Princess Health and Doctors' lobby still working for changes in 'pill mill' legislation.Princessiccia

Princess Health and Doctors' lobby still working for changes in 'pill mill' legislation.Princessiccia

doctor shopping doctors drugs General Assembly legislation legislature lobbying physicians prescription drug abuse prescription drugs privacy

Gusty 09:15 Add Comment

By Al Cross
Kentucky Health News

The Kentucky Medical Association, historically one of the most powerful lobbying interests at the General Assembly, has mounted a last-ditch attempt to change or perhaps kill the bill that would crack down on "pill mills" that contribute to prescription drug abuse.

The bill would require pain clinics to be owned by doctors, require doctors to participate in the state's prescription-tracking system, and move the system to the attorney general's office from the Kentucky Board of Medical Licensure, which is made up almost entirely of doctors and has done little to curb the growing problem.

The tracking system remains the central concern for the KMA, which issued a "call to action" for physicians to contact legislators and argue that it "could infringe on privacy and lead to excessive oversight of legitimate medical practices," reports Mike Wynn of The Courier-Journal. "Other critics have said the bill could make doctors reluctant to provide pain medication for legitimate patients."

KMA President Shawn Jones told Wynn, �We would like to see something come out of this session. We would just like to make sure that it is something that addresses both the needs of law enforcement and at the same time is not overreaching in its imposition on our ability to practice medicine in a professional way.�

The KMA�s call notes that the system "tracks medications such as Xanax, Valium and Klonopin and was placed under the cabinet�s responsibility partly for patient privacy and protection," Wynn notes. Jones told him, �The access to that data really should be limited to government agencies that are charged with public health, and not law enforcement.�

Moving the tracking system to the attorney general's office is "pretty much a cornerstone of this legislation," Senate Majority Floor Leader Robert Stivers, R-Manchester, left, told Ryan Alessi Friday night on cn|2's "Pure Politics" program. He said the medical licensure board "hasn't done a whole lot" about prescription drug abuse, and indicated that part of the bill would stand.

However, Stivers said he and other supporters of the bill might drop the bill's 30-day limit on the length of painkiller prescriptions because of concerns that it would raise costs to patients. Those concerns helped delay the bill on the 59th day of the legislature's 60-day session. House Speaker Greg Stumbo "has said the issue could be resolved with a simple fix in the bill�s language," Wynn notes.

Stivers and Stumbo were among a group of bipartisan political leaders, led by Gov. Steve Beshear, who issued a statement Friday calling on the General Assembly to pass the bill Thursday, when it is scheduled to reconvene. The legislature is in recess, pending possible vetoes of other legislation by Beshear.

KMA "also takes issue with a $50 fee that the attorney general would be able to charge doctors to fund the program," Wynn reports. "Jones said the amount will only continue to climb in coming years to address a societal problem that doctors did not create. Proponents contend that the fee is nominal and is capped by statute except for inflation adjustments." (Read more)

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.

Princess Health and In bipartisan way, political leaders push passage of 'pill mill' bill.Princessiccia

Princess Health and In bipartisan way, political leaders push passage of 'pill mill' bill.Princessiccia

doctor shopping doctors drugs General Assembly legislation legislature physicians prescription drug abuse prescription drugs state governments

Gusty 13:34 Add Comment

A bipartisan group of political leaders issued a call today "to pass a bill that will help the state battle one of its most significant threats � prescription drug abuse," a press release from Gov. Steve Beshear's office said. Beshear, Attorney General Jack Conway, House Speaker Greg Stumbo, Senate Republican Floor Leader Robert Stivers, Sen. Jimmy Higdon, R-Lebanon, and House Judiciary Committee Chairman John Tilley, D-Hopkinsville, said the legislature should pass House Bill 4 when it returns to Frankfort for its final day April 12.

"Since the beginning of 2012, more than 400 Kentuckians have been hospitalized because of prescription drug overdoses � a statistic that the leaders say underscores the crucial need to pass this bill in this legislative session," the release said. "Kentucky has the nation�s sixth-highest rate of prescription drug overdose deaths, at nearly 18 deaths per 100,000."

Conway said in the release, �I'm hopeful everyone, including the medical community, can get on board with House Bill 4 to ensure that we don't lose another generation in Kentucky to prescription drug abuse.� The bill would move the Kentucky All Schedule Prescription Electronic Reporting (KASPER) system to Conway's office from the Kentucky Board of Medical Licensure, which is controlled by doctors and has done little to rein in "pill mills" that churn out prescriptions for painkillers.

