Princess Health and Trying to stop overdose epidemic, CDC tells docs to limit most opioid prescriptions to 3-7 days, use low doses and warn patients. Princessiccia

Princess Health and Trying to stop overdose epidemic, CDC tells docs to limit most opioid prescriptions to 3-7 days, use low doses and warn patients. Princessiccia

addiction drugs federal government health insurance Medicaid Medicare narcotics pain pain management prescription drug abuse prescription drugs

Gusty 20:35 Add Comment

Graphic from CDC guideline brochure

Kentucky Health News

Doctors who prescribe highly addictive painkillers for chronic pain should stop and be much more careful to thwart "an epidemic of prescription opioid overdoses" that is "doctor-driven," the federal Centers for Disease Control and Prevention said Tuesday, March 15.

"This epidemic is devastating American lives, families, and communities," the CDC said. "The amount of opioids prescribed and sold in the U.S. quadrupled since 1999, but the overall amount of pain reported by Americans hasn�t changed."

Kentucky ranks very high in use of opioids and overdoses from them, and Louisville reported a big increase in overdoses this month, Insider Louisville reports.

The agency said doctors should limit the length of opioid prescriptions to three to seven days, use "the lowest possible effective dosage," monitor patients closely, and clearly tell them the risks of addiction.

It said most long-term use of opioids should be limited to cancer, palliative and end-of-life treatment, and that most chronic pain could be treated with non-prescription medications, physical therapy, exercise and/or cognitive behavioral therapy.

The guidelines are not binding on doctors, but Dr. Thomas Frieden, the CDC director, "said state agencies, private insurers and other groups might look to the recommendations in setting their own rules," the Los Angeles Times reported.

However, Modern Healthcare reported that the guidelines are unlikely to change physicians' practices. "One current hurdle to curbing the number of prescriptions is that it's much easier for a busy clinician to prescribe a 30-day supply of oxycodone or Percocet to treat a patient's chronic pain than it is to convince him or her to do physical therapy," Steven Ross Johnson writes. "The time constraints affecting physicians' practice has never been more acutely felt than in this era of health-care reform that emphasizes quality and value-based payment."

Money could be a key in making the guidelines effective. Sabrina Tavernise of The New York Times writes, "Some observers said doctors, fearing lawsuits, would reflexively follow them, and insurance companies could begin to us them to determine reimbursement." The federal Centers for Medicare and Medicaid Services could also play a role.

Johnson notes that physicians are trained to "reserve opioids for severe forms of pain . . . but in the 1990s, some specialists argued that doctors were under-treating common forms of pain that could benefit from opioids, such as backaches and joint pain. The message was amplified by multi-million-dollar promotional campaigns for new, long-acting drugs like OxyContin, which was promoted as less addictive."

Purdue Pharma, maker of OxyContin, agreed to pay $600 million in penalties to settle federal charges that it over-promoted the drug to doctors, prompting the epidemic, especially in Central Appalachia.

"When reports of painkiller abuse surfaced, many in the medical field blamed recreational abusers. In recent years, however, the focus has shifted to the role of doctors," Harriet Ryan and Soumya Karlamangla report for the Times, noting that a 2012 analysis "of 3,733 fatalities found that drugs prescribed by physicians to patients caused or contributed to nearly half the deaths."

Doctors, insurers, drug companies and government agencies "all share some of the blame, and they all must be part of a solution that will probably cost everyone money," Caitlin Owens writes for Morning Consult, which also notes prescribers' complaints and CDC's responses.

Princess Health and CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much.Princessiccia

Princess Health and CDC says state spends less than 8% of what it should on preventing use of tobacco; companies spend 13 times as much.Princessiccia

advertising children's health federal government smoking smoking cessation state budget state budgets state governments tobacco tobacco prevention youth

Gusty 16:43 Add Comment

Kentucky spends only 7.6 percent of what it should spend on preventing the use of tobacco, the federal Centers for Disease Control and Prevention says in its latest annual report on the subject.

The state spent $4.33 million on tobacco-control programs in 2011, the year covered by the report. The CDC said spending of $57.2 million was called for, since 29 percent of Kentuckians smoked that year. Tobacco-related illnesses are estimated to cost Kentuckians $3.3 billion a year.

