Kentucky Spirit can't terminate its Medicaid contract with the state a year early without facing fines, judge rules

By Molly Burchett
Kentucky Health News

A Frankfort circuit judge ruled Friday that Kentucky Spirit, one of three companies hired by the state in November 2011 to manage health care for more than 540,000 Medicaid recipients, cannot pull out of its contract with the state a year early with no financial penalty.

Kentucky Spirit, a subsidiary of St. Louis-based Centene Corp., announced in October 2012 that it was pulling out of Kentucky's managed-care system because it was losing money, but the company could face fines if it terminates its three-year contract before expiration in July 2014, Franklin Circuit Judge Thomas Wingate said in his ruling.

Kentucky Spirit argued in its lawsuit that the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million. It made the lowest bid, and on average, gets about $100 less per month for each patient than the other two MCOs, Coventry Cares and WellCare.

The Cabinet for Health and Family Services replied that Kentucky Spirit had breached its contract with the state. Wingate said it had not, because it gave notice of early termination, but it will be subject to fines if it pulls out of the state before July 2014, reports Beth Musgrave of the Lexington Herald-Leader.

Kentucky Spirit had argued that its contract allows it to to be terminated with six months notice. The six-month provision could only be interpreted to mean six months prior to the end of the three-year contract, said Wingate, because there has to be enough time for the state to move hundreds of thousands of Medicaid patients from Kentucky Spirit to another managed-care provider.

Jill Midkiff, a spokeswoman for the cabinet, told Musgrave that state officials were thrilled with Wingate's decision. "The cabinet's priorities are the members who receive health care through Medicaid and the taxpayers who pay for the program," she told Musgrave. "This is the right decision for both."

Friday's decision came three days after another Franklin Circuit Court judge ruled that Kentucky Spirit must reimburse health departments for services provided by school nurses to Medicaid-eligible children, which is estimated include about $8 million in back payments.

Centene officials say they are considering options for both cases, which include appeals.

Kentucky Spirit's legal battles are part of ongoing tensions between health-care providers and managed-care companies, and providers have repeatedly complained that the companies are delaying payments for services. The cabinet is hosting a series of forums across the state designed to help providers resolve such issues with the managed care companies.

New report ranks Kentucky 45th in overall senior health

By Molly Burchett
Kentucky Health News

Everyone dreams about retirement being a happy, healthy time to finally settle down, take time for yourself, travel and count your blessings, but a recent reports suggests that if you want to retire right now in a healthy environment, don't stay in Kentucky.

Kentucky ranks 45th in overall health rankings for seniors and last in two measures: total health outcomes for seniors and preventable hospitalizations, says United Health Foundation's America’s Health Rankings Senior Report. Kentucky was next to last in cognition and education of seniors and  prevalence of dental visits, and likewise second worst in premature death rate for seniors.

The report shows Minnesota at the top of the list, with Vermont and New Hampshire following closely and Mississippi as the least healthy state for older adults.

This report aims to point out the health challenges affecting today’s seniors and encourage action that improves communities' overall health. In Kentucky, the reports shows community support is low, with total community expenditures at $358 per person aged 65 and older living in poverty, much lower than Minnesota's $542 per capita.

Not all of the report's findings about Kentucky were bad; the state is strong in three areas: underweight seniors, activity-limiting arthritis pain and low-care nursing home residents. And, on another positive note, Kentucky ranks 15th in the number of seniors receiving flu vaccines and 10th in pain management for seniors. Click here for details.

Determinants that were considered in the state's ranking include behaviors like smoking and dental visits; micro and macro community and environment measures like poverty and social support; policy measures like the state's geriatrician shortfall; and measures of clinical care like home health or hospital care and diabetes management.

The health of our state's seniors is critical, especially as baby boomers age. The number of Americans age 65 and older is expected to more than double by 2050, from 40.3 million to 88.5 million, according to the federal Centers for Disease Control and Prevention. About 13.5 percent of Kentuckians are 65 or older, which is higher than the national average.  Considering this, the report generates a provoking question. If our state's seniors are unhealthy, can Kentucky be healthy?