"Law enforcement members warn that Ohio, Tennessee, West Virginia and Florida have passed legislation similar to HB 4 to address pill mills, and failing to pass similar legislation could create a diversion effect in which Kentucky could become a source state for prescription painkillers," the release said.

Stumbo, who preceded Conway as attorney general, said in the release, �Given the true epidemic we are seeing, we cannot afford to wait another year to try to pass this again.� In October, Stumbo, Beshear and Conway "announced creation of an advisory board of physicians, dentists, nurses, and pharmacists to work with KASPER officials and law enforcement professionals to create guidelines for generally accepted prescribing practices among different medical disciplines," the release said. "These criteria will be used as a guide for when a prescriber or dispenser�s KASPER reports may be flagged for unusual prescribing activity."

The bill would require all prescription providers to register and use KASPER, require pain management clinics to be owned by a licensed medical practitioner, make medical licensure boards investigate prescribing complaints within four months. 

Princess Health and Body-mass index fails to identify some as obese, mainly women.Princessiccia

Princess Health and Body-mass index fails to identify some as obese, mainly women.Princessiccia

gender disparities obesity

Gusty 13:15 Add Comment

Many Americans, particularly women, are actually obese though they think their weight is healthy because of weaknesses in the body-mass index formula.

A study comparing people's BMIs to a blood test and body scan found that the height-to-weight ratio formula was wrong in half of women and 1 in 4 men.

"It's commonly acknowledged that the BMI can produce inaccurate results for athletes and others with a lot of muscle mass,"  Misti Crane reports for The Columbus Dispatch . "But this research illuminates a problem on the other end of the scale: people who think they're fine but are carrying a lot of fat and little muscle."

"Particularly women, as they age, their muscles become inserted with fat, even though they stay thin and beautiful in a dress," said Dr. Eric Braverman, a New York physician who co-wrote the study.

Braverman and co-author New York State Health Commissioner Nirav R. Shah propose that the BMI cutoff for determining obesity should be 24 for women and 28 for men. Now, it's 30 for both sexes. "They also say that doctors should consider blood tests to measure leptin, a hormone that goes up with increased body fat, and DXA scans. The scans are commonly used to assess bone density but can be used to analyze body fat," Crane reports.

Though experts know the BMI calculation is not perfect, there is one major advantage: It's free. "You have to understand that BMI is an estimate of fatness, it's not a measure of fatness. But there are very few screening-tool estimates we have that are as simple to use," said Dr. Patricia Choban, medical director of the bariatric-surgery problem at Mount Carmel West Hospital. (Read more)

Princess Health and Obesity adds more health-care costs than smoking, study finds.Princessiccia

Princess Health and Obesity adds more health-care costs than smoking, study finds.Princessiccia

health care obesity research smoking tobacco

Gusty 13:12 Add Comment

Obesity costs the health care system more than smoking does, a new study has found. The annual health costs for someone who is obese average $1,850 more than for a person a normal weight. The excess costs were up to $5,500 per year for people who are morbidly obese. Smokers' health costs averaged $1,275 more than those of nonsmokers.

Researchers studied the additional costs "of smoking and obesity among more than 30,000 Mayo Clinic employees and retirees. All had continuous health insurance coverage between 2001 and 2007," reports research-reporting service Newswise. The findings were published in the Journal of Occupational and Environmental Medicine.

The additional costs associated with obesity appeared to be lower after they were adjusted for other related health problems. "This may lead to underestimation of the true incremental costs, since obesity is a risk factor for developing chronic conditions," said James P. Moriary and his fellow researchers. (Read more)

Princess Health and Doctor groups say to do 45 common tests, procedures less often.Princessiccia

Princess Health and Doctor groups say to do 45 common tests, procedures less often.Princessiccia

doctors health care costs

Gusty 12:44 Add Comment

Doctors should perform 45 common tests and procedures less often, a group of nine medical specialty boards recommended today. The move will "likely alter treatment standards in hospitals and doctors' offices nationwide," reports Roni Caryn Rabin for The New York Times.

