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Saturday, 21 April 2012

Princess Health and Appalachian hospital chain, facing loss of 25,000 Medicaid patients, sues managed-care firms and state.Princessiccia

Princess Health and Appalachian hospital chain, facing loss of 25,000 Medicaid patients, sues managed-care firms and state.Princessiccia

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"Appalachian Regional Healthcare, the largest health care system in Eastern Kentucky, has filed lawsuits against two of the state's Medicaid managed care companies, alleging that the managed care companies had not paid claims promptly," report Valarie Honeycutt Spears and Beth Musgrave of the Lexington Herald-Leader. ARH said it treats about 25,000 Medicaid patients at its eight Kentucky hospitals.

The moves came after Coventry Cares, one of three managed-care organizations hired by the state, said it would cancel its contract with ARH as of May 4. ARH sued Coventry in federal court on Monday; the previous Thursday, April 12, it sued "in Franklin Circuit Court against Kentucky Spirit Health Plan Inc. and the Cabinet for Health and Family Services." On March 29, "Coventry Coventry told ARH that it was terminating its contract with ARH effective May 4."

Coventry spokesman Matthew Eyles told the Herald-Leader, "We were effectively forced to break our ties with ARH until the Commonwealth takes steps to treat all MCOs equally and makes some key decisions to guarantee greater stability in the program, such as paying MCOs fairly based on whether they have healthier or sicker members." Cabinet spokeswoman Jill Midkiff said the issues don't indicate a problem with the managed-care system the state adopted Nov. 1. (Read more)

Friday, 20 April 2012

Princess Health and Pill-mill bill passes; attorney general won't get drug-monitoring system but narcotic-prescribing doctors will have to use it.Princessiccia

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House Speaker Greg Stumbo, center, walks
with House budget committee chair Rick
Rand and House Majority Floor Leader
Rocky Adkins. (Courier-Journal photo).
Legislators have sent Gov. Steve Beshear a bill to curb prescription drug abuse and crack down on rogue pain clinics, ending the special session of the General Assembly.

The final version left the state's prescription drug-monitoring system under the control of the Cabinet for Health and Family Services and the doctor-controlled Kentucky Board of Medical Licensure rather than move it to the attorney general's office, as the last version in the regular session would have. But in another significant change, it will require doctors and pharmacists who prescribe or dispense Schedule II and III drugs, such as oxycodone and morphine, to use the Kentucky All Schedule Prescription Electronic Reporting system. Only about 25 percent of Kentucky physicians now use KASPER.

Putting the drug-monitoring system in the hands of the attorney general was considered a linchpin of efforts to help law enforcement to proactively identify suspicious prescribers; law enforcement officers can access the database only if they have a case opened, and say they need the data to open cases. But the Kentucky Medical Association called giving law enforcement oversight of information with prescription-drug information a violation of personal privacy. "You are essentially legislating medical care," said Shawn Jones, president of the KMA.

Beshear, who repeatedly pressured legislators to pass a bill pertaining to the issue, issued a statement this evening expressing his delight. "Even though the prescription drug bill doesn't include every element we had hoped, it is an enormous bipartisan accomplishment, and it restores Kentucky as a leading state in innovative tactics in battling prescription drug abuse," he said. "The elements of the bill also help prevent Kentucky from becoming a source state for prescription pills.

House Speaker Greg Stumbo, who sponsored the bill, called its passage "a step forward" though he "would have preferred a stronger version." He told reporters that he did not feel this would be the last time lawmakers would be changing laws to fight the problem, and noted that Beshear could use his gubernatorial reorganization powers to change the administration of the system: "I think the governor, in the days ahead, will continue to take aggressive action on addressing this problem."

The measure will require pharmacists to submit information to KASPER within 24 hours of dispensing a narcotic and doctors must check the system before prescribing one to a new patient. They then would be required to check a KASPER report every three months during a patient's treatment.

