Thursday, December 18, 2014

Ky. ranks 8th in the number of high-prescribing Medicare physicians for powerful narcotic painkillers and stimulants

Kentucky ranks eighth in Medicare physicians who are considered "high prescribers" of Schedule 2 medications, drugs that have the highest potential for abuse like oxycodone, fentanyl, morphine and Ritalin, according to an analysis of Medicare data analyzed by ProPublica, Laura Ungar reports for The Courier-Journal. About 1,000 Kentuckians die each year from drug overdoses.

Medicare's drug program, Part D, covers about 38 million seniors and disabled and pays for more than one of every four prescriptions dispensed in this country, Charles Ornstein and Ryann Grochowski Jones report for ProPublica, a non-profit investigative news organization.

Further analysis by The Courier-Journal found that Kentucky doctors prescribed narcotic painkillers to a "much larger percentage of their elderly and disabled patients" compared to other states, and that Kentucky had 11 of the 269 prescribers who wrote more than 3,000 prescriptions for Schedule II drugs under the program, Ungar reports.

"One in five doctors who wrote at least 3,000 prescriptions for Schedule 2 drugs have faced some kind of sanction or investigation, according to the ProPublica analysis," Ornstein and Jones write.

Kentucky's top prescribers, those with the largest numbers of Medicare patients who received at least one prescription for a narcotic painkiller in 2012, include three pain doctors, an adult-medicine physician and an internal-medicine doctor, Ungar reports.

In 2012, 12 of Medicare's top 20 prescribers of Schedule 2 drugs faced disciplinary actions by their state medical boards, Ornstein and Jones report. In Kentucky, only one of its top prescribers, Dr. Gregory Mick, a Lexington adult-medicine physician, has been disciplined by the Kentucky Board of Medical Licensure, which ordered him to stop prescribing controlled substances, Ungar reports.

The other four top prescribers told Ungar that "they are practicing good medicine and have legitimate reasons for having more than 1,000 Medicare patients each who received at least one narcotic painkiller prescription."

Beginning in mid-2015, Medicare will have the authority to kick doctors out of the program if they prescribe in abusive ways, Ornstein and Jones report. Medicare sent letters to 760 high prescribers in September "in hopes that they will examine their prescribing and make changes."

ProPublica obtained the data under the Freedom of Information Act to update its online Prescriber Checkup tool with the most recent numbers available and shared it with The Courier-Journal and other Gannett Co. news organizations. A Courier-Journal reporter further analyzed the information about Kentucky doctors.

Wednesday, December 17, 2014

Spending bill allows schools that show 'hardship' to vary from requirement to serve 100 percent whole grains

By Melissa Patrick
Kentucky Health News

The massive 2015 spending bill signed by President Obama Dec. 16 includes a provision to help schools struggling with the whole-grain and sodium requirements that are part of the Healthy, Hungry-Free Kids Act. It did not allow, as House Republicans had hoped, schools to opt out of the healthier school meal standards if they lost money on meal programs over a six-month period.

Beginning with the 2014 school year, schools had to serve 100 percent whole grains in their meals and snacks, and also follow the first restrictions on sodium, or salt. The sodium restrictions were scheduled to get progressively stricter over the years, with the next move set for 2017.

The law allows schools that demonstrate the rule is a "hardship" to continue serving 50 percent whole grains. It also says sodium standards cannot be tightened until the "latest scientific research establishes the reduction is beneficial for children," Mary Clare Jalonick reports for The Associated Press.

Some schools say they have had trouble complying with these requirements because many of the affordable whole grain pastas have proven difficult to cook en masse and the whole-grain versions of many foods, like biscuits and tortillas, simply don't taste the same.

On salt, schools say budgeting the allowed amounts among meals, snacks and a la carte items is often a challenge. The issue hit Anderson County schools earlier this year when they couldn't find a low-sodium ketchup; their solution was to not offer ketchup. Parent and student complaints prompted a reversal of that move, but to do that, sodium had to be removed elsewhere in the menu.

The new law won't have much effect on Fayette County Schools, Director of School Nutrition Michelle Coker said in a telephone interview. "Basically, we use 100 percent whole grains in everything," she said. "But there are products, like tortilla shells, that aren't as flavorful and this gives us some flexibility."

Fayette County has transitioned slowly to whole grains over the last five to six years to help students adjust to them, Coker said, and as whole-grain products have become "tastier" the transition has not been an issue.

"Whole grain pasta products have come a long way," Coker said. "Three to four years ago they were dark, but now it is difficult to tell the difference. Kentucky has really good vendors."

Coker, a registered dietitian, welcomed the possible delay in lower salt limits, saying most students are active and involved in sports and shouldn't need such low sodium restrictions. "These kids are growing and need electrolytes," she said.

The School Nutrition Association, a group that represents both school nutrition directors and the food companies that produce foods for schools, wanted even deeper rollbacks than the spending bill included, but said it "strongly supports" the budget-bill language.

Alabama Rep. Robert Aderholt, chairman of the House subcommittee that oversees nutrition issues, said the whole-grains waiver is "the best bill that we are going to get" as long as Democrats are in control the Senate, Jalonick reports.

Republicans will control both houses of Congress next year, so the battle is far from over, and the overall law governing child nutrition policy, including school lunches, expires next year and will require legislation to be renewed, Jalonick notes.

First Lady Michelle Obama, champion for improving school's nutrition and decreasing child obesity, said this summer that she would fight "to the bitter end" to make sure kids have good nutrition in schools.