"Overuse is one of the most serious crises in American medicine," said Dr. Lawrence Smith, physician-in-chief at North Shore-LIJ Health System and dean of the Hofstra North Shore-LIJ School of Medicine, who was not involved in the effort. "Many people have thought that the organizations most resistant to this idea would be the specialty organizations, so this is a very powerful message."

Some estimates show unnecessary treatment accounts for one-third of medical spending in the United States.

The American Board of Internal Medicine Foundation is advising against physicians testing with EKGs during a physical when there is no sign of heart trouble; MRIs ordered whenever a patient has back pain; and antibiotics for mild sinusitis. "The American College of Cardiology is urging heart specialists not to perform routine stress cardiac imaging in asymptomatic patients, and the American College of Radiology is telling radiologists not to run imaging scans on patients suffering from simple headaches. The American Gastroenterological Association is urging its physicians to prescribe the lowest doses of medication needed to control acid reflux disease," Rabin reports.

Oncologists will also be urged to reduce the number of scans for patients with early stage breast cancer and prostate cancers that aren't likely to spread.

Some specialists are cautious, however. "These all sound reasonable, but don't forget that every person you're looking after is unique," said Dr. Eric Topol, chief academic officer of Scripps Health. "This kind of one-size-fits-all approach can be a real detriment to good care."

Others applauded the effort. "It's courageous that these societies are stepping up," said Dr. John Santa, director of the health ratings center of Consumer Reports. "I am a primary care internist myself, and I'm anticipating running into some of my colleagues who will say, 'Y'know, John, we all know we've done EKGs that weren't necessary and bone density tests that weren't necessary, but, you know, that was a little bit of extra money for us.'" (Read more)

Princess Health and This is Child Abuse Awareness Month; tips for prevention.Princessiccia

Princess Health and This is Child Abuse Awareness Month; tips for prevention.Princessiccia

child abuse children's health legislation legislature open government open records privacy state government; General Assembly

Gusty 12:42 Add Comment

April is child abuse awareness month, and the state Cabinet for Health and Family Services is reminding Kentuckians that it's the law to report suspected child abuse or neglect.

"Protecting our children should be everyone's number one priority, and during the month of April, we are raising awareness about the warning signs of child abuse and how to report it," Gov. Steve Beshear said. "The cabinet works year round to educate our families and investigate every aspect of abuse. Together, we can make Kentucky a safer place for all our children."

To report child abuse, Kentuckians should call 800-KYSAFE1. Calls are anonymous. If the report meets the criteria for abuse, an investigation is conducted within 24 hours in most cases or, if the child is suspected to be in immediate danger, they are conducted within the hour.

Callers should try to know the child's name, approximate age, address, parents' names and location of the child when the call is made. They should also have names and phone numbers of other people who have information about the suspected abuse.

The ultimate goal is to reunite families when circumstances improve. "We want children to return home to a stronger, safer family," said Jim Grace, assistant director of the Department for Community Based Services' Division of Protection and Permanency.

The cabinet's handling of child abuse investigations and its reluctance to release records pertaining to child abuse deaths and near deaths has been a hot-button issue in the past year. The Courier-Journal and Lexington Herald-Leader both sued the cabinet for refusing to turn over records and a judge twice ruled the cabinet was wrong not to do so. Since, it has released hundreds of pages of records, but has chosen to redact, or omit, some of the information therein. In January, Beshear acknowledged the cabinet had been accused of "operating under a veil of secrecy in a supposed attempt to protect inept workers and a poorly designed system."  Legislators have since heard hours of arguments about the issue, and a bill that would create an external panel to review child abuse cases involving fatalities and near-fatalities, while imposing more secrecy, is one of the few measures that could pass the General Assembly when it re-convenes for one day next Thursday to end its legislative session.

In its effort to increase awareness about child abuse, the cabinet offered strategies for parents to prevent abuse, including:

� never discipling a child when a parent's anger is out of control

� never leaving a child unattended, especially in a car

� learning the signs of physical abuse, nothing bruises, cuts, burns or other injuries a child can't explain

� teaching children the difference between "good touches," "bad touches" and "confusing touches"

� listening to a child when he or she doesn't want to go with something

� noting a change in a child's behavior or attitude

� teaching children what if he or she gets lost

� teaching children the correct name for private body parts

� being alert for talk that indicates premature sexual understanding

� paying attention when someone shows an unusual interest in a child

� making sure a child's school or daycare will only release him or her to a designated person
(Read more)

Princess Health and What will high court do on health law? 4 most possible scenarios.Princessiccia

Princess Health and What will high court do on health law? 4 most possible scenarios.Princessiccia

Congress courts federal legislation health insurance health reform Patient Protection and Affordable Care Act

Gusty 20:32 Add Comment

Last week, U.S. Supreme Court justices heard arguments about the constitutionality of the federal health-care reform law. At the center of the debate is whether the government can force people to buy health insurance, a provision often referred to as the individual mandate. There are four likely scenarios that will be the outcome of the justices' decisions, asserts Jennifer Haberkorn for Politico, all of which come with their own problems.