Judge orders Medicaid managed-care firm to pay for school health services, including $8 million in claims; appeal possible

Medicaid managed care company Kentucky Spirit must cover preventive care services provided by local health departments in schools, a judge has ruled.

Circuit Judge Phillip Shepherd of Frankfort said the company must pay $8 million for the services already provided by school nurses, which would be only .07 percent of its estimated profit for 2013, according to the updated earnings report of Centene Corp. of St. Louis, the parent company for Kentucky Spirit. The company is the only one of the five managed care organizations in Kentucky  that had disputed the coverage of school health services.

Kentucky Spirit stopped providing coverage for school health services last summer, saying its state contract didn't require payment for such services,but Shepherd noted that the state reimbursed health departments for school services before it transitioned to managed care, reports Tom Loftus of The Courier-Journal. “Kentucky Spirit is not free to disregard this longstanding interpretation of Medicaid eligibility and unilaterally re-interpret these to the detriment of local health departments,” Shepherd wrote.

Health departments and school districts will now find some relief because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for services. “It’s great news because there have been dozens of districts that have had to either say they are going to cut back on nurses, or that they are going to close clinics, or that they are going to dip into their reserves to try to cover the additional costs,” Kentucky School Boards Association spokesman Brad Hughes told Loftus.

Gov. Steve Beshear said Kentucky Spirit had “sought a loophole” in its contract to avoid paying for school health services covered by Medicaid, writes Loftus. Centene released a statement later Tuesday saying that the company is reviewing options and considering an appeal.

This isn't the only payment Centene is trying to avoid. A ruling is expected soon in a lawsuit the company filed against the state last year seeking to end its contract a year early, saying the state rushed to privatize Medicaid in 2011 and provided incorrect cost information to the bidders, causing the firm to lose about $120 million.

Appalachian Regional Healthcare, the largest health-care system in Eastern Kentucky, filed suit in April of this year against Kentucky Spirit for $5.9 million in unpaid claims. This suit is still pending, and was filed just before Centene raised its full-year forecast for premium and service revenue to $10.1 billion to $10.4 billion, Reuters reports.

Sick of all the bad facts about Kentucky's health? Here's encouraging news about oral health and drug treatment

Despite the plethora of bad news about Kentucky's poor health status, there are many positive initiatives for Kentucky's oral health and substance abuse treatment, which were stories buried under health news headlines about Medicaid expansion and low health rankings.

The Kentucky Board of Dentistry recently established the position of public heath dental hygienist, permitting hygienists to go into Kentucky schools to assess teeth on the front lines, which will provide basic preventive dental care to underserved kids with tooth problems through local health departments, Al Smith, left, reports in an opinion piece for the Lexington-Herald Leader.

"These hygienists will be able to do school fluoride varnish programs, place sealants, refer kids in pain, and promote dental health programs (like brushing and better nutrition) in the schools without being supervised by a dentist," Dr. Rankin Skinner, director of the Clark County Dental Health Initiative, told Smith. "I think this is a major step in developing dental health program like ours across the state and moving our kids towards better health in general."

The initiative, comprising 17 dentists and 127 volunteers, was selected as a national model by a national association of all the health departments. "It isn't often that a private volunteer program in Kentucky sets a national standard," Skinner told Smith.

Meanwhile, in Florence, Kentucky's first lady, Jane Beshear, a Democrat, joined her Republican co-chair of Recovery Kentucky, Lexington homebuilder Don Ball, to celebrate the Brighton Recovery Center's fifth birthday and nearly 800 graduates.

Brighton is one of the 10 new homes for Recovery Kentucky, a program that is also becoming a national model, Smith writes. Since its inception during the Fletcher administration, the program has provided supportive housing and addiction recovery programs to over 10,000 men and women, writes Smith.

Beshear said the next steps are for her and Ball to create more drug-free housing and jobs for graduates of the program, Smith reports. This goal creates hope for other successful initiatives and shines a ray of light at the end of a dark and dreary tunnel.

Pikeville Medical Center joins Mayo Clinic Care Network

Pikeville Medical Center President Walter May and Dr. 
Stephen Lange, Mayo Clinic's Southeast medical director

Pikeville Medical Center joined the Mayo Clinic Care Network last week, extending the clinic's knowledge and expertise to PMC staff, which the hospital says will improve health care delivery for 420,000 Appalachians while allowing them to stay close to home.

