Thursday, July 26, 2012

Children's health and education improves in Kentucky, but one in four kids lives in poverty, report shows

New data show one in four Kentucky children live in poverty, a sharp increase since 2005, but the state is improving when it comes to children's health and education. These were the latest findings in the influential Kids Count report by the Annie E. Casey Foundation, as assessment of children's overall well-being in the country.

Compared to national averages, fewer Kentucky children go without health insurance (6 percent compared to the nation's 8 percent) and there are fewer teens who abuse alcohol or drugs (6 percent in Kentucky; 7 percent nationwide).

Though it remains higher than the national average, Kentucky's rate of child and teen deaths decreased considerably from 2005 to 2009 (41 per 100,000 to 32 per 100,000). And the number of babies who are born underweight dropped slightly in Kentucky from 2005 to 2009 (9.1 percent to 8.9 percent), though the number remains higher than the country as a whole (8.2 percent).

These were some of the 16 factors, shown below, that the report used to assess overall child well-being. The factors fell into four main groups: economic well-being, family and community, education and health. Kentucky ranked a somewhat dismal 35th among the 50 states in overall well-being of children. But in education, it was 28th, and in health, 25th.

The report shows the share of Kentucky children living in poverty grew by 18 percent from 2005 to 2010, meaning they lived at or below the federal poverty line. In 2010, that meant "an annual income of less than $22,113 for a family of two adults and two children," Valarie Honeycutt Spears reports for the Lexington Herald-Leader.

The Courier-Journal's Jessie Halladay points out that more children have access to health insurance in part because of a statewide push to get more children enrolled in the federally funded Kentucky Children's Health Program, known more commonly as KCHIP. Now, about 65,000 children are enrolled. "We are clearly making a difference in easing the difficulty these tough economic conditions put on our families," said Gov. Steve Beshear, who launched the effort.

But much work remains to be done, points out Terry Brooks, executive director of Kentucky Youth Advocates. He referred to the fact that while more fourth-graders are proficient in reading than they were in 2005, a whopping 65 percent of them were still not considered reading proficient in 2010. "At one level you want to celebrate us doing well compared to other states, but you can't celebrate too much," Brooks told Halladay. (Read more)

Whooping cough on the rise in Kentucky and nationwide

A resurgence of whooping cough in Kentucky and the nation has officials urging the public to get vaccinated. The state has already had 171 reported cases this year, making it "on track to beat our record from just two years ago," said Dr. Kraig Humbaugh, state epidemiologist with the Cabinet for Health and Family Services.

The Centers for Disease Control and Prevention announced recently there have been 18,000 cases nationwide so far in 2012, double the number of confirmed cases at the same time last year. "At that pace, the number for the entire year will be the highest since 1959, when 40,000 illnesses were reported," Mary Meehan reports for the Lexington Herald-Leader.

Washington and Oregon have been hit hardest. In Kentucky, Madison County has 24 cases. Estill County has 20, while the Northern Kentucky Health Department, which serves Boone, Campbell, Grant and Kenton counties, has reported 61 cases. In Lexington, there have been 15.

Whooping cough is spread by respiratory droplets transmitted person to person through close contact. It is sometimes characterized by a cough that ends with a high-pitched "whoop" sound during the next intake of breath. Immunization against the disease is required for school-age children, but many adults may not have gotten the vaccine or might need to get a booster shot. Officials urge them to do so. (Read more)

Looking for 'a few short-term wins' to start, Kentucky Oral Health Coalition formally reorganizes

By Amy Wilson
Kentucky Health News

LOUISVILLE, July 25 – There was no whitewashing the ruinous state of the state's teeth Wednesday when the Kentucky Oral Health Coalition formally reorganized with the goal of fixing as much as they can as fast as it can. With almost a fourth of Kentuckians over 65 having complete tooth loss and almost half of children between 2 and 4 already having twice the national average of cavities, there is work to be done on every front.

