Bill to ease prescription rules for advanced-practice nurse practitioners is first to pass in this legislative session

The first bill to pass the 2014 General Assembly and go to the governor is Senate Bill 7, which would allow more experienced advanced-practice registered nurses to prescribe non-narcotic drugs without having an agreement with a physician. Advocates of the bill say it is needed more than ever now that federal health reform and expansion of Medicaid are bringing more people into the regular health-care system.

"SB 7 is good for Kentucky’s health!" said Sheila Schuster, a Louisville psychologist who lobbied for the bill. "It will increase access – particularly in under-served areas (map) – to the safe, quality healthcare provided by advanced-practice registered nurses."

The bill's passage ended a five-year battle between doctors and APRNs, represented by the Kentucky Coalition of Nurse Practitioners and Nurse Midwives. The House passed a bill last year to repeal the doctor-agreement law entirely, but it stalled in the Senate. Sen. John Schickel, R-Union, negotiated a deal with the APRNs and the doctors' lobby, the Kentucky Medical Association. The bill would allow APRNs who have practiced for four years to prescribe such medicine without any relationship with a doctor.

Patient care, hospitals' future at stake as smaller hospitals lag behind larger ones in electronic health records

Electronic health records have been hailed as a great boon to patients and health-care providers, but the next phase of their implementation poses obstacles for many small, independent hospitals, Jennifer Bresnick reports for EHR Intelligence.

Most hospitals have implemented a basic EHR system, but costs have discouraged them from purchasing the advanced capabilities called for by the federal health-reform law that allow them interact with other systems to share and analyze data and use clinical data warehousing, population health management and quality benchmarking. Not having these advanced capabilities may hurt these small hospitals in the long run, Bresnick reports.

“The larger hospitals are doing well,” Lorren Pettit, vice president of market research for HIMSS Analytics, told Bresnick. “But we have seen that where the applications are behind the curve tends to be in the smaller hospitals. There really is a correlation between hospital size and the breadth and depth of their applications—how advanced their infrastructure is.”

Pettit said he is concerned about critical access hospitals, those that limit their beds and procedures in return for slightly larger Medicare and Medicaid reimbursements. Kentucky has 29 such hospitals. He fears they are getting too far behind the larger hospitals in implementing the advanced capabilities of the electronic health records, creating a situation where there is a difference in the quality of care between urban and rural areas.

Pettit said the most successful critical area hospitals are those that are part of a larger system that helps them with their technology. He told Bresnick, "Being an independent, small hospital . . . there’s just too much at stake and too much investment, and it’s going to impede a lot of these hospitals from moving forward.”

Chief sponsor of statewide smoking ban says it has the votes to pass the House; prospects in the Senate are not as good

A bill to ban smoking in most workplaces and public places, including restaurants and bars, is on its way to the House floor, its main sponsor said after fast approval in committee.

After the House Health and Welfare Committee approved the ban for the fourth straight year, Rep. Susan Westrom said she finally has enough votes to pass it in the full House, so it will hit the floor for the first time.

Rep. Susan Westrom

"I feel confident we have our numbers," Westrom, D-Lexington, told Linda Blackford of the Lexington Herald-Leader. Westrom said she expects the Democrat-controlled House to vote on the bill next week.

The ban's prospects in the Republican-controlled Senate are not as good, but for the first time this year it is in a Senate bill, sponsored by Sen. Julie Denton, R-Louisville, chair of the Senate Health and Welfare Committee.

"Denton said she hopes to hear her bill next week, but cautioned that support remains uncertain in that chamber," The Courier-Journal's Mike Wynn reports. "Senate President Robert Stivers, R-Manchester, has said that, while he doesn't like smoking, he remains adamantly opposed to a statewide ban. According to Smoke Free Kentucky, a coalition of public health organizations and other groups that back the measure, about 24 states have similar laws."

The House committee approved House Bill 173 on a 10-3 vote. The opponents were Republican Reps. Russell Webber of Shepherdsville, Addia Wuchner of Florence and Tim Moore of Elizabethtown, who said, "This is too far-reaching and impacts people's liberty and freedom to do something that is legal."

