Health agencies in Rockcastle, Jackson, Clay, Harlan to lose 14 employees, some environmental and food-safety inspections

In the latest example of Medicaid changes' impact on local health departments, environmental and food-safety inspections will be reduced by layoffs in four counties served by the Cumberland Valley District Health Department, Nola Sizemore of the Harlan Daily Enterprise reports. Health departments in Harlan, Rockcastle, Clay and Jackson counties will lose a total of 14 employees later this month. (Enterprise photo: Harlan County Health Department)

Health Department Interim Director Lynett Renner told Sizemore said the layoffs, along with furlough days, are a result of decreased funding and the "advent of managed care organizations" in November 2011. The agency has almost $1 million in outstanding accounts because payments from those organizations have been slow to come in. "Also, one of the things that affected the health departments tremendously is we’re the only provider in the state required to pay a Medicaid match, which means for every service we provide for a client who has Medicaid, we have to pay the state back 20 percent and that recently increased to 28 percent," Renner said.

Renner told Sizemore that environmental services and restaurant health inspections would be most affected, adding that public health is often taken for granted by the local community. "So much is done behind the scenes to ensure the health and safety of every citizens," she told Sizemore. "My fear is they're reducing the ability of the public health infrastructure to be able to maintain that level of service that provides protection." (Read more)

Danville newspaper examines problems hospitals and doctors have with state's managed-care Medicaid program

All the talk about "Obamacare" may have obscured Kentucky's biggest health-care story, Kendra Peek of The Advocate-Messenger in Danville suggests, in a look at Kentucky's troublesome shift to managed-care Medicaid. "It's the biggest story in the state that's not being told," said Vicki Darnell, president and CEO of Ephraim McDowell Regional Medical Center in Danville, told Peek. Her story is an example of how a smaller newspaper can show the impact of a statwwide policy. (A-M photo)

On Nov. 1, 2011, Medicaid in Kentucky switched to a managed care program, which essentially means management of Medicaid was outsourced to private insurance companies Peek reports. There are three managed care organizations (MCOs) statewide: Coventry Cares of Kentucky, Kentucky Spirit and WellCare of Kentucky.

The time for payments to doctors and hospitals has doubled since MCOs were implemented, McDowell Chief Financial Officer Bill Snapp told Peek. Before, they were getting paid for Medicaid patients' care within 17 to 20 days. Immediately after the switch, he said, it took as long as 70 days. Some private physicians have been forced to make hard financial decisions because of delays, and because MCOs reimburse doctors at "significantly lower rates than private insurers," Peek reports. Some hospitals, physicians and health departments have had to lay off employees, and some doctors are refusing to see Medicaid patients because they can't afford to.

In some cases, patients have had to find doctors or hospitals where the MCO they selected would be accepted, Peek reports. Hospitals cannot legally deny treatment to anyone based on insurance, but having to find hospitals or physicians that accept particular MCOs can become expensive out-of-pocket for patients. Some primary physicians may not be allowed to work at certain facilities, requiring their patients to be shifted to another doctor.

MCOs have been in the news for these issues. Coventry Cares canceled contracts with Appalachian Regional Healthcare, a network of hospitals in Eastern Kentucky, in a move that drew significant backlash. Kentucky Spirit has announced it would end its managed-care contract in July, saying it has concerns about the sustainability of the plan. (Read more)

Fiscal-cliff deal revives program that helps rural hospitals dependent on Medicare; 200 in nation, 10 in Kentucky

Even though most of the hospital industry wasn't happy with the fiscal-cliff deal that will only pay half the $30 billion needed to avoid a 27 percent Medicare fee cut for doctors, the deal gave about 200 rural hospitals, including 10 in Kentucky, reason to celebrate. It extends a program that pays hospitals up to several millions of dollars a year because they have fewer than 100 beds, are located in rural areas and have a high percentage of Medicare patients, Phil Galewitz of Kaiser Health News reports.

The Medicare Dependent Hospital Program was created in 1990 and is one of several payment programs designed to help small, rural hospitals deal with financial challenges that larger hospitals don't face. The program is based on the idea that "some rural hospitals have such a high percentage of Medicare patients they are unable to get enough money from higher paying privately insured patients to make up for the lower government reimbursements," health lawyer Eric Zimmerman told Galewitz.