As before, the measure will require most pain clinics be owned by at least one doctor; 33 of Kentucky's 77 pain clinics are owned by people with no medical background. Those who already own clinics and haven't had run-ins with the law will be "grandfathered" and be allowed to continue operating. "That really waters it down. A lot!!" Operation UNITE Director Karen Kelly said on Facebook.

Lawmakers also passed the transportation budget bill, which was the main reason why they were called in for a special session by Beshear. They reached an impasse last week when the Senate would not approve the budget, a move Beshear and Senate President David Williams blamed on each other.

There were suggestions that the road and drug issues, the only items that the legislature could consider under Beshear's call of the session, were related. "As the Senate receded on the amendment to put back $50 million of [road] money into Senate President David Williams' district, word went out that the House would compromise on the pill bill and let the Senate keep KASPER [where it is] as long as a funding change took place," Ryan Alessi reports for cn|2. "The Senate sprang into action amended the pill bill and leaders from the two chambers worked together to pass legislation before supper time."

Princess Health and Kentucky's pill mill fight makes headlines in Wall Street Journal.Princessiccia

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A man gets arrested at a pain clinic in Lexington.
Photo by Charles Bertram for the Lexington
Herald-Leader.
The Wall Street Journal has featured Kentucky's legislative battle over its pill-mill bill in today's paper, calling the state an "epicenter of abuse."

"Kentucky is ground zero of the effort to move prescription-drug monitoring programs out of the health-care arena into law enforcement," said Even Jenkins, executive director of the West Virginia State Medical Association, a physicians trade group, and a Democratic state senator.

"The Republican-controlled Senate is considering a vote as early as Friday on a bill that would restrict ownership of pain clinics to licensed physicians and give law enforcement easier access to the state's prescription-drug database," writes Timothy W. Martin.

But, he notes, there is strong opposition to the bill from the Kentucky Medical Association, which worries "giving law enforcement oversight of a database with prescription-drug information is a violation of personal privacy."

"You are essentially legislating medical care. We think doctors should write those regulations, not legislatures," said Shawn Jones, president of the KMA. He called the bill an "overreach."

"The struggle over the Kentucky bill highlights the complicated path policy makers and law enforcement are traversing nationwide in their attempts to fight abuse of prescription painkillers," Martin reports. "Unlike importers and dealers of illicit drugs such as cocaine, the supply chain for prescription drugs is made up largely of legitimate businesses and professionals."

Legislative pushes in Ohio, West Virginia, Florida and other states have been met with fierce opposition from physician and pharmacy trade groups, Martin writes.

About 48 states have legislation requiring prescription drug-monitoring programs. That's up by 16 from 10 years ago, but restrictions for who can access the data varies by state, Martin reports. Kentucky law enforcement has complained it cannot access the data in time to single out problem prescribers, which is the reason House Bill 1 would transfer the tracking system from the Cabinet for Health and Family Services to the attorney general's office.

"The data is all there � it's just under a rug," said Attorney General Jack Conway, saying law enforcement cannot know now who are the highest prescribers in the state. Having access to the database would solve that problem, he said. (Read more)

Princess Health and Hospitals get antsy about leasing space to fast-food chains.Princessiccia

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McDonald's has space in the Cleveland Clinic. (AP photo)
While the U.S. Department of Agriculture decides what to suggest about junk food in schools, hospitals are likewise at a crossroads, with many administrators feeling conflicted about housing fast-food chains in their facilities.

At Truman Medical Center in Kansas City, the cafeteria features low-fat meals, on the other side of a wall from a McDonald's. CEO John Bluford said the golden arches send "an inconsistent message" to patients, staff and community because of the unhealthy offerings, but Truman agreed to a 25-year contract with the chain in 1992 "at a time when the financial benefit of having a stable food-service client in the hospital outweighed any potential health concerns," reports Elana Gordon for NPR.