Advocates say the bill would protect people, including restaurant and bar workers, from secondhand smoke, which has been shown to cause cancer and other diseases. Noting a recent poll that showed two out of three Kentucky adults favor a ban, Westrom said the issue has reached a “tipping point. . . . Our argument is so scientifically sound, people can’t turn their head away and say we are invading their lives. No, we are saving lives.”

Pharmacy chain with 65 Ky. stores will stop selling tobacco

CVS Caremark pharmacies will stop selling cigarettes and other tobacco products in all of its 7,600 U.S. stores by Oct. 1. Kentucky has 65 CVS Caremark stores.

This is the first national pharmacy chain to make this decision. "CVS Caremark sets a powerful example," President Obama said.

"CVS Caremark is continually looking for ways to promote health and reduce the burden of disease," Troyen A. Brennan, the company's chief medical officer, said in a press release. "Stopping the sale of cigarettes and tobacco will make a significant difference in reducing the chronic illnesses associated with tobacco use."

Kentucky has the nation's highest percentage of adult smokers (28.3%), with 7,800 yearly deaths caused from smoking, and ranks third in youth smoking, says the Campaign for Tobacco-Free Kids. Tobacco is the leading cause of premature disease and causes almost 500,000 deaths annually in the U.S.

CVS said it will offer a smoking cessation program this spring to members of its pharmacy benefit management plan. The press release says that seven in 10 smokers say they want to quit and about half attempt to quit each year. Kentucky recently added smoking cessation programs to its Medicaid program for people earning up to 138 percent of the federal poverty threshold.

CVS posted net revenue of $123.1 billion in 2012. It said it expects to lose $2 billion in revenues annually by ending tobacco sales.

Poll shows about 63% of Jessamine County residents support a statewide smoking ban

A recent poll facilitated by Asbury University's Psychology Department for the Jessamine County Health Department showed that about 63 percent of the county's residents endorse a statewide law banning smoking in every workplace, and about 66 percent support a county law banning smoking in workplaces, Mike Moore reports for The Jessamine Journal.

Asbury polled Jessamine County Chamber of Commerce members, too, and found a statewide smoking ban "strongly favored" by  56.3 percent and "somewhat favored" by 16.3 percent. The poll surveyed 690 Jessamine County residents using a landline and 80 members of the chamber of commerce between September and November 2013.

Health department director Randy Gooch said his agency's community-wide health assessment in 2013 revealed smoking as one of the top three health issues, prompting it to seek and get a grant from the state Department for Public Health to do the poll. "Because policy development is one of the most effective ways to affect a community's health, we wanted current data to support decision-makers on any opportunities they may have to enact smoke-free policy in our county or the state," Gooch said.

The poll indicated that while most people support the prohibition of indoor public smoking, opinions varied more when it came to bars and taverns, Moore reports. Non-smokers were typically more supportive of the bans than were smokers. Shana Peterson, the department's health educator, said attitudes have changed since 2006, when the University of Kentucky Survey Research Center polled on the issue. "The current poll shows an approximate 10 percent increase in the number of residents who support smoke-free policy now versus the polling in 2005, which proves there is more awareness about the dangers of involuntary secondhand smoke exposure," Peterson said.

Gooch told Moore that residents have become more aware of the effects of smoking and secondhand smoke through community education, advocacy and personal experience, and "Many folks have experienced the effects of smoke-free policy in Lexington and like the change in the environment as well as the culture, which creates a desire for this change in their own community." An overwhelming majority in the poll said secondhand smoking is associated with adverse health conditions.

Health departments in Clark, Madison and Woodford counties have passed smoking regulations, and Gooch expressed concern for Jessamine, noting that an estimated 34 percent of adults in the county smoke, compared to the state's 28.3 percent. "Something desperately needs to be done," he said, noting that the poll and other resources have been sent to local governments and the county Board of Health.

Gooch said he hopes the poll will encourage the General Assembly to pass House Bill 173, which would ban smoking in most workplaces, including restaurants and bars. (Read more)

How to succeed in health insurance for your small business without really trying -- well, maybe without trying too hard

UPDATE, Feb. 11: The Obama administration has again delayed and relaxed the requirements for employers to provide health insurance. Employers with 50 to 99 employees won't be required to cover them until 2016, and those with 100 or more will only have to cover 70 percent of them next year, not 95 percent, which will remain the requirement for 2016, Sarah Kliff reports for The Washington Post.