Some of the resources that will now be available to PMC physicians and providers include its online point-of-care information system and electronic consulting that connects physicians with Mayo Clinic specialists about diagnosis, therapy or care management, says a PMC news release.

“Pikeville Medical Center is honored that we have been asked to become a member of Mayo Clinic Care Network,” says Walter E. May, president and chief executive officer of PMC. “I have admired Mayo Clinic for many years and tried to make Pikeville Medical Center more like the Mayo Clinic. This new agreement will take our hospital to the next level.”

The primary goal of the Mayo Clinic Care Network is to offer Mayo Clinic expertise close to home so that patients only travel when necessary, says the release. The network was launched in 2011 and has member organizations based in Arizona, Florida, Illinois, Kentucky, Michigan, Minnesota, Missouri, Montana, New Hampshire, North Dakota, Puerto Rico and Mexico. See details about specific hospitals in the map below.

“We are pleased to welcome Pikeville Medical Center and its more than 2,000 employees into our Mayo Clinic Care Network family,” says Stephen Lange, M.D., southeast medical director of the Mayo Clinic Care Network. “Our mission is to work collaboratively to improve the quality of health care and value for our patients. We are very excited to work together with Pikeville to find bold and innovative ways to enhance the quality of life for the patients in that region of the country.”

PMC serves 420,000 people and 15 counties in Kentucky, Virginia and West Virginia, and the hospital is currently undergoing a $150 million expansion.

Religious business owners and corporations have filed half the lawsuits over health reform mandate to cover contraception

By Molly Burchett
Kentucky Health News

Some religious business owners are filing suit against the government, saying the health-reform law violates the constitutional freedom of religion by mandating employee contraceptive and abortion-inducing drug coverage; the lawsuits are expected to land in the U.S. Supreme Court, and a case filed by Hobby Lobby is the first of this kind to be heard by a federal appeals court.

Challenges to the mandate that will require businesses with more than 50 employees to provide no-cost coverage of all contraceptives, sterilization procedures, plus education and counseling, are not just coming from Catholic entities with a religious, moral objection to contraception. About half of the cases have been filed by corporations, reports Robert Barnes of The Washington Post.

There are now 60 cases involving 190 individuals representing hospitals, universities, businesses, schools and people opposed to the mandate, says the Becket Fund for Religious Liberty. The Becket Fund maps the cases, as shown below; for the interactive version, click here.

Since the law mandates contraceptive coverage, groups such as Catholic bishops have accused the Obama administration of waging war on religious liberty, reports Barnes. In February, the administration announced an exemption for faith-based organizations from covering employees' contraception costs because the conceptions would be covered by a third party. Self-insured organizations like Catholic schools sued, arguing that the accommodation would not apply to them because there is no third-party insurer to cover contraception. But those cases have been dismissed in court because such organizations are given a one-year grace period to comply with the mandate, reports Laura Bassett of the Huffington Post.

Businesses don't qualify for faith-based exemption from mandates

Hobby Lobby's David and Barbara Green

Business do not meet the new exemption either, because they are not religious organizations. However, some businesses like Hobby Lobby, which was founded and is still owned by an evangelical Christian family that believes life begins at conception and already covers contraceptives through existing employee health coverage, are fighting the law's mandate to cover abortion-inducing drugs or devices, like morning-after and week-after pills.

"They ought to be able — just like a church, just like a charity — to have the right to opt out of a provision that infringes on their religious beliefs," said Kyle Duncan, who argued the case Thursday before the 10th Circuit Court of Appeals on behalf of the Green family, and a sister company, Christian booksellers Mardel Inc, reports The Associated Press.

Other suits have been filed by religious business owners of diverse enterprises, from a company that makes wooden cabinets to owners of Panera Bread restaurants, reports Barnes, but all the cases base their arguments on the First Amendment guarantee of free exercise of religion and on the Religious Freedom Restoration Act of 1993. The Hobby Lobby case also specifies that the mandate violates freedom of speech and the Administrative Procedure Act because it was imposed without prior notice or sufficient time for public comment.

