More dental patients using ERs, showing lack of dental coverage, shortage of dentists and the stepchild status of oral health

More patients are going to hospital emergency rooms for dental care, illustrating how oral health remains the stepchild of the health system despite health-care reform.

"An analysis of the most recent federal data by the American Dental Association shows dental ER visits doubled from 1.1 million in 2000 to 2.2 million in 2012, or one visit every 15 seconds, Laura Ungar reports for The Courier-Journal and USA Today.

Christopher Smith of Jeffersonville, Ind., had a dental
infection that put him in a Louisville hospital for a
week. (Courier-Journal photo by Sam Upshaw Jr.)

"This is something I deal with daily," Dr. George Kushner, director of the oral and maxillofacial surgery program at the University of Louisville, told Ungar. "People still die from their teeth in the U.S."

A longstanding federal law requires ERs to treat patients regardless of their ability to pay. "Although they often provide little more than painkillers and antibiotics to dental patients, the visits cost more than three times as much as a routine dental visit, averaging $749 if the patient isn't hospitalized — and costing the U.S. health care system $1.6 billion a year," Ungar reports.

Private dental insurance is not common. "Just over a third of working-age adults nationally, and 64 percent of seniors, lacked dental coverage of any kind in 2012, meaning they had to pay for everything out of pocket," Ungar writes. The Patient Protection and Affordable Care Act "requires health plans to cover dental services for children but not adults," and "Medicare generally doesn't cover dental care at all," she notes.

In Kentucky, the expansion of Medicaid under Obamacare has increased dental visits in the program by 37 percent, but it offers "only a short list of dental services," such as extractions, which patients often choose instead of restorative work, for which they would have to pay.

Another big issue is that many dentists don't accept Medicaid, which pays them only 41 percent of private reimbursement, Ungar reports. Also, Kentucky has a shortage of dentists. "A 2013 workforce study by Deloitte Consulting found the state needs 612 more to meet demand," Ungar notes.

More dentists would encourage more preventive treatment, which dentists say would save a lot of money. "If we were going to the dentist more often, we could avoid a lot of this," Dr. Ruchi Sahota, a California dentist and consumer adviser for the ADA, told Ungar. "Prevention is priceless."

Fewer than 60 percent of Kentuckians saw a dentist in 2013, making their dental-visit frequency 43rd in the nation, according to the Kentucky Health Issues Poll.

Half again as many Kentucky newborns were hospitalized for drug dependency last year as the year before

Mother Samantha Adams and her newborn Leopoldo Bautista,
10 days old, spend quality time inside the Louisville Norton
Healthcare child care center for children experiencing drug
withdrawal. (Photo by Alton Strupp, The Courier-Journal)

Increasing drug abuse drove up hospitalizations of drug-dependent newborns in Kentucky by 48 percent last year, to 1,409 from 955 in 2013. "The latest numbers represent a 50-fold increase from only 28 hospitalizations in 2000," reports Laura Ungar of The Courier-Journal.

"The seemingly never-ending increase every year is so frustrating to see," Van Ingram, executive director of the state Office of Drug Control Policy, told Ungar. "It's a horrible thing to spend the first days of your life in agony."

"These infants are born into suffering," Ungar writes. "They cry piercingly and often. They suffer vomiting, diarrhea, feeding difficulties, low-grade fevers, seizures — and even respiratory distress if they're born prematurely."

Drug-dependent newborns are becoming more common nationwide, Ungar notes, but "Vanderbilt University researchers publishing in the Journal of Perinatology [a subspecialty of obstetrics concerned with the care of the fetus and complicated, high-risk pregnancies] say rates are highest in a region encompassing Tennessee, Mississippi, Alabama and Kentucky."

While the increase is blamed mostly on illegal drug use, the Vanderbilt study found that 28 percent of pregnant Medicaid recipients in Tennessee filled at least one painkiller prescription, Ungar writes: "Legitimate use not only raises the risk of having a drug-dependent baby, it can sometimes lead to abuse and addiction."

While Medicaid now pays for behavioral-health and substance-abuse treatment, "Drug treatment for pregnant women is sorely lacking," Ungar reports. In Kentucky, only 71 of the 286 treatment facilities listed by the U.S. Substance Abuse and Mental Health Services Administration treat pregnant women. 

Dr. Steven J. Stack of Lexington is sworn in as 170th president of the American Medical Association

Dr. Steven J. Stack, an emergency physician practicing in Lexington, was sworn in as the 170th president of the American Medical Association, the nation’s largest physician organization.

Dr. Steven J. Stack

He is the organization’s youngest president in the past 160 years and is the first board-certified emergency-room physician elected to the post.

Stack says he will focus his tenure on advancing the AMA’s three strategic areas: improving health outcomes for those with pre-diabetes and hypertension; accelerating change in medical education to ensure physicians are prepared to meet the needs of a 21st century health care system; and enhancing physician satisfaction and practice sustainability.

