Princess Health and Kentuckians tell pollsters they are concerned about air quality, but don't seem to put their concern into action.Princessiccia

Princess Health and Kentuckians tell pollsters they are concerned about air quality, but don't seem to put their concern into action.Princessiccia

air pollution Foundation for a Healthy Kentucky poll public health

Gusty 14:08 Add Comment

A recent poll shows that more than half of Kentucky adults, especially women, are concerned about air quality in their community, but only 48 percent say they change their behavior when an air quality alert is issued.

Perhaps they have never heard of an air quality alert, which is issued by a local or state air-pollution authority to protect the public's health from air pollution. The U.S. Environmental Protection Agency monitors air quality and uses an Air Quality Index to warn the public when the amount of particle pollution or ozone in the air may harm their health.
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When pollution gets to a level of concern, alerts or action days are issued in participating areas, which in Kentucky are Louisville, Lexington and the Mammoth Cave area (primarily Edmonson County). This could explain why almost 30 percent of poll respondents from Louisville said they were very concerned about air quality in their community, and only 13 percent of respondents from Appalachia indicated this level of concern.

Almost 60 percent of Appalachians said they are not concerned at all about the air quality in their community, compared to 26 percent of Louisville respondents that aren't at all concerned. Few Eastern Kentucky counties are part of an air-quality monitoring program. In addition to the areas monitoring for alerts or action days, 37 Kentucky counties (colored in the map) participate in the monitoring program. Click here to compare counties.?

Counties covered by an air-quality monitoring program are colored.

The poll indicated that just 20 percent of Kentucky adults said they change or limit their activities a lot when air quality alerts are issued, and about 30 percent said they change their behavior a little.  Respondents from the Louisville region were most likely to change or limit their activities, while those in the Lexington area were the most likely to not change or limit their behavior at all. 

When air quality is at an unhealthy level, people can protect themselves by limiting outdoor activities or avoiding heavy exertion.  These protective measures are even more important for those sensitive to air pollution, such as people with heart or lung disease, the elderly and children.

�The quality of our air impacts all of us, but is particularly important for sensitive groups, such as children with asthma. When an air quality alert is issued, we can protect ourselves and our families by avoiding heavy exertion and limiting outdoor activities,� said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll. �We can also do our part to limit emissions and protect our neighbors by turning off our car�s engine while we are waiting.� 

Almost 30 percent of Kentucky adults and 40 percent of Western Kentucky adults said they never turn their car�s engine off when waiting in their car and not moving, as in a traffic jam, train crossing or drive-through. Including those who never turn off their cars, more 60 percent said they wait at least four minutes before turning off their car�s engine when waiting in the car and not moving. Experts recommend turning off a waiting car�s engine after just ten seconds in order to save gas and limit emissions.

The poll was funded by the foundation and the Health Foundation of Greater Cincinnati and was conducted last year from Sept. 20 to Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults from throughout Kentucky was interviewed by telephone, including landlines and cell phones and the poll has a margin of error of plus or minus 2.5 percentage points.

Princess Health and Public Health Week theme: It's a good investment, saving lives and money.Princessiccia

Princess Health and Public Health Week theme: It's a good investment, saving lives and money.Princessiccia

health departments public health

Gusty 13:15 Add Comment

April 1-7 is National Public Health Week, and the Kentucky Department for Public Health is working to raise awareness and help people live longer, healthier lives by promoting the 2013 week's theme: the return on investment of public-health services.

Everyone likes sound, stable and high-return investments, and research shows that investing just $10 per person each year in proven, community-based public health efforts can save the nation more than $16 billion within five years. That�s a $5.60 return for every $1 invested.

�Our nation and community simply cannot sustain the current trajectory of health care spending and chronic disease Dr. Stephanie Mayfield, the state health commissioner, said in a Cabinet for Health and Family Services release. �Fortunately, we know that investing in prevention and public health can make an enormous difference and it�s the right direction for Kentucky to move in to address poor health outcomes.�

Supporting public health approaches to better health outcomes does reap life-saving returns, said Mayfield. For example, research shows that each 10 percent increase in local public health spending contributes to a nearly 7 percent decrease in infant deaths, a 3.2 percent decrease in cardiovascular deaths and a 1.4 percent decrease in diabetes-related deaths.

�In some way, public health touches everyone, every day in Kentucky. We are dedicated to making our infrastructure even stronger, including ongoing work to become nationally accredited in 2014, finding opportunities for improvement within our programs, and focusing on overall prevention for the health and well-being of Kentuckians,� said Mayfield.

Since 1995, communities nationwide have celebrated National Public Health Week each April to draw attention to the need to help protect and improve the nation�s health and to educate the public, policymakers and practitioners.

�We hope this week will serve as an opportunity for the public to learn more about the vital role of public health in Kentucky,� said Mayfield. (Click to learn more about the Kentucky Department for Public Health or National Public Health Week)

Princess Health and Food Reward Friday. Princessiccia

Princess Health and Food Reward Friday. Princessiccia

Food reward Fridays

Gusty 03:00 Add Comment

This week's "lucky" winner... milkshakes!