In the early stages of litigation, lower courts have split on the issue. Some have rejected Hobby Lobby's request for an exemption to the mandate, and requests by other businesses for a temporary injunction, saying for-profit businesses aren't covered by the faith-based exemption. However, courts in St. Louis and the Seventh Circuit have granted temporary injunctions. (Read more)

Website eases application process for SNAP, formerly food stamps, and promotes healthy food

With a federal grant, the state Department for Community Based Services has launched a customer service website to promote healthy foods by assisting the families receiving food benefits through the Supplemental Nutrition Assistance Program, formerly called food stamps.

The portal allows people to check their eligibility for SNAP and apply for benefits with a shorter application that will be followed by a DCBS interview. They can also check their benefit status, report changes and receive electronic notices.

The agency says an online application eliminates any transportation issues a family may have with visiting a DCBS office, and encourages applications. “Modern improvements like this make it easier for families to apply for benefits and ultimately increase access to healthy food,” said Audrey Haynes, secretary of the Cabinet for Health and Family Services, which houses DCBS.

“SNAP helps people of all ages afford healthy food,” said DCBS Commissioner Teresa James. “For some of our DCBS customers, it means the difference between having a family meal or nothing at all. This website makes applying for benefits, making updates or accessing information even easier since customers don’t have to make an office appointment or even pick up the phone to get help.”

Since the portal’s launch on March 11, DCBS has received more than 1,000 electronic applications. Click here to learn more about SNAP. 

Health insurers could exclude one in four Americans from coverage because they don't have bank accounts

By Molly Burchett
Kentucky Health News

Federal Deposit Insurance Corp. graphic

A new study says if corrective action isn't taken, health-insurance companies could exclude 27 percent of qualifying Americans now eligible for premium-assistance tax credits under the health-reform law because they plan to require customers to pay premiums automatically through a bank account. More than 1 in 4 of these people do not have a bank account.

If insurance companies won't do business with them, that will undermine efforts to expand health coverage and equalize access to health care, denying coverage to the more than 8 million "unbanked" Americans, says the report from tax firm Jackson Hewitt.

Unbanked households are those that lack any kind of deposit account, checking or savings, at an insured depository institution, so requiring a checking account for coverage could also worsen the existing disparities in both health-care access and health status of minority groups. African Americans and Hispanics are over 40 percent more likely than whites to be "unbanked," says the report.

Most health plans accept a credit card for the first month’s premium payment and thereafter require monthly payment from a checking account. An estimated 30 percent of U.S. households are "unbanked" or underbanked, with the highest rates among non-Asian minorities and lower-income, younger and unemployed households; underbanked households hold a bank account but also rely on alternative financial services, and one in five households use such check-cashing stores and money lenders instead of a traditional bank, says the Federal Deposit Insurance Corp.

This all goes against the basic ideals behind the health care law's "comprehensive reforms that improve access to affordable health coverage for everyone and protect consumers from abusive insurance company practices. The law allows all Americans to make health insurance choices that work for them while guaranteeing access to care for our most vulnerable, and provides new ways to bring down costs and improve quality of care," says the White House website.

Law doesn't protect Americans from discrimination

Federal officials are wary taking action that may discourage insurance companies from participating in the exchanges, current and former state health officers who have pressed the U.S Department of Health and Human Services for a ruling told Varney.

“I think there is a dawning awareness that this is a large problem,” Brian Haile told Varney; Haile is senior vice president for health policy at Jackson Hewitt Tax Service and has called on federal official to set a uniform standard requiring all insurers to accept all forms of payment.

Neither the health law nor other laws require insurance companies to accept all forms of payment, says Sarah Varney of Kaiser Health News. Alternative forms of payment include credit cards or pre-paid debit cards that people without bank accounts often use, and although health insurance companies are evaluating these options, they are not required to do so, reports Varney.

“I’ve not seen any specific guidance that says you have to be able to accept these types of payments,” Ray Smithberger, Cigna’s general manager of individual and family plans, told Sarah Kliff of The Washington Post.