Tuesday, December 16, 2014

Tennessee's Republican governor will use Obamacare Medicaid money to expand coverage

One of the longest and starkest boundaries in health care for the last year has been the border of Kentucky and Tennessee, because the Bluegrass State expanded Medicaid under the federal health-reform law and the Volunteer State did not. That is about to change, because Republican Gov. Bill Haslam of Tennessee will use federal Medicaid money to expand health insurance in his state.
Kentucky, Arkansas and West Virginia expanded Medicaid; Tennessee and Virginia haven't yet.
"Like most other Republican governors who want to take the health-care law's generous federal funding, Haslam is now offering a plan that deviates from the Medicaid expansion envisioned under the Affordable Care Act," writes Jason Milliman of The Washington Post. "Haslam, who made the announcement almost a month after his re-election, said the Obama administration has verbally approved the approach."

The Tennessee plan includes a two-year waiver program with two tracks. "It will offer vouchers to people earning up to 138 percent of the federal poverty level—or about $16,100 for an individual—to help purchase employer coverage they would otherwise struggle to afford," Milliman reports. "Other newly eligible individuals can sign up in health plans modeled after health reimbursement accounts, with people earning above the poverty level required to pay premiums and copays. Haslam's administration didn't immediately offer details about how those payments are structured."

In November the Kaiser Family Foundation estimated that Tennessee has "about 142,000 low-income adults fall into what's known as the coverage gap—people who earn too much to qualify for the existing Medicaid program but not enough to qualify for subsidies to purchase private coverage on the Obamacare health insurance marketplaces," Millman writes.

"Nine Republican governors have expanded Medicaid so far, while Indiana Gov. Mike Pence is still negotiating with the feds on leveraging an existing state program to expand coverage," Millman reports.

Sunday, December 14, 2014

Dec. 15 is deadline for Jan. 1 Kynect coverage; final deadline in second open enrollment is Feb. 15

Kentuckians can sign up for coverage under the Patient Protection and Affordable Care Act through Kynect, Kentucky's health insurance exchange, through Feb. 15. But to be covered on Jan. 1, you must sign up by Dec. 15.

Coverage for those who miss the Dec. 15 deadline and sign up between Dec. 16 and Jan. 15, will begin on Feb. 1. Those who enroll between Jan. 15 and the Feb. 15 deadline will have a March 1 effective date.

Nearly 18,000 new applications have been filed since open enrollment began Nov. 15, with more expected to sign up in the coming days, state officials told Chris Kenning of The Courier-Journal. It has not yet been determined how many of these applicants were for Medicaid and how many were for private plans.

This year, the penalty for not having coverage in 2015 will rise from $95 per adult, or 1 percent of household income, to $325 per adult or 2 percent of household income, whichever is greater.

And if you are one of the 80,000 Kentuckians who purchased private plans last year that will be automatically re-enrolled, changes in subsidies and premium amounts may cause an increase in your plan cost so it is important for this group to re-evaluate their plans this year, Kenning writes.

 "You could get a bigger subsidy, a lower monthly cost, or more network options if you shop again,"  Carrie Banahan, executive director of Kynect, told Kenning.

Officials estimate 290,000 Kentuckians are potentially eligible for subsidies with the Affordable Care Act, Kenning reports. Subsides are based on income, but are capped at $46,680 for individuals and $95,400 for a family of four.

He offers these examples of how subsidies might work: a 35-year-old single parent of two who earns $35,000 per year could get a monthly subsidy of $240; or a retired couple with $50,000 in income could get a $526 monthly subsidy.

To examine Kynect options, visit or call 1-855-4kynect (459-6328)

Flu activity becomes widespread, closing schools

Kentucky's flu activity level has become widespread, which means at least half the regions of the state have reported confirmed cases of influenza.

Schools are a testimony to this increase in activity, as they have been swamped with absences related to illness, many reporting flu or flu-like symptoms. Several of them have closed their doors Friday hopes for recovery over the weekend.

One of the first big episodes came several weeks ago when Lexington's Paul Laurence Dunbar High School Band cancelled its appearance in the Lexington Christmas Parade because of widespread illness. They had just returned from marching in the Macy's Thanksgiving Day Parade in New York City. Kathy Jaeger, president of the band boosters, told WKYT-TV that nearly 100 band members and two band directors were sick with strep throat and flu-like symptoms.

WKYT reported that up to 20 percent of students were out sick last week at some Central Kentucky schools. Paris Elementary reported 20 percent of its students out, most with flu-like symptoms.

Toliver Elementary in Danville cancelled classes for Friday, Dec. 12 because of the number of sick students and teachers, sending a note home to students that said: "The staff has worked overtime to keep the doors open, wiping noses, taking temperatures, and teaching. Worn down by the effort and in such close contact with students, significant numbers of staff are now ill as well. The number surmounts resources available."

Harrison County Schools also cancelled classes Friday because of the rising number of reported student illnesses, Donald Richie reported for The Cynthiana Democrat.

Greg Hollon, Clark County director of pupil personnel student support services, told WKYT that parents should keep their kids at home if they are sick.

"If your child is exhibiting symptoms, they're nauseous, they're coughing, they have a high fever, any of those symptoms, symptoms that would warrant taking them to the doctor. We always would encourage parents to exercise good judgment," he said.

The flu is highly contagious and because it is spread from person to person, it is easily spread in school environments. And this year a strain of the flu  (H1N1) that is especially hard on children and young adults is circulating, according to a state press release.

“In this flu season so far, H1N1 has continued to circulate and there have been reports nationally of severe illness in young and middle-aged adults,” Health Commissioner Stephanie Mayfield said. “We strongly recommend vaccination of children, teenager and young to middle-aged adults, even if they are healthy, to prevent the spread of and complications from the flu this year. All forms of flu vaccine available in Kentucky this year provide protection against the pandemic H1N1 influenza virus.”

The most common symptoms of the flu are high fever, chills and shakes, extreme tiredness, headache and body aches, sore throat, headaches, a dry hacking cough, and vomiting and belly pain.

