Ky. is already short of doctors, dentists; how will its health-care system handle expansion of Medicaid and private insurance?

By Molly Burchett and Al Cross
Kentucky Health News

In the wake of Gov. Steve Beshear’s recent decision to expand Medicaid under federal health reform, there is concern that Kentucky's health-care system will not be able to care for the newly insured.

Health reform means that an estimated 308,000 new Kentuckians will qualify for Medicaid, and 332,000 more will qualify for subsidies to buy private insurance through the state insurance exchange that will start taking enrollments Oct. 1.

But Kentucky already has a health care provider shortage, especially in rural areas. A study for the state estimates that it needs 3,790 more doctors just to meet current demand, to say nothing of what will be needed to care for those who haven't been a regular part of the health-care system, reports Laura Ungar of The Courier-Journal.

The report by Deloitte Consulting made 11 recommendations, including authority for nurse practitioners to prescribe less risky drugs without a written agreement with a doctor, and one that would be even more controversial, putting limits on medical malpractice awards, said Ungar.

The report also recommended expanding and increasing Medicaid reimbursements in rural areas, to encourage more physicians to take Medicaid patients.

It did not mention complaints by health-care  providers about getting paid by the managed-care Medicaid system that the state began in November 2011; Gov. Steve Beshear said when he announced Medicaid expansion that those problems are being worked out.

"Consultants said 61 percent of the 3,790 'full-time equivalent' physicians needed (which includes primary care doctors and specialists) were in rural counties," reports Ungar. Jonathan Felix of Deloitte said, “Primary care, dental care and behavioral health are all big needs in the state.”

The report said the state needed 183 more primary-care doctors, even before Medicaid expansion, but a 2012 Kentucky Physician Workforce Needs Assessment report by the University of Kentucky said the state needs 557 more primary-care physicians and 1,655 more total physicians to meet the national ratios for physicians to population.

The consultants said the state already needs 612 more dentists. It now has 1,711.

Complicated provider shortage problem, no easy answer

About 192 federally identified areas in Kentucky — including 47 counties — have shortages of health professionals, Ungar reports. Kentucky counties who will have the most non-elderly residents eligible for Medicaid often have fewer primary-care doctors per person, according to data analyzed by The Courier-Journal. Ungar notes that Casey County, for example, ranks in the bottom third for doctors per capita, but it has the highest portion of newly eligible residents at 13.5 percent.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” Susan Zepeda, president and chief executive officer for the Foundation for a Healthy Kentucky, told Ungar.

Nationally, there is a primary-care shortage, partly because such doctors make less money than most, and low reimbursement rates exacerbate that. A 2012 study in the journal Health Affairs said 21 percent of office-based physicians in Kentucky did not accept new Medicaid patients in 2011, Ungar notes.

The health reform law will raise the Medicaid fees to match what Medicare pays primary-care doctors, but only for two years. Kentucky's Medicare rates are about 72 percent of the Medicare rates, compared to a national average of 59 percent, says an Urban Institute study. But the time limit leaves some practitioners wary.

“If I choose to increase the number of Medicaid patients, and two years down the road that payment drops back to two-thirds, all of a sudden I’m going to have an awful lot of trouble keeping my doors open,” Reid Blackwelder, a family practitioner and incoming president of the American Academy of Family Physicians, told Michael Ollove of Stateline. 

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness, particularly in Kentucky and other states that are expecting the largest percentage increases in Medicaid enrollees and that have low numbers of primary-care physicians.

“I’m not sure who’s going to pick up all those patients into their practices,” Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, told Ungar. Legislation to let nurse practitioners prescribe non-scheduled drugs without a doctor agreement failed in the state Senate this year.

While some policy analysts have touted nurse practitioners as a solution to the rural primary-care shortage because they often provide primary care in rural and isolated areas that do not have doctors nearby, they would not be covered by the two-year reimbursement increase. Ewen said the reimbursement is only $23 for a lower-level visit by an established patient.

A possible long-term solution includes greater reliance on community health centers, some say. And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, said her system is looking to open new primary care offices and hire more staff.

Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from its new partner, KentuckyOne, to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agree that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it. The state estimates that 188,000 of the 308,000 newly eligible will enroll, but some think that estimate is low.

By Molly Burchett and Al Cross
Kentucky Health News

In the wake of Gov. Steve Beshear’s recent decision to expand Medicaid under federal health reform, there is concern that Kentucky's health-care system will not be able to care for the newly insured.

Health reform means that an estimated 308,000 new Kentuckians will qualify for Medicaid, and 332,000 more will qualify for subsidies to buy private insurance through the state insurance exchange that will start taking enrollments Oct. 1.

But Kentucky already has a health care provider shortage, especially in rural areas. A study for the state estimates that it needs 3,790 more doctors just to meet current demand, to say nothing of what will be needed to care for those who haven't been a regular part of the health-care system, reports Laura Ungar of The Courier-Journal.

The report by Deloitte Consulting made 11 recommendations, including authority for nurse practitioners to prescribe less risky drugs without a written agreement with a doctor, and one that would be even more controversial, putting limits on medical malpractice awards, said Ungar.

The report also recommended expanding and increasing Medicaid reimbursements in rural areas, to encourage more physicians to take Medicaid patients.

It did not mention complaints by health-care  providers about getting paid by the managed-care Medicaid system that the state began in November 2011; Gov. Steve Beshear said when he announced Medicaid expansion that those problems are being worked out.

"Consultants said 61 percent of the 3,790 'full-time equivalent' physicians needed (which includes primary care doctors and specialists) were in rural counties," reports Ungar. Jonathan Felix of Deloitte said, “Primary care, dental care and behavioral health are all big needs in the state.”

The report said the state needed 183 more primary-care doctors, even before Medicaid expansion, but a 2012 Kentucky Physician Workforce Needs Assessment report by the University of Kentucky said the state needs 557 more primary-care physicians and 1,655 more total physicians to meet the national ratios for physicians to population.

The consultants said the state already needs 612 more dentists. It now has 1,711.