"I am honored and privileged to be named president of an organization that is dedicated to the art and science of medicine and the betterment of public health and a profession that is working to improve the health of our nation," Stack said in a press release. "I look forward to serving on behalf of America’s physicians to not only create a brighter future for the medical profession but a healthier America one patient at time, one family at a time and one community at a time."

Stack gained national recognition for his expertise in health information technology while serving as chair of the AMA's Health Information Technology Advisory Group from 2007 to 2013. He has also served on multiple federal advisory groups for the Office of the National Coordinator for Health Information Technology and as Secretary for eHealth Initiative, a non-profit multi-stakeholder organization committed to advancing health care through health information technology.

In Kentucky, Stack has served as medical director of the emergency departments at Saint Joseph East in Lexington and Saint Joseph Mount Sterling, both part of KentuckyOne Health. He was also previous medical director of the emergency department at Baptist Memorial Hospital in Memphis, Tenn.

Stack was elected to the AMA Board of Trustees in 2006. In the last eight years, he has served in many leadership positions, including chair and secretary. Prior to his service on the AMA board, he was an elected leader in numerous state, national and specialty medical associations.

He is the second Lexington physician to lead the AMA in three years. Dr. Ardis Dee Hoven, an infectious-disease specialist at the University of Kentucky, led the group in 2013-14.

Bluegrass Family Health changes name to Baptist Health Plan

Bluegrass Family Health, the insurance arm of Baptist Health, is changing its name to Baptist Health Plan.

This change will make the Lexington-based health insurance carrier, which has offered insurance through area employers for more than 20 years, be more readily identified with its parent organization, which is based in Louisville, a news release said. It will take a few months for the name transition to be completed.

“As health care continues to evolve, it’s important to bring together the different parts of the Baptist Health system so everyone knows our entire organization is working toward the same goals of improving the health of our communities,” Baptist CEO Stephen C. Hanson said.

Bluegrass Family Health has nearly 80,000 members in Kentucky and parts of adjoining states.

“We look forward to continuing to expand our insurance business, bringing our products and services to both existing and new markets in Kentucky, Indiana, Ohio, Illinois, West Virginia and Tennessee,” James Fritz, president of the plan, said in the release.

Lexington Herald-Leader says Kentucky Hospital Association report on members' finances damages the group's credibility

The Kentucky Hospital Association's recent "Code Blue" report on its members' finances is a symptom of "financial hypochondria," the Lexington Herald-Leader said in a long editorial Sunday. It said the title, "signaling a patient needs resuscitation, is an unintentionally fitting title because the KHA's credibility could use a little CPR."

Read more here: http://www.kentucky.com/2015/05/17/3855678/hospitals-suffering-financial.html#storylink=cpy

The report "voices a universal human desire: more money, less accountability. The association implies that federal financial penalties aimed at reducing harm to patients are too onerous for hospitals that care for Kentuckians," the editorial says. "Little more than anecdotes are offered with no acknowledgment that some Kentucky hospitals are recording record bottom lines and steep drops in uncompensated care."

The newspaper offered its own anecdote, a large one, noting that the University of Kentucky's medical center is a major beneficiary of the Medicaid expansion under federal health reform: "The 2014 period saw an 83 percent drop in non-paying inpatients, a 66 percent drop in non-paying outpatients and a $60 million increase in Medicaid revenue. UK Healthcare's annual net income through March is up $70 million over the same time last year. Not all of that increase is due to the Medicaid expansion or Kynect," the state exchange for enrolling in Medicaid or buying private insurance.

"The important point," the paper says, is that "Slowing down spending on hospital care is one of the best things we can do for the economy and our health. The United States spends the highest percentage of its GDP on health care of any country but gets worse outcomes. Even by U.S. standards, Kentuckians over-utilize hospital care."

Read more here: http://www.kentucky.com/2015/05/17/3855678/hospitals-suffering-financial.html#storylink=cpy

Kentucky hospitals say they're losing money on Obamacare, as cost of treating new Medicaid patients exceeds reimbursements

By Melissa Patrick
Kentucky Health News

Kentucky hospitals are struggling financially because of the billions of dollars in cuts caused by the implementation of the Patient Protection and Affordable Care Act, and many aren't sure they will survive, the Kentucky Hospital Association said at its annual meeting May 8.

KHA applauded the successful implementation of the federal health reform in Kentucky, which has extended health insurance coverage to approximately 500,000 more Kentuckians, mainly through expansion of Medicaid, but said that has come at a "significant cost to our commonwealth hospitals."

"The expansion [of Medicaid] has infused money into some of our hospitals, which is good, but the rest of the story is the cuts," KHA President Michael Rust said.