The federal Centers for Disease Control and Prevention says that the best way to prevent the flu is to get a vaccine, and it recommends a vaccine for everyone 6 months of age and older.

People who are especially encouraged to receive the flu vaccine, because they may be at higher risk for complications or negative consequences, include:

 • Children age 6 months to 19 years;
 • Pregnant women;
 • Young and middle-aged adults for the 2013-2014 influenza season;
 • People 50 years old or older;
 • People of any age with chronic health problems;
 • People who live in nursing homes and other long-term care facilities;
 • Health care workers;
 • Caregivers of or people who live with a person at high risk for complications from the flu; and
 • Out-of-home caregivers of, or people who live with, children less than 6 months old.

Fulton hospital says it will close by March 31 due to shrinking population and patient counts

Citing population losses and lower patient counts, Community Health Systems has announced that it will close Parkway Regional Hospital in Fulton by March 31. The hospital has 70 beds, larger than most rural hospitals that have closed recently.

The closure will cost 192 jobs, and hurt the city and county directly. "The hospital pays nearly $256,000 in utility, payroll and property tax to the city, making up 18 percent of city revenue," Rob Canning reports for WKMS in Murray. "Fulton is one of the poorest communities in Western Kentucky."

Patients who would have gone to Fulton are now likely to go to Martin or Union City, Tenn., both 12 miles away, or Mayfield's Jackson Purchase Medical Center, 22 miles away. Fulton County Judge-Executive David Gallagher is "in negotiations with the Fulton, South Fulton, Tenn., and Hickman city governments to extend a one-year contract with Tri-City Ambulance, a paid EMS service, to keep it active despite the closing," WKMS reports.

Saturday, December 13, 2014

Kentucky drops two spots in America's Health Rankings, based on data since 2012 or earlier

Kentucky dropped two spots in the 25th annual America's Health Rankings report this year and finds itself once again as one of the bottom five healthiest (or unhealthiest) states.

Since the rankings were first released in 1990, with the exception of 2008 when it ranked 39th, Kentucky has ranked in the bottom 10 states for health. This year it ranks 47th.

The rankings are based on data gathered in the last two to three years, or even earlier, a fact state officials noted as they mentioned the Patient Protection and Affordable Care Act.

"While we have made much headway in the last year, we still have much work to do," said a statement from the Cabinet for Health and Family Services. "We expect that Kentucky’s statistics will begin to improve over time as the full effect of the ACA is reflected in future rankings. However, this change may take time, as Kentucky will be compared to other states that may more quickly see their health outcomes improve.”

Gov. Steve Beshear has made changing health behaviors to create a healthier population a priority for the state. He initiated the Kyhealthnow initiative, which established seven major measurable goals to improve the health status of Kentuckians over the next five years. He has also banned the use of tobacco products on most state properties.

Kentucky's latest ranking should come as no surprise since the state ranks in the bottom five states for eight of the measures: smoking, drug deaths, obesity, children in poverty, preventable hospitalizations, poor mental health days, poor physical health days and cancer deaths. Additionally, it ranks in the bottom 10 states for physical inactivity, air pollution, cardiovascular deaths and premature deaths.

Kentucky has already shown an improvement in smoking. While Kentucky still ranks second in smoking, fewer Kentuckians are smoking. In the past two years, smoking has decreased by 9 percent to 26.5 percent from 29 percent. In 1990, 35.3 percent of Kentuckians smoked.

"The decline in smoking rates stands out as a significant health improvement over the past 25 years," says the American Health Rankings news release. "Cigarette smoking is still associated with one of every five deaths in the United States, making it the leading cause of preventable death in the country."

Kentucky, like the rest of the nation, is getting fatter and becoming more sedentary.

Kentucky ranks fifth in obesity, with 33.2 percent of its adults having a body mass index of 30.0 or higher. In 1990, only 12.2 percent were obese. Kentucky doesn't fare much better with physical inactivity, ranking ninth with 27.4 percent reporting inactivity in the last 30 days.

Nationwide, obesity rates increased by 7 percent to 29.4 percent from 27.6 percent and the percentage of adults reporting inactivity in the last 30 days increased to 23.5 percent from 22.9 percent.

Kentucky has also seen a steady increase in the percentage of its adults with diabetes. Kentucky ranks 33rd in diabetes, with 10.6 percent of its adults reporting they have been told by a doctor that they have diabetes. In 1996, 3.6 percent of Kentuckians reported having diabetes.

Drug deaths have increased by 30 percent in the last two years, to 24 per 100,000 population from 18. Kentucky ranks third in this measurement.

Kentucky ranks first in four measures: children in poverty (31.8 percent), preventable hospitalizations (94.4 per 1,000 Medicare beneficiaries), poor mental health days (4.5 days reported in the previous 30 days), and cancer deaths (228.3 deaths per 100,000 population).

The number of children in poverty has increased by 36 percent in the past two years (31.8 percent from 23.3 percent).

Kentucky does have a few bright spots on the evaluated health measures including a low prevalence of binge drinking, a low violent crime rate and high immunization coverage among children.

Hawaii, Vermont, Massachusetts, Connecticut and Utah are ranked as the top five healthiest states. Mississippi is ranked 50th this year, preceded by Arkansas (49), Louisiana (48), Kentucky (47) and Oklahoma (46). West Virginia and Alabama moved out of the bottom five.

The report, published by United Health Foundation in partnership with American Public Health Association and Partnership for Prevention, uses data from well-recognized outside sources, such as the Centers for Disease Control and Prevention, American Medical Association, FBI, Dartmouth Atlas Project, U.S. Department of Education and Census Bureau.

To see the Rankings in full, visit

Kentucky 's spending of tobacco settlement on tobacco-prevention programs fall far short of what CDC recommends

Kentucky ranks 39th in the country in funding programs that prevent kids from smoking and help smokers quit, according to a national report from a coalition of public-health organizations.

