kentucky that dentists have identified a tooth-decay syndrome of "Mountain Dew mouth."

Coca-Cola, PepsiCo, Dr. Pepper Snapple Group and Kraft Foods produce two-thirds of the 900 products analyzed.

Coca-Cola accounted for three out of four brand appearances seen by children and teens. Nearly two-thirds of all full-calorie soda or energy drink ads on TV included sponsorship of an athlete, sports league or teams, or an event or cause.

In 2010, black children and Hispanic teens saw 80 to 90 percent more TV ads than white children. Marketing on Spanish-language TV is also growing. In 2010, Hispanic children and teens saw nearly twice the number of sugary drink and energy drink ads as in 2008.

The American Academy of Pediatrics says highly caffeinated energy drinks "have no place in the diet of children and adolescents." But in 2010, teenagers saw 18 percent more TV ads and heard nearly twice as many radio ads for energy drinks than adults did. (Read more)

Cyber predators have easier access to children because of phones, video games

Child predators have it easier than ever to entice their young victims, due to the ever-growing accessibility of the Internet. "It's a lot easier now than everybody has the Internet in their pocket," Lexington Police Detective David Flannery told Karla Ward of the Lexington Herald-Leader. "Every day that we think of a way to combat it, people are thinking of a way to get around us," Flannery said. "It changes every day, and you have to keep up with it."

Using the World Wide Web to lure children for sex acts has skyrocketed since 1998, when the National Center for Missing and Exploited Children received 707 reports of people trying to entice children via the Internet. In 2008, there were 8,787 reports.

"Computers and cell phones remain the primary means of communication, but game systems including Xbox 360, Nintendo DS and Wii also can be connected to the Internet, giving predators another way to gain access to children," Ward reports.

Though parents are becoming more aware, more education is needed, said Erin May Roth, an assistant U.S. attorney and the Project Safe Childhood coordinator for the Eastern District of Kentucky. "What they don't really think about is the fact that their kids are going to sleep with their phone," she said.

Flannery is the only police officer in Lexington assigned full-time to investigate Internet crimes against children. While he does not go into detail about his methods to track down predators, the concept involves pretending. "Anything that a kid can do, we can do," Flannery said.

Sometimes officers from several agencies and departments work together. The Kentucky State Police administers an Internet Crimes Against Children Task Force, the state attorney general's office has a similar unit, and, because cases can involve a number of jurisdictions, sometimes the Federal Bureau of Investigations, the U.S. Postal Service, the Secret Service and U.S. Immigrations and Customs Enforcement are involved.

Mother Frieda Curry, right, discovered her 14-year-old daughter was entangled with a 38-year-old man who initially pretended to be 16. She contacted the Richmond Police Department and found more than 40 text messages and 10,000 pages of messages and videos on the computer. "I was frantic," she said. "I was in the worst state I've ever been in." (Photo by H-L's David Perry)

But Curry, whose daughter is now in college, dealt with the problem and the predator was sentenced in U.S. District Court to 10 years in prison. Thinking about the crimes can be difficult, but "only by shining a light on the problem will we ever hope to find a solution for it," said Assistant Commonwealth's Attorney Lou Anna Red Corn. (Read more)

Brain-injured man disappeared when home staff wasn't looking

On the day of his disappearance, a resident of a personal-care home who was found dead four weeks later had not been checked on by staff for nearly three hours, reports Valarie Honeycutt Spears of the Lexington Herald-Leader, citing documents from a state investigation.

Additionally, Falmouth Nursing Home did not have a policy to make sure residents were under constant supervision and "the facility failed to establish" one, investigators found.

Larry Joe Lee, right, was a ward of the state and had a brain injury stemming from a childhood accident. He was "schizophrenic, bipolar and diabetic," Spears writes. He disappeared from the nursing home Aug. 4. His body was found Sept. 3 near the Licking River by bow hunters. The cause of his death has not yet been determined.

Spears' calls to the  home were not returned. It has since submitted a plan of correction to the state, which includes professional development for staff and new policies to keep track of patients' whereabouts.

"Since Lee's death, advocates and state lawmakers have been questioning whether personal care homes are the appropriate plate for people with brain injuries," Spears reports. Republican Sen. Jimmy Higdon, who comes from Lee's hometown of Lebanon, said he is on a fact-finding mission to see what changes need to be made to prevent a similar occurrence from happening. (Read more)

Kentucky court hearing more than 100 cases about drug that caused heart arrhythmia

More than 100 lawsuits filed by people who say they or their family members were hurt by Darvon, Darvocet or other drugs that contain the ingredient propoxyphene have been heard in U.S. District Court of the Eastern District of Kentucky since August. So far, none of the cases originated in Kentucky, but stem from people living in other parts of the country.