Complicated provider shortage problem, no easy answer

About 192 federally identified areas in Kentucky — including 47 counties — have shortages of health professionals, Ungar reports. Kentucky counties who will have the most non-elderly residents eligible for Medicaid often have fewer primary-care doctors per person, according to data analyzed by The Courier-Journal. Ungar notes that Casey County, for example, ranks in the bottom third for doctors per capita, but it has the highest portion of newly eligible residents at 13.5 percent.

“We can’t grow physicians fast enough to meet the need, in the rural areas especially,” Susan Zepeda, president and chief executive officer for the Foundation for a Healthy Kentucky, told Ungar.

Nationally, there is a primary-care shortage, partly because such doctors make less money than most, and low reimbursement rates exacerbate that. A 2012 study in the journal Health Affairs said 21 percent of office-based physicians in Kentucky did not accept new Medicaid patients in 2011, Ungar notes.

The health reform law will raise the Medicaid fees to match what Medicare pays primary-care doctors, but only for two years. Kentucky's Medicare rates are about 72 percent of the Medicare rates, compared to a national average of 59 percent, says an Urban Institute study. But the time limit leaves some practitioners wary.

“If I choose to increase the number of Medicaid patients, and two years down the road that payment drops back to two-thirds, all of a sudden I’m going to have an awful lot of trouble keeping my doors open,” Reid Blackwelder, a family practitioner and incoming president of the American Academy of Family Physicians, told Michael Ollove of Stateline. 

A report last year by the non-partisan Center for Studying Health System Change said the temporary nature of the pay raise could limit its effectiveness, particularly in Kentucky and other states that are expecting the largest percentage increases in Medicaid enrollees and that have low numbers of primary-care physicians.

“I’m not sure who’s going to pick up all those patients into their practices,” Julianne Ewen, a nurse practitioner in Lexington and president of the Kentucky Coalition of Nurse Practitioners and Nurse Midwives, told Ungar. Legislation to let nurse practitioners prescribe non-scheduled drugs without a doctor agreement failed in the state Senate this year.

While some policy analysts have touted nurse practitioners as a solution to the rural primary-care shortage because they often provide primary care in rural and isolated areas that do not have doctors nearby, they would not be covered by the two-year reimbursement increase. Ewen said the reimbursement is only $23 for a lower-level visit by an established patient.

A possible long-term solution includes greater reliance on community health centers, some say. And hospital officials said they plan to continue expanding primary care and employ telemedicine. Ruth Brinkley, president and chief executive officer of KentuckyOne Health, said her system is looking to open new primary care offices and hire more staff.

Dr. David Dunn, vice president for health affairs at the University of Louisville, said the university is increasing physician training in such areas as family medicine and geriatrics and using funds from its new partner, KentuckyOne, to expand the nursing work force with professionals, such as advanced nurse practitioners.

Health providers and advocates agree that getting more people insured should produce a healthier population in the end. But they said much remains unknown, including how many of those eligible for coverage under health reform will sign up for it. The state estimates that 188,000 of the 308,000 newly eligible will enroll, but some think that estimate is low.

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At least one in eight teens, and perhaps one in five, have a mental-health issue; ADHD tops, substance abuse also high

The most comprehensive report yet on mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in those aged 3-17, and the most common health issues for teenagers include addiction to drugs, alcohol and tobacco.

An estimated 13 to 20 percent of U.S. children experience a mental disorder in a given year, says a new report by the Centers for Disease Control and Prevention, and children are increasingly suffering from and being hospitalized for mood disorders like depression; that hospitalization rate has increased 80 percent from 1997 to 2010, says the report. And, while 3.5 percent of children under 18 have behavioral problems, almost 7 percent of them are diagnosed with ADHD.

About 4.7 percent of teens, or 1.7 million children aged 12–17, have disorders involving abuse and dependence upon alcohol, drugs or tobacco, says the report. Alarmingly, two-thirds of teenagers had an illicit drug use disorder, one million teenagers abused drugs or alcohol, and more than 695,000 were addicted to tobacco.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC Director Dr. Tom Frieden said. “No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

The most comprehensive report yet on mental disorders in children shows attention deficit hyperactivity disorder (ADHD) is the most commonly diagnosed problem in those aged 3-17, and the most common health issues for teenagers include addiction to drugs, alcohol and tobacco.

An estimated 13 to 20 percent of U.S. children experience a mental disorder in a given year, says a new report by the Centers for Disease Control and Prevention, and children are increasingly suffering from and being hospitalized for mood disorders like depression; that hospitalization rate has increased 80 percent from 1997 to 2010, says the report. And, while 3.5 percent of children under 18 have behavioral problems, almost 7 percent of them are diagnosed with ADHD.

About 4.7 percent of teens, or 1.7 million children aged 12–17, have disorders involving abuse and dependence upon alcohol, drugs or tobacco, says the report. Alarmingly, two-thirds of teenagers had an illicit drug use disorder, one million teenagers abused drugs or alcohol, and more than 695,000 were addicted to tobacco.

“This first report of its kind documents that millions of children are living with depression, substance use disorders, ADHD and other mental health conditions,” CDC Director Dr. Tom Frieden said. “No parent, grandparent, teacher or friend wants to see a child struggle with these issues. It concerns us all. We are working to both increase our understanding of these disorders and help scale up programs and strategies to prevent mental illness so that our children grow to lead productive, healthy lives.”

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Spring-clean the cabinet and dump your drugs Saturday, April 27

Dump your unwanted prescription drugs this Saturday, April 27, from 10 a.m. to 2 p.m. as part of the National Prescription Drug Take-Back Day, which in the past has coordinated with local law enforcement to haul in more than than 2 million pounds or 1,018 tons of prescription medications.

According to the Drug Enforcement Administration, the National Prescription Drug Take-Back Day aims to provide a safe and convenient way to throw away unwanted or unused drugs, keeping them out of the wrong hands while also educating the general public about the potential for abuse of these medications.

This is a great opportunity for those who missed the previous events or those that have accumulated unwanted, unused prescription drugs since the last event to safely dispose of them. Click here to find the nearest collection site and here to learn more about the DEA initiative.