Kentucky ranks sixth in high-school smoking in the 2013 Centers for Disease Control and Prevention Youth Risk Behavior Surveillance System report, with 17.9 percent of high schoolers reporting they smoke cigarettes. Nationwide, the rate is 15.7 percent. The report challenges states to get their rates as low as Florida's 7.5 percent.

"If Kentucky reduced its high school smoking rate from 17.9 percent to 7.5 percent, it would prevent 148,150 kids from becoming adult smokers, saving 52,290 lives and $2.6 billion in future health care costs," the Campaign for Tobacco-Free Kids says in a press release.

The campaign says it's not that the state lacks the money to spend on such programs.

"Kentucky will collect $347.3 million in revenue this year from the 1998 tobacco settlement and tobacco taxes but will spend only 0.7 percent of the money on tobacco-prevention programs," says the release. "Kentucky spends $2.5 million per year on tobacco prevention and cessation programs, which is 4.4 percent of the $56.4 million recommended by the Centers for Disease Control and Prevention."

Soon after the settlement, the Kentucky General Assembly decided to spend half the settlement on diversifying and improving the state's agricultural economy, with the rest going to health, early-childhood development and other programs. The legislature later began using the fund for water and sewer projects in rural areas.

Kentucky is not alone in scrimping on such programs. Collectively, states have budgeted just 14.8 percent of the $3.3 billion the CDC recommends. States will collect $25.6 billion this year from the tobacco settlement and tobacco taxes but will spend only 1.9 percent of it ($490.4 million) on tobacco prevention programs, the campaign says.

Meanwhile, kids get plenty of tobacco-company marketing enticing them to smoke. "Tobacco companies spend $271.1 million per year to market their products in Kentucky – 109 times what the state spends on tobacco prevention," says the release.

The campaign says tobacco annually claims 8,900 Kentucky lives and costs the state $1.9 billion in health care bills. "Right now, Kentucky is also putting its children at risk and costing taxpayers money by failing to properly fund tobacco prevention efforts that are proven to save lives and health care dollars," says Matthew Myers, president of the campaign for Tobacco-Free Kids. "We need elected leaders in Kentucky to enact a comprehensive smoke-free law and increase funding for proven tobacco-prevention programs,"

The report is titled "Broken Promises to Our Children: A State-by-State Look at the 1998 State Tobacco Settlement 16 Years Later." It was also released by the American Heart Association, the American Cancer Society Cancer Action Network, the American Lung Association, the Robert Wood Johnson Foundation and Americans for Nonsmokers' Rights.

Friday, December 12, 2014

Anti-obesity program targets preschoolers, will expand to rural Kentucky next year

By Melissa Patrick
Kentucky Health News

The latest America's Health Rankings report ranks Kentucky as the 47th healthiest state, a fall from 45th last year. With the exception of one year, Kentucky has found itself ranked as one of the bottom 10 states since the rankings began in 1990.

How does Kentucky even begin to dig itself out of this hole?

The long-term answer will likely be found in changing the health habits of our children, which is exactly what the Kentucky Department for Public Health is trying to do by participating in the National Early Care and Education Learning Collaborative Project, a childhood obesity-intervention program that targets child-care and education providers for preschool children.

Kentucky is one of a few states in the program, and will be expanding next year to locations in southeastern and western Kentucky.

“Sustained well-being is made possible when people learn the lessons of a healthy lifestyle early on,” Health Commissioner Stephanie Mayfield said in a press release. “By working with the early-care and education community, we are able to reach many of Kentucky’s young children and help them build the foundation for being healthy and active.”

Child obesity has been considered a national epidemic, with 17 percent of U.S. children considered obese and almost 32 percent considered overweight. Kentucky ranks eighth in child obesity, with 19.7 percent between the ages of 10 and 17 obese, according to the Trust for America’s Health and the Robert Wood Johnson Foundation’s annual "The State of Obesity" report.

The same report says nearly 16 percent of low-income children under the age of 5 in Kentucky who are enrolled in federally funded maternal and child health programs are characterized as obese. That is the target population for the project.

The project, which is part of a multi-state pilot funded by the federal Centers for Disease Control and Prevention and managed by Nemours Children’s Health System, aims to fight back against this epidemic by placing a focus on improving nutrition, increasing physical activity, reducing screen time, and providing breast-feeding support through a national curriculum and learning collaborative method with early care and education providers, according to a Nemours press release.

Kentucky received a $275,000 grant from Nemours to be a part of this project. Currently, nine states participate in the National ECELC Project.

The first phase of the Kentucky Early Care and Education Learning Collaborative includes 65 early care environments in Jefferson County, Fayette County and Northern Kentucky. The programs represent Head Start classrooms, non-profit and commercial child care, private preschool and public preschool settings and has reached 7,559 children.

Phase II of the project allows funding to launch four more collaboratives in 2015. The first two will launch in March: a second one in Jefferson County, and one in Laurel County, which will include an invitation to the early-care programs in the surrounding counties to participate. The second launch will happen in October, but these locations, which will be located west of Interstate 65, have not yet been determined.

Child-care centers in the program "participate in group learning and action planning and have access to technical assistance, tools, materials and resources to aid in their continuous improvement. Information is shared within and between teams," the state press release said.

The project is not designed to measure child outcomes, which would add tremendous cost in both time and money to this project, Rebekah Duchette, Kentucky's project coordinator, said in an e-mail. But they are seeing positive results from the program.

"We are seeing changes in environments, policies and practices around nutrition, physical activity, screen time, breastfeeding, family engagement and juice consumption," she said.

One of the missions of the project is to implement and influence policy around childhood obesity. Kentucky has taken this charge to heart both at the program level as well as the state level.