By Melissa Landon
Kentucky Health News

The new Patient Protection and Affordable Health Care Act brings changes not only for individuals seeking health care but also for small business owners. Many tips for small business owners to successfully navigate the new system were offered by panelists Tuesday at a panel discussion, "Navigating the Affordable Healthcare Act: Making it work for your small business" sponsored by Business Lexington.

The broad goals of the reform law were to increase health-care quality, make it affordable for everyone and require everyone to have it. The idea is that if the pool expands enough—to include young people who may not have bought coverage but are now required to do so—premiums would go down.  Also, people now cannot be denied coverage because of pre-existing conditions, and income is the deciding factor for cost—not age. On the other hand, smokers can be charged more.

Another change is that all insurance plans must include 10 essential health benefits: ambulatory patient services, emergency services, hospitalization, maternity and newborn care, mental-health and substance-use disorder services (including behavioral-health treatment), prescription drugs, rehabilitative/habilitative services and devices, laboratory services, preventive and wellness serivces/chronic disease management and pediatric services—including oral and vision care, according to the federal website, HealthCare.gov.

How should you determine if you are required to offer health coverage for your employees? If a company has more than 100 full-time employees, it must offer health coverage to the employees or face a monetary penalty. "Equivalent" means that part-time employees count, too; for example, two part-time employees equal a full-time employee. In order to offer employees a group plan, 70 percent of of those who can't get insurance elsewhere (Medicaid, for example) must participate, and 50 percent of all employees—including those who can get coverage elsewhere—must participate. (Other examples of getting insurance elsewhere are through a spouse, being 26 or younger and remaining on a parent's plan.) For example, if a small business employed 60 people, and 18 qualified for Medicaid, the business could still offer a group plan if all the other employees participated. However, if 36 of the 60 wanted to enroll in Medicaid, the business could not offer a group plan because it would not meet the participation requirement of 50 percent of all employees.

Kentuckians are eligible for Medicaid if their annual income is 138 percent or less of the federal poverty threshold each year. It's important for a business to find out if employees qualify. Some small businesses do not have very sophisticated human-resources functions, so may find it more challenging to gather this information. Meeting with employees to discuss these issues is very important, the panelists stressed. Panelist Gary Ramsey, chief marketing officer at Bluegrass Family Health, advised talking with employees with both a concern for their well-being and also the success of the company in mind.

Once you have learned the specifics from your employees, you can decide how to proceed. You can send the information in a spreadsheet to your insurance agent (whom you should make sure is up-to-date with how the state health-insurance exchange works). Employers can offer a particular plan or let the employees choose from the plans on the exchange; keep in mind that the employer also qualifies for coverage. Make sure your employees understand what the coverage includes and what doctors they can see under each plan. Visits to doctors outside a network may not be covered, or be more expensive. "The bottom line is, you have to educate your employees," said panelist Betsy Johnson, an attorney with Stites & Harbison. All the panelists encouraged those learning about health plans to think about new options different from what was done in the past.

Plans for small businesses are procured through a special section of the exchange, which is increasingly called a "marketplace" for insurance. The Kentucky marketplace is branded Kynect, and its segment for small businesses is the Small Business Health Options Program (SHOP). Businesses with 25 or fewer employees can receive federal subsidies for coverage, much like those given to individuals. Trained representatives called "Kynectors" are available to help businesses and individuals navigate the system.

Though the system is complicated, and is subject to change, the panelists urged business owners to act now in educating themselves about the health marketplace, informing their employees and proceeding in a manner most beneficial to their businesses and their workers.

Study says overweight kids become overweight teens

If a child is overweight in kindergarten, she probably will be in eighth grade, says a study published in the New England Journal of Medicine. And if your baby was heavy at birth, it has a greater chance of being fat.

It found overweight kindergartners had four times the risk of becoming obese by age 14 as those of normal weight. In other words, almost half (45.3 percent) of overweight kindergartners will be obese by the eighth grade.

