Princess Health and With crackdown on pill abuse, will legitimate patients be able to get the prescriptions they need?.Princessiccia

Princess Health and With crackdown on pill abuse, will legitimate patients be able to get the prescriptions they need?.Princessiccia

pain clinics pain management pill mills prescription drug abuse prescription drugs

Gusty 11:23 Add Comment

The crackdown on prescription-pill abuse has some patients worried they won't be able to get the medicine they need because doctors are fearful of over-prescribing. "It's a huge concern in a nation where chronic pain afflicts 116 million American adults and is associated with up to $635 billion in health care costs," reports Laura Ungar in an ongoing series for The Courier-Journal.

"Pain patients feel ashamed or weak that they have to take these medications ... (and) shy away from being treated," said Dr. James Murphy, a pain specialist in Louisville. 

But there is little evidence that pain patients who really need medicine are unable to find treatment. Ungar reports: "It may take longer for them to find a doctor, experts said, and they may be subjected to urine tests and pill counts to ensure they're not abusing their medicines. But most eventually are able to get the medication they need."

"I don't see any decrease in the amount of opioid prescribing in any jurisdiction," Dr. Nathaniel Katz, president and chief executive officer of the Masschusetts-based consulting firm Analgesic Solutions, told Ungar. "So it's difficult to justify a position that legitimate opioid prescribing is being chilled."

Some worry that making physicians use the state's prescription drug monitoring system � commonly known as KASPER � for new patients could create that chilling effect. A survey of controlled-substance prescribers made to use KASPER found about half didn't change their prescribing habits and about 13 percent said they actually prescribed more opioids. But 35 percent, or 190 prescribers, said they had decreased the amount of controlled substance they subscribed because of "media coverage of abuse, increased law enforcement activity related to prescription-drug abuse and fear of investigations by law enforcement or the medical board," Ungar reports.

Some are concerned that "if more doctors make that choice, desperate pain patients may feel forced to seek relief at unscrupulous pain clinics," Ungar reports. (Read more)

Princess Health and Couple shares 'horrible journey' of prescription drug abuse.Princessiccia

Princess Health and Couple shares 'horrible journey' of prescription drug abuse.Princessiccia

health journalism newspapers pain management pill mills prescription drug abuse prescription drugs

Gusty 08:20 Add Comment

Recovering pill addict Stacy Pennington
of Ashland is due to give birth next month.
(Courier-Journal photo by Matt Stone)

Stacy and James Pennington had to lose everything, including their children and home, before they were able to face their prescription drug abuse problem. Now in recovery at The Healing Place in Louisville, they spoke to The Courier-Journal's Laura Ungar of their downward spiral.

"It had gotten to the point where my prescription drugs were my everything. As long as I had them, I was OK," said James, 40, of Ashland. "Before, we had everything we could want. In the end, we were just feeding an addiction. We had lost everything."

Stacy Pennington said she took her first painkillers in 2002 after she cut her finger on a glass candle jar and needed two surgeries. "A year later, she was diagnosed with cervical cancer, then severe endometriosis, and she required several more surgeries," Ungar reports. "Each of her 14 operations brought another prescription for pain pills."

James Pennington took prescription drugs for the first time at age 14 after he dislocated his shoulder. After he broke his shoulder in a motorcycle accident when he was 25, he got a 30-day supply for Percocet and, later, was prescribed more of the drug after a knee injury. "Pain medications became my drug of choice from there on out," he said.

Soon, he was traveling to "pill mills" in Florida to fuel his addiction, pills he sold and shared with his wife. When Stacy gave birth to their daughter, she was heavily addicted and eventually lost custody of her. James' older daughter was also taken from the home. 

Before Stacy Pennington checked in to The Healing Place, she had sold her engagement ring, the Penningtons sold their home before they lost it, and they were spending $100 to $500 a day to feed their addiction. Now, Stacy is expecting another child and the couple is fighting for their sobriety. "It's a horrible journey. I had to absolutely lose everything. But I see that as a blessing," said James Pennington. "I'm so glad I'm on the other side today." (Read more)

Princess Health and Louisville has highest concentration of nursing-home and extended-care companies in U.S..Princessiccia

Princess Health and Louisville has highest concentration of nursing-home and extended-care companies in U.S..Princessiccia

elderly long-term care nursing homes

Gusty 06:53 Add Comment

Louisville has the largest concentration of nursing-home and extended-care companies in the country. Of the 570,000 people who call Louisville home, 4,000 work in the industry and produce $28 billion in revenue, reports Frank Browning for Kaiser Health News. (Kaiser photo illustration)

Though the city didn't intend to become the leader in the long-term care industry, companies opted to cluster around each other, with Humana the nucleus of the movement. "As its influence grew, the health insurance giant created spinoffs and attracted like-minded businesses, including a growing number of companies dealing with long-term care," Browning writes, without noting that Humana itself began as a nursing-home company, Extendicare, then evolved into a hospital firm and an insurance company.

There are seven key players in theindustry who have headquarters in the city: Kindred Healthcare, Trilogy Health Services, Atria Senior Living Group, Elmcroft Senior Living, ResCare, and Signature Health Care. Those companies then attracted firms such as RecoverCare and PharMerica. "It's been an evolution," Christian Furman, a gerontologist at the University of Louisville medical school, told Browning.

One of the key moves was attracting Signature, which has 73 long-term care facilities in seven states, from Florida to Kentucky. A promise of up to $4 million of corporate income tax credits in 10 years helped, but "access to talent was most important. There's an incredible amount of expertise here," said CEO Joe Steier.