"We are working on some exciting policy changes and equally exciting clarifications for programs. At the program level we see programs implementing policies that go above what the state of Kentucky requires in child-care regulations: centers that are incorporating fresh fruits and vegetables, changing to seasonal menus that expose children to a larger variety of foods, eliminating pre-fried and fried foods from menus, adding more physical activity to the daily schedules and using physical activity time as learning time," Duchette said.

"As part of our sustainability planning we are working with early education stakeholders to develop a proposed list of child care regulations that support the best practices in healthy behaviors. Additionally, we are working with various branches of the state that regulate child care to clarify some existing regulations and send a consistent message to early care programs about how to implement best practices and stay in compliance with all state and local regulations."

“Reaching kids early is the key to combating childhood obesity,” Debbie I. Chang, vice president of policy and prevention at Nemours, said in the press release.

Thursday, December 11, 2014

Kentuckians rank high in colorectal cancer deaths; study will use emergency rooms to promote screening to save lives

University of Kentucky College of Nursing Associate Professor Jennifer Hatcher has received a two-year $359,528 grant for her project, “Promoting Colorectal Cancer Screenings in Rural Emergency Departments.”

The grant, given by the National Cancer Institute, will be used to study how effective motivational interventions are in helping non-emergency patients in rural Appalachian emergency departments to get screened for colorectal cancer, Hatcher said in an interview. Patients' companions in the emergency rooms can also participate in the interviews.

Of cancers that affect both men an women, colorectal cancer is the second leading cause of cancer-related deaths in the United States and the third most common cancer in men and in women, according to the Centers for Disease Control and Prevention.

Kentucky leads the way in these national health statistics.  It has the highest rate of colorectal cancer in the nation at 55.1 per 100,000 and is the fourth highest in the nation for deaths caused by colorectal cancer at 19.8 per 100,000. And those in Kentucky's Appalachian counties have a higher incidence rate than the rest of the state and nation overall at 57.2 percent, according to a Kentucky Colon Cancer Screening Program annual report.

“Residents of rural Appalachia have a higher incidence and mortality rate from colorectal cancer than residents of any other region of the country," Hatcher said in the release. "In light of the fact that colorectal cancer is one of the few cancers that can actually be prevented by screening, this grant presents a tremendous opportunity for us to address one of the key factors affecting this disparity for rural Appalachians—limited access to the health care system."

The interventions for the study will be conducted by lay health workers, trained local people who are interested in the health of the community and helping their neighbors get screened. They will talk to the patients or their companions about their perceived barriers related to colorectal screening and help them work toward resolving those barriers. All interactions are voluntary, Hatcher said in an inteview.

The lay health workers act as connections between the patients and whatever resources they may need to get screened, or helps alleviate fears they may have about colorectal screening. They are also trained to provide education on what types of screenings are available and discuss what is best for each individual.

Patients who agree to the intervention will get a follow-up call one week after the emergency room intervention to see if they need further assistance in setting up a screening and will receive yet another call in three month.

The project will be the first to address the disproportionate incidence and mortality from colorectal cancer in rural Appalachia utilizing the emergency department as an access point, says the release.

"We believe that using an emergency department as an access point for this project will allow us to reach more individuals who are at risk for developing colorectal cancer, thereby reducing the disparate mortality rates that rural Appalachians suffer from this disease,” Hatcher said in the release.

KET program to host authors of "Life Lessons from Cancer" to discuss inspirational messages of book

"One to One" with Bill Goodman will feature the authors of Life Lessons from Cancer, Keen Babbage and his sister-in-law Laura Babbage, on Sunday, Dec. 21 at 1 p.m. ET to discuss the book and its inspirational messages, especially the importance of family when facing life's challenges.

Keen Babbage, a teacher and native Lexingtonian, was diagnosed with cancer in his late 50s, despite a lifetime of healthy habits. He felt moved to share his experience in print.

With the help of his sister-in-law, a registered nurse and chaplain at the Chandler Medical Center at the University of Kentucky, they wrote Life Lessons from Cancer, published in September.

Keen told an audience at the first promotional event in October that he hoped the lessons in the book would be an inspiration and offer guidance for other patients with cancer as well as a resource for health-care providers.

The show will also air on Tuesday, Dec. 23 at 7:30 p.m. ET on KET2.

Study: Secondhand smoke and road pollution contribute to obesity in children more in combination than separately

Diet and physical activity aren't the only causes for the obesity epidemic that is sweeping our nation; a recent study finds that secondhand smoke and roadway pollution are also contributors, Ryan White writes for Reporting on Health.

Photo by
Researchers at the University of Southern California have found that secondhand smoke and roadway pollution contribute to body-mass-index increases and obesity in children. The study is published in Environmental Health Perspectives.

“Our findings strengthen emerging evidence that exposure to tobacco smoke and [near-roadway pollution] contribute to development of childhood obesity and suggest that combined exposures may have synergistic effects,” the study’s authors write.

The study collected data on 3,318 students through home questionnaires about tobacco exposure in homes, and scientifically estimated each student's exposure to roadway pollution, White reports. Meanwhile, the student's BMI was measured annually between ages 10 and 18. "BMI levels estimate body fat based on height and weight. “Normal” weight scores range from 18.5 to 24.9, with higher figures considered overweight and 30 the threshold for obesity"

The study allowed for a long list of "confounding variables," or other factors that might be responsible for these elevated BMIs, including: team sports participation, asthma history, social makeup of family and neighborhood, parents’ education, neighborhood walkability, recreation facilities, population density, unemployment rates and so forth, White reports.

"After crunching the data, researchers found that exposure to high levels of roadway pollution alone was associated with average increases of 0.80 BMI units over the eight-year study, while children with secondhand smoke exposure and low roadway pollution averaged 0.85 units higher, compared to similar peers. But when investigators looked at children with high exposures to both tobacco smoke and air pollution, their BMIs were on average 2.15 higher over eight years," White writes.