South Carolina and Texas, which spent 6.5 percent and 7 percent of the recommended amounts, were also singled out for criticism by the CDC. Nationally, states spend less than 18 percent of what they should, $3.7 billion, in the agency's view. "Only Alaska and North Dakota funded programs at the CDC-recommended levels, $10.7 million and $9.3 million, respectively," Samantha Ehlinger of McClatchy Newspapers reports.

Read more here: http://www.kentucky.com/2015/06/25/3918046/cdc-says-kentucky-isnt-spending.html#storylink=cpy

"States that made larger investments in tobacco prevention and control have seen larger declines in cigarettes sales than the United States as a whole, and the prevalence of smoking has declined faster as spending for tobacco control programs has increased," the CDC report said. "Evidence suggests that funding tobacco prevention and control efforts at the levels recommended . . . could achieve larger and more rapid reductions in tobacco use and associated morbidity and mortality."

In contrast to the state spending of $658 million on tobacco control, tobacco companies spent more than 13 times as much on advertising and promotion in 2011: $8.8 billion, or $24 million per day, the report noted.

"During the same period, more than 3,200 youth younger than 18 years of age smoked their first cigarette and another 2,100 youth and young adults who are occasional smokers progressed to become daily smokers," the report said. "If current rates continue, 5.6 million Americans younger than 18 years of age who are alive today are projected to die prematurely from smoking-related disease. However, the tobacco-use epidemic can be markedly reduced by implementing interventions that are known to work."

For the CDC's latest comprehensive report on tobacco use in Kentucky, with data from 2012, click here. For county-by-county figures on adults smoking in Kentucky in 2011-13, click here.

Princess Health and Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate.Princessiccia

Princess Health and Supreme Court upholds Obamacare subsides in all states; ruling has no direct effect on Kentucky, but focuses political debate.Princessiccia

Affordable Care Act federal government governor's race health care law health insurance insurance coverage insurance exchange obamacare Patient Protection and Affordable Care Act U.S. Supreme Court

Gusty 15:40 Add Comment

By Molly Burchett
Kentucky Health News

The U.S. Supreme Court ruled Thursday that the tax subsidies provided under the Patient Protection and Affordable Care Act are legal in every state.

While the ruling has no effect on Kentucky, and would have had no direct effect if it had gone the other way, it sets the table for continued political debate about health policy in Congress and in Kentucky's race for governor.

"Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them," Chief Justice John Roberts wrote in the 6-3 majority opinion. "If at all possible, we must interpret the Act in a way that is consistent with the former, and avoids the latter."

The law says the federal government can pay subsidies to help people afford insurance bought through �an Exchange established by the State.� The lawsuit argued that Americans in the 34 states using the federal exchanges were not eligible for the subsidies, which are crucial to the law's success, helping to make health insurance more affordable, reducing the number of uninsured Americans. Proponents of the law say not providing subsidies to individuals in those 34 states relying on the federal exchange would have upended the law, notes CNN.

President Obama called on critics to accept the law as permanent, saying after the ruling, "The Affordable Care Act is here to stay."

But Senate Majority Leader Mitch McConnell, R-Ky., called Obamacare �a rolling disaster for the American people,� with a �multitude of broken promises, including the one that resulted in millions of Americans losing the coverage they had and wanted to keep. Today�s ruling won�t change the skyrocketing costs in premiums, deductibles, and co-pays that have hit the middle class so hard over the last few years.�

Maps: Percentage uninsured in 2012, above, and 2014, below

Obama countered, "The setbacks I remember clearly. But as the dust has settled, there can be no doubt that this law is working. It has changed, and in some cases saved, American lives. It set this country on a smarter, stronger course." He added, "The law has helped hold the price of health care to its slowest growth in 50 years" and "Nearly one in three Americans who was uninsured a few years ago is insured today. The uninsured rate in America is the lowest since we began to keep records."

A White House fact sheet noted that the law also expanded "access to preventive care, including immunizations, well-child visits, certain cancer screenings, and contraceptive services, with no additional out-of-pocket costs as well as no more annual caps on essential benefit coverage and new annual limits on out-of-pocket costs."