Kentucky has one of the highest childhood obesity rates in the country, tying Mississippi for the highest percentage of youth in grades 9 to 12 that are obese (18 percent).  It has the third highest percentage of children ages 10 to 17 who are obese (21 percent), compared to 16.4 percent nationally, says a report from the Kentucky Task Force on Childhood Obesity.

Kentucky children ages 10 to 17 who are considered either overweight or obese is much higher, at 35.7 percent, according to The Henry J. Kaiser Family Foundation.

The recent study of more than 7,000 children also found that most weight gain occurred in lower grades, with the greatest increase between first and third grades.

Another finding was that children who weighed 9 pounds or more at birth (12 percent of the population) were more at risk of becoming obese adolescents; more than 36 percent of the high-birth-weight children in the study were obese by 14.

The study suggests that obesity-prevention efforts should be focused on children who are overweight by the age of 5, since they are most susceptible to becoming obese.

Winter can be risky time for infants if 'safe sleep practices' are not followed, health department says; here are several safety tips

Practicing "safe sleep practices" and creating a safe environment for your baby could mean the difference between life and death during these cold winter months, the state Department for Public Health says in a press release.

"Kentucky’s infant mortality rate remains higher than the national average. This is due in part to sleep-related accidents that could be prevented with safety practices,” Ruth Ann Shepherd, M.D., director of the department's Division of Maternal and Child Health, said in the release.

Shepherd stressed the importance of never smoking around a baby, since secondhand smoke can contribute to sudden infant death.

So, what are safe sleep practices? The American Academy of Pediatrics gives these guidelines to prevent sleep-related deaths and to keep infants safe and comfortable:

Babies need to sleep alone in a crib, bassinet or play yard. An adult bed is never a safe place for an infant to sleep.

Ask your health-care provider when it is time to give the baby his or her own room.

Always place infants on their backs to sleep.  This reduces the risk of Sudden Infant Death Syndrome (SIDS).

Do not put soft objects in a baby's sleeping space. That means no stuffed animals, toys, loose bedding, bumper pads or pillows.

Put your baby back in his or her own crib after breast feeding.  While breast-feeding reduces the risks of SIDS, falling asleep with your baby after a feeding can be dangerous.

How you dress your infant for winter sleep is also important to keep your infant safe. The health department offers these guidelines:

• Dress infants in one-piece pajamas or wearable blankets, layered over an undershirt or "onesie."  The important thing is to not let your baby get too hot from overdressing or being wrapped in heavy blankets.
• Keep the baby's room at a temperature comfortable for an adult.
• If you must use a blanket for warmth, only cover the baby's feet and lower body.  Do not let the blanket come higher than the baby's chest.  The blanket should also be tucked in around the mattress at the sides and bottom of the crib so that it cannot slide up to cover the baby's face.

Portable heaters can also create a danger to infants. “Remember to keep all portable heaters away from the baby’s sleep area. The baby can overheat if too close to a heater, get burned or tangled up in the cords of small electric heaters,” said Sherry Rock, who runs the child-fatality prevention program. “These are just small steps for parents and caregivers, but they can make all the difference in keeping infants safe.”

Poor air quality can make it hard for kids to succeed in school

Poor air quality in schools can affect children's health and inhibit their learning, one Kentucky school board heard recently as it considered a proposal to improve energy efficiency and air quality at a school about to be renovated.

Representatives from Harshaw Trane proposed a computerized energy system to the Christian County Public Schools board that promises to control air quality and cut energy use, and therefore cost, over time, Magarita Cambest reports for the Kentucky New Era of Hopkinsville.

The company said the additional cost of the system at Pembroke Elementary would be more than recouped over time, and "will reduce absenteeism, improve energy efficiency and raise test scores," Cambest reports. Kathy Hancock, the district's chief administrative officer, said dirty air filters make students breathe more carbon monoxide, making it harder for them to stay awake and do well in school.