This is the first study to look at tobacco smoke and air pollution in combination. Other studies have looked at each of these contributors independently and found "secondhand smoke is associated with increased obesity risk in children and patterns of overweight children from mothers who smoked during pregnancy are well documented," White writes. Another study associates "prenatal exposure to roadway pollution with higher BMI and obesity by age 7."

But White notes that socioeconomic status, while ruled out as a "confounder," must still be considered as those who have a lower socioeconomic status are more likely to smoke, live in neighborhoods bisected by busy roadways, have less access to healthy foods and fewer places to exercise.

Sunday, December 7, 2014

New cardiovascular inpatient unit opens at UK

UK HealthCare's new 64-bed Cardiovascular Inpatient Unit, one of the largest intensive-care units in the country, accepted its first patients Monday, says a University of Kentucky news release.

"This new unit doubles our capacity to treat Kentucky's sickest heart patients and brings the best technology medicine has to offer right to a Kentucky heart patient's backyard," UK President Eli Capilouto said in the release.

The new unit, located on the 8th floor of the Albert B. Chandler Hospital's new Pavilion A, has 32 intensive care beds and 32 progressive care beds.

Dr. Susan Smyth, medical director of the Gill Heart Institute, told UKNow that the unit "represents an unequaled opportunity to help staff provide patients with the highest standard of care in a technologically advanced healing environment."

One of the unique features of the CV Unit is that it has its own Central Monitoring Service station embedded on the floor, says the release.

"Even though the nursing staff is situated immediately outside a patient's room, they are often away from one patient while helping ambulate another," Smyth said in the release. "Having trained staff monitoring patients in such close proximity provides an extra layer of care."

The unit also has its own imaging suite for echocardiography. This not only minimizes patient transfers for testing, but will open up existing imaging areas for other inpatient and outpatient use, thereby reducing wait times. The Gill Heart Institute performs approximately 25,000 imaging studies each year, says the release.

Additionally, the floor is the first in Pavilion A to use new barcode technology for patient medication administration, which will minimize medication errors. It also offers interactive TVs in every room, with programming available specific to the patient and their heart health needs.

"Patients will be able to access videos describing their condition, their treatment, and education about self-care and healthy lifestyles," Dr. Michael Sekela, surgical director of the Gill Heart Institute, told UKNow. "Once they are home, they will be able to access the same information from their home computer, which should help minimize post-discharge confusion and the readmissions that often result from that."

The unit will continue its longtime policy to ambulate every cardiac patient at least once a day, regardless of their diagnosis or treatment, says the release. This is accomplished by a group of physical therapy students and volunteers caled CATWalkers.

"This new unit brings the highest level of cardiac care available anywhere on one floor, in an environment that's efficient for our staff and conducive to healing for our patients."Dr. Michael Karpf, UK executive vice president for health affairs, said in the release."Combined with the Gill Affiliate Network partnerships, this means patients get the level of care they need as close to home as possible."

If you have a Kynect policy, or are buying one, shop around to get the best deal; prices and tax credits change each year

Obamacare customers in Kentucky probably need to shop around the Kynect health insurance marketplace if they want to get a better deal this year.

"More than 70 percent of people currently enrolled in Affordable Care Act health-insurance-marketplace insurance can find a 2015 health plan offering the same level of coverage at a cheaper premium," reports Jason Millman of The Washington Post, citing a report from the federal Department of Health and Human Services. The report says 80 percent of current enrollees could likely "find a health plan with a monthly premium lower than $100 after tax credits are applied."

The reason, according to the department, is that premiums for the benchmark "silver" plan, the second-lowest cost plan in each area, are increasing an average of 2 percent this year. The benchmark plan is used to calculate how much a tax credit a consumer can receive on any plan, and it may have changed in each area, causing a change in the tax credit in 2015.

Most people generally stick with their health insurance, even if it means passing up a better deal, and the Obama administration "is begging" people to shop around to make sure they have the best plan available to them, Milliman reports.

Shoppers have until Feb. 15 to pick a health plan, but they only have until Dec. 15 to choose a plan for coverage starting Jan 1.

The health-reform law is working well, but “One fundamental challenge remains: If Obamacare is to succeed in holding down premiums over the long run, it needs consumers to shop around," rather than treating health insurance like finance or a utility, and falling victim to "consumer inertia," James Surowiecki writes for The New Yorker magazine.

"Consumer inertia" in health care
New Yorker illustration by Christoph Niemann
"People have no difficulty comparison-shopping and changing allegiance when it comes to, say, automobiles or consumer electronics. Companies in those markets face huge pressure to keep quality high and prices low," Surowiecki writes. "But there are also markets where consumers tend to stick with the same choice forever, even though switching could save them quite a bit of money. Energy bills are a classic example. We’ve long been told we can save money by leaving incumbent providers for newer upstarts, but the vast majority of us haven’t. Economists call it consumer inertia, and you can see it in many fields, including banking, credit cards, and health insurance."

Surowiecki elaborates on several factors that cause this inertia: the complicated and confusing nature of health insurance, which often offers complex and multiple options; the time and energy it takes to do enough research to make an informed switch; the added complexity of factoring in subsidies and taxes that comes with Obamacare; and the greatest one, the very real fear of changing doctors if you change insurance.

This inertia benefits insurance companies, making it easy for them to raise prices, Surowiecki writes. He offers this example: If you have a storage unit, you may well have been lured by an attractive monthly rate, only to find that it soon started rising by significant increments. (What are you going to do? Move all your stuff?) "Similarly, even though there are lots of affordable new Obamacare plans this year, many of last year’s are raising premiums substantially," he writes.

