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.

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.