The program has come under scrutiny. Congress allowed it to expire in September 2012, but two senators from New York and Iowa made sure $100 million for the program made it into the budget deal. The Medicare Payment Advisory Commission said hospitals in the program will receive about 25 percent higher reimbursements as a result of the funding. (Read more)

The Kentucky hospitals in the program are Clinton County Hospital, Fleming County Hospital, Harrison Memorial Hospital, Jewish Hospital Shelbyville, Logan Memorial Hospital, Monroe County Medical Center, Parkway Regional Hospital in Fulton, Rockcastle Regional Hospital, Taylor Regional Hospital and Westlake Regional Hospital in Columbia. The Appalachian Regional Hospital in Williamson, W.Va., is also considered a Kentucky hospital in the program.

Painkiller epidemic was driven in part by drug makers' financial relationships with researchers who discounted the risks

For almost a decade, medical officials and experts claimed OxyContin rarely posed problems of addiction for patients. The drug's label, which was approved by the Food and Drug Administration, said addiction risks were small. Research published in the New England Journal of Medicine also said OxyContin wasn't addictive; so did a study in another journal, which OxyContin manufacturer Purdue Pharma reprinted 10,000 times. Since the drug first hit the market, it has fueled a large-scale swath of prescription pain killer addiction, beginning in Central Appalachia, that has grown into a national epidemic, especially in rural areas.

The epidemic was driven in no small part by doctors' lack of knowledge about OxyContin, which was perpetuated by the drug's manufacturer through false claims that became scientific consensus. But now, "Many in the medical profession have rediscovered the destructive power of opiates," and are calling that consensus into question, Peter Whoriskey of The Washington Post reports. "A closer look at the opioid painkiller binge, in which retail prescriptions have roughly tripled in the past 20 years, shows that the rising sales and addictions were catalyzed by a massive effort by pharmaceutical companies to shape medical opinion and practice."

Doctors were wary of prescribing painkillers to any patient except those with cancer for years. But manufacturers and some pain specialists "helped create a body of scientific research assuaging the long-standing worries about opioids and pushed to expand the use of the drugs in people with chronic pain: bad backs, arthritis, sore knees," Whoriskey reports.

Through an examination of key scientific papers, court documents and FDA records, the Post found that many of the studies claiming OxyContin wasn't addictive were supported by Purdue Pharma. The conclusions those studies reached were sometimes not supported by data, and when the FDA needed to develop an opioid policy, it turned to a panel of doctors who had financial relationships with Purdue Pharma and other drug makers. (Read more)

Health reform drives hospital mergers and affiliations, and makes clinical collaborations more important

Is your community's hospital one of the many rural hospitals considering sale, merger or affiliation with a larger hospital or group of hospitals, all options that are becoming more common, partly due to federal health-care reform? A recent article in HealthLeaders magazine, which examines some of the considerations, may inform your coverage.

Basing decisions on past experiences "is difficult because the creativity surrounding partnerships among hospitals and health systems is expanding rapidly," writes Philip Betbeze, the magazine's senior leadership editor. For example, clinical collaborations have become more important in affiliations. "Whether they own or don't own each other doesn't matter as much as coming up with a structure for sharing those value-based purchasing points together," Joseph R. Lupica, chairman of Newpoint Healthcare Advisors, told Betbeze, who writes: "That's a sea change compared to prior affiliations or mergers. In the past, such deals were driven by traditional aims around increasing market share and increasing bargaining power."

Health reform will create incentives for better patient outcomes, which upsets the old "iron trangle" of hospitals: "volume, rates, and the ability to decrease unit costs," said Dr. Gregg Meyer, chief medical officer of Dartmouth-Hitchcock, a New Hampshire hospital group that recently affiliated with the Mayo Clinic, more than 1,000 miles away, "because we know that patients who come to us for care will often seek a second opinion. In the past, that meant going to Boston or New York, and we lost out on that because we lost the ability to keep that care local. Now we can have a virtual second opinion with arguably the most famous health system in the world."

The article has several more examples. to read it, click here.