Insurance carriers take a risk by accepting credit cards and pre-paid debit cards because transaction fees can run as high as 4 percent and pre-paid cards are popular among low-wage workers, Haile told Varney. 

“If you accept re-loadable debit cards, are you in fact getting folks with lower health status?” Haile told Varney. “That’s a real risk when you’re in the insurance business. So you can’t be the only one picking up those risks.”

The Jackson Hewitt report calls for immediate action by federal policy makers to ensure insurers cannot discriminate against the 'unbanked' through their payment acceptance policies by creating a system-wide rule requiring all forms of payment must be accepted.

"Given the dilemma presented to insurance companies by the strong financial incentives to discourage non-bank payment mechanisms, insurers are unlikely to resolve this issue without federal action," says the report.

Fort Campbell works to address post-traumatic stress disorder, common ailment of Afghanistan-Iraq veterans

Research shows almost 14 percent of veterans returning home from Iraq and Afganistan suffer from post-traumatic stress disorder (PTSD), and as an estimated 2 million veterans are coming home, Fort Campbell has quickly acted by reaching out to the medical community in Kentucky to help address the challenges of PTSD.

Top behavioral health and brain injury research experts came to Ft. Campbell on Tuesday to teach civilian behavioral health professionals about the military's current PTSD and brain injury research and treatments, reports Kristin Hall of The Associated Press.

PTSD can be one of war's ugly side effect, and it is an anxiety disorder that can develop after exposure to a terrifying event in which ther's potential for grave physical harm, such as "violent personal assaults, natural or human-caused disasters, accidents, and military combat," says the National Institute of Mental Health. Not properly treating PTSD symptoms can lead to alcohol or drug use, spouse or child abuse, depression or suicide

The clinics at Ft. Campbell will focus on PTSD and brain trauma treatment and will each have 13 mental health professionals to offer more personalized, focused care, which is expected to reduce "cases of psychiatric problems, spouse or child abuse, sexually transmitted diseases, suicides and drug use," like the pilot program at Fort Carson in Colorado, reports Adam Ghassemi of News Channel 5.

Some Kentucky veterans, like Mike Jeffrey who spoke about his physical and mental battles after his two tours in Iraq at a Veteran's Recognition Program, are addressing other problems associated with PTSD, which are that many veterans won't talk about it, and they both families and veterans lack awareness about treatment options. Jeffrey talked about the struggles he had when returning home and his "baby steps" toward normalcy.

“I woke up and had kicked down my apartment doors overnight without knowing it,” he said. “It was hell just living with myself,” reported Tracy Harris of The News Democrat. Jeffrey started counseling for his PTSD and is now using a service dog trained specifically for veterans, Seal Team.

“Seal Team is his security blanket,” said Jeffrey's wife, Shelly, who contacted four service dog organizations before finding K-9 trainer Mike Halley, a Vietnam veteran living in Florida, reports Harris. In addition to suggesting use of a service dog, Jeffrey said veterans shouldn't bury their own experience with PTSD, which many are reluctant to talk about.

“We all grew up in the suck-it-up-and-drive Army,” he said. “But you can only suck it up for so long,” said Jeffrey.

Efforts like the ones made by Ft. Campbell and Mike Jeffrey represent progress in treatment of mental health issues. And while these efforts alone won't address the problem, work within local communities can make a world of difference for struggling veterans.

Retired Maj. Gen. Mark Graham said "there is no quick way to eliminate the stigma often attached to seeking out mental health care, but the key is partnerships with the communities," writes Hall.

The story of returning veteran's is a big one that may be hard to cover, so click here for journalism tips. Click here to learn more about PTSD programs in Kentucky, or click the link below to watch news coverage about the behavioral health clinics in Ft. Campbell.

Ft. Campbell Opens Behavioral Health Clinics To Fight PTSD - NewsChannel5.com | Nashville News, Weather & Sports

Ky. is already short of doctors, dentists; how will its health-care system handle expansion of Medicaid and private insurance?

By Molly Burchett and Al Cross
Kentucky Health News

In the wake of Gov. Steve Beshear’s recent decision to expand Medicaid under federal health reform, there is concern that Kentucky's health-care system will not be able to care for the newly insured.