The district's current system requires changing 2,283 filters monthly, Facilities Coordinator Ted Hautala said.  He suggested that replacing better filters less often would save the district money. Kyle Johnson, a Harshaw Trane representative, said the program saves the Bullitt County School System “at least half a million dollars a year.” (Read more; subscription may be required)

Danville newspaper's story on Obamacare and Kynect captures the problems and anxiety among the uninsured

http://www.centralkynews.com/amnews/news/local/boyle/kynect-sign-up-in-boyle-brings-much-concern-some-relief/article_ca58abfe-8a7c-11e3-be4e-001a4bcf6878.html

Beshear says Obamacare will make Kentucky healthier, wealthier

Beshear speaks at the Good Morning Bluegrass
event in Lexington. (Photo by Melissa Landon)

Gov. Steve Beshear focused on health issues in remarks to a civic meeting Friday in Lexington. "We are leading this country in economic development, in education reform and in providing health care for our people," he said, noting the progress Kentucky is making in health and the direction it will go in the future.

"Kentucky is one of the least healthy states in the country," Beshear said. "I'm not proud of that." He said he knew something had to be done about it—then along came the Patient Protection and Affordable Care Act.

"You can like it; you can not like it, but for the first time in our history . . . we've got a tool to provide affordable health care for every single Kentuckian," Beshear said. He acknowledged the system is imperfect, but said Kentucky is recognized nationally as the model for health-insurance exchanges.

Beshear reported that almost 200,000 of the 640,000 previously uninsured Kentuckians have signed up for health care through the exchange, branded as Kynect. Most are in Medicaid, the free program for the poor; Beshear expanded the program to include people with incomes up to 138 percent of the federal poverty threshold.

The federal government will pay the cost of the expansion through 2016; the state will pay 3 percent in 2017, rising to the law's cap of 10 percent in 2020. A state-funded study said the expansion would create enough jobs to pay for itself, and Beshear said his emphasis on education and health would create jobs.

"A healthy workforce is the key to the future of the Commonwealth of Kentucky," because prospective employers are primarily concerned with whether an area has a healthy, trained educated workforce to help get the job done, the governor said. "The Affordable Care Act is giving us the opportunity to increase the healthiness of our workforce."

For a county-by-county list of Kynect signups for insurance and Medicaid, click here.

Obamacare in Ky.: Those who say they have enough info on how it affects them favor it; those who lack info say they don't favor it

Kentuckians' support of the federal health-reform law remains low, with only 30 percent saying they view it favorably and 48 percent unfavorably, but 57 percent said they didn't have enough information to say how the law would affect them personally.

Of those who said they did have enough information to know how the reform would affect them, 57 percent thought it would affect them favorably, and 39 percent said they thought it would affect them unfavorably. Among those who said they didn't have enough information, the results were almost exactly the reverse: 39.5 percent favorable and 59 percent unfavorable.

In the Kentucky Health Issues Poll, 66 percent of Kentucky adults said the law had no personal effect on them or their families. The poll was taken from late October to late November, the first and second months that the state health-insurance exchange created under the law was open.

The exchange offers private insurance plans for individuals and small businesses, and the opportunity for low-income people to sign up for the free Medicaid program. However, the health-insurance market in Kentucky is dominated by large groups, whose members are much less likely to realize the law's impact. The law has many other effects that are less visible, such as rebates from insurance companies that don't spend at least 80 percent of their premium revenue on health care. It may be too early in the game for most people to have discovered how exactly the new law will affect them.

The negative effects were clear for people who had to pay more for health insurance because their policies weren't sufficient to comply with the law. That showed in the poll's finding that 21 percent of Kentuckians reported that the it had affected them negatively, up from 16 percent in 2011. Seven percent said it had affected them positively, down from 11 percent in 2011.

The poll was funded by the Foundation for a Healthy Kentucky and Interact for Health, formerly the Health Foundation of Greater Cincinnati, and was conducted by researchers at the University of Cincinnati Oct. 25 through Nov. 26. Its error margin is plus or minus 2.5 percentage points.

A Public Policy Polling survey in earlly January yielded similar results regarding Kentuckians' views of the PPACA. According to this poll, only 30 percent of voters in Kentucky approved of the Affordable Care Act, while 56 percent did not approve. The majority—69 percent—believe the health reform has been a failure in the rest of the country, while 22 percent of Kentuckians believe it has been a success. "There's only so much voters in Kentucky are going to say nice about anything related to Obamacare, so even breaking even on the implementation numbers in the state seems to be a pretty big success for Beshear," the report said.