Chart shows how to get coverage under federal health reform

The core of the Patient Protection and Affordable Care Act is helping people get health insurance, beginning next year. That will be relatively simple for some people, but complicated for others, as this infographic produced by the Kaiser Family Foundation for the Journal of the American Medical Association shows. For a larger, clearer, PDF of the chart, click here. In most states, including Kentucky, a key question remains unanswered: Will the state opt to expand Medicaid eligibility to households with incomes up to 133 percent of the federal poverty level (138 percent with a fudge factor)?

UK has its pediatric heart program under review; chief is on leave, and patients are being referred to other hospitals

Kentucky Children's Hospital at the University of Kentucky is reviewing its cardio-thoracic surgery program and referring surgical patients to other hospitals, "but the reasons why are unclear," Brenna Angel reported Dec. 21 for WUKY-FM, the university-owned station.

Angel did identify "the surgeon at the center of the review," Dr. Mark Plunkett, left, who is on a leave of absence but "remains on staff at UK with a $700,000 annual salary," as chief of cardio-thoracic surgery. "UK denied an open-records request for the date of his most recent surgery and his patient mortality rate," citing privacy rules in the federal Health Insurance Portability and Accountability Act. It was unclear how release of such statistics, without any personally identifying information, would compromise privacy. Plunkett and officials of the medical center refused to be interviewed.

"It's been pretty hush-hush," Tabitha Rainey of Lexington, the mother of a Plunkett patient, told Angel, who reported: "Plunkett and his assistant Dr. Deborah Kozik operated on Waylon seven days after he was born. Tabitha was later told that Dr. Plunkett was taking a leave of absence." Rainey told Angel, "Months went past and they lost another patient, who was a dear friend of mine, and it was pretty heavy in the unit at the time. Then soon after I guess they decided to stop doing the surgeries and review the entire program."

Angle was able to get some records from UK and reported they showed that "The number of children Dr. Plunkett operated on this year is down around 43 percent from two years ago." UK Trustee Dr. Charles Sachatello, a surgeon who sits on the Board of Trustees' health-care committee, told Angel, "I was not aware of that, and that was never announced at the Board of Trustees meeting." Sachatello told Angel that UK should merge its pediatric heart program with the one at the University of Louisville because of the high operational costs of such programs. (Read more)

Generic OxyContin and Opana, headed for market soon, could make fight against pain-pill abuse tougher, McConnell says

With generic versions of the two most commonly-abused painkillers, Opana and OxyContin, coming on the market next year, police, hospitals and health clinics in Kentucky have voiced concern that "these generic crushable drugs lack the tamper-resistant gel coating of the brand-name drugs," says a news release from U.S. Sen. Mitch McConnell.

"Without this technology, addicts crush the pills in order to achieve an immediate heroin-like high from sniffing or injecting the painkillers," the release says. "If these generics come to market without the tamper-resistant coating, much of the work that law enforcement and health care providers have done to stem the tide of pain pill abuse in Kentucky will be lost."

McConnell's news release said he has asked the Food and Drug Administration to keep the crushable drugs off the market "until a workable solution can be found." McConnell, the Senate Republican leader, met Wednesday with the Department for Health and Human Services’ acting general counsel, Bill Schultz, to discuss the issue. (Read more)

Group of 550 doctors in Central Ky. leaving Medicaid's Coventry

A Lexington-area network of doctors says it will no longer contract with Coventry Cares, a Medicaid managed-care company, after Coventry said "it would begin to pay less than the established Medicaid rate in reimbursements — as much as 10 percent less for care from specialists," Cheryl Truman reports for the Lexington Herald-Leader.

The Physicians' Network is a group of 550 independent physicians, headed by Dr. Ralph Alvarado of Winchester. He said the cuts will mean that some doctors will be paying to treat Medicaid patients.

d more here: http://www.kentucky.com/2012/12/20/2450679/central-kentucky-doctors-cut-ties.html#storylink=cpy

Coventry issued a statement saying, "This decision would not take effect until March 7, and we do not expect any network access issues for our members. That said, Coventry would like our members to continue enjoying access to this group of providers. We remain committed to continuing negotiations . . . " (Read more)

Deaths from drug overdoses in Kentucky hit new high in 2010; more than half involved prescription drugs

Deaths from drug overdoses in Kentucky jumped to a new high in 2010, and "rose a staggering 296 percent from 2000 to 2010," Bill Estep of the Lexington Herald-Leader reports. "A tidal wave of prescription-drug abuse drove the steep increase," with just over half of the deaths involving prescription drugs, according to a study by researchers at the University of Kentucky.