Since Kentucky established its own exchange, Kynect, for buying subsidized health insurance or signing up for Medicaid, the ruling may seem moot for Kentuckians. However, it establishes some of the facts for a health-care policy debate in the governor's race between Republican Matt Bevin and Democratic Attorney General Jack Conway.

The exchanges and the expansion of the federal-state Medicaid program are choices for the states, and Bevin has said that if elected he would shut down Kynect and end the Medicaid expansion, which has covered about 430,000 Kentuckians. The federal government is paying their entire cost through next year; in 2017 the state would start picking up a small share, rising to the law's limit of 10 percent in 2020.

Conway has acknowledged questions about whether the state can afford to pay its share, but to �say you�re going to kick a half a million people off of health insurance based on what we may or may not be able to afford in 2021 is irresponsible.� A Conway spokesman said he "appreciates the court's careful consideration of this case and agrees with today's decision," reports the Lexington Herald-Leader.

The Herald-Leader's Mary Meehan interviewed officials and experts for a package of questions and answers about the law and Kentucky. It is published at http://www.kentucky.com/2015/06/25/3917832_in-light-of-the-supreme-court.html.

Outgoing Gov. Steve Beshear, a Democrat who expanded Medicaid, said in a statement that the decision �reaffirms that, from the very start, we did the right thing for the more than 500,000 Kentuckians who have qualified for health-care coverage through Kynect since January 1, 2014.�

Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, said in a release, "While many have been awaiting this important decision, we must remember that much remains to be done to assure that all Kentuckians � and all Americans � have timely access to safe, effective and affordable quality care." Zepeda said Kentuckians continue to work on ways to improve and protect Kentuckians' health, such as reforming the way we pay for care and making health care cost and pricing more transparent.

"As people who have forgone care too long because of its expense now gain access to care, it will place a larger short-term burden on the health-care system, which approaches like these can help to address," said Zepeda. "The Affordable Care Act permits � and incentivizes � local health care innovation. We can and must shape Kentucky solutions to Kentucky�s health challenges."

Princess Health and Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud.Princessiccia

Princess Health and Three doctors, nine others in western half of Kentucky are indicted in the largest-ever federal 'takedown' of Medicaid fraud.Princessiccia

accidents controlled substances courts doctors drug abuse drugs federal government fraud Medicaid Medicare narcotics pain physicians prescription drug abuse

Gusty 06:07 Add Comment

Former Dr. Fred Gott of Bowling Green was arrested.
(Photo: Miranda Pederson, Bowling Green Daily News)

Twelve people in the western half of Kentucky, including three doctors, have been charged with Medicaid fraud in what the federal government calls its biggest-ever "takedown" of the problem, Andrew Wolfson of The Courier-Journal reports.

The indictments allege "a half-dozen schemes involving nearly $8 million in alleged fraudulent billings," Wolfson writes. "The offenses include $5 million in false billings for muscle-relaxant injections that were never delivered to patients, as well as a staged car wreck in which three people allegedly conspired to get controlled substances and fraudulent reimbursements."

In another case, Wolfson reports, "a medical practice that treated car wreck patients is accused of using the DEA numbers of nurse practitioners to order hydrocodone for herself and falsely billing it to an insurance company. Nationally, the sweep resulted in charges against 243 people, including 46 doctors, nurses and other licensed medical professionals."

John Kuhn, acting U.S. attorney for the Western District of Kentucky, told Wolfson that about $1 billion of annual Medicare and Medicaid expenses are fraudulent. Medicare is the federal health-insurance program for people over 65; Medicaid is the federal-state program for the poor and disabled.

Former Dr. Fred Gott of Bowling Green, a 63-year-old cardiologist, was charged with "conspiracy to dispense controlled substances, health care fraud and money laundering," Deborah Highland reports for the Bowling Green Daily News. "The Bowling Green-Warren County Drug Task Force opened an investigation into Gott�s practices after Warren County Coroner Kevin Kirby alerted the task force about drug overdose deaths involving Gott�s patients, task force director Tommy Loving said."

