Free-standing emergency departments could be the solution to keeping hospital services in rural areas

The tribulations of rural hospitals in Georgia, and the response, could signal a new direction for saving such facilities. Four rural hospitals in Georgia "have closed in the past two years, and several more either have closed or significantly reduced services since 2001," Bob Herman reports for Modern Healthcare. "Nationwide, more than two dozen rural hospitals have shut down since 2013. For people in rural areas, a closed hospital means they have to travel farther, sometimes hours, for care. And that could mean life or death in situations such as cardiac arrest, car accidents, workplace injuries and other emergencies."

Republican-led Georgia, where officials have refused to expand Medicaid under federal health reform, "has proposed a regulatory change that some observers think could help rural hospitals across the country," Herman writes. Republican Gov. Nathan Deal said in March that "financially struggling rural hospitals can offer fewer inpatient services and still keep their hospital licenses. In essence, they can convert into free-standing emergency departments that stabilize and transfer patients to bigger hospitals. Under Deal's proposal, these rural facilities also could offer other basic services such as labor and delivery."

Some people are critical of the idea. Brock Slabach, a senior vice president at the National Rural Health Association, "said the financial sustainability of free-standing rural EDs in Georgia as outlined by Deal would be low," Herman writes. Salbach told him, “Emergency departments would be nice for access, but that doesn't provide (insurance) coverage. These rural communities are still going to be having problems of paying for these services. We need to try to find a way to expand coverage to these poor populations in a way that's not going to be called Obamacare.”

There are somewhere between 400 to 500 EDs in the U.S., Herman writes. Most "are affiliated with a hospital or health system, serving as a feeder for patients needing inpatient care. The EDs usually are within 20 miles of a full-service hospital. More recently, for-profit ED companies have been building in affluent suburbs, targeting privately insured patients who see the EDs as more convenient than making an appointment with a primary-care physician."

The problem is that few are located in rural areas, Herman writes. For urgent-care centers and free-standing EDs to survive in underserved rural areas the “operating model will need to adapt,” said Alan Ayers, a vice president for Concentra, the urgent-care subsidiary of giant Louisville-based insurer Humana Inc. "They will have to use mid-level clinicians including physician assistants and nurse practitioners, reduce operating hours, and offer other high-volume services such as primary care and occupational medicine. That could help rural facilities offset the typically high fixed costs, Ayers said."

"Perhaps the most feasible solution for rural areas is a hybrid model, mixing lower-level emergency care with primary-care services," Herman writes. "An example is Carolinas HealthCare System Anson in Wadesboro, N.C., a town of 5,800. In 2012, Carolinas HealthCare System—a large system based in Charlotte, N.C., with $4.7 billion in annual revenue—decided to overhaul Anson Community Hospital, a Hill-Burton facility with 125 staffed acute-care and nursing beds."

"The system spent $20 million and downsized the hospital's inpatient capacity from 30 beds to 15," he writes. "The new facility, which opened in July, offers 24/7 emergency care in addition to the limited number of acute beds. Carolinas officials said Anson's major innovation and attraction is that it uses a patient-centered medical home model, offering residents access to primary-care providers with the help of a patient navigator." (Read more)

Claims that health-reform law is putting Kentuckians out of work don't hold up to scrutiny, economic experts say

"Key Republicans running for election Nov. 4 say the federal Affordable Care Act is putting Kentuckians out of work, but employment data and interviews with Kentucky-based economists suggest otherwise," John Cheves reports for the Lexington Herald-Leader.

The objects of Cheves's scrutiny are a television commercial for U.S. Rep. Andy Barr, R-Lexington, saying Democratic challenger Elisabeth Jensen "supports Obamacare, which has decimated Kentucky jobs," and an opinion piece, by Sen. Mitch McConnell saying "There are so many stories about businesses holding back from expanding or hiring — or even cutting back on their workforces — it's hard to even count."

McConnell's anecdotal assertion proves nothing, and Barr's appears to be false. Cheves notes that Kentucky has gained 3,600 health-care jobs during the last year and quotes experts: Manoj Shanker, an economist at the state Office of Employment and Training, who said the law "is expected to be a net gain for the economy . . . and not just for doctors and nurses. It will mean the creation of jobs in other areas, including clerical staff for processing claims, more receptionists, more pharmacy technicians and clerks, more janitors, orderlies and ambulance drivers."

Glen Mays, a University of Kentucky public-health professor who studies health economics, told Cheves, "I think the law is definitely going to stimulate the health-care segment of our local economies, especially where we've seen substantial drops in the numbers of people who are uninsured. People who were forgoing medical care because they did not have insurance now can access it."