Surowiecki says Obamacare both limits and encourages this inertia. It limits through the influx of new customers who pay attention to price, pressuring insurance companies to keep premiums reasonable. He also suggests that people with lower incomes, as many using the law are, will scrutinize the price of their insurance. But the automatic renewals of insurance built into the law, for those who don't change plans, encourages the inertia.

One study found that “fully informed” consumers saved a couple of thousand dollars compared with those who were less well informed, as long as they are confronted with the information, Surowiecki reports.

Saturday, December 6, 2014

If you haven't gotten your flu shot yet, this week is an excellent time to get it, with the holidays coming up

State health officials are encouraging Kentuckians to get a flu vaccination during National Influenza Vaccination Week, Dec. 7-13.

"Getting a flu vaccine is an early holiday gift you can give to yourself and your family,” said Dr. Stephanie Mayfield, commissioner of the Department for Public Health. “As the holidays approach, people will be traveling, and families will gather together, increasing the potential for exposure to the flu. We are strongly urging anyone who hasn’t received a flu vaccine, particularly those at high risk for complications related to the flu, to check with local health departments or other providers.”

National Influenza Vaccination Week is a reminder to those people who have not yet received a flu vaccine that the time to get vaccinated continues into winter – through January or later, when flu season typically peaks. Because it takes about two weeks for the body to develop protective antibodies against the flu following vaccination, Kentuckians who have not had a chance to be vaccinated should seek out the opportunity during this season.

Throughout the week, health departments and the federal Centers for Disease Control and Prevention will highlight the importance of vaccinations for those people at high risk, their close contacts and all those who want to be protected against the flu. In addition, good health habits such as washing hands often with soap and warm water; avoiding touching your eyes, nose or mouth; and staying at home from work or school when sick will also be emphasized.

Kentucky’s flu activity level has recently increased to regional, which indicates an upturn in influenza-like illness or outbreaks of flu in some regions of the state.

The best way to protect against the flu is to receive a flu vaccination. The CDC’s Advisory Committee on Immunization Practices recommends flu vaccine for all individuals 6 months of age and older. People who should especially receive the flu vaccine because they may be at higher risk for complications or negative consequences include:
• Children ages 6 months through 18 years;
• Pregnant women;
• People 50 years old or older;
• People of any age with chronic health problems;
• People who live in nursing homes and other long-term care facilities;
• Health care workers;                               
• Caregivers of or people who live with a person at high risk for complications from the flu; and
• Out-of-home caregivers of or people who live with children less than 6 months old.

Kentuckians should receive a new flu vaccination each season for optimal protection. Healthy, non-pregnant people ages 2 through 49 can be vaccinated with either the flu shot or the nasal vaccine spray. Children younger than 9 years old who did not receive a previous seasonal flu vaccination should receive a second dose at least four weeks after their first vaccination.

High-dose flu vaccine is available for persons aged 65 years and older this year.

The CDC says some of the nation’s circulating flu viruses may not be covered well by this year’s vaccine.  That is not unusual. "Despite the possibility of a poor vaccine match for one of the circulating strains, vaccination still provides the best protection against influenza," a state news release said. "The vaccine appears to be a good match for many of the strains which are being transmitted, and because of antibody cross-protection, should help to reduce hospitalizations and deaths, even in persons who may contract the mismatched strain of influenza."

In addition to flu vaccine, the health department strongly encourages all adults 65 years and older and others in high risk groups to ask their health care provider about the pneumococcal vaccines. These vaccines can help prevent a type of pneumonia that is one of the flu’s most serious and potentially deadly complications. The CDC now recommends that adults 65 years or older receive the pneumococcal conjugate vaccine (PCV13, Prevnar-13) in addition to the pneumococcal polysaccharide vaccine (PPSV23, PneumoVax-23). Getting both vaccines offers the best protection against pneumococcal disease. Between 3,000 and 49,000 deaths are attributed to flu and pneumonia nationally each year, with more than 90 percent of those deaths occurring in people age 65 and older.

Kentucky Hospital Association backs state smoking ban

The Kentucky Hospital Association on Thursday reiterated its support of smoke-free workplaces and public places throughout the state in hopes that 2015 will be the year that legislators pass a statewide ban on smoking in enclosed spaces.

“Kentucky hospitals have treated illnesses like asthma and heart disease as a result of secondhand smoke exposure for too long, only to send patients back out to the very job conditions where they are getting sick," KHA president Michael Rust said. "Secondhand smoke exposure-related illnesses are completely preventable by simply asking smokers to step outside."

Kentucky leads the nation in smoking and lung cancer. The state's lung-cancer death rate is 46 percent higher than the national average, and nearly 1,000 Kentuckians are estimated to die each year from secondhand smoke. And all of these statistics come with a price tag.

"Smoking costs Kentucky $1.92 billion a year in health care costs, $487 million of that in Medicaid costs alone," KHA said in a press release. "It also costs Kentucky $2.3 billion in lost productivity. Secondhand smoke exposure costs Kentucky an estimated $106 million in health care costs each year. Kentucky can no longer afford to shoulder these costs."

Dennis Johnson, KHA board chair and president of Hardin Memorial Health, said "If Kentucky wants to improve our health and attract economic development opportunities, it must make indoor workplaces and public places smoke-free.”

Rust closed the press conference by urging calls to legislators at 1-800-372-7181. "Tell them you support a smoke-free law which would make Kentucky workplaces and public places smoke-free."

Rep. Susan Westrom, D-Lexington, will again be the lead sponsor of the statewide smoking ban bill, according to her office.

As Ky., other states debate smoking bans, Ariz. county considers ban on hiring smokers, penalizing employees who smoke

Smoking bans for public places are still the subject of debate in Kentucky and many other places, but the Arizona county that contains Tucson may take the war on tobacco to a new level, refusing to hire smokers.