As the state with the 49th worst-looking mouths in the country, explained Andrea Bennett, senior policy analyst for Kentucky Youth Advocates, "What we're looking for is a few short-term wins."

It appears that the top priority, as voted by the coalition's members, is to improve oral health literacy and education. That means that members will be looking for ways – including maybe getting themselves a celebrity spokesperson – to explain what good oral hygiene is and how to get it.

Close behind in priorities will be efforts to expand school-based oral health services, including for those in Head Start and all child-care settings. Members also expressed a desire to increase the number of Kentucky dentists who accept Medicaid, thus expanding the numbers of those who can be treated.

How they do that is under discussion. The group, which existed a decade ago but lost momentum, has decided to revitalize into a more active, more inclusive, perhaps even more legislatively inclined group. It all depends on its new leadership, said Dr. James Cecil, a national leader in public health and a former University of Kentucky dental school professor.

Cecil, who now works with KYA, a nonprofit whose staff will handle a lot of the coalition's workload, explained that funding for the initial work of the group is expected to come from the renewal of a grant from DentaQuest, a continuous source of funding for Kentucky dental projects for three years. New programs, as drawn up by and agreed to by the new executive committee elected Wednesday, will seek other sources of funding through corporations and other grants, Cecil said. In their current treasury is $20,000, left over from the old KOHC.

The coaltion is now chaired by Laura Hancock Jones, Western Kentucky Dental Outreach Program director in the University of Kentucky College of Dentistry's Division of Public Health. A well-known and well-respected practicing pediatric dentist, she is self-described "passionate" advocate for education and literacy about oral health. She runs a program that provides a fluoride varnish on children as young as 2.

"I have seen how much we've done and it's not been enough," Hancock-Jones said. "We have not moved the needle." The answer, she said, is "from the bottom. You have to talk to the kids." In her own health-department experience, she dogged one family for three years, she said, through the school Family Resource and Service Center, social workers, and eventually the judicial system, to get their children care. Eventually, she did and "the kids are" getting care and thinking "It really is a good thing to go to the dentist."

Members of the coalition include dentists, dental hygienists, insurance providers, public health officers, school nurses and students. Donna Ruley, executive director of the Kentucky Dental Hygienist Association, was elected secretary of the group Wednesday. She said she believes it's important that her profession is at the table when talking about dental priorities and potential scope of job description legislation. "Our impact on education is huge," said Ruley. "The legislature just recently passed a public-health hygienist role that would allow for a greater number of people to be taught prevention services without a dentist's supervision." That, she added, is a great need in a lot of far-flung rural reaches of the state.

The vice chair of the group is Linda Poynter of the Kenton County Health Department. The treasurer is Dr. Lee Mayer of the University of Louisville dental school.

Bath salts, synthetic drugs change too fast for foes to fight

Bath salts, which mimic the effects of drugs like cocaine
and speed. The Patriot-News photo by Chris Knight.

Though legislators across the country, including Kentucky, have passed laws to ban synthetic drugs like bath salts, there are so many new formulations of the substances the states can't keep up.

Experts estimate there are more than 100 types of bath-salt chemicals. "The moment you start to regulate one of them, they'll come out with a variant that sometimes is even more potent," said Dr. Nora Volkow, director of the National Institute on Drug Abuse.

The drugs, which mimic the effects of drugs like cocaine and amphetamines, are usually sold at small stores "in misleading packaging that suggests common household items like bath salts, incense and plant food," Matthew Perrone reports for The Associated Press. "But the substances inside are powerful, mind-altering drugs that have been linked to bizarre and violent behavior across the country." The products are sold under brand names like "Ivory Wave," "Vanilla Sky" and "Bliss." The American Association of Poison Control got more than 6,100 calls about the drugs in 2011 — up from 304 in 2010 — and 1,700 calls so far this year.