KHA Chair Dennis Johnson, CEO of Hardin Memorial Health in Elizabethtown, said  the revenue from the expansion "is less than the cuts Kentucky hospitals will experience in order to finance the ACA."

Kevin Halter, KHA's incoming chair and CEO of Our Lady of Bellefonte Hospital in Ashland, said,
“Much has been made about the fact that Kentucky hospitals have received an additional $506 million in Medicaid payments last year through the expansion, suggesting that hospitals' bottom lines are healthier as a result, but what is often not mentioned is that hospitals lose money on every Medicaid patient they treat.”

The report says that changes in the way hospitals are paid under Obamacare are projected to result in the loss of almost $7 billion in federal cuts to Kentucky hospitals through 2024:

• Lower-than-cost Medicaid and Medicare reimbursements, 82 percent and 86 percent respectively, with actual Medicaid and Medicare payment cuts from 2010 to 2024 projected to be $4.6 billion
• Readmission penalties, which can be as much as 3 percent of Medicare payments, imposed on hospitals that readmit patients within 30 days of discharge, regardless of the reason
• Medicare cuts to hospitals that have any increase in hospital-acquired infections
• Cuts, delayed until 2017, in extra payments to hospitals that have a "disproportionate share" of Medicare and Medicaid patients.

KHA also cited impacts that aren't associated with the reform law, such as sequestration, or automatic across-the-board federal budget cuts, and other cuts in Medicare.

Hospital officials said that rural hospitals have been hit hardest by these changes because 72 percent of their patients are on Medicaid or Medicare. A recent report by state Auditor Adam Edelen found that 68 percent of Kentucky's rural hospitals have below-average of poor financial health, with 34 percent of the total in the latter classification.

Part of the problem is that the law was built on the nationwide presumption that about half of the newly insured would have private health insurance and the other half Medicaid, but in Kentucky, a poor state, 75 percent of the newly insured are covered by the Medicaid expansion, which covers those earning less than 138 percent of the federal poverty line, or about $33,000 for a family of four.

Halter said while hospitals got $506 million for treating patients covered by the expansion, that treatment costs the hospitals $617 million to deliver that care. While low Medicaid reimbursement is not a new problem, Johnson said, "There's no question it's been accelerated under the ACA."

Gov. Steve Beshear said expanded Medicaid payments had "blunted the impact of other fiscal pressures on hospitals. . . . We are very aware of the challenges that medical providers face in Kentucky. Rather than trying to turn back the clock and return to old business practices, we are working directly with providers to help them develop new strategies for better, more efficient, quality health care delivery."

The challenges are real.

A September 2014 survey found that more than 65 percent of the 109 responding Kentucky hospitals had reduced staff since June 2013, eliminating more than 7,700 positions, with more jobs lost in rural hospitals than the urban ones. About 44 percent had frozen or reduced wages, and 40 percent of had cut costs by reducing or eliminating programs, such as closing psychiatric units and outpatient clinics.

"The reality is that hospitals are being forced to reduce costs to deal with these financial pressures," said Charles Lovell, CEO Caldwell Medical Center in Princeton. "This is the third year without our employees getting an increase."

While Obamacare has reduced hospitals' losses on patients who can't pay, Halter noted that 12 percent of Kentuckians remain uninsured, and the report said hospital emergency rooms are still the first choice for many new Medicaid patients because they have't found a regular physician. Many Kentucky counties are short of doctors.

Federal agency offers a consumer-friendly website that ranks patients' experiences in your local hospitals

Consumers now have access to a website that ranks 3,500 hospitals around the country on patients' experiences to help them choose a hospital and better understand the quality of care participating hospitals offer, according to a Centers for Medicare and Medicaid Services press release.

The 12 star ratings on Hospital Compare are based on 11 of the publicly reported measures from the Hospital Consumer Assessment of Healthcare Providers and Systems Survey, and a summary rating for the survey. The survey asks patients questions about nine topics:communication with doctors, communication with nurses, responsiveness of hospital staff, pain management, communication about medicines, discharge information, cleanliness of the hospital environment, quietness of the hospital environment, and transition of care. This survey information is self-reported by patients and will be updated quarterly.

“The patient experience star ratings will make it easier for consumers to use the information on the Hospital Compare website and spotlight excellence in health care quality,” Dr. Patrick Conway, acting principal deputy administrator for the CMS, said in the release.

Consumers already have access to Medicare star systems to rate nursing homes, dialysis centers, private Medicare Advantage insurance plans and certain situations for physicians and group practices, but are they using it?

Not much, according to a recent Kaiser Family Foundation poll. It found that only 31 percent of those polled had seen any information comparing doctors, hospitals, and health insurance plans in the past 12 months. When asked specifically if they had seen information comparing prices or quality across plans and providers, fewer than 1 in 5 people said they had seen such information, and fewer than one in 10 reported using such information.