The Pima County Board of Supervisors is scheduled to vote Dec. 16 on a proposal that "prevents the county from hiring smokers and slaps a 30 percent health insurance surcharge on employees who do smoke or use other tobacco products," Mariana Dale reports for the Arizona Daily Star. "County health officials predict the new policy could save the county more than $1 million annually on health-care costs as tobacco-users retire and are replaced with healthier workers. . . . Pima County estimates 32 percent or 2,304 of its current employees are tobacco users and they cost the county about $13.4 million each year, according to a memo from the Health Department."

Dr. Michael Siegel, a professor of public health at Boston University and an advocate of smoke-free workplaces, "says a ban on employee tobacco use in their personal life goes too far," Dale reports.

Friday, December 5, 2014

UK hospital's request to add 120 beds clears hearing phase; decision now before state officials

The University of Kentucky's plan to add 120 beds to its hospital moved forward Friday as no one filed a request for a public hearing on its application for a certificate of need, or license. State officials must rule on the application by Feb. 18.

"State law allows any 'affected parties,' defined as anyone who gets health care in the geographic area served by the hospital, other places that provide similar care or third-party payers such as health insurance companies, to request a public hearing to state their reasons for challenging the application," Mary Meehan reports for the Lexington Herald-Leader. "The other large hospital chains operating in Lexington did not request a public hearing and had no comment."

The beds would be added to the hospital's new tower, which is half empty, and bring its total to 945 beds.

Read more here:

USDA makes grants to expand Farm to School in Ky.

The U.S. Department of Agriculture is sending nearly $313,000 to Kentucky in grants under the Farm to School program, which encourages the use of fresh, local food in schools.

Two grants for a total of $87,957 went to the Kentucky Department of Agriculture, which manages the program in Kentucky and will use most of the money to expand it. “This will help our children grow up to be healthy and strong,” Agriculture Commissioner James Comer said. “This also will help Kentucky farmers have the certainty of a market for their products.”

Other Farm to School grants awarded to Kentucky were: $100,000 to the Food Literacy Project at Oxmoor Farm Inc., to create a working vegetable farm that will give students hands-on gardening experience and provide vegetables for students in the Jefferson County Public Schools; $79,750 to the Owsley County School District for equipment needed to expand and diversify crops the locally produced foods served in the schools’ cafeterias; and $45,000 to the Taylor County School District for a school garden where students will grow produce that will be sold to the school food-service office. The district also will develop an assessment for its farm-to-school program.

U of L plans to create statewide health institute with $4 million, three-year grant from KentuckyOne Health hospital firm

The University of Louisville is creating an institute to improve Kentucky's health through research, education and advocacy of health policies.

KentuckyOne Health is giving the university $4 million over three years to establish the Commonwealth Institute of Kentucky in U of L's School of Public Health and Information Sciences. Dean Craig Blakely said the institute will work in western Louisville but also on statewide issues, focusing on data gathering and analysis.

"Kentucky has the nation's highest rates of cancer deaths and smoking, and ranks among the top for cardiovascular disease, obesity, prescription drug abuse and other health problems," Laura Ungar notes for The Courier-Journal. "And certain neighborhoods, regions and populations suffer disproportionately, with even higher rates."

Thursday, December 4, 2014

Lung cancer gets much less research funding than other cancers, but is deadlier, especially in Kentucky

Lung cancer takes more lives annually than breast, prostate, and colon cancers combined, but the disease "generally doesn't get the public attention or research dollars in proportion to its lethality," Arielle Densen, co-founder of Lung Cancer Free World, writes for CNN.

Lung cancer receives $1,442 in federal research funds per death, compared with $26,398 for breast cancer (lung cancer kills nearly twice as many women as breast cancer) and $13,419 for prostate cancer according to a National Institutes of Health study. Funding by private donations increases the gap even further, she writes.

And though lung cancer is usually thought of as a "smokers disease" and often comes with a stigma attached, "the majority of those diagnosed with lung cancer are former smokers or have never smoked at all," Densen writes.

Densen shares the story of her mother, who was diagnosed with lung cancer but had never smoked. Her mom, being a non-smoker and generally "healthy," was told she had pneumonia despite a "lingering, months-long cough." Because she wasn't a smoker it "didn't trigger any red flags." Eventually, a CT scan found a mass in her lung. She was told she had stage 4 lung cancer and had one year to live. But "thanks to advancements in targeted therapies" she lived for 40 months after the diagnosis. She was 59 when she died.

Lung cancer is especially deadly because it usually doesn't cause symptoms until it's already spread to other parts of the body. Kentucky has more cases of lung cancer than any other state, and its lung cancer mortality rate is nearly 50 percent higher than the national average.

The five-year survival rate for lung cancer is around 16 percent and has been for decades and the survival rate for a stage 4 cancer is 4 percent, Densen reports.

New partnership will provide children in Kentucky with a home for medical and dental care

Community Dental of Kentcky and the University of Louisville Pediatrics are partnering to provide Kentucky children in the Medicaid program with a medical, dental health care home through co-located facilities, says a press release from Gov. Steve Beshear's office.

“One of the most effective ways to combat chronic health conditions is to identify potential problems early and address them," Beshear said in the release. "This means ensuring that our children have easy access to the health care they need and deserve. This partnership seeks to meet that need, not just medical care, but also dental care. Through the creation of a health home for children, we believe we will be able to reverse some of the major health problems facing Kentucky.”

 Community Dental, an Alabama-based non-profit with a clinic in Louisville, is a full-service dental organization that provides health care in underserved communities with the goal of improving the overall health of the population, says the release. 

 “We are honored to partner with the Commonwealth and the University of Louisville,” Jeffrey Parker, chairman of Community Dental of Kentucky, said in the release. “Gov. Beshear has created the environment for preventive care as a major tool for combating the health care problems faced by the people in the state.”