The sticky wicket in controlling the surge of formulations stems from the fact that "U.S. laws prohibit the sale or possession of all substances that mimic illegal drugs, but only if federal prosecutors can show that they are intended for human use," Perrone reports. On almost every packet of these drugs, there is a warning that says they are not fit for human consumption. Be that as it may, "everyone knows these are drugs to get high, including the sellers," said Barbara Carreno, a spokeswoman for the Drug Enforcement Administration.

Kentucky banned bath salts in 2011. In May 2012 Gov. Steve Beshear signed a mandate that "closes legal loopholes by banning classes, not just compounds, of synthetic drugs," reports Jeffery Smith for WFIE-TV in Evansville, Ind. The 2011 law "extends seizure and forfeiture laws to retailers who sell the items, makes sales a felony for a second or subsequent offense, and makes simple possession a misdemeanor," Smith reports.

Still, those fighting on the front lines of the problem said it's difficult to curb. "The problem is these drugs are changing and I'm sure they're going to find some that are a little bit different chemically so they don't fall under the law," said Dr. Sullivan Smith of Cookeville Regional Medical Center in Tennessee. "Is it adequate to name five or 10 or even 20? The answer is no, they're changing too fast." (Read more)

Bath salts, which mimic the effects of drugs like cocaine
and speed. The Patriot-News photo by Chris Knight.

Four pain clinics already closed as 'pill mill' bill takes effect; Beshear says nine more haven't applied, will be investigated

By Tara Kaprowy
Kentucky Health News

Just days after new legislation has taken effect to combat prescription drug abuse, four pain clinics in Kentucky say they will close, Gov. Steve Beshear announced today. "The word is out. Kentucky is deadly serious about stopping this scourge of prescription drug abuse and now we have some of the strongest tools in the country to make that happen," the governor said, adding that nine other pain-management clinics have not applied for licenses and will be investigated.

The law puts more restrictions on pain clinics to prevent so-called "pill mills" from setting up shop in the state. To be licensed, pain clinics must be owned by a licensed medical practitioner, and the law requires licensing boards to investigate complaints immediately.

It also requires doctors who prescribe controlled substances to refer to the state's drug-monitoring system known as KASPER before they write a prescription so they can see if a patient appears to be doctor shopping. The licensing boards have been charged to set up standards to increase oversight and spell out how doctors should be using KASPER (Kentucky All Schedule Prescription Electronic Reporting).

Though changes are still possible, the licensing boards issued those regulations last week, which were more expansive than originally required in the new law. The boards indicated they wanted KASPER to track all Schedule II and III drugs and 15 more Schedule IV drugs. The statute originally only required tracking of Schedule II and Schedule III drugs that contain hydrocodone.

Cracking down on actual pill mill owners, drug abusers and dealers had been difficult up until now since law enforcement couldn't see the data in KASPER without already having a case file opened. In his first four years in office, Attorney General Jack Conway said repeatedly he never got a referral from the Kentucky Board of Medical Licensure saying an investigation should be conducted.

Now when a complaint about prescription drug abuse is lodged with any investigative agency — the attorney general's office, Kentucky State Police, any of the licensing boards or the Cabinet for Health and Family Services — it must be shared with the other agencies within three days. However, the six licensing boards (medical licensure, nursing, dentistry, pharmacy, podiatry and optometry) don't have to share among each other. "This alleviates concerns that the professional organizations would be forced to report information to other boards that have no jurisdiction over the complaint," Beshear said.

If the Kentucky State Police sees there has been a complaint made by another agency, its officers do still need to open "a bona fide specific investigation on that designated individual" before they can request their own KASPER report or see the one used to prompt the complaint, said CHFS spokeswoman Jill Midkiff.

Some critics have said the legislation interferes with the care doctors provide for their patients and threatens confidentiality. To that end, Beshear said people who legitimately need prescription drugs "have nothing to fear. You'll get your medicine." For doctors who are concerned they won't be able to prescribe as they wish, Beshear said provisions have been built into the law to prevent that from happening.