Getting out of these contracts can be tricky. The Cleveland Clinic tried to end its agreement with McDonald's 10 years ago, but the restaurant remains in operation. "We're just going to live with it," said Bill Barum, director of hospitality and retail services. "When the contract ends, we'll have the opportunity to reexamine the space."

Of the 14,000 McDonald's in the country, there are 27 in hospitals, and officials say the restaurant's menu can be tailored to health-conscious diners.

Some hospitals have five fast-food outlets, a survey by the Physicians Committee for Responsible Medicine found. The report's top five "worst hospital environments" housed at least one fast-food restaurant. "In this day and age, you would think a hospital might be proud enough, if not shamed enough, to cut or end these contracts with fast-food outlets," said Susan Levin, a dietitian with PCRM.

But while some hospitals are looking to end fast-food contracts, some are signing them, including the Texas Medical Center's St. Luke's Episcopal Hospital and the Medical University of South Carolina University Hospital, where Chick-fil-A is  open for business. (Read more)

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

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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)

Thursday, 19 April 2012

Princess Health and As U.S. teen birthrate reaches 70-year low, Ky. still 7th highest.Princessiccia

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The teenage birth rate nationwide is the lowest in nearly 70 years, but Kentucky's rate is much higher than the national average � 46.2 births per 1,000 compared to 34.3 across the U.S.

That ranks it seventh highest in the nation, but the figure is down from 53.1 per 1,000 in 2007. Nationwide, the number is down from 61.8 per 1,000 in 1991. "Young people are being more careful," Sarah Brown, CEO of the National Campaign to Prevent Teen and Unplanned Pregnancy, told Sharon Jayson of USA Today.

In 2010, a total of 367,752 infants were born to mothers ages 15 to 19. Mississippi had the highest rate, with 55 teen births per 1,000 and New Hampshire had the lowest with 15.7, according to the National Center for Health Statistics.

Girls who are having sex for the first time are much more likely to use contraception than their predecessors, notes Laura Lindberg, a senior research associate with the non-profit Guttmacher Institute in New York. She credited the lower teen-birth rate to "the elimination of pelvic exams before receiving prescriptions for hormonal methods, as well as use of long-acting methods such as IUDs." (Read more)

Princess Health and Kids needs to cut out an average of 41 calories a day to stop gaining weight.Princessiccia

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Children and teens need to cut their food intake an average of only 41 calories a day in order to stop gaining weight, a new study has found. If they don't do that, they'll end up weighing even more than they do now � four more pounds across the board, say the researchers from  Columbia University, the Harvard School of Public Health and the Robert Wood Johnson Foundation.. (Photo: iStockphoto.com)

Without reducing consumption, more than one in five children will be obese nationwide, researchers concluded. In Kentucky, 37.1 percent of children were overweight or obese in 2007, numbers by theNational Conference of State Legislature show.

While cutting 41 daily calories is significant, that number will only stop children from getting heavier. "The federal government really wants children to be slimmer than they are now," reports Nancy Shute for NPR. In order to lower the childhood obesity rate to just 5 percent, children would have to cut an average of 120 calories a day � 33 calories for preschoolers, 149 calories for grade-schoolers, and 177 calories a day for teens.

In order to do so, teens would have to jog at least 30 minutes per day or cut out a 16-ounce soft drink.

The study's "numbers are based on population averages; individuals' experiences will be different," Shute reports. "But the numbers show that the public health world has a lot of work to do to help children keep or reach a healthy weight."

According to a nutrition chart by the American Heart Association, children should consume an average of 900 calories at age 1 and 1,000 calories at age 2. Girls should consume 1,200 calories a day from ages 4 to 8; 1,600 calories from ages 9 to 13; and 1,800 calories a day from ages 14 to 18. Boys should consume 1,400 calories from ages 4 to 8; 1,800 calories ages 9 to 13; and 2,200 calories ages 14 to 18. (Read more)
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