Dump your unwanted prescription drugs this Saturday, April 27, from 10 a.m. to 2 p.m. as part of the National Prescription Drug Take-Back Day, which in the past has coordinated with local law enforcement to haul in more than than 2 million pounds or 1,018 tons of prescription medications.

According to the Drug Enforcement Administration, the National Prescription Drug Take-Back Day aims to provide a safe and convenient way to throw away unwanted or unused drugs, keeping them out of the wrong hands while also educating the general public about the potential for abuse of these medications.

This is a great opportunity for those who missed the previous events or those that have accumulated unwanted, unused prescription drugs since the last event to safely dispose of them. Click here to find the nearest collection site and here to learn more about the DEA initiative.

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Most Kentucky adults don't know that drug overdose is the leading cause of death in the state, but those in the east do

Drug overdoses, driven largely by prescription drug abuse, overtook motor vehicle accidents as the leading cause of unintentional deaths in Kentucky back in 2010 and remain the state's leading cause of death. From 2000 to 2010, the number of drug-overdose deaths in Kentucky rose a staggering 296 percent, highlighting the state's drug abuse epidemic that now kills more than 1,000 Kentuckians a year. But a recent poll suggests many Kentuckians are not fully aware of the state's drug problem.

In an effort to gauge awareness of the problem, the Kentucky Health Issues Poll asked Kentucky adults whether traffic accidents, falls, firearms or unintentional drug overdoses resulted in the highest dumber of deaths in the state each year. Only 44 percent of Kentucky adults correctly indicated that drug overdose is the leading cause of unintentional Kentucky deaths; 43 percent incorrectly identified traffic accidents as the leading cause.

Respondents from Eastern Kentucky, where the problem is most prevalent  were more likely to correctly identify it as the leading cause of death, at 69 percent. However, only 29 percent of Louisville-area respondents did.

“Experts have reported significant prescription pain reliever abuse in eastern Kentucky,” said Susan Zepeda, presient of the Foundation for a Healthy Kentucky, which co-sponsored the poll.  “It is no surprise that the Kentuckians most aware of this issue are those who are living in this region.  Awareness is the first step towards curbing this trend – it is up to all of us to get involved and take action to reduce the toll of this health crisis.”

The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by land line and cell telephones, and the poll's margin of error is plus or minus 2.5 percentage points.

Drug overdoses, driven largely by prescription drug abuse, overtook motor vehicle accidents as the leading cause of unintentional deaths in Kentucky back in 2010 and remain the state's leading cause of death. From 2000 to 2010, the number of drug-overdose deaths in Kentucky rose a staggering 296 percent, highlighting the state's drug abuse epidemic that now kills more than 1,000 Kentuckians a year. But a recent poll suggests many Kentuckians are not fully aware of the state's drug problem.

In an effort to gauge awareness of the problem, the Kentucky Health Issues Poll asked Kentucky adults whether traffic accidents, falls, firearms or unintentional drug overdoses resulted in the highest dumber of deaths in the state each year. Only 44 percent of Kentucky adults correctly indicated that drug overdose is the leading cause of unintentional Kentucky deaths; 43 percent incorrectly identified traffic accidents as the leading cause.

Respondents from Eastern Kentucky, where the problem is most prevalent  were more likely to correctly identify it as the leading cause of death, at 69 percent. However, only 29 percent of Louisville-area respondents did.

“Experts have reported significant prescription pain reliever abuse in eastern Kentucky,” said Susan Zepeda, presient of the Foundation for a Healthy Kentucky, which co-sponsored the poll.  “It is no surprise that the Kentuckians most aware of this issue are those who are living in this region.  Awareness is the first step towards curbing this trend – it is up to all of us to get involved and take action to reduce the toll of this health crisis.”

The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by land line and cell telephones, and the poll's margin of error is plus or minus 2.5 percentage points.

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Deadly, recalled pills still circulating in Pennyrile Region

A pain reliever that has been recalled and declared dangerous by the Federal Drug Administration is still circulating around southern Kentucky.

The drug marketed under the name Reumofan Plus is being distributed in Elkton and the broader Pennyrile Region, despite being recalled, and a local doctor's office says patients on the drug have had dangerous side effects, reports Nick Tabor of the Kentucky New Era.

Dr. Keith Toms of Generations Primary Care told Tabor three of his patients have taken the drug and had bad side effects. One patient had dangerous elevations of liver enzymes, and two diabetic patients had dangerous spikes in blood sugar.

The Food and Drug Administration has received reports of deaths, strokes, severe internal bleeding, dizziness, insomnia, high blood sugar and other problems associated with the drug since June. The manufacturer, operating under the names Reumofan Plus USA, LLC and Reumofan USA, LLC, announced a voluntary product recall last month, reports Tabor.

According to the FDA, undeclared ingredients in the drug, which is used as a treatment for muscle pain, arthritis, osteoporosis, bone cancer and other conditions, could result in serious illness. Tabor reports a FDA laboratory analysis of Reumofan Plus found that it contains diclofenac sodium, a non-steroidal anti-inflammatory drug, and methocarbamol, a muscle relaxant.

Tabor reports the FDA has issued an alert telling consumers to stop taking the drug immediately and consult a health-care professional. The agency also said it may follow up on the Reumofan recall with warning letters, seizure, injunction requests or criminal charges. (Read more)

A pain reliever that has been recalled and declared dangerous by the Federal Drug Administration is still circulating around southern Kentucky.

The drug marketed under the name Reumofan Plus is being distributed in Elkton and the broader Pennyrile Region, despite being recalled, and a local doctor's office says patients on the drug have had dangerous side effects, reports Nick Tabor of the Kentucky New Era.

Dr. Keith Toms of Generations Primary Care told Tabor three of his patients have taken the drug and had bad side effects. One patient had dangerous elevations of liver enzymes, and two diabetic patients had dangerous spikes in blood sugar.

The Food and Drug Administration has received reports of deaths, strokes, severe internal bleeding, dizziness, insomnia, high blood sugar and other problems associated with the drug since June. The manufacturer, operating under the names Reumofan Plus USA, LLC and Reumofan USA, LLC, announced a voluntary product recall last month, reports Tabor.