"But if you're doctor-shopping, buying extra pills for recreational use, or prescribing pills for cash, you'd better change your vocation or change your location, because we're coming after you," he said.

As for arguments that checking with KASPER to see if a patient has a questionable prescription history will be too time consuming for providers, "nine times out of 10, it will take as much time as measuring a patient's blood pressure or recording their insurance information," said Mary Begley, CHFS inspector general. CHFS reports 90 percent of KASPER reports are completed within 15 to 30 seconds.

A prescriber or pharmacist can also choose delegates — like a nurse or an aid — to run reports on their behalf, Midkiff said.

The licensing boards have allowed a grace period until Oct. 1 to allow practitioners to time to learn how the new policies will work, according to Beshear's press release.

Kentucky Health News is a service of the Institute for Rural Journalism and Community Issues, based in the School of Journalism and Telecommunications at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

CBO estimates court ruling will mean 3 million fewer people than predicted will get insurance, saving federal government $84 billion

The Congressional Budget Office estimates 3 million fewer people will get health insurance than expected before the U.S. Supreme Court's decision on the Patient Protection and Affordable Care Act. The CBO forecasts that will reduce the law's estimated cost by $84 billion over the next 10 years.

Fewer people will have coverage because some states will opt not to expand their Medicaid programs up to 138 percent the federal poverty level — an option states now have because of the decision. This runs counter to a report by the conservative American Action Forum that predicted states declining to expand Medicaid would increase the law's cost.

Sarah Kliff of The Washington Post breaks down the nonpartisan congressional agency's calculation: "The CBO estimates that for every person who does not enroll in Medicaid, and because of that goes uninsured, the federal government saves $6,000 in spending by 2022. For the average person who does not enroll in Medicaid, but instead gets subsidized coverage from the health-insurance exchange, the federal government spends $9,000 — $3,000 more than they would have had those individuals been on Medicaid."

Thus, the CBO says it will be more expensive for taxpayers if more people are on Medicaid instead of getting their insurance from the exchanges. With about 6 million fewer people than expected on Medicaid, and only about 3 million signing up for insurance exchanges, leaving 3 million more uninsured than expected, "The projected decrease in total federal spending on Medicaid is larger than the anticipated increase in total exchange subsidies," the CBO notes. Here is its graphic representation:

Associated Press photo by Michael Schennum.

The days of hanging up a shingle and opening shop are becoming more and more unusual for doctors. Afraid of being left without protection in the face of changes caused by federal health-care reforms, doctors are leaving their private practices and moving under the shelter of large hospitals.

The shift is "driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers," reports J.D. Harrison for The Washington Post. In general, large hospitals have more financial security and are more equipped to keep track of new regulations.

In 2000, 57 percent of physicians owned their own firms compared to 43 percent in 2009, research by Accenture shows. The number is expected to fall to 33 percent by 2013. "The classic model of independent, small physician practice still exists today, but it's rapidly becoming a relic of a bygone era," Mark Smith, president of physician-recruiting firm Merritt Hawkins, told the House Small Business Committee last week. "This model is only likely to persist in any numbers in smaller, rural areas where there are few physicians; and even here, physicians will likely need to partner or affiliate with larger entities in some way."

Part of the change stems from the fact that accountable-care organizations are now an official part of Medicare. This health-care model, in which groups of providers "take responsibility for the care for an entire patient group," encourages hospitals to take on physician partners, Harrison notes. "Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary-care physicians, particularly, as well as specialists that they can have in their accountable care organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.

New regulations and non-compliance penalties that are built into the law are also making doctors run for cover. "There is so much more regulation, and the penalties are so great, physicians are very fearful that they'll make an honest mistake and be held financially accountable," Smith said. (Read more)
Hat tip to The Lane Report

Associated Press photo by Michael Schennum.

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