The effort is the result of U.S. District Judge Danny Reeves being selected by a federal panel to handle all cases pertaining to the subject, reports Jennifer Hewlett of the Lexington Herald-Leader. "It's basically in the interest of judicial economy so that multiple judges aren't handling the same issue," said deputy U.S. District Clerk Susan Baker.

Last last year, the U.S. Food and Drug Administration asked Xanodyne Pharmaceuticals to withdraw Darvon and Darvocet from the market after receiving evidence propoxyphene can cause serious or fatal heart rhythm abnormalities. Now, thousands of suits are being filed by people who took the drug. "Our issue is people took a bad drug that hurt people and they want to have their day in court," said attorney Richard Schulte of Dayton, Ohio, whose firm is dealing with 2,000 cases or potential cases. "We're looking for justice for our clients. You're not supposed to die when you take a pill for mild pain." (Read more)

Giuliani backs P'Pool, citing attorney general candidate's opposition to health-care reform law

Republican Rudy Giuliani, former mayor of New York City and presidential candidate in 2007-08, has endorsed GOP nominee Todd P'Pool in the race for attorney general, citing the candidate's "eagerness to join the legal fight against President Barack Obama's health care overhaul," reports Bruce Schreiner of The Associated Press.

"You've got to elect Todd as your next attorney general because you want to put Kentucky on the side of those states that say 'enough' with how far left our government has gone ... on health care policy," Giuliani said at a rally.

Twenty-six states are "challenging the law's requirements that people buy health insurance or pay a penalty on their taxes" starting in 2014, Schreiner reports. All of the attorneys general in the case are Republicans, except those in Iowa, Nevada and Wyoming. (In some states, attorneys general are appointed.) The case is headed to the U.S. Supreme Court.

Conway, who is seeking a second term, has defended the basic approach of the law, bringing into coverage most of the uninsured who now use emergency rooms to get care, while saying parts of it need changing. Giuliani said, "Your attorney general has Kentucky in a position, by not opposing it, of supporting Obamacare." (Read more)

What would solve primary-care crisis, create jobs and help banks? Building community health centers, writer contends

The federal health-care reform law will mean a glut of new patients who will be newly insured and bog down the primary-care system. Thousands of construction workers are out of jobs as the economy remains stagnant. And the banking sector is still reluctant to lend. The answer to all three problems? Build more community health centers, writes Jeffrey Leonard in an opinion piece in The Washington Monthly. (Photo: Vista, Calif., Community Clinic)

"The way to meet the flood of new patients coming down the pike is to expand the nation's existing network of community health centers — nonprofit clinics that offer primary care to the medically under-served, often in rural areas or inner cities," writes Leonard, CEO of the Global Environment Fund and chairman of the magazine's board of directors. "But to get this done, there's no need to appropriate billions more in direct government spending. Rather, there is a way to lure skittish banks in lending private capital to finance a health-center construction boom in all 50 states, simply by tweaking the language of an existing federal lending program."

Though community health centers generally have difficulty raising their own funds to expand or build facilities, in part because they serve uninsured, low-income patients who can't donate to building projects, they are sound investments, Leonard contends, pointing out only "one or two" of the 1,200 community health centers in America today have ever defaulted on a loan.

Still, they have trouble getting loans from banks, even once they have been able to raise a chunk of funds, in large part because centers "in an economically distressed inner-city neighborhood serving a mixture of Medicaid patients and the uninsured, or one in a depressed heartland town where real estate prices are spiraling downward" are seen as a risk, Leonard explains.

Leonard suggests the centers be eligible for the Small Business Administration's 504 loan program, in which a small business asks a non-profit lender to issue "low-interest, fixed-rate, government-backed bonds to finance up to 40 percent of the project," Leonard writes. As of now, the loan program is only open to some for-profit businesses. But Congress could change that, thus opening up possibilities. Moreover, the loan program is "routine and efficient to process" and the "interest rates are among the lowest on the market," Leonard contends.

Another option would be for construction companies and real estate developers to put up the equity themselves, build the facilities and then rent them out to nonprofits "on a long-term lease or through various lease-to-own arrangements." "Indeed, hungry developers and construction firms would find any number of ways to get the hammers swinging," Leonard writes.