According to the FDA, undeclared ingredients in the drug, which is used as a treatment for muscle pain, arthritis, osteoporosis, bone cancer and other conditions, could result in serious illness. Tabor reports a FDA laboratory analysis of Reumofan Plus found that it contains diclofenac sodium, a non-steroidal anti-inflammatory drug, and methocarbamol, a muscle relaxant.

Tabor reports the FDA has issued an alert telling consumers to stop taking the drug immediately and consult a health-care professional. The agency also said it may follow up on the Reumofan recall with warning letters, seizure, injunction requests or criminal charges. (Read more)

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House panel approves bill easing rules of 2012's pill-mill bill

They could call it the pill they're taking to fix the pill-mill bill.

A state House committee approved a bill Tuesday that would tweak last year's legislation aimed at cracking down on prescription drug abuse through doctor shopping and "pill mills" where painkiller prescriptions are easily available for a fee.

House Speaker Greg Stumbo told the House Judiciary Committee that House Bill 217 would fix “unintended consequences” of 2012's House Bill 1 while still requiring that health-care providers use the Kentucky All Schedule Prescription Electronic Reporting system to track painkiller prescriptions.

The bill "would exempt hospitals and long-term care facilities from HB 1’s per-unit patient dosing restrictions and ensure that physicians decide when physicals are needed," the Kentucky Press News Service reported. "It would limit restricted access to narcotic pain medication for surgery patients, end-of-life patients, cancer patients and a few other categories of patients who may need increased pain management, Stumbo said." (Read more)

They could call it the pill they're taking to fix the pill-mill bill.

A state House committee approved a bill Tuesday that would tweak last year's legislation aimed at cracking down on prescription drug abuse through doctor shopping and "pill mills" where painkiller prescriptions are easily available for a fee.

House Speaker Greg Stumbo told the House Judiciary Committee that House Bill 217 would fix “unintended consequences” of 2012's House Bill 1 while still requiring that health-care providers use the Kentucky All Schedule Prescription Electronic Reporting system to track painkiller prescriptions.

The bill "would exempt hospitals and long-term care facilities from HB 1’s per-unit patient dosing restrictions and ensure that physicians decide when physicals are needed," the Kentucky Press News Service reported. "It would limit restricted access to narcotic pain medication for surgery patients, end-of-life patients, cancer patients and a few other categories of patients who may need increased pain management, Stumbo said." (Read more)

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Big papers' Page 1 stories spotlight recovery center for pill addicts, lack of state program for problem gamblers

Gripping stories from recovering addicts, on the front pages of Kentucky's two largest newspapers this morning, highlight Kentuckians' fights against all types of addiction, from gambling to drugs.

Hope of recovery emerges from Laura Ungar's story in The Courier-Journal that focuses on the Isaiah House recovery center in Willisburg. A gymnasium at the site has been transformed into a factory of sorts, where a pill addict who has been clean three weeks polishes car parts, while a morphine addict with 103 days’ sobriety hammers nails into wood to make pallets, Ungar reports.

Work is an essential part of recovery at the Isaiah House, giving structure to chaotic lives, teaching job skills and building confidence. “It gives them a sense of purpose, of accomplishment,” Executive Director Mark LaPalme told Ungar. “They get their dignity back — that’s what work does.”

LaPalme, a Connecticut native and recovering cocaine addict, said he started Isaiah House in his basement in 1999, after a spiritual experience moved him to set aside seven bedrooms for other addicts. Today, the house helps to rebuild the lives of drug and alcohol addicts, while promoting worth ethic and responsibility throughout the recovery process (Read more).

Jack Brammer of the Lexington Herald-Leader writes about Kentucky's lack of a state program to treat problem gamblers. It is one of 13 states without such a program.

Billy Stephens, 66, Hawesville Mayor Rita Stephens' husband, said he lived a "a life of lies" with his gambling addiction, but with professional treatment, has not gambled since 2010. When he finally sought treatment, he could find no affordable treatment in Kentucky. The family had to borrow money to pay for his $6,000 treatment in a 36-day program in Louisiana, which is free to residents of the Bayou State.

"My addiction almost destroyed me," he told Brammer. "My insurance in Kentucky would have helped with my treatment if it were alcohol. But it was gambling." (Read more)

Gripping stories from recovering addicts, on the front pages of Kentucky's two largest newspapers this morning, highlight Kentuckians' fights against all types of addiction, from gambling to drugs.

Hope of recovery emerges from Laura Ungar's story in The Courier-Journal that focuses on the Isaiah House recovery center in Willisburg. A gymnasium at the site has been transformed into a factory of sorts, where a pill addict who has been clean three weeks polishes car parts, while a morphine addict with 103 days’ sobriety hammers nails into wood to make pallets, Ungar reports.

Work is an essential part of recovery at the Isaiah House, giving structure to chaotic lives, teaching job skills and building confidence. “It gives them a sense of purpose, of accomplishment,” Executive Director Mark LaPalme told Ungar. “They get their dignity back — that’s what work does.”

LaPalme, a Connecticut native and recovering cocaine addict, said he started Isaiah House in his basement in 1999, after a spiritual experience moved him to set aside seven bedrooms for other addicts. Today, the house helps to rebuild the lives of drug and alcohol addicts, while promoting worth ethic and responsibility throughout the recovery process (Read more).

Jack Brammer of the Lexington Herald-Leader writes about Kentucky's lack of a state program to treat problem gamblers. It is one of 13 states without such a program.

Billy Stephens, 66, Hawesville Mayor Rita Stephens' husband, said he lived a "a life of lies" with his gambling addiction, but with professional treatment, has not gambled since 2010. When he finally sought treatment, he could find no affordable treatment in Kentucky. The family had to borrow money to pay for his $6,000 treatment in a 36-day program in Louisiana, which is free to residents of the Bayou State.

"My addiction almost destroyed me," he told Brammer. "My insurance in Kentucky would have helped with my treatment if it were alcohol. But it was gambling." (Read more)

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FDA likely to make hydrocodone painkillers harder to prescribe

Prescription painkillers containing hydrocodone should be placed in a more restrictive federal category, a Food and Drug Administration advisory panel of experts voted on Friday. The changes would be an effort to stem the tide of prescription painkiller abuse and addiction in the U.S., much of it in rural areas, beginning in Central Appalachia. Painkillers containing hydrocodone are the most widely prescribed drugs in the country.