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

Princess Health and Business leaders discuss possibility of expanding Medicaid through private insurance.Princessiccia

Affordable Care Act business federal government governor health care access health care costs health insurance Medicaid Patient Protection and Affordable Care Act state government

Gusty 13:32 Add Comment

By Molly Burchett
Kentucky Health News

Some Kentucky business leaders are discussing a possible endorsement of expanding Medicaid through private insurance, in a plan similar to one the federal government approved for Arkansas.

The Health Policy Council of the Kentucky Chamber of Commerce discussed the idea last Friday. A talking paper for the meeting highlighted presumed benefits of the approach, in which people newly eligible for Medicaid could use federal funds to buy private insurance through the insurance exchange that the state is constructing.

The health council has yet to decide the chamber's position on Medicaid expansion, but the council's talking paper said expanding Medicaid privately might be a better option than expansion of traditional Medicaid, considering the state's tight budget and already problematic managed care system.

The paper says a private plan would be beneficial to Kentucky because it would allow market forces to control costs and ultimately result in better health care. Private expansion would also prevent a flood of newly eligible people from entering the managed care system. "If Kentucky accepts the traditional Medicaid expansion, everyone that qualifies would be put into the already struggling managed care system, which until changes are made, cannot support the influx," the paper asserted.

The Obama administration has encouraged states to consider the Arkansas approach, the paper says.  To do so, states need to apply for a waiver, and the administration has provided information on how a state would apply. "Florida, Ohio, Louisiana, Maine and Pennsylvania are all looking into this option," the paper said.

An estimated 181,000 uninsured adults would become eligible for Medicaid in 2014, if Kentucky decides to accept the funds offered by the health law to provide coverage to those earning up to 138 percent of the federal poverty level.

Gov. Steve Beshear has said he will make his decision about Medicaid expansion no later than July 1. His office has declined to say whether the privatized option is under consideration, saying, "The governor is considering multiple issues as he determines whether Kentucky will expand Medicaid eligibility.  Along with affordability for the state, he is also looking at potential economic impact through jobs and investment created by possible expansion, as well anticipated changes in health outcomes for newly-eligible Kentuckians."

Princess Health and Baucus sees a health-reform 'train wreck,' fearing insurance exchanges won't be ready.Princessiccia

Princess Health and Baucus sees a health-reform 'train wreck,' fearing insurance exchanges won't be ready.Princessiccia

federal government health care reform health insurance insurance insurance exchange Patient Protection and Affordable Care Act state governments

Gusty 12:59 Add Comment

Max Baucus (J. Scott Applewhite, AP)

Senator Max Baucus, who as Senate Finance Committee chair helped write the health-care reform law, has become the highest-ranking Democrat to publicly voice concerns about its implementation, saying he thinks it�s headed for a collision with itself.

�I just see a huge train wreck coming down,� the Montanan told Health and Human Services Secretary Kathleen Sebelius during a budget hearing.

Matt Gouras of The Associated Press notes that polls show that Americans are confused by the complex law, which is designed to cover about 30 million uninsured people through a mix of government programs and tax credits. Baucus told Sibelius he�s �very concerned� that new health insurance exchanges will not open on time in every state and residents will not have enough information to make choices even if they do open on time, as Kentucky's seems likely to do.

"The administration�s public-information campaign on the benefits of the Affordable Care Act deserves a failing grade,� Baucus lectured. �You need to fix this.� Baucus� office later told Gouras that the senator still thinks the Affordable Care Act is a good law, but questions its roll-out.

Sebelius said that the administration is on track to fully implement exchanges in January, and to be open for open enrollment on Oct. 1, 2013, reports Gouras. Kentucky is among the states that have chosen to build a fully state-based exchange. Others have chosen a state-federal partnership exchange, or defaulted into a federally facilitated exchange. The map below shows the lay of the land about that decision. Yellow states have defaulted to a federal exchange, light blue states are planning for a partnership and blue states have chosen a state-based exchange.

Map provided by the Kaiser Family Foundation

Princess Health and Lawsuit alleges state health insurance exchange is unauthorized.Princessiccia

Princess Health and Lawsuit alleges state health insurance exchange is unauthorized.Princessiccia

federal government General Assembly governor health insurance health reform insurance exchange legislature state government

Gusty 08:38 Add Comment

Tea Party activist David Adams filed a lawsuit Monday challenging Gov. Steve Beshear's legal authority to create Kentucky's health insurance exchange without approval from the General Assembly. The governor created the exchange by executive order to offer health insurance plans for Kentuckians under federal health reform, but did not ask the legislature to approve it.