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Princess Health and Will Kentucky expand Medicaid, and if so, how?.Princessiccia

Princess Health and Will Kentucky expand Medicaid, and if so, how?.Princessiccia

Affordable Care Act governor health insurance insurance managed care Medicaid poverty

Gusty 11:30 Add Comment

By Molly Burchett
Kentucky Health News

Kentucky is one of the last states to decide whether to expand Medicaid under federal health reform, and now that the General Assembly has gone home, Democratic Gov. Steve Beshear can turn his attention to the many questions that linger. Some Republican legislators think he will expand the program, but they worry about the cost when the state would have to start helping cover the new expenses, beginning in 2017.

Republican Gov. Bill Haslam of Tennessee decided Wednesday that he will not pursue Medicaid expansion, saying that it could put hospitals in financial jeopardy by giving them more patients on which they lose money, reports Michelle Kaske of Bloomberg. If he is right and the same logic applies to Kentucky, Medicaid expansion in the state could harm the rural hospitals and providers -- some of whom are already squeezed by the issues with the new managed-care system.

Along with Kentucky, 10 other states are undecided about Medicaid expansion: Alaska, Indiana, Kansas, Nebraska, New York, Oregon, Utah, Virginia, West Virginia and Wyoming. The map by The Advisory Board Company shows the lay of the land; for an interactive picture that outlines the research behind the map, click here.?????

Red=Not participating; Pink=Leaning toward not participating;
Gray=Undecided; Blue=Participating; Light Blue=Leaning toward participating

Only three states with Democratic governors are undecided; 18 Republican governors have rejected expansion. Kentucky is shown as leaning for it because Beshear has repeatedly said that he will expand Medicaid if the state can afford it. He has also mentioned that the state can reserve the right to pull out of the deal in 2017, when it must paying 3 percent of the cost of covering the newly insured, reaching 10 percent in 2020. Still, the questions about cost and affordability remain, and Beshear could be considering another option.

Tennessee has joined Ohio and Arkansas in negotiating with the Obama administration over plans to use federal Medicaid money to purchase private insurance for those who can't afford it but don't qualify for Medicaid now. However, Haslam's plan has been held up because the administration placed too many conditions on the money, writes Kaske. Republicans in other states, including Florida, Louisiana, Pennsylvania and Texas, have expressed interest in this option since Gov. Mike Beebe of Arkansas, a Democrat, ignited the wildfire of creating a hybrid of the two alternatives, reports Robert Pear of The New York Times.

The idea of privatizing Medicaid expansion appeals to many doctors and hospitals because they typically receive higher payments from commercial insurance than from Medicaid. However, many Kentucky hospitals and providers are concerned about the managed-care program that is run by three private organizations, and are calling for immediate action. Beshear has not said whether he will sign or veto a bill that would subject the managed-care firms to the prompt-payments and dispute-resolution rules of the state Department of Insurance.

"Action is needed to address the problems that patients and hospitals are experiencing with Medicaid managed care and to make the system work properly," wrote Harold "Bud" Warman, chair of the Kentucky Hospital Association, and Charles Lovell, chair-elect of the association, in a recent Herald-Leader article that laid out the various problems with the system. "And with the possibility that Medicaid will be expanded in Kentucky to include an additional 350,000 people, it is critical that these issues be addressed right away to avoid even greater problems in the future."

Either using federal dollars to buy private insurance in order to cover newly qualified individuals (the hybrid plan) under the health law's expansion  or expanding in the "traditional" way will not change the current managed care structure of Medicaid in Kentucky. Yet, it would mean that 350,000 more Kentuckians would be covered under managed care; Medicaid would cover those earning up to 138 percent of the federal poverty level, currently up to $15,856 a year for an individual.

The money that the federal government offers for expansion is very tempting. The question then may be, how will it be used?

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

Princess Health and Senate sends bill for prompt payment by managed-care firms to Beshear, who won't say whether he will sign or veto it.Princessiccia

Princess Health and Senate sends bill for prompt payment by managed-care firms to Beshear, who won't say whether he will sign or veto it.Princessiccia

General Assembly governor health insurance legislature managed care Medicaid mental health state government

Gusty 14:15 Add Comment

A bill aimed at resolving payment disputes between medical providers and Medicaid managed-care companies passed unanimously Monday in the Senate, and has been sent to Gov. Steve Beshear for his consideration.

House Bill 5, sponsored by House Speaker Greg Stumbo, D-Prestonsburg, would apply existing prompt-payment laws to managed-care firms and would set up an appeal process in the Department of Insurance to handle disputes between them and medical providers. Those claims are now handled by the Cabinet for Health and Family Services, which administers Medicaid and has had some problems with the bill.

Hospitals, doctors and other health-care providers have complained that the cabinet is not resolving their payment disputes with managed-care firms, putting many rural hospitals, clinics and health departments in serious financial binds.  Mental health centers have also reported cutting back services.