Sabrina Tavernise of The New York Times reports the FDA is likely to adopt the panel's recommendations, which include limiting access to hydrocodone drugs such as Vicodin by making them harder to prescribe. Refills wouldn't be allowed without a new prescription, and faxed or called-in prescriptions wouldn't be accepted. Only a hanwritten prescription from a doctor would be allowed, and pharmacists would be required to keep the drugs in special vaults.

Many said these changes would be a key step in reducing painkiller addiction. However, dissenters in the vote were concerned that this move wouldn't make a difference. Oxycodone, the main ingredient in the highly-abused painkiller OxyContin, has been classified in a restrictive category since it was first introduced on the market but it is still widely abused, dissenters said. They also said the change could create unfair obstacles for legitimate patients. (Read more)

Prescription painkillers containing hydrocodone should be placed in a more restrictive federal category, a Food and Drug Administration advisory panel of experts voted on Friday. The changes would be an effort to stem the tide of prescription painkiller abuse and addiction in the U.S., much of it in rural areas, beginning in Central Appalachia. Painkillers containing hydrocodone are the most widely prescribed drugs in the country.

Sabrina Tavernise of The New York Times reports the FDA is likely to adopt the panel's recommendations, which include limiting access to hydrocodone drugs such as Vicodin by making them harder to prescribe. Refills wouldn't be allowed without a new prescription, and faxed or called-in prescriptions wouldn't be accepted. Only a hanwritten prescription from a doctor would be allowed, and pharmacists would be required to keep the drugs in special vaults.

Many said these changes would be a key step in reducing painkiller addiction. However, dissenters in the vote were concerned that this move wouldn't make a difference. Oxycodone, the main ingredient in the highly-abused painkiller OxyContin, has been classified in a restrictive category since it was first introduced on the market but it is still widely abused, dissenters said. They also said the change could create unfair obstacles for legitimate patients. (Read more)

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Poll shows depth of prescription drug abuse in Kentucky

By Molly Burchett and Al Cross
Kentucky Health News

One-third of Kentucky adults have friends or relatives who have experienced problems from abusing prescription pain relievers, and 8 percent have used pain medicine when it wasn't prescribed or for the feeling it caused, according to a statewide poll conducted last fall.

The Kentucky Health Issues Poll found that in Eastern Kentucky, 45 percent reported that prescription drug abuse have caused problems for friends or family members. In the 17-county Bluegrass Area Development District, which includes some Appalachian counties, the figure was 37 percent. It was 32 percent in Northern Kentucky, 31 percent in the seven-county Louisville area and 25 percent in Western Kentucky.

The poll found that young adults are more likely to have the problem. Among those 18 to 29 years old, 13 percent said they had used pain medicine when it wasn't prescribed or for the feeling it caused, and 49 percent said they had a friend or relative who had been affected.

The Foundation for a Healthy Kentucky, which co-sponsored the poll, noted that drug-overdose deaths in Kentucky correspond to a steep increase in the sales of opioid prescription pain relievers, which include OxyContin, Vicodin, Percocet and codeine. More than half of Kentucky adults in the poll reported being prescribed such drugs.

“While these types of medications are important for controlling pain in patients who need them, opioids also carry the potential for abuse,” said Dr. Susan Zepeda, President and CEO of the foundation. “Our state ranks sixth in the nation for prescription pain reliever overdose deaths, and these data provide a window on how many Kentuckians are impacted – directly or indirectly – by prescription misuse.” (Read more)

The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

By Molly Burchett and Al Cross
Kentucky Health News

One-third of Kentucky adults have friends or relatives who have experienced problems from abusing prescription pain relievers, and 8 percent have used pain medicine when it wasn't prescribed or for the feeling it caused, according to a statewide poll conducted last fall.

The Kentucky Health Issues Poll found that in Eastern Kentucky, 45 percent reported that prescription drug abuse have caused problems for friends or family members. In the 17-county Bluegrass Area Development District, which includes some Appalachian counties, the figure was 37 percent. It was 32 percent in Northern Kentucky, 31 percent in the seven-county Louisville area and 25 percent in Western Kentucky.

The poll found that young adults are more likely to have the problem. Among those 18 to 29 years old, 13 percent said they had used pain medicine when it wasn't prescribed or for the feeling it caused, and 49 percent said they had a friend or relative who had been affected.

The Foundation for a Healthy Kentucky, which co-sponsored the poll, noted that drug-overdose deaths in Kentucky correspond to a steep increase in the sales of opioid prescription pain relievers, which include OxyContin, Vicodin, Percocet and codeine. More than half of Kentucky adults in the poll reported being prescribed such drugs.

“While these types of medications are important for controlling pain in patients who need them, opioids also carry the potential for abuse,” said Dr. Susan Zepeda, President and CEO of the foundation. “Our state ranks sixth in the nation for prescription pain reliever overdose deaths, and these data provide a window on how many Kentuckians are impacted – directly or indirectly – by prescription misuse.” (Read more)

The poll was conducted for the foundation and The Health Foundation of Greater Cincinnati from Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points.

Kentucky Health News is an independent service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Health Kentucky.

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FDA could require tamper-resistant painkillers; without such action, prescription-drug abuse problem would worsen

UPDATE, Jan. 14 : Laura Ungar of The Courier-Journal reports, "Addicts by the scores used to get a quick and easy high from snorting or shooting up the powerful narcotic OxyContin — until manufacturer Purdue Pharma developed a new version that’s harder to abuse. But with the company’s patent on its original drug set to expire in April, activists, lawmakers and doctors are worried that cheaper, easily crushable generic versions will flood Kentucky and worsen the state’s already-devastating prescription drug abuse problem."

The Food and Drug Administration will force generic manufacturers of powerful pain pills to switch to a tamper-resistant composition if it finds evidence the composition curbs prescription drug abuse and addiction, Alan Rappeport of The Financial Times reports. Public-health advocates worry that if generic versions of opiate pills are not made tamper-resistant, the prescription drug abuse epidemic may worsen.