KET will discuss asthma Monday night: living with it, its environmental affects, and available resources to deal with it

KET's current "Health Three60" program is "Easing the Burden of Asthma," discussing a disease that hospitalizes more than 6,000 Kentuckians a year. After debuting on KET Sept. 29 at 9 p.m., it will air on KETKY Sept. 30 at 2 p.m., again on KET Oct. 1 at 3 a.m., again on KETKY Oct. 1 at 9 a.m., again in KET Oct. 2 at 4 a.m. and KETKY Oct. 2 at 4 p.m. (all times EDT).

Host Renee Shaw and guests discuss what it means to live with asthma, daily asthma management and the need for better education and support. They will also explore how the environment affects asthma, both outdoors and indoors.  One segment will look at a pioneering initiative at the Ashland-Boyd County Health Department, which sends health professionals into the homes of people with asthma to help them improve their indoor air quality and reduce asthma triggers. It will also discuss how smoke-free laws help people with asthma. Another segment will look at how to access and utilize resources to help with asthma, such as the Kentucky Asthma Partnership.

Guests on the program include Beth VanCleave, asthma educator at Kosair Children's Hospital, Louisville; Connie White, deputy commissioner of the Kentucky Department for Public Health; David Mannino, professor, University of Kentucky College of Public Health; James Sublett, co-founder of Family Allergy and Asthma and president-elect of the American College of Allergy, Asthma and Immunology.

Kentucky school officials make foods look more appetizing and easier to eat, in order to decrease food waste

Some school districts are working to keep fruits and vegetables from being thrown out by students who seem to be unhappy with their school lunches that must follow stricter nutrition guidelines to get federal subsidies. "The key to getting students to eat healthier is to make the food look appetizing and easy to eat," Rich Suwanski reports for the Messenger-Inquirer in Owensboro.

A recent study by the Harvard School of Public Health in four low-income schools in Massachusetts found that while the guidelines had increased fruit and vegetable consumption, students threw away 60 percent of fresh vegetables and 40 percent of fresh fruits.

Lisa Sims, Daviess County Public Schools nutrition director, and Lisa McCarty, Owensboro Public Schools human resources and food services officer, are trying to keep that from happening in the county. Sometimes it's as simple as "like cutting up the fruit to make it easier to eat," Sims told Suwanski. "Even high school kids won't eat apples and oranges whole because it's more work, and they've got a short amount of time for their lunch break, so we slice the fruit and bag it. They could eat a whole apple if they wanted to, but that's not what their lunch break is all about. It's about socializing, too, and we realize that."

McCarty told Suwanski that the Owensboro schools don't see a lot of wasted fruit and vegetables, but they pay attention to what is being thrown out, and then figure out why. She told him they sometimes will swap out items to foods the students like better and make sure that the foods they serve look appealing.

Federal guidelines have also required schools to increase whole grains and decrease the sodium in their menus. The whole grain mandate began this year. Sims and McCarty told Suwanski that those changes have been a challenge, but by making them gradually, the students have adjusted. Shifts have been made toward offering whole-grain breads, biscuits, pizza crust, pasta and even the breading on the chicken.

"Little by little, we've been changing to whole grain and there's not a lot of reaction against it, " Simms told Suwanski. "Actually, we're kind of surprised to see them taking the whole grain pasta."

Lots of research has established that children with egg allergies can still get a flu shot; those with asthma especially should

Flu season can start as early as October, and  children with egg allergies are now encouraged to get a flu shot, especially if they have asthma, according to a news release from the American College of Allergy, Asthma and Immunology.

Children with egg allergies may have been told in the past to not get a flu shot because of a possible reaction to trace amounts of eggs in which the vaccine is produced, but recent research now says that the vaccine is safe for these kids.

“We now know administration is safe, and children with egg allergies should be vaccinated,” Michael Foggs, president of the American College of Allergy, Asthma and Immunology, said in the news release. “We recommend that, as with any vaccine, all personnel and facilities administering flu shots have procedures in place for the rare instance of anaphylaxis, a life-threatening allergic reaction.”

The release says "a large number of research studies published over the last several years have shown that thousands of egg-allergic children, including those with a severe life-threatening reaction to eating eggs, have received injectable influenza vaccine as a single dose without a reaction."

More than 21,100 children under the age of five are hospitalized annually because of the flu, with only 55 percent of children ages 5-17 getting a flu shot, according to the Centers for Disease Control and Prevention, says the release.

Foggs especially recommended that children with asthma get the vaccine, because even though they are not more likely to get the flu, it can be more serious for those with asthma, says the release.

"Children with asthma really need to get the flu vaccine," Foggs said in the release. “Asthma sufferers are among the most vulnerable because the flu compromises their airways even further than they already are.”