CMS said the website helps meet goals of the Patient Protection and Affordable Care Act, which calls for transparent, easily understood and widely available public reporting. The agency also reminds consumers that the site is just one tool to help them make a decision abut which hospital to use, and encourages them to talk to their health-care providers about hospital quality, and to use "multiple factors" when deciding about a hospital, such as clinical outcomes and other publicly reported data that is on the website.

To see the rankings:

• Go to the Hospital Compare website
• Type in your ZIP code, or the name of a particular hospital
• Click on "Search"
• Choose three hospitals, by clicking on the "Add to Compare" button
• Click on "Compare Now," located at the top of the screen
• Click on "Survey of Patients' Experiences"
• Scroll down and view star ranking and additional information results

This is a screen shot of the final screen, with a bar of options to click on.

Fate of rural hospitals rests in the hands of community members, writes publisher of weekly Crittenden Press in Marion

Just like country grocery stores in rural areas often have to close because community members drive past them to chain stores to save a few cents, rural hospitals will also suffer and eventually disappear if citizens do not use them, Publisher Chris Evans writes for The Crittenden Press in Marion.

When Evans was growing up in northwest Tennessee, his grandparents had to close their grocery store, which had been the center of the community, because too many people chose to purchase their food and other items from the new Walmart eight miles down the road. "Our rural hospitals are headed down the same path of extinction unless we recognize and reverse the trend," Evans writes.

Charlie Hunt, volunteer chairman of Crittenden Health Systems, which owns the local hospital, told Evans, "The only way for rural hospitals to survive is through community support."

In Kentucky, one-quarter of the 66 rural hospitals are in danger of closing, according to state Auditor Adam Edelen. In general, "Country hospitals do not have a good record for making money or breaking even, for that matter," Evans writes in a front-page column for the weekly he and his wife own.

Based on the results of Obamacare, Evans opines, it appears that America is moving toward a single-payer health care system like Canada's. Then instead of the government paying for 85 percent of Crittenden Hospital's services, it will pay for 100 percent. "When that happens, hospitals will have to play solely by government rules or get completely out of the game," Evans writes. Most of the 50 rural hospitals that have been shuttered in the past few years have been in the rural South.

"Hunt, who chairs the board, said that approximately 10 percent of the future of this hospital rests in the hands of its leaders. The other 90 percent falls squarely on the shoulders of this community," Evans writes. The column is not online, but PDFs of the pages on which it appears are posted here.

Up to 1/3 of rural hospitals in poor financial shape, auditor finds, calling report a baseline for local decisions that could be tough

By Melissa Patrick and Al Cross
Kentucky Health News
For a video of Edelen's press conference, click here. For a cn|2 report with video, go here.

FRANKFORT, Ky. -- As many as one-third of Kentucky's rural hospitals are in poor financial shape, and the survival of some will likely depend on their willingness to adopt new business models, state Auditor Adam Edelen said Monday.

Unveiling a nine-month study, Edelen said 15 of the 44 hospitals examined were in "poor financial health," and warned, "Closure may be an unfortunate reality for some."

Rural hospitals in purple declined to make useful financial information available to the auditor's office.

The study did not include 22 of the 66 Kentucky hospitals that are located outside metropolitan areas, which declined to participate or didn't provide the type of information requested. Edelen said those hospitals are mainly privately owned. If they had been included, Kentucky Hospital Association CEO Michael Rust said, the financial picture "would be better, but I don't think they would be substantially different."

Gov. Steve Beshear said the report was "a dated snapshot" because its most recent data was from 2013, before federal health reform was fully implemented. "Conditions are no longer the same," Beshear said in a news release. "Hospitals received more than $506 million in 2014 through new Medicaid expansion payments, while seeing significant reductions in uncompensated care costs.  Those are huge changes to hospitals’ bottom lines that are not shown here."

Edelen, who was Beshear's first chief of staff, said the full effect of federal health reform isn't certain. His report noted that Kentucky hospitals have had higher-than-average penalties from Medicare for readmitting patients within 30 days, a newly implemented feature of the law. Forty of the 63 hospitals penalized were rural, and nine of the 39 in the U.S. that got the maximum penalty were in Kentucky.

"This report doesn't speak to causation" by the reform law or the state's relatively new managed-care system for Medicaid, Edelen said, it is "not a rebuke" of either, but provides "a baseline for monitoring" by policymakers at the state and local levels.

The report says that to survive, rural hospitals must adapt to new business models, such as merging with larger hospitals or hiring them as managers, forming coalitions with other rural hospitals, or finding a health-care niche that hasn't been served.

Edelen cited Rockcastle Regional Hospital, which has become a niche provider of ventilator dependent care and the coalition formed by Morehead's St. Claire Regional Medical Center and Highlands Regional Hospital in Paintsville to provide more efficient care, improve patient access and adapt to changes under the reform law.