Asked last night what he would do with the bill, Beshear said the cabinet "has worked with the managed-care organizations and health-care providers to reduce problems during the change, and many concerns have been addressed.  However, I recognize that some issues persist.  I will review this bill carefully.�

Beshear has 10 days, excluding Sundays, to decide whether to veto the bill, sign it into law or allow it to become law without his signature. Stumbo said that if bill is vetoed it would likely be House Bill 1 in the 2014 session, reports Jessie Halladay of The Courier-Journal. The bill is a top priority for many health-care providers.

Princess Health and State Auditor Edelen says state must fix managed-care issues that have put rural hospitals and providers on brink of survival.Princessiccia

Princess Health and State Auditor Edelen says state must fix managed-care issues that have put rural hospitals and providers on brink of survival.Princessiccia

health care access hospitals managed care Medicaid rural health state government

Gusty 19:52 Add Comment

State Auditor Adam Edelen said last week that shoring up the financial base for rural hospitals in Kentucky is the number one challenge to the state's Medicaid managed-care system.

The managed-care system has left rural hospitals at a tipping point that determines whether or not they will survive, which is deeply disconcerting when considering access to quality health care for Kentuckians in rural areas, Edelen said in a cn|2 "Pure Politics" interview. The state has a significant rural population, and "you can't overstate the importance of these rural hospitals," he said.

Hiring private companies to manage Medicaid has helped Kentucky slow cost increases in the $6 billion program, but the system has serious structural issues, and hospitals, doctors, dentists and other providers say the managed-care organizations (MCOs) are not paying them for treating Medicaid patients, Jacqueline Pitts of cn|2 reported.

There are many stories "about providers who have submitted claims and all of sudden, these MCOs change the rules, and so these claims are deemed unclear or improper and they are sent back," House Speaker Greg Stumbo said.

Edelen said the problem is that there is no consistent oversight in the claims process from the cabinet, and there is no opportunity for the provider to respond. "Right now we have our providers up against such a wall that the choice is to do one of two things," he said. "It's either to opt out of Medicaid, which is not something we want to do considering we have one of the largest percentage of population on Medicaid anywhere in the country, or go to the courts," which is inefficient and expensive.

�You have good people in the cabinet trying to manage it, you�ve got providers that are just trying to provide services to people, but we�ve got to have a better system of oversight and accountability because if that happen and we begin to lose hospitals in rural Kentucky then we have significantly reduced the level of quality of life for the people of Kentucky,� Edelen said.

Fixing the system for those hospitals and doctors is what is so important to the state as a whole, he said. He said the state and MCOs have had enough time to work out glitches with doctors and hospitals, and they must make some substantial changes before medical care for Kentucky�s neediest suffers any more.

Princess Health and Managed care, pension payments causing problems for community mental health centers; Edelen, C-J call for changes.Princessiccia

Princess Health and Managed care, pension payments causing problems for community mental health centers; Edelen, C-J call for changes.Princessiccia

community health centers health care managed care Medicaid mental health mental illness

Gusty 19:33 Add Comment

"Kentucky mental health centers are cutting back services and struggling to assist patients the first time they�re admitted because of ongoing struggles with Medicaid managed care," Don Weber reports for cn|2. "At the same time, they�re losing out on federal grants because of red flags caused by their administration costs being inflated by increasing contributions to the public pension system."

NorthKey Community Care Mental Health Center in Northern Kentucky, which serves eight counties, had to close its adult day-treatment programs for the seriously mentally ill. Dr. Owen Nichols, the president and CEO, told Weber, �I get calls periodically from elderly parents in the community wanting help with their adult child that suffers from schizophrenia because they�re now wandering the streets, having some difficulties with local authorities.�

A recent editorial in The Courier-Journal addresses Kentucky's need for better mental health treatment, saying that Kentucky has "an underfunded, fragmented and now �thanks mostly to Medicaid managed care �hopelessly complicated system of mental health care."

The editorial notes last week's C-J articles in which reporters Laura Ungar and Chris Kenning uncovered the problems families face when navigating a fragmented mental-health system while trying to provide appropriate treatment for a loved one suffering form a severe mental illness, in addition to the "F" grade Kentucky received for its poor mental-health funding.

The editorial also describes how structural issues with managed care, which began in November 2011, have complicated the state's mental-health system. It notes the community mental-health centers asked to be left out of managed care, "pointing out they already operate efficiently and amount to only about 3 percent of the state�s $6 billion a year Medicaid program."

In addition, the editorial notes, "State Auditor Adam Edelen recommended the Cabinet for Health and Family Services take mental health out of managed care and let the state resume running it." Against his advice and the requests of community mental-health centers, the state expanded managed care of mental health. Now some haven�t been paid for Medicaid services since January, when managed care took effect, the editorial says.

"The nightmare needs to end for the many Kentuckians who need basic mental health services," says the editorial. "It�s time for the state to fully explore this system and, if folks are serious about improving it, fix the problems and find the money to fund it." (Read more)