Health reform means that an estimated 308,000 new Kentuckians will qualify for Medicaid, and 332,000 more will qualify for subsidies to buy private insurance through the state insurance exchange that will start taking enrollments Oct. 1.

But Kentucky already has a health care provider shortage, especially in rural areas. A study for the state estimates that it needs 3,790 more doctors just to meet current demand, to say nothing of what will be needed to care for those who haven't been a regular part of the health-care system, reports Laura Ungar of The Courier-Journal.

The report by Deloitte Consulting made 11 recommendations, including authority for nurse practitioners to prescribe less risky drugs without a written agreement with a doctor, and one that would be even more controversial, putting limits on medical malpractice awards, said Ungar.

The report also recommended expanding and increasing Medicaid reimbursements in rural areas, to encourage more physicians to take Medicaid patients.

It did not mention complaints by health-care  providers about getting paid by the managed-care Medicaid system that the state began in November 2011; Gov. Steve Beshear said when he announced Medicaid expansion that those problems are being worked out.

"Consultants said 61 percent of the 3,790 'full-time equivalent' physicians needed (which includes primary care doctors and specialists) were in rural counties," reports Ungar. Jonathan Felix of Deloitte said, “Primary care, dental care and behavioral health are all big needs in the state.”

The report said the state needed 183 more primary-care doctors, even before Medicaid expansion, but a 2012 Kentucky Physician Workforce Needs Assessment report by the University of Kentucky said the state needs 557 more primary-care physicians and 1,655 more total physicians to meet the national ratios for physicians to population.

The consultants said the state already needs 612 more dentists. It now has 1,711.

Complicated provider shortage problem, no easy answer

About 192 federally identified areas in Kentucky — including 47 counties — have shortages of health professionals, Ungar reports. Kentucky counties who will have the most non-elderly residents eligible for Medicaid often have fewer primary-care doctors per person, according to data analyzed by The Courier-Journal. Ungar notes that Casey County, for example, ranks in the bottom third for doctors per capita, but it has the highest portion of newly eligible residents at 13.5 percent.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” Susan Zepeda, president and chief executive officer for the Foundation for a Healthy Kentucky, told Ungar.

Nationally, there is a primary-care shortage, partly because such doctors make less money than most, and low reimbursement rates exacerbate that. A 2012 study in the journal Health Affairs said 21 percent of office-based physicians in Kentucky did not accept new Medicaid patients in 2011, Ungar notes.

The health reform law will raise the Medicaid fees to match what Medicare pays primary-care doctors, but only for two years. Kentucky's Medicare rates are about 72 percent of the Medicare rates, compared to a national average of 59 percent, says an Urban Institute study. But the time limit leaves some practitioners wary.

“If I choose to increase the number of Medicaid patients, and two years down the road that payment drops back to two-thirds, all of a sudden I’m going to have an awful lot of trouble keeping my doors open,” Reid Blackwelder, a family practitioner and incoming president of the American Academy of Family Physicians, told Michael Ollove of Stateline. 

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness, particularly in Kentucky and other states that are expecting the largest percentage increases in Medicaid enrollees and that have low numbers of primary-care physicians.

“I’m not sure who’s going to pick up all those patients into their practices,” Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, told Ungar. Legislation to let nurse practitioners prescribe non-scheduled drugs without a doctor agreement failed in the state Senate this year.

While some policy analysts have touted nurse practitioners as a solution to the rural primary-care shortage because they often provide primary care in rural and isolated areas that do not have doctors nearby, they would not be covered by the two-year reimbursement increase. Ewen said the reimbursement is only $23 for a lower-level visit by an established patient.

A possible long-term solution includes greater reliance on community health centers, some say. And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, said her system is looking to open new primary care offices and hire more staff.

Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from its new partner, KentuckyOne, to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agree that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it. The state estimates that 188,000 of the 308,000 newly eligible will enroll, but some think that estimate is low.

Don't get burned, bitten or bamboozled this summer; here are safety tips for dealing with the sun, insects and sales pitches

By Molly Burchett
Kentucky Health News

Summer is finally here, and after one of the coldest Kentucky springs, who doesn't want to be outside swimming, skiing, fishing, barbecuing or soaking up rays on the beach? While summer may bring much-anticipated fun in the sun, it's important to take some  safety precautions to make sure you and your family are not getting too much of a good thing.