Overall, it's a win-win, Leonard argues."It's hard to imagine Congress appropriating any more direct spending to fuel the construction of health centers," he writes. "But there's no good reason why they shouldn't change a few words in a statute to achieve the same end. Not only would it quickly create much-needed jobs in the construction trades, it would also spark economic activity over the long run in some of the places in America that need it most." (Read more)

Boys should get HPV vaccine to keep from spreading virus

A federal committee has recommended that boys receive the human papilloma virus vaccine, already recommended for girls, to fight the sexually transmitted virus that is known to cause cervical cancer. The vaccine could also protect boys against genital warts and anal cancer.

The Advisory Committee on Immunization Practices released its recommendation Wednesday. It is the first time there has been a public push for boys to receive the vaccine, though it has been licensed for male use for the past two years.

Dr. Baretta Casey, director of Cervical Cancer-Free Kentucky, applauded the move. "To stem the spread of the HPV virus and the many problems it causes is the best thing," she said.

The vaccine is usually given at the age of 11 or 12 and is only effective if it is given before a person becomes sexually active. As many as 80 percent of men and women are infected with HPV during the course of their lives, but most do not develop symptoms or illness, the Centers for Disease Control and Prevention reports.

The vaccine has been met with reluctance by parents, some of whom fear it would encourage sexual activity. Last year, just 49 percent of adolescent girls nationwide had received at least the first of its three doses, and only a third had gotten all three. In Kentucky, only 25 percent of adolescent females had received the first dose, and fewer than 11 percent had received all three doses.

Casey attributed parents' hesitation to a fear that the vaccine is harmful, though research shows otherwise. "It's our hope that people understand that this is a vaccine that has been around for quite a while now," she said. "The effects of the immunization are similar to other vaccines that we currently give our children. And if I can give my child a vaccine that would prevent them from ever developing cancer, I'm for it." On average, 391 Kentucky women develop cervical cancer and 66 die.

The cost of the vaccine — about $110 for each of the three doses — is also believed to be a factor in the low vaccination numbers, though Casey said Medicaid covers it, as do major health insurance providers such as Blue Cross Blue Shield and Anthem. Though the numbers are low, Casey said she is seeing some boys being vaccinated in Kentucky "but it's not a widely done practice." (Read more)

PIkeville Medical Center agrees to pay $36,000 to settle claim that it improperly billed Medicare

Pikeville Medical Center has agreed to pay more than $36,000, but does not have to admit any wrongdoing, to settle a lawsuit that accused it of improperly billing Medicare.

The suit was brought by Dr. Michael Fletcher, director of the pain management clinic from May 2005 to July 2007. "The hospital used improper billing codes for the pain management clinic, which indicated services were provided in a private physician's office, rather than a clinic," reports Brett Barrouquere of The Associated Press.

Fletcher alleged the same was being done at the hospital's radiation oncology and medical oncology units and told hospital administration as much, but nothing was done. Fletcher will receive $7,228 as part of the settlement of the suit, filed under the federal False Claims Act. (Read more)

Jury tells nursing home to pay $1 million to former resident

A Fayette County jury has decided that Lexington's Cambridge Place Nursing Home will have to pay more than $1 million in damages to a former resident who fell and was found in an equipment storage room with broken bones in her face.

In January 2009, Irene Hendrix, who has Alzheimer's disease, was reportedly walking up and down a hall using a Merry Walker, which is a walker that has a seat. At some point, Hendrix, right, fell and was found with bleeding in her brain, a 4-centimeter cut on her forehead and the broken bones, the Lexington Herald-Leader's Valarie Honeycutt Spears reports. Hendrix's daughter and guardian filed a lawsuit against the facility later that year, alleging negligence.

After two hours of deliberation, the jury awarded Hendrix $1 million for physical pain, suffering and mental anguish. It also awarded Hendrix more than $27,000 for her medical bills. "A jury spoke today regarding the level of care they expect for their loved ones in nursing homes in Fayette County," plaintiff's lawyer Scott Owens said.

The Cabinet for Health and Family Services and the Office of the Kentucky Attorney General previously investigated Hendrix's case and a state adult-protection worker "determined that Hendrix was a victim of caretaker neglect and had been exposed to an extreme safety risk," Spears reports. "The protection worker told the attorney general's office that she thought Hendrix's injuries were the result of an accident." The attorney general's office closed the case in March 2009. (Read more)