Adaptations might be a hard pill to swallow for many rural hospitals because they call for yet more change in the rapidly changing health-care landscape of electronic health records, managed care, Medicaid expansion and full implementation of the Patient Protection and Affordable Care Act.

Edelen said adaptation is important for rural communities, for whom "the importance of rural hospitals cannot be understated. They provide health care to 45 percent of Kentuckians and in every community they serve they act as one of the larger employers, paying a significantly higher wage than the average the community experiences."

He also cited the many small hospitals that have formed relationships with larger networks to relieve the increased administrative burden associated with the three-year-old managed-care system. The report says half the hospitals studied have reported an increase in hours spent on administration.

The report suggested that the state Cabinet for Health and Family Services negotiate better contracts with managed-care organizations, partly to streamline MCO rules and paperwork to reduce the administrative burden. "We are optimistic that the current work of the cabinet to improve those contracts is going to bear real fruit," Edelen said.

The new contracts will start July 1. In an interview, cabinet Secretary Audrey Haynes sounded optimistic about them but said she couldn't give details.

Haynes has been saying since she became secretary three years ago that many hospitals must change the way they do business. She said in an interview that the readmission penalties have forced hospitals to change by providing better discharge planning, and utilizing outpatient services like home health, nursing homes and rehabilitation.

One Kentucky hospital, in Nicholas County, has closed in the last year. Haynes said the cabinet is working with Fulton County, whose hospital is scheduled to close March 31, to explore how to continue providing care at the facility, such as an emergency room or an ambulatory surgical center.

Haynes recommended in the interview that all nonprofit hospitals put audited financial records and their tax returns on their websites and adhere to open-meeting laws.

In a lengthy response, included in the report, Haynes rejected Edelen's suggestion that her cabinet regularly monitor the fiscal strength of rural hospitals. She said in the interview that would pose a conflict of interest, since the cabinet regulates the hospitals.

Edelen's analysis of hospitals' financial health was based on percentage of revenue kept as profit, number of days of cash on hand, debt financing and depreciation. It found that the financial condition of 68 percent of Kentucky’s rural hospitals scored below the national average.

Edelen's office also surveyed rural hospital administrators, held 11 public hearings and met with representatives of all five Medicaid managed-care companies. His report found that:

• Rural hospitals that were geographically well-positioned, such as Pikeville Medical Center, scored high while geographically-isolated hospitals, like those in Clinton and Wayne counties, scored low. The Clinton County Hospital is in bankruptcy to restructure debt incurred for an expansion and modernization.
• The Pikeville hospital, formerly Pikeville Methodist, was one of only three judged to be in excellent financial health. The others were critical-access hospitals in Franklin and Morganfield.
• Critical-access hospitals, which limit their beds, services and patient stays to qualify for federal reimbursement at 101 percent of cost, scored better than regular acute-care hospitals. They accounted for seven of the 14 that were above the national average and thus were rated "good."
• Fifteen hospitals were rated "fair" and 15 were rated "poor." Westlake Regional Hospital in Columbia, which is in bankruptcy, was at the bottom, far worse than the next highest, St. Joseph Mount Sterling.
• The number of health-care providers across the state – particularly in rural Kentucky – dropped significantly between 2013 and 2014. The cabinet disputed that finding, based on different measurements.

Here are the rankings (click on the image for a slightly larger version):

Health reform law has been good for hospital finances, health-care costs, Obama administration says

U.S. hospitals have saved billions of dollars because the federal health-reform law has provided coverage for patients who were once charity cases, the Obama administration announced Monday, the fifth anniversary of the Patient Protection and Affordable Care Act.

"Hospitals also saw fewer emergency room visits, which rack up far higher costs and often leave hospitals with the tab," Sarah Ferris writes for The Hill, which covers Congress. "The government’s report, which focuses on the benefits of Medicaid expansion, is an effort to entice states that have been politically resistant to expanding the program."

Kentucky hospitals have acknowledged that the law has reduced their losses from "uncompensated care," but say other aspects of the law have created a mixed effect, depending partly on hospitals' ability to adapt. The increase in coverage has brought hospitals much more money, but they say continued problems with managed-care Medicaid have cause them financial difficulty.

From paying patients' point of view, the law appears to have reduced inflation in health-care costs, but has not achieved advocates' goal of reducing costs. A White House report said, "Since the Affordable Care Act was enacted, health care prices have risen at the slowest rate in nearly 50 years. Thanks to exceptionally slow growth in per-person costs throughout our health care system, national health expenditures grew at the slowest rate on record from 2010 through 2013."

For the White House's Kentucky-specific list of benefits of the law, click here.

Study suggests there's too much imaging of low-risk prostate- and breast-cancer patients in the Evansville and Louisville areas

Hospitals and doctors in the Evansville and Louisville areas may be doing too much medical imaging on patients with low-risk prostate or breast cancer, according to a study of cases in the middle of the last decade.