If the agency finds tamper-resistance significantly deter abuse, it has legal authority to require generic drug makers to switch their opiate formulas. Just as manufacturers of some pain pills began switching formulas to make the pills harder to crush, easily crushable, generic forms of OxyContin and Opana were released. Purdue Pharma and Endo Pharmaceuticals, which make Opana, have hoped to extend patent life of their drugs by pushing the FDA to prevent generic makers from using old versions of their drugs. Generic makers argue this will keep patients from buying cheaper drugs.

The FDA said it will take a "flexible" approach to determining the effectiveness of tamper-resistant drugs because abusers are constantly finding new ways to avoid deterrents. (Read more)

UPDATE, Jan. 14 : Laura Ungar of The Courier-Journal reports, "Addicts by the scores used to get a quick and easy high from snorting or shooting up the powerful narcotic OxyContin — until manufacturer Purdue Pharma developed a new version that’s harder to abuse. But with the company’s patent on its original drug set to expire in April, activists, lawmakers and doctors are worried that cheaper, easily crushable generic versions will flood Kentucky and worsen the state’s already-devastating prescription drug abuse problem."

The Food and Drug Administration will force generic manufacturers of powerful pain pills to switch to a tamper-resistant composition if it finds evidence the composition curbs prescription drug abuse and addiction, Alan Rappeport of The Financial Times reports. Public-health advocates worry that if generic versions of opiate pills are not made tamper-resistant, the prescription drug abuse epidemic may worsen.

If the agency finds tamper-resistance significantly deter abuse, it has legal authority to require generic drug makers to switch their opiate formulas. Just as manufacturers of some pain pills began switching formulas to make the pills harder to crush, easily crushable, generic forms of OxyContin and Opana were released. Purdue Pharma and Endo Pharmaceuticals, which make Opana, have hoped to extend patent life of their drugs by pushing the FDA to prevent generic makers from using old versions of their drugs. Generic makers argue this will keep patients from buying cheaper drugs.

The FDA said it will take a "flexible" approach to determining the effectiveness of tamper-resistant drugs because abusers are constantly finding new ways to avoid deterrents. (Read more)

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Pike court will keep lawsuit county and attorney general filed against Purdue Pharma over damage done by its OxyContin

A state court will hear the Kentucky attorney general's 2007 lawsuit against OxyContin manufacturer Purdue Pharma, against the wishes of the company. The U.S. Court of Appeals for the 2nd Circuit affirmed a lower court's order returning the suit to Kentucky from New York's Southern District, where Purdue wanted the case heard. The suit was filed in Pike Circuit Court, in Kentucky's easternmost county.

"After years of delay tactics, Purdue will now answer to a Kentucky court and a Kentucky jury," Attorney General Jack Conway said. Purdue Pharma spokeswoman Libby Holman said the company is disappointed by the decision, but now it is "fully prepared to vigorously defend this action on its merits, and we expect to prevail."

Then-AG Greg Stumbo and Pike County sued Purdue Pharma in October 2007, alleging that the company's "aggressive and deceptive marketing campaign saddled taxpayers with millions of dollars in social, health care and other costs," Laura Ungar of The Courier-Journal in Louisville reports. The suit also alleges the company misled health-care providers, consumers and the government about the highly addictive nature of OxyContin. The suit is largely based on admissions of guilt made by the company and several top-ranking company officials in a May 2007 Virginia federal court settlement. Purdue Pharma, its president, chief legal counsel and former medical director pleaded guilty to misleading doctors, regulators and patients about OxyContin during that case.

The nation's prescription-drug epidemic apparently began in the region, largely because of the introduction and high rate of prescription of OxyContin. Kentucky has nearly 1,000 overdose deaths a year. Conway's office said the suit against Purdue Pharma seeks reimbursement for drug-abuse programs, law-enforcement actions and prescription payments through Medicaid and the Kentucky Pharmaceutical Alliance Program. (Read more)

A state court will hear the Kentucky attorney general's 2007 lawsuit against OxyContin manufacturer Purdue Pharma, against the wishes of the company. The U.S. Court of Appeals for the 2nd Circuit affirmed a lower court's order returning the suit to Kentucky from New York's Southern District, where Purdue wanted the case heard. The suit was filed in Pike Circuit Court, in Kentucky's easternmost county.

"After years of delay tactics, Purdue will now answer to a Kentucky court and a Kentucky jury," Attorney General Jack Conway said. Purdue Pharma spokeswoman Libby Holman said the company is disappointed by the decision, but now it is "fully prepared to vigorously defend this action on its merits, and we expect to prevail."

Then-AG Greg Stumbo and Pike County sued Purdue Pharma in October 2007, alleging that the company's "aggressive and deceptive marketing campaign saddled taxpayers with millions of dollars in social, health care and other costs," Laura Ungar of The Courier-Journal in Louisville reports. The suit also alleges the company misled health-care providers, consumers and the government about the highly addictive nature of OxyContin. The suit is largely based on admissions of guilt made by the company and several top-ranking company officials in a May 2007 Virginia federal court settlement. Purdue Pharma, its president, chief legal counsel and former medical director pleaded guilty to misleading doctors, regulators and patients about OxyContin during that case.

The nation's prescription-drug epidemic apparently began in the region, largely because of the introduction and high rate of prescription of OxyContin. Kentucky has nearly 1,000 overdose deaths a year. Conway's office said the suit against Purdue Pharma seeks reimbursement for drug-abuse programs, law-enforcement actions and prescription payments through Medicaid and the Kentucky Pharmaceutical Alliance Program. (Read more)

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Legislature likely to tweak, clarify and limit last year's 'pill mill bill'

State lawmakers could narrow the focus of last year's "pill mill bill" during the legislative session that begins tomorrow, to concentrate on adults with long-term prescriptions for frequently abused painkillers, John Cheves of the Lexington Herald-Leader reported yesterday. Doctors, hospitals and patients have complained that HB 1 in its current from "restricts too many drugs in too many clinical settings, needlessly complicating medical care in an effort to shut down storefront pain clinics that recklessly hand out prescriptions," Cheves writes.