Sunscreen can protect you from cancer, but don't spray it

The sun is bad for your skin, and exposure to its harmful ultraviolet (UV) rays can increase your risk for skin cancer, which is the most common cancer in the U.S., says the federal Centers for Disease Control and Prevention. It's critical to protect yourself and your children from sun damage because just one blistering sunburn in childhood more than doubles the odds of developing skin cancer later in life, says the Mayo Clinic.

Fortunately, it’s never too late or too early to lessen your risk of sun damage by using sunscreen, and the Environmental Working Group has recently released its 2013 Guide to Sunscreens, which rates more than 1,400 sunscreens, lip balms, and SPF moisturizers and cosmetics for safety and effectiveness.

This year, EWG says 184 sunscreens, 25 percent of those on the market, met its criteria of offering adequate UV protection and posing few safety concerns. You can click here to view that product list, or here to check out the EWG findings for moisturizers, lip balm and makeup.

EWG also created a somewhat surprising list of things NOT to bring on vacation because they are unsafe or do not provide adequate UV protection:

• Spray sunscreen: These sprays may pose serious inhalation risks, and they make it too easy to not apply enough sunscreen or to miss a spot.
• High-SPF sunscreens: These products may tempt people to stay in the sun too long, which can increase the risk of other kinds of skin damage, and EWG recommends that consumers avoid products labeled higher than SPF 50.
• Oxybenzone: Used in half of sunscreen products, this chemical penetrates the skin and can adversely impact health in several ways; in the body, it acts like the female hormone estrogen and can cause allregic reactions.
• Loose powder sunscreen: Tiny zinc particles in these products can also end up in your lungs when you breathe them in during application, which irritates the lungs.
• Retinyl palmitate: Some sunscreens contain this chemical, which is a form of vitamin A, but when applied to sun-exposed skin, it may speed development of skin tumors and lesions.
• Combined sunscreen/bug repellents: Studies show this combination leads to increased skin absorption of the repellent ingredients.
• Sunscreen towelettes: Whether they really work is unknown.
• Tanning oils: They are simply a bad idea and can ultimately lead to behavior that increases risk of developing skin cancer.

So, check the ingredients for your sunscreen, avoid high-SPF's or sprays and make it a habit to wear sunscreen during sports or whenever you're outside. Be sure to reapply often to ensure UV protection, particularly if you get wet or sweaty. Click here to read EWG's "Nine Surprising Facts about Sunscreen."

Hats and clothing: Choose the right kind

Children are more vulnerable to sun damage, so in addition to actual sunscreen, the best sun protections for them are a hat and shirt (which also protect adults). The CDC recommends avoiding straw hats that let sun through the holes, and to wear a hat with UV protection or a wide brim to shield the face, head, ear and neck. If you do chose to wear a baseball cap, protect your ears and neck with clothing, sunscreen (with at least SPF 15) or spend lots of time in shade.

Wear clothing to protect exposed skin. The CDC says loose-fitting long-sleeved shirts and long pants made from tightly woven fabric offer the best UV protection. Darker colors may offer more protection than lighter colors, and a wet t-shirt offers much less UV protection that a dry one.

Sunburn treatment: People with fair skin or light-colored hair are more likely to be sunburned. If you get sunburned, remember that "The skin heals but is forever damaged," writes University of Kentucky nursing Professor Mollie Aheshire. "The more frequent and more severe the burns, the more damage there is," along with risk for cancer and premature aging. "If a sunburn is blistering and covers a large portion of your body; is accompanied by a high fever, extreme pain, confusion, nausea or chills; or does not respond to at-home treatment within a few days . . . see a health-care provider." Mild sunburns can be treated with over-the-counter pain relievers, cold compresses and moisturizing creams — aloe vera or hydrocortisone lotions. "If blisters form, do not break them," Aheshire writes. "Drink plenty of fluids to prevent dehydration. Treat peeling skin gently. Stay out of the sun until redness and pain resolve." (Read more)

Sunglasses: Not just to help you see now, but to keep you seeing longer

Besides being dangerous for your skin, UV rays are dangerous to your eyes and can cause vision disorders, premature aging of the eyes or even blindness. It is important to wear sunglasses to protect eyes from sun damage, although a new survey from the American Optometric Association shows that only 40 percent of consumers cite this protection as the primary reason for wearing sunglasses, says a Kentucky Optometric Association press release.