Adams claims state law requires the exchange to get legislative approval, and he seeks an injunction against it. The law allows the governor to temporarily reorganize units of state government and calls for them to be approved by the General Assembly.

Beshear's office says he exercised his constitutional authority to meet the requirements of federal law, reports Jack Brammer of the Lexington Herald-Leader.

Adams said in a telephone interview, "There is nothing in the constitution that allows him to set up a new bureaucracy that taxes, gains fees or spends money without legislative approval." He added, "This isn't about politics. It is simply about gubernatorial authority in the absence of legislative approval."

Kentucky has received about $250 million from the federal government to cover the initial costs of exchange, but Adams said that is being spent rather quickly and funds will be exhausted by 2014, he said. The state will be responsible for all funding for the exchange beginning in 2015; it plans to fund it with fees from participating insurance companies.

Kentucky is one of 17 states that the federal government approved to build its own exchange, which will be operated by the Cabinet for Health and Family Services and is expected to help insure more than 600,000 Kentuckians. (Read more)

Princess Health and Feds plan to let states impose co-payments on Medicaid patients above poverty level to encourage them to expand the program.Princessiccia

Princess Health and Feds plan to let states impose co-payments on Medicaid patients above poverty level to encourage them to expand the program.Princessiccia

Affordable Care Act federal government health care access health care costs health care law legislation Medicaid Patient Protection and Affordable Care Act poverty state government

Gusty 18:22 Add Comment

By Molly Burchett and Al Cross
Kentucky Health News

If Kentucky expands its Medicaid program, it will probably be able to reduce the cost by requiring patients whose incomes are above the federal poverty level to help pay for their care. That could make it more feasible for the state to expand the program to people with incomes up to 138 percent of the poverty line.

A proposed federal policy will let states charge co-payments and increased premiums for doctor visits and some prescription drugs and hospital care. Robert Pear of The New York Times reports that the policy is designed to encourage states to expand Medicaid under the federal health-care reform law, with generous federal help. By shifting costs to patients, the state and federal governments would pay less.

That adds a new perspective to the cost consideration in Kentucky's debate over expansion of Medicaid. It could influence the state's decision, Republican state Sen. Julie Denton of Louisville said Friday during a legislative panel at the Kentucky Press Association convention.

Denton cautioned that the state needs to fix its problems with Medicaid managed care before it expands the program. Democratic Gov. Steve Beshear has said he wants to expand Medicaid if the state can afford it, and since there is no deadline for deciding whether to participate in the expansion, the debate may carry over into 2014.

Some Republicans have said Kentucky can't afford the expansion. If the state expands Medicaid eligibility to 138 percent of poverty from its current threshold of 70 percent, the federal government would pay all the cost of the expansion until 2017, when the state would begin helping out, with its share reaching 10 percent in 2020. The federal share of the state's current program is 72 percent.

This proposed rule could have important implications not just for state finances, but for Medicaid patients. It means that a family of three with an annual income of $30,000 could be required to pay $1,500 in premiums and co-payments, Pear reports in the Times.

As published in the Federal Register last week, the rule proposes to "update and simplify Medicaid premium and cost sharing requirements, to promote the most effective use of services and to assist states in identifying cost-sharing flexibilities." It proposes "new options for states to establish higher cost sharing for nonpreferred drugs and to propose higher cost sharing for non-emergency use" of emergency rooms.

Barbara K. Tomar, director of federal affairs at the American College of Emergency Physicians, told Pear that the administration had not adequately defined the �nonemergency services� for which the poor might have to pay. "In many cases, she said, patients legitimately believe they need emergency care, but the final diagnosis does not bear that out," Pear writes.

The proposed rule has no limit on emergency department charges for "non-emergency use." It says the hospital will have responsibility to assess the individual clinically and ensure access to other sources of care before requiring payment, which could pose problems for hospitals.

The public has until Feb. 13 to comment on the proposed rule, which can be submitted at www.regulations.gov.