Scenario 1: The individual mandate is struck down, as well as insurance reforms: If these parts of the Affordable Care Act are scrapped, "Insurance companies will still be able to deny coverage based on customers' costly pre-existing conditions and charge more to older and sicker � or female patients," Haberkorn reports.

If that happens, the Obama administration and Democrats would likely blame Republicans for promoting a lawsuit that puts insurance companies in charge again. If reaction from the public is strong, Republicans may feel obligated to enact insurance reforms without an individual mandate. Ideas for doing this include "charging more if a person buys insurance at the last minute, tax incentives and a promise that if a person buys coverage, that person wouldn't lose it if he or she were to get sick and need it," Haberkorn reports.

Scenario 2: The mandate is struck down, but insurance reforms stay intact: Part of the reason why insurance companies agreed to stop denying coverage based on pre-existing conditions is they could offset the losses because the law would enlarge their insurance pool by 30 million people � the number of Americans who lack coverage.

If insurance companies are still required to stop denying coverage based on pre-existing conditions but the individual mandate is struck down "They could start a mini revolt over having to cover expensive patients without the mandate," Haberkorn reports.

Scenario 3: The entire law, or the majority of it, is axed: That would mean unpopular parts of the law would be trashed, but so would popular ones, including the pre-existing conditions piece as well as a provision that allows young adults to stay on their parents' health insurance until the age of 26.

In 2010, 26 provisions took effect and another 17 did last year. Nine new provisions are taking place this year. "Lawmakers designed the phase-in, in part, with the thought that the public would become more supportive of the law once certain provisions began to take hold," report Michael Doyle and David Lightman for McClatchy Newspapers.

Scrapping the law entirely could cause the most political fallout. "Republicans would try to move quickly to enact a small-scale health reform legislation aimed at restoring some of the popular pieces of the health law," Haberkorn reports. "But Democrats won't want to support something far less comprehensive than the Affordable Care Act, not with some 50 million Americans uninsured."

Scenario 4: The law stands: Though this is the hope of the Obama administration, "The mandate is considered relatively weak: The penalty for not obeying it starts at $95 in 2014 � that's nothing compared with the cost of insurance premiums," Haberkorn reports. The amount increases to $695 by 2016.

As for what the justices will do, "at least some of the court's conservatives seem prepared to kill the whole bill," report Doyle and Lightman. "My approach would be, if you take the heart out of the statue, the statute is gone," Justice Antonin Scalia said.

Justice Elena Kagan countered, "Half a loaf is better than no loaf," while Justice Ruth Bader Ginsburg suggested, "It's a question between a wrecking operation and a salvage job."

Some justices said the whole bill should be sacked, "on the theory that members of Congress would not have voted for it without the mandate," Adam Liptak reports for The New York Times. But Justice Sonia Sotomayor said killing the whole law "would be too broad an assertion of judicial power," Liptak notes. Justice Anthony Kennedy, the likely swing vote, said "We would be exercising the judicial power, if one provision was stricken and the others remained, to impose a risk on insurance companies that Congress had never intended."

The justices probably decided the future of the law Friday morning, reports Mark Sherman for The Associated Press. Typically, an initial vote is "followed soon after by the assignment of a single justice to write a majority opinion, or in a case this complex, perhaps two or more justices to tackle different issues. That's where the hard work begins, with the clock ticking toward the end of the court's work in early summer," Sherman writes.

In Kentucky, health advocates and officials are watching closely to see what happens. "I think the entire health-care sector and insurance sector are watching this closely because it has significant implications on both industries," said Stephen Williams, chief executive officer of Norton Healthcare. "This is very far-reaching."

In Kentucky, the law extends coverage for 35,000 young adults, reports Laura Ungar for The Courier-Journal. (Read more)