Researchers at New York University examined Medicare records from 2004 through 2007 of 9,219 men with low-risk prostate cancer and 30,398 women with low-risk breast cancer, across 84 of the nation's hospital referral regions. They concluded that unnecessary imaging was done in 44 percent of men and 42 percent of women, they report in the journal JAMA Oncology.

The report did not give rates for each hospital region, but ranked them, and Evansville was second, right behind Slidell, La., and Louisville was 24th. Owensboro was 37th. Other regions listed were Paducah, 45th; Nashville, 57th; and Lexington, 78th. For the study appendix, listing the hospital areas and their rankings, click here.

The study found that "hospitals in the Northeast reported higher use of imaging tests for low-risk patients, while other regions, such as the Northwest and Utah, demonstrated more appropriate use of imaging," an NYU press release said. It quoted Dr. Danil V. Makarov, the lead investigator and professor, as saying, “Policy makers and researchers need to target high-utilization regions and promote incentives for appropriate care. Such a focus would enhance efforts to cut excessive health spending and build value-based strategies into health care practice.”

Imaging for prostate cancer generally involves CT scans or bone scans. Imaging for breast cancer generally involves CT, MR and PET scans.

Advocates of state appeals for Medicaid managed-care claims make last-ditch effort to get it passed, by hijacking another bill

By Melissa Patrick
Kentucky Health News

FRANKFORT, Ky. -- Advocates of a bill to create a state appeals process for health-care providers to appeal decisions of Medicaid managed-care companies are trying to jam it through at the end this short legislative session on the coattails of an unrelated bill that appears to be uncontroversial.

Rep. Joni Jenkins

Senate Bill 120, sponsored by Sen. Ralph Alvarado, a Republican physician from Winchester, would create an administrative appeals process in the Cabinet for Health and Family Services, which opposes the idea. A Senate committee has attached Alvarado's language as an amendment to House Bill 71, sponsored by Rep. Joni Jenkins, D-Louisville, that would allow judges to order a person who is "incapacitated by alcohol and other drug abuse" into treatment.

"I think it has the potential of killing this bill," Jenkins said in an interview. "I heard there was a really large price tag put on [Senate Bill 120], a large fiscal load. So this late in a non-budget year, it is probably going to kill it."

Sen. Julie Raque Adams, chairperson of the Senate Health and Welfare Committee, disagreed. "Everybody in the Senate [is] very supportive of Rep. Jenkins' bill, and we have also passed out Senate Bill 120 from this chamber," she said in an interview.

SB 120 passed the Senate 35-0 on March 2. HB 71 passed the House 90-1 on Feb. 26.

Rep. Robert Benvenuti of Lexington, Republican co-chair of the Democrat-controlled House Health and Welfare Committee, said he thought SB 120 "has a lot of support" on the House floor if leaders of the House's Democratic majority allowed it to come up for a vote.

But to get a floor vote it must first come out of the committee, and that appears unlikely. The legislature can still pass bills on March 23 and March 24, after the 10-day recess for Democratic Gov. Steve Beshear to veto bills, but if he vetoes bills passed then there is no opportunity to override vetoes.

"I think it is a bill that properly sets up a process for providers who believe they have not been properly reimbursed to have some redress," Benvenuti said in an interview. "Our health care providers who serve this commonwealth need to have an avenue of redress so that they can be properly paid for medically necessary services that they provide."

Alvarado has said an administrative appeals process is necessary because managed-care organizations are denying claims for medically necessary treatments and then denying the providers' appeals, which means providers are not getting paid for their work.

The cabinet says it should not be responsible for an appeals process for MCOs because they do not have any legal authority between a contract made between a provider and the MCO. They have also said it would cost the state money. MCOs are paid a flat fee for each person whose care they manage, but an increase in approval of initially denied claims could give them leverage in negoiations for the next annual contract.

The fiscal note for this bill says the cabinet estimates its administrative cost for an appeals process would be at least $1 million a year, which would increase in later years. Alvarado maintains that the added cost to the state should be minimal.

Jenkins, whose nephew, Wesley, died of a heroin overdose two years ago, said that this is the fourth year she has tried to pass this bill, with a lack of funding to pay for the program its main obstacle, "but with the passage of the ACA, it has opened up private insurers and Medicaid to pay."

Jenkins said if the House didn't concur with the changes made by the Senate, she hoped the Senate would withdraw its amendment.

Adams said if the House didn't concur, she would be "very receptive" to going into conference committee to resolve their differences because Rep. Jenkins "has got a very important bill that we need to pass."

Bardstown hospital sponsors monthly 'Walk With a Doc'

Here's an interesting idea to promote physical activity and maybe even health literacy: take a walk with your doctor.