Princess Health and Poll finds parents overwhelmingly support more nutritious school food; USDA expected to issue new guidelines.Princessiccia

Princess Health and Poll finds parents overwhelmingly support more nutritious school food; USDA expected to issue new guidelines.Princessiccia

childhood obesity federal government nutrition school health school lunch

Gusty 06:05 Add Comment

Photo by Reuters' Lucy Nicholson

Chocolate bars, Cheetos and cheesy fries may soon be a thing of the past at public schools in America, and that's fine with parents, a new poll has found.

The survey found "most people agreed the chips, soda and candy bars students buy from vending machines or school stores in addition to breakfast and lunch are not nutritious, and they support a national standard for foods sold at schools," reports Susan Heavey for Reuters.

As it did for school lunch earlier this year, the U.S. Department of Agriculture is expected to release new guidelines for vending machines and � la carte sales by June, some experts say.

In Kentucky, schools are already not allowed to sell food that competes with the national school lunch and breakfast programs from the minute students arrive in the morning until 30 minutes after the last lunch period. Only water, 100 percent fruit juice, lowfat milk and any beverage that contains no more than 10 grams of sugar per serving are allowed to be sold in school vending machines, as per state mandate. There are no limits as to what food or drinks that can be sold in fundraisers.

The poll, conducted by advocacy group Kids' Safe and Healthful Foods Project, found 80 percent of the 1,010 adults surveyed said they would support nutritional standards that limit the calories, fat and sodium in such schools.

Students eat one-fifth to one-half of their daily diet at schools, and the Centers for Disease Control and Prevention report 20 percent of American children are obese, As of 2007 in Kentucky, more than 37 percent of children were either obese or overweight, a study by the National Conference of State Legislatures shows.

A study by the National Academy of Sciences reports that about $2.3 billion worth of snack food and drinks are sold each year in schools nationwide. As such, changes might be controversial. The new guidelines for school lunch met with resistance from lawmakers, who "locked limits to french fries and counted pizza as a vegetable because it contains tomato sauce," Heavey reports.  There are concerns industry lobbyists and members of Congress could dilute the USDA proposals. (Read more)

Princess Health and Rogers joins bill to link up states' prescription drug monitoring systems.Princessiccia

Princess Health and Rogers joins bill to link up states' prescription drug monitoring systems.Princessiccia

federal government pain clinics pill mills prescription drug abuse

Gusty 06:46 Add Comment

Though a state bill aimed at quashing "pill mills" by proactively tracking drug prescriptions has so far failed to pass in the Kentucky General Assembly, Republican U.S. Rep. Hal Rogers of Eastern Kentucky's 5th District has joined a federal effort to allow state prescription drug tracking systems to share information. Though 48 states have such systems, there is no way for them to communicate with each other.

On Thursday, federal lawmakers introduced legislation "that would establish technical standards and security and encryption procedures to ease sharing information," James R. Carroll reports for The Courier-Journal.

"While my region of Southern and Eastern Kentucky became ground zero for the abuse of prescription drugs a decade ago, it is now wreaking havoc on communities small and large and cutting across socioeconomic and gender lines," Rogers said in a statement.

About 1,000 people in Kentucky died last year from prescription drug abuse, though the real number is suspected to be higher, due to under-reporting.

Missouri and New Hampshire are the only states that do not have, or don't have plans to set up, a drug-monitoring system that allows "doctors, pharmacists and law enforcement to share information that may identify abuse and misuse of pharmaceuticals," Carroll reports.

"It is high time we get these systems linked up to eliminate the interstate doctor-shopping which has been fueling the pill pipeline around our country," Rogers said.

The proposal would not create a new national database, but would also states to communicate with each other through data hubs already in place. The bill is expected to get the support of the White House administration, Carroll reports. (Read more)

Last week, Gov. Steve Beshear said Kentucky would sign an agreement to share and receive prescription drug dispensing data with at least 20 other states. "The blight of prescription drug abuse is tearing our families and communities apart, and we must use every tool available to attack this deadly scourge on our state," he said. "One of our key strategies is sharing information with surrounding states, so that we can not only cut off access to abusers, but also identify the problem prescribers." (Read more)