To help reduce the risks of harmful UV exposure on the eyes, children and adults should start wearing protective sunglasses as as early as possible, and parents should ensure that babies are protected by sunglasses too, says the release. When choosing sunglasses or protective contact lenses, make sure that they block more than 95 percent of UV-A and more than 99 percent of UV-B radiation, says the KOA, and sunglasses should have a frame that fits close to the eyes so the UV rays can't sneak around the sides.

Insect repellent: Bugs can bug you, but don't over-react to them

Although nothing can ruin a relaxing summer picnic faster than bugs, take precautions to ensure you're using the right type of bug repellent-- one that's been approved by the Environmental Protection Agency -- and that you're using it wisely.

Not only are bugs annoying, they can also carry dangerous diseases, and for the safe and effective use bug repellents, always read the product label before using the product, EPA says. It says to follow these bug-repellent safety tips:

• Repellents should be applied only to exposed skin and/or clothing. Do not use them under clothing.
• Store insect repellents safely out of the reach of children.
• Do not apply near eyes and mouth, and be use sparingly around the ears.
• When using sprays, spray on the hands first and then apply to the face, not directly to the face.
• Never use repellents over cuts, wounds or irritated skin.
• Do not spray in enclosed areas and avoid spraying near food.
• After returning indoors, wash treated skin and clothes with soap and water.
• Do not use any product on pets or other animals
• Most insect repellents do not work on lice or fleas. 
• Click here to search for a repellent that's right for you.

Beware if you want to use a wearable repellent that's not sticky and has to be continuously resprayed, such as Off!'s clip-on mosquito repellent. It works once the cloud of mosquito protection is built around the wearer, says Brighid Moret of The Washington Times, but it's not a good option for an active or young child. The manufacturer warns on the label that a chemical on the product's enclosed disk is harmful if swallowed, directly inhaled or absorbed through the skin, and young children should not wear it.

Whether you're going on vacation or a "stay-cation," these tips can help protect you and your family from the sun and bugs in order to safely make the most of your summer. Click here for more sun safety tips from EWG.

U of L's Trover medical campus ranked among best for rural medicine education and addresing rural physician shortage

The University of Louisville School of Medicine Trover Rural Campus in Madisonville was rated third best in the nation for preparing medical students to practice in rural areas, which is critical to the state since most of Kentucky's rural counties are considered to be short of health professionals.

“From the president and the deans to the individual faculty and staff, our team has proven the value of a collaboration of a rural campus and an urban university. The beneficiaries are our students and the rural Kentucky communities who receive these new doctors who are well prepared to care for them,” Dr. Bill Crump, right, associate dean for the Trover campus, said in a UofL press release.
  
The study by researchers at the University of Colorado, which will be published in Academic Medicine in August, ranked 35 programs across the nation and found that 62 percent of Trover graduates practice medicine in rural areas, says the release.

“This national recognition is the fulfillment of Dr. Loman Trover’s vision outlined almost 60 years ago of providing first class medical education in a small town with the goal of producing more physicians for rural Kentucky, and is a testament to the strong support we’ve had from the Louisville Campus over the past 15 years,” said Crump.

Nationally, there is a physician shortage in rural areas because only 3 percent of medical students report want to practice rural medicine, while 16 percent of Americans live in rural areas. This problem is especially large in Kentucky, says the release, since a majority of the state's 59 counties classified as rural are considered to be short of medical professionals..

“Our Trover campus is vital to fulfilling this mission and especially critical now because our state faces such a significant shortage of physicians, especially in rural areas. Dr. Crump’s leadership of the program is one of the reasons for its success. We view the program as a model that has the potential to be implemented in other areas of Kentucky,” said School of Medicine Dean Dr. Toni Ganzel.