Flaget Memorial Hospital in Bardstown hosts monthly "Walk With a Doc" events as part of a nationwide program. Participants can also receive complementary health screenings at the event, says a news release from KentuckyOne Health, which owns Flaget.

"According to America Walks, brisk walking has been shown to reduce body fat, lower blood pressure, increase high-density lipoprotein, and even reduce risks of bone fracture," the release says. "Not only that, it is also associated with lower mortality rates from cardiovascular disease and cancer."

The walks begin at 10 a.m. on the second Saturday of each month, so the next one is March 14. The walks begin at the Court Square in the middle of Bardstown. For more information, call 502-350-5040.

UK gets approval to add 120 hospital beds, bringing its total to 945 and long-term building project's cost past $1 billion

The University of Kentucky has received state approval to add 120 beds to its hospital complex, which will bring its total to 945 beds at UK Chandler Hospital, Kentucky Children’s Hospital and UK Good Samaritan Hospital.

The project is "part of the overall strategy to make UK the regional hospital of choice among several states and a powerhouse that will survive when health care is so uncertain," Lexington Herald-Leader higher-education reporter Linda Blackford said Friday on KET's "Comment on Kentucky."

Dr. Michael Karpf

Blackford writes for the newspaper, "The 120 beds are the next phase in the patient tower project that began in 2004 with an estimated cost of $400 million and an original completion date of 2009. The cost of the expansion has risen to roughly $1 billion, and there is no longer a completion date, said Dr. Michael Karpf, executive vice president for health affairs at UK. After the 120 beds are added, the tower still will have several empty floors.

"The shifting timetables are all a part of coping with a fast-growing patient base and ever-changing medical technology, Karpf said. Originally, the patient tower was to be a replacement for Chandler Hospital, which was built in the 1950s. But a rapid increase in the number of patients meant the space now will be used for new beds, he said."

Read more here: http://www.kentucky.com/2015/02/19/3703219_state-approves-uk-hospital-expansion.html?rh=1#storylink=cpy

Karpf said in a UK news release, "About 10 years ago, we committed to develop UK HealthCare into a research intensive, referral academic medical center to ensure all Kentuckians — no matter how complex their medical problem — could be taken care of in Kentucky and not required to leave the state for advanced subspecialty medical care," said Karpf. "This strategy, while crucial to our goal of taking care of patients in the commonwealth, has resulted in substantial growth beyond our initial aggressive projections."

Students in poor Louisville neighborhoods learn healthful behaviors in Farm to Family Initiative

A program to fight childhood obesity and foster healthy habits in Louisville’s under-served youth has seen positive results since its launch in October 2013, says KentuckyOne Health. Results include:

• 41 percent of students now eat at least five servings of fruits and vegetables daily, up from 23 percent.
• 91 percent of students engage in at least 60 minutes of daily physical activity, up from 63 percent.
• 90 percent of students have eaten a vegetable they harvested or picked themselves, up from 59 percent.
• 93 percent of students know how to prepare a healthy recipe, up from 63 percent.

The Farm to Family Initiative is a collaboration between the Food Literacy Project and Sts. Mary & Elizabeth Hospital, part of KentuckyOne. It aims to influence long-term health and food literacy for students at Hazelwood and Wellington elementary schools, where more than 90 percent of students qualify for free or reduced-price lunches.

The project is funded by a $200,000 grant from the Johnson & Johnson Community Health Care Program Award for the Prevention of Childhood Obesity.

Health care changes are driven by more than reform law; Beshear says patients need rewards for changing their behavior

"Your doctor's visits might get longer, you deductibles probably will be higher and you might be paying cash to be treated at a Wal-Mart near you as Kentucky adapts to a vastly changing health care landscape," Mary Meehan reports for the Lexington Herald-Leader. "Nearly everything you know about how health care is paid for and provided will change during the next few years as patients and providers sort out the nuts and bolts of the Affordable Care Act."

But it's not just the health-reform law that's changing health care, Meehan reports from the Health Leadership Summit, held Thursday in Frankfort by state government and the Kentucky Hospital Association. She paraphrases the main speaker, Chas Roades, chief research officer for The Advisory Board Co., a Washington-based health consultant firm:

Read more here: http://www.kentucky.com/2015/01/29/3668247/frankfort-summit-focuses-on-changing.html#storylink=cpy

"Even if parts of the law are dismantled, he said, the health care needs of aging baby boomers are driving a fundamental change in the system. If patients have more choice, he said, it will be important for doctors to make more personal connections with patients. The focus won't be rolling patients through the door at a furious clip but on spending time with them to find out what it is going on."

Roades said the focus is shifting from treatment of illnesses to prevention, so health-care providers will be rewarded for keeping people healthy, and the transition period for health-care providers will be tough. "We need to get from fee-for-service to fee-for-value," he said, but until all government programs pay on that basis, and 75 percent of private insurance does, "We won't break even . . . We have to get everybody moving in the same direction at the same time." But he said the transition will be tough for hospitals that are small, rural and not connected with a larger organization.