Under the law, people with long-term prescriptions for controlled substances must submit to urine drug testing to determine if they are actually taking the drug rather than selling it, and if other unprescribed drugs are in their systems. Some patients complained they were being charges hundreds of dollars for urine tests because their insurance companies denied coverage of such testing. One couple was charged more than $900 for tests to get prescriptions for insomnia and anti-anxiety medication.

The new rules, being drafted by the Kentucky Board of Medical Licensure, would reduce the mandate for drug screening to pain medicine prescriptions of 90 days or more. Other medications would not require testing unless the doctor thinks it's necessary. The new rules will say that other types of testing which would be cheaper, including hair, could be used. The board is also restricting its focus to powerful painkillers, including hydrocodone and oxycodone.

The new regulations are subject to approval by the legislature, which could write its own restrictions into law, but the consensus appears to be that the law needs tweaking, not major changes. for example, House Speaker Greg Stumbo said it should be changed to clarify that hospitals don't have to run a new background check on a patient every time they give another dose of a controlled substance during his stay. (Read more)

State lawmakers could narrow the focus of last year's "pill mill bill" during the legislative session that begins tomorrow, to concentrate on adults with long-term prescriptions for frequently abused painkillers, John Cheves of the Lexington Herald-Leader reported yesterday. Doctors, hospitals and patients have complained that HB 1 in its current from "restricts too many drugs in too many clinical settings, needlessly complicating medical care in an effort to shut down storefront pain clinics that recklessly hand out prescriptions," Cheves writes.

Under the law, people with long-term prescriptions for controlled substances must submit to urine drug testing to determine if they are actually taking the drug rather than selling it, and if other unprescribed drugs are in their systems. Some patients complained they were being charges hundreds of dollars for urine tests because their insurance companies denied coverage of such testing. One couple was charged more than $900 for tests to get prescriptions for insomnia and anti-anxiety medication.

The new rules, being drafted by the Kentucky Board of Medical Licensure, would reduce the mandate for drug screening to pain medicine prescriptions of 90 days or more. Other medications would not require testing unless the doctor thinks it's necessary. The new rules will say that other types of testing which would be cheaper, including hair, could be used. The board is also restricting its focus to powerful painkillers, including hydrocodone and oxycodone.

The new regulations are subject to approval by the legislature, which could write its own restrictions into law, but the consensus appears to be that the law needs tweaking, not major changes. for example, House Speaker Greg Stumbo said it should be changed to clarify that hospitals don't have to run a new background check on a patient every time they give another dose of a controlled substance during his stay. (Read more)

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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Here are the seven factors driving health care cost increases

Escalating health care costs are everybody's problem and no one entity's fault. Julie Appleby at Kaiser Health News reports that the United States spends about18 percent of its gross domestic product -- or about $2.6 trillion a year -- on health care costs. So what's making that figure rise? A Bipartisan Policy Center study took on the task of finding out and came up with it believes are seven major factors:

1. Paying our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient. Even insurers like Medicare pay on a fee-for-service system. New efforts in the federal health law look to change that.
2. Growing older, sicker and fatter as a nation.Medicare is set to grow by an average of 1.6 million people annually. With two-thirds of adults are either overweight or obese, lots of additional medical spending looms.
3. Wanting the latest drugs, technologies, services and procedures. Prices for newer treatments are often higher than for the products they replace.
4. Employers and employees get tax breaks on health insurance, and it costs employees little to seek care. Appleby writes, "The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care."
5. Not having enough information to make decisions on which medical care is best for us.
6. Hospitals increasingly gain market share through consolidation and demand higher prices.
7. Legal issues complicate efforts to slow spending. Doctors sometimes prescribe tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing is another concern. The report notes that laws sometimes limit the ability of medical professionals to do work for which they are trained but that more highly paid doctors must do. (Read more)

To read the entire Bipartisan Policy Center report here.

Escalating health care costs are everybody's problem and no one entity's fault. Julie Appleby at Kaiser Health News reports that the United States spends about18 percent of its gross domestic product -- or about $2.6 trillion a year -- on health care costs. So what's making that figure rise? A Bipartisan Policy Center study took on the task of finding out and came up with it believes are seven major factors:

1. Paying our doctors, hospitals and other medical providers in ways that reward doing more, rather than being efficient. Even insurers like Medicare pay on a fee-for-service system. New efforts in the federal health law look to change that.
2. Growing older, sicker and fatter as a nation.Medicare is set to grow by an average of 1.6 million people annually. With two-thirds of adults are either overweight or obese, lots of additional medical spending looms.
3. Wanting the latest drugs, technologies, services and procedures. Prices for newer treatments are often higher than for the products they replace.
4. Employers and employees get tax breaks on health insurance, and it costs employees little to seek care. Appleby writes, "The majority of people with insurance get it through their jobs. The amount employers pay toward coverage is tax deductible for the firm and tax exempt to the worker, thus encouraging more expensive health plans with richer benefits, the report says. How that coverage is designed also plays a role: Low deductibles or small office co-payments can encourage overuse of care, the report says. Increasingly, however, employers are moving toward high-deductible coverage as a way to slow premium growth and require workers to pay more toward the cost of care."
5. Not having enough information to make decisions on which medical care is best for us.
6. Hospitals increasingly gain market share through consolidation and demand higher prices.
7. Legal issues complicate efforts to slow spending. Doctors sometimes prescribe tests or treatment out of fear of facing a lawsuit, the report says. Fraudulent billing is another concern. The report notes that laws sometimes limit the ability of medical professionals to do work for which they are trained but that more highly paid doctors must do. (Read more)

To read the entire Bipartisan Policy Center report here.

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Covington police chief: New prescription-drug law has unintended consequence of encouraging pain pill addicts to use heroin, commit crimes

Black tar heroin

Kentucky's new prescription drug law may be having its desired effect of taking prescription painkillers off the streets, but could be forcing those very same addicts into using heroin. That's the view of Covington Police Chief Spike Jones, who took his case to the state Senate Judiciary Committee last week to complain about increased crime in his area and to ask for some money for help.