The clincher was "the whole alignment of public and private support, including the University of Louisville, that has made the city into a national and international center for aging care companies," Steier said. (Read more)

Princess Health and Coventry, ARH at impasse over Medicaid; state says service will not be interrupted for 25,000 affected.Princessiccia

Princess Health and Coventry, ARH at impasse over Medicaid; state says service will not be interrupted for 25,000 affected.Princessiccia

managed care Medicaid state government

Gusty 07:42 Add Comment

Though negotiations between Appalachian Regional Healthcare and Coventry Cares appear to be futile, the state is taking steps to make sure there won't be an interruption in care for the Medicaid recipients who will be affected by the impasse.

"The cabinet will assure the judge that, in the event that a notice is received from Coventry that ARH will not be in their network as of July 1, members will be able to call the Department for Medicaid Services to switch" to another managed-care organization, said Jill Midkiff, spokeswoman for the Cabinet for Health and Family Services.

Coventry Cares is one of four companies chosen by the state to provide care to Medicaid recipients. The move to managed care � intended to save money � has been rocky, with providers complaining about delayed payments from the companies and cumbersome pre-approval processes for treatments. ARH sued Coventry, and another managed-care company, saying they owed the hospital chain more than $18 million for services. But Coventry says the state allowed another managed care company not to include ARH in its network, which means a lot of higher-risk, higher-cost patients covered by Coventry.

ARH operates eight hospitals and health clinics in Eastern Kentucky and serves 25,000 Medicaid patients, reports Valarie Honeycutt Spears for the Lexington Herald-Leader. Coventry agreed to extend its contract with ARH until June 30, but will likely not extend it again. A Coventry document filed in court last week says "it appears unlikely that these differences can be bridged." (Read more)

Princess Health and Improvements to Rx monitoring systems worth the expense, study finds; using systems influence doctors' prescribing decisions.Princessiccia

Princess Health and Improvements to Rx monitoring systems worth the expense, study finds; using systems influence doctors' prescribing decisions.Princessiccia

pain clinics pain management pill mills prescription drug abuse state government

Gusty 07:22 Add Comment

A plan for an ideal prescription drug monitoring system was published today in the New England Journal of Medicine, with its authors concluding spending more money to improve systems is worth the expense.

To improve databases, the paper's authors recommended "standardization of the type of information submitted to the databases, and a move toward the use of bar-coded prescription paper to more quickly log entries, or a robust e-prescribing system that would eliminate paper and the resulting prescription fraud and 'doctor shopping' that contributes to illicit use of these controlled substances," reports research-reporting service Newswise. (Read more)

Forty-three states, including Kentucky, now have databases to monitor prescriptions for pain relievers and another five states have passed laws to create them, reports Mary Wisniewski for Reuters. Part of the reason for the push is prescription drug abuse is an increasingly big problem, with more people dying from prescription drug overdoses each year than cocaine and heroin combined. Kentucky is a hot spot, with nearly 1,000 people dying from prescription drug overdoses in 2010.

On July 12, a new law will take effect in Kentucky that will make it mandatory for a physician to consult the state drug-monitoring system before writing a prescription for certain drugs for a new patient. Doing so can influence how a doctor chooses to prescribe. A study by the emergency department of the University of Toledo's College of Medicine found "doctors or pharmacists who reviewed state prescription data changed how they managed cases 41 percent of the time," Wisniewski reports

The study found 61 percent of prescribed either no opioid medicine, or less than originally planned, while 39 percent decided to prescribe more. (Read more)

Princess Health and Significant management improvements at Passport Health Plan, audit finds.Princessiccia

Princess Health and Significant management improvements at Passport Health Plan, audit finds.Princessiccia

audits managed care Medicaid

Gusty 16:59 Add Comment

Passport Health Plan has improved significantly since a 2010 audit uncovered wasteful spending and other problems, a new audit has concluded.

The managed care organization that cares for Medicaid recipients in Jefferson and 15 surrounding counties "has made significant improvements in accountability and financial record-keeping," a press release from Audrey Tayse Haynes, the new secretary of the Cabinet for Health and Family Services. "Patient satisfaction with the health care provider remains high," she states.

"The audit is a follow-up to former State Auditor Crit Luallen's scathing report of November 2010 in which Luallen found lavish spending by Passport's former executives on travel, meals and other expenses," reports Tom Loftus for The Courier-Journal. "It also questioned transfers of about $30 million of reserve funds to the major health-care organizations represented on Passport's board of directors."

Gov. Steve Beshear ordered a plan to correct the problem, which involved replacing Passport's executives, among other changes. Though there has been improvement, "after having exclusive rights to the region for about 14 years, Passport will have to bid against other managed care organizations if it wants to be among those that will serve it in 2013," Loftus reports.

Still, since the state has switched to managed care for the rest of the state and severe problems have surfaced with the three companies that have been hired to serve those recipients, Passport's reputation has improved substantially. State Auditor Adam Edelen said in February the state was unprepared for the quick transition to managed care in the rest of the state. (Read more)

Princess Health and Task force to consider middle-school sports regulation.Princessiccia

Princess Health and Task force to consider middle-school sports regulation.Princessiccia

General Assembly legislature school health sports safety

Gusty 08:14 Add Comment

A task force made up of legislators, educators and athletic officials will examine what guidelines should be in place for sports at the middle school level, which are not regulated in Kentucky.

The task force was created by the 2012 General Assembly to "discuss 'best practice' guidelines for middle school sports and to take into consideration non-profit organizations that oversee some individual teams," reports Valarie Honeycutt Spears for the Lexington Herald-Leader.

"It remains to be seen" what the task force could recommend, Rep. Bob Damron, D-Nicholasville, told Spears. But Damron, who sponsored the resolution creating the task force, said "in the long run that's probably a good direction to have one entity standing for middle school athletics."

The Legislative Research Commission will name task force members by Aug. 1. Recommendations to legislative committees are expected by Dec. 7. (Read more)