State Health Secretary Audrey Haynes, who convened the meeting, said "We have to figure out how to have quality health-care services in the rural area of the state just like we do in the urban area."

One attendee at the meeting asked Roades when providers and payers could expect to see patients changing their behavior and being more responsible about their health. "We have to walk a fine line," he replied, suggesting that the focus needs to be on "rising risk" patients, 15 to 35 percent of the population, who may not have their chronic conditions under control.

Roades said educating people about better health should involve community organizations such as churches. "The average American has a fifth-grade health literacy," he said.

Gov. Steve Beshear said one key will be finding ways to reward patients for making responsible, informed choices: "We will fall short of our goals if we can't find ways to engage our patients in new and effective ways."

Read more here: http://www.kentucky.com/2015/01/29/3668247/frankfort-summit-focuses-on-changing.html#storylink=cpy

Medicare starts to overhaul the way it pays providers, rewarding them for quality, penalizing them for shortcomings

By Molly Burchett
Kentucky Health News

The Obama administration on Monday set a timeline for historic changes in how it pays doctors, hospitals and other health providers under Medicare, shifting away from the program's traditional fee-for-service model and towards a model that rewards care quality.

Rather than give the usual yearly fee increases to Medicare doctors for every procedure or service, the Department of Health and Human Services will tie 30 percent of traditional, fee-for-service payments to models like "accountable care organizations," which base payments (and penalties) on patients' health outcomes. The goal is for half of all Medicare payments to be handled this way by 2018, reports Jason Millman of The Washington Post.

"Today's announcement is about improving the quality of care we receive when we are sick, while at the same time spending our health-care dollars more wisely," said HHS Secretary Sylvia Burwell. "We believe these goals can drive transformative change, help us manage and track progress and create accountability for measurable improvement."

Medicare is the country's largest payer for health-care services, so these payment changes will affect doctors' offices and hospitals across the country. Many experts have viewed this broader shift to rewarding care quality as long overdue, but it's still uncertain how well the approach will work.

"We still know very little about how best to design and implement [value-based payment] programs to achieve stated goals and what constitutes a successful program," concluded a 2014 Rand Corp. study funded by HHS, Millman reports.

Some health-care professionals said Medicare is just aligning with what is already working in the private sector by moving away from fee-for-service, reports Alex Wayne of Bloomberg Businessweek.  “The private sector is further ahead than Medicare right now,” said Justine Handelman, vice president for legislative and regulatory policy at the Blue Cross and Blue Shield Association.

Since Medicare is already limiting payments as part of the 2010 health-reform law, the government must “ensure that only reforms proven to be efficient and effective are put in place,” Chip Kahn, CEO of the Federation of American Hospitals, told Wayne. “Further cuts would undermine our ability to invest in delivery system innovations needed to continue this trend.”

The announcement marks the first time that goals have been set to fundamentally change the way Medicare pays for health care, giving providers incentives to reduce unnecessary services.

Dr. Douglas Henley, CEO of the American Academy of Family Physicians, told CNBC: "We're all partners in this effort focused on a shared goal. Ultimately, this is about improving the health of each person by making the best use of our resources for patient good. We're on board, and we're committed to changing how we pay for and deliver care to achieve better health."

Officials of hospitals and state government to discuss future of Ky. health care at Jan. 29 'summit' In Frankfort

State government and the Kentucky Hospital Association will co-host a summit for hospital CEOs, hospital board members and other elected officials and decision makers on the future of health-care delivery in Kentucky on the afternoon of Jan. 29 at the Capital Plaza Hotel in Frankfort.

“The health-care market and delivery systems all across the nation are currently undergoing an unprecedented transformation,” Gov. Steve Beshear said in a statement. “The rapid pace of this transition poses challenges to healthcare stakeholders, both rural and urban, that are facing fundamental changes to how they deliver care to patients in our communities.”

State Health Secretary Audrey Tayse Haynes said the state "has been very successful in getting Kentuckians enrolled in quality, affordable health-care coverage," but "We must now translate that coverage into quality, efficient and effective treatment. . . . The methods of treatment delivery must adapt to accommodate this new population of patients.”

Under federal health reform, hospitals are moving from volume-based to value-based reimbursements, and getting a larger share of Medicare and Medicaid patients, and for some that has meant empty beds, lower revenues and in some cases bankruptcy. Many Kentuckians have chronic illnesses, "which result in very low margins for some providers," a state news release said.

Letters of invitation have been sent to all members of the General Assembly and hospital CEOs. Space is limited, so invited guests are encouraged to register soon.

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."

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: http://www.kentucky.com/2014/12/05/3577578_1-billion-hospital-expansion-at.html?rh=1#storylink=cpy