The drug law passed in April 2012, designated House Bill 1, requires Kentucky doctors to complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief. It has required a vast network of oversight of doctors and patients by government and licensing entities. This has reportedly caused some doctors to stop writing those prescriptions completely.

Tiffany Wilson of Cincinnati's WKRC-TV reports that Chief Jones reports more prostitution, theft, car thefts and car break-ins in his northern Kentucky region. He asked the state legislature for money to research how deep the problem is and to discuss the need for more treatment facilities. 

Jones pointed to the recent closure of the pain management clinic of Dr. Gary Shearer in Florence as adding to the problem. Shearer's license was suspended following the death of 15 patients from prescription-drug overdoses. These patients, Jones told Wilson, are exactly the ones at risk for taking the next step and turning to heroin. He added that heroin dealers will often give potential customers the first hit for free, "and from that point, there's no returning to prescription pills." (Read more)

Black tar heroin

Kentucky's new prescription drug law may be having its desired effect of taking prescription painkillers off the streets, but could be forcing those very same addicts into using heroin. That's the view of Covington Police Chief Spike Jones, who took his case to the state Senate Judiciary Committee last week to complain about increased crime in his area and to ask for some money for help.

The drug law passed in April 2012, designated House Bill 1, requires Kentucky doctors to complete patients' medical histories, conduct physicals, check photo identifications and run names through the state's KASPER (Kentucky All Schedule Prescription Electronic Reporting) database before prescribing a controlled substance for pain relief. It has required a vast network of oversight of doctors and patients by government and licensing entities. This has reportedly caused some doctors to stop writing those prescriptions completely.

Tiffany Wilson of Cincinnati's WKRC-TV reports that Chief Jones reports more prostitution, theft, car thefts and car break-ins in his northern Kentucky region. He asked the state legislature for money to research how deep the problem is and to discuss the need for more treatment facilities. 

Jones pointed to the recent closure of the pain management clinic of Dr. Gary Shearer in Florence as adding to the problem. Shearer's license was suspended following the death of 15 patients from prescription-drug overdoses. These patients, Jones told Wilson, are exactly the ones at risk for taking the next step and turning to heroin. He added that heroin dealers will often give potential customers the first hit for free, "and from that point, there's no returning to prescription pills." (Read more)

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Pill-mill bill causing problems for patients who have long-term prescriptions: expensive drug-screening tests

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

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Government says health-reform law to save average Kentuckian with Medicare coverage $5,000 through 2022

The U.S. Department of Health and Human Services says the Patient Protection and Affordable Care Act will likely save the average person with traditional Medicare coverage $5,000 from 2010 to 2022, and people with Medicare who have high prescription drug costs will save more than $18,000 over the same period, based on the agency's estimates.

The department also announced that seniors and people with disabilities in Kentucky have already saved $85.5 million on prescription drugs since the law was enacted. Nationwide, the report states that over 5.5 million people have saved nearly $4.5 billion on prescription drugs since the law was enacted. This includes $195 million in savings on prescriptions for diabetes, over $140 million on drugs to lower cholesterol and blood pressure, and $75 million on cancer drugs so far this year.

The U.S. Department of Health and Human Services says the Patient Protection and Affordable Care Act will likely save the average person with traditional Medicare coverage $5,000 from 2010 to 2022, and people with Medicare who have high prescription drug costs will save more than $18,000 over the same period, based on the agency's estimates.

The department also announced that seniors and people with disabilities in Kentucky have already saved $85.5 million on prescription drugs since the law was enacted. Nationwide, the report states that over 5.5 million people have saved nearly $4.5 billion on prescription drugs since the law was enacted. This includes $195 million in savings on prescriptions for diabetes, over $140 million on drugs to lower cholesterol and blood pressure, and $75 million on cancer drugs so far this year.

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Doctor complaints about bill aimed at reducing prescription drug abuse largely based on misconceptions, health officials say

State health officials say doctors' complaints about House Bill 1, which cracks down on pill mills and doctors who supply the illegal prescription pill trade, result from misunderstandings and misconceptions about the law's language and intent, Mike Wynn of The Courier-Journal reports. Doctors say the bill's regulations are excessive and restrict their ability to write common prescriptions.

Assistant deputy inspector general Stephanie Hold, of the Cabinet for Health and Family Services, said doctors have at least 19 misconceptions about the state's drug tracking system, Kentucky All Schedule Prescription Electronic Reporting, and said checking KASPER before writing prescriptions "should not impede them in any way," Wynn reports. Mike Rodman, director of the Kentucky Board of Medical Licensure, said there's nothing in the law that prevents doctors from prescribing controlled substances. He said many doctors have for years practiced prescription standards similar to those in the bill, but feel uncomfortable with them being written as law.

The co-chair of the state oversight committee, Democratic Rep. John Tilley, said there are some legitimate concerns about the bill "that need discussion after we can distill what is fact and what is myth," but lawmakers could likely address all of them without changing the statute. (Read more)

State health officials say doctors' complaints about House Bill 1, which cracks down on pill mills and doctors who supply the illegal prescription pill trade, result from misunderstandings and misconceptions about the law's language and intent, Mike Wynn of The Courier-Journal reports. Doctors say the bill's regulations are excessive and restrict their ability to write common prescriptions.

Assistant deputy inspector general Stephanie Hold, of the Cabinet for Health and Family Services, said doctors have at least 19 misconceptions about the state's drug tracking system, Kentucky All Schedule Prescription Electronic Reporting, and said checking KASPER before writing prescriptions "should not impede them in any way," Wynn reports. Mike Rodman, director of the Kentucky Board of Medical Licensure, said there's nothing in the law that prevents doctors from prescribing controlled substances. He said many doctors have for years practiced prescription standards similar to those in the bill, but feel uncomfortable with them being written as law.

The co-chair of the state oversight committee, Democratic Rep. John Tilley, said there are some legitimate concerns about the bill "that need discussion after we can distill what is fact and what is myth," but lawmakers could likely address all of them without changing the statute. (Read more)

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