As usual, the problem is worst in Appalachian Kentucky, as illustrated by this Herald-Leader map:

"The increase in deaths might have been even greater because information was not available for Kentucky residents treated in neighboring states, and because some death certificates might not have listed an overdose as the cause of a person's death when in fact it was," Estep reports. "The report did not measure the impact of changes Kentucky lawmakers made this year aimed at confronting the prescription-drug problem, though it will provide a way to help measure the impact of the law."

Read more here: http://www.kentucky.com/2012/12/20/2451315/drug-overdose-deaths-up-296-percent.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/12/20/2451315/drug-overdose-deaths-up-296-percent.html#storylink=cpy

Read more here: http://www.kentucky.com/2012/12/20/2451315/drug-overdose-deaths-up-296-percent.html#storylink=cpy

State Auditor Edelen faults Bluegrass mental-health agency for executive compensation, lax management and board oversight

The Bluegrass Regional Mental Health-Mental Retardation Board, a nonprofit agency that gets two-thirds of its money from taxpayers, "paid more than $2.8 million in executive-benefit contributions since 1997 to the president/CEO and various other employees solely at the discretion of the President/CEO with no scrutiny by board members," state Auditor Adam Edelen said in a press release this morning. "The contributions, which are designed to retain talent within an organization, were largely awarded to a core group of central office administrative staff while health-care employees received either no contributions or less significant amounts."

Edelen's release said the audit, made in response to "news media reports and anonymous concerns," also "found problems with . . . spending without supporting documentation and lax management practices." For example, Bluegrass spent $172,025 on lobbying from January 2011 to September 2012 without adequate documentation, and President/CEO Shannon Ware, right, and a consultant "spent nearly $38,000 on credit cards during an 18-month period without detailed receipts to document the business purposes," the release said. The full report is available here. It confirmed several findings by the Lexington Herald-Leader; for the H-L story on the audit, by John Cheves, go here.

U.S. teens' cigarette use drops to a new low, but use of alcohol goes up a bit and more 12th graders are smoking marijuana

Teenagers' cigarette smoking dropped to a record low this year but alcohol use rose slightly after seven years of decline, according to a survey of 45,000 eighth-, 10th- and 12th- graders for the National Institute of Drug Abuse.

The survey also found that the use of illicit drugs dropped slightly among eighth-graders but rose slightly among 12th-graders. Among them, 36.4 percent reported using marijuana in the past year, up from 34.8 percent in 2010, and the share who saw great risk in smoking marijuana occasionally dropped significantly, to 20.6 percent, from 24.5 percent in 2010.

Among all three age groups, only 10.6 percent said they had smoked cigarettes in the past 30 days, down from 11.7 percent in 2010. The University of Michigan researchers who did the survey said the decline was significant, and may have been driven by a big increase in the federal tobacco tax in 2009.

"A 1-percentage-point decline may not sound like a lot, but it represents about a 9 percent reduction in a single year in the number of teens currently smoking," principal researcher Lloyd Johnston said in a news release. Among eighth-graders, the decline was about 20 percent. For other results of the survey, click here; for a PDF version, here. For the full survey report, go here.

"Teen attitudes toward smoking also continued to become more negative. For example, 80 percent of teens said they preferred to date nonsmokers in 2012," Steve Gorman reports for Reuters. "But anti-tobacco advocates said their battle to stamp out teen smoking was far from over, noting that 17 percent of high school seniors still graduate as smokers." And the figure is higher in many rural areas.

Kentucky ranks at or near the top in youth smoking. In 2010, the last year for which state figures are available, 16 percent of Kentucky children aged 12 to 17 (a slightly younger group than the one above) reported smoking a cigarette in the past month. The national rate for that age group was 10 percent, according to the Centers for Disease Control and Prevention.