Community paramedics program could help provide primary-care services, help address state's provider shortage

Next spring, the Kentucky Board of Emergency Medical Services could establish a community paramedics pilot program that has the potential to ease the state's shortage pf primary-care health providers.

The idea was prompted by the likelihood that the state's expansion of the Medicaid program would lead to a shortage of primary-care personnel. It would add community paramedics to a local health care delivery system, reports Chuck Mason of the Bowling Green Daily News.

“We’re in the first stages of looking into this,” Michael Poynter, executive director of the EMS board, told Mason. “Vulnerable populations with new health insurance plans will not have access to a provider because of the increase in demand.” The provider shortage, particularly in rural areas, especially affects those without to transportation, said Poynter.

Under the program, a primary-care partner could refer a patient to EMS personnel to provide services such as fall prevention, blood draws or medication administration, in the patient’s home. The paramedic would provide documentation to the patient’s primary care physician.

The program has the potential to allow paramedics to play a more active role in care delivery, changing the face of emergency medical services, writes Mason. "The big question at this point is how health care providers would receive reimbursement from the government for expenses related to community paramedics and how the concept would integrate into the health care systems already in place in Kentucky," Poynter told Mason.

Some say such a program could reduce overall health care costs, reports Mason. It could even help reduce hospital re-admissions, potentially saving them millions of dollars because federal health reform penalizes them for re-admissions.

EMS personnel "have the training, expertise and scope of practice to provide essential primary care services," Poynter told Mason. He said such programs have been successful in Colorado, Minnesota and Pennsylvania, where paramedics are practicing community medicine after completing a training program.

Kentucky's training could be provided by colleges and universities, Mason writes. Western Kentucky University is exploring coursework for emerging jobs in the health care field. "Patient education, teaching about healthy best practices and health care screening could be some of the roles filled by the community paramedic," Poynter told Mason. "The idea is not to replace home health or physician office visits, but rather to augment the health care." (Read more)

Kentucky among states selected to study, address expensive problem of 'superusers' of emergency rooms

Kentucky is one of a few states teaming up with the National Governors Association to address the expensive problem of uninsured or Medicaid-covered "superusers" who over-use hospital emergency rooms or other costly health services instead of lower-cost alternatives like primary care.

“I’m proud Kentucky has been chosen to participate in this important program,” Gov. Steve Beshear said in a news release. “Across the nation, an understanding has been growing that we must focus our efforts on providing the best in coordinated care, helping to direct individuals who may be using more expensive, less effective services to more cost-efficient preventive services that provide better health outcomes in the long run. It’s by achieving these outcomes that we will build a healthier future for Kentucky.”

Kentucky, Alaska, Colorado, Kentucky, New Mexico, Puerto Rico and West Virginia will participate in a policy academy designed to help them create systems for these "superusers", enabling state officials to confront rising Medicaid expenditures while improving quality of care and health, says an NGA release.

These "superusers," sometimes called "super-utilizers" or "frequent flyers," often go to a hospital or emergency room for recurring health issues that can be treated more effectively and less expensively in other ways. Kentucky Medicaid spent more than $219 million on emergency-room use in 2012, and 4,400 Medicaid recipients used ERs 10 or more times during that year, says Beshear's release.

“There’s a handful of people who drive most of our spending,” Dan Crippen, the executive director of the governors’ association, told Kelsey Miller of Kaiser Health News. While the median ER visit cost $615 in 2009, an office-based visit with a physician cost $361, according to the federal Medical Expenditure Panel Survey.

“Kentucky has too long lagged behind in health rankings, and now is the time for us to begin truly moving the needle in the right direction,” said Cabinet for Health and Family Services Secretary Audrey Tayse Haynes. “By participating in this national effort, we can learn what has worked for other states and share Kentucky’s experiences as well.”

State leaders will first meet as a group with consultants from various health-care sectors, then officials will spend 18 months implementing the plans in their communities, says Miller. Funding for the effort is provided by the Robert Wood Johnson Foundation and the Atlantic Philanthropies.

Eye doctors warn about danger from fireworks, even sparklers; optometrists provide safety tips

The Fourth of July goes hand in glove with firework displays. Most families protect parents and children against the dangers of fireworks, but thousands still visit the emergency room every year, many with eye injuries.

According to a report from the U.S. Consumer Product Safety Commission, about 9,600 people were treated for injuries due to fireworks in U.S. emergency rooms during 2011; it says 17 percent of those injuries were to the eyes, and about 45 percent of those eye injuries involve children age 15 or under. Most eye injuries were bruises, cuts and other diagnoses that included foreign objects in the eye, and one in six fireworks-related eye injuries result in permanent vision loss or blindness, says the American Academy of Opthalmology.

“Celebrating the Fourth of July with fireworks is a great tradition, but safety needs to be the top priority,” Dr. Jon Shrewsbury, an optometrist in Beaver Dam, Ky., said in a Kentucky Optometric Association release.  “Children are especially vulnerable to injury from fireworks, particularly sparklers since they are handled at such close range.”

The innocent-looking sparkler can be very dangerous, especially to children, who are most likely to play with them. They heat up to 2,000 degrees or hotter, and are the primary cause of fireworks-related visits to emergency rooms. In addition to not allowing younger children to play with sparklers or fireworks and ensuring that older children are supervised by an adult when doing so, the KOA offers these tips to help protect and preserve eyesight during firework season:

· Discuss firework safety with children and teens prior to the Fourth of July holiday.
· Never leave them unsupervised near fireworks.
· Wear protective eyewear when lighting and handling fireworks of any kind.
· Store fireworks, matches and lighters in a secure place where children won’t find them.
· Be aware of your surroundings, and only light fireworks when family, friends and children are at a safe distance.

“If a firework-related eye injury does occur, always follow up with a full optometric eye exam,” Shrewsbury said. “An optometrist will help ensure that the injury heals correctly and will continue to monitor for future vision problems.” To find an optometrist in your area, click here.

Harlan doctor tells White House summit about his changeover to electronic health records

Dr. Carl Smith Jr.

Almost a decade ago, Dr. Carl Smith Jr. did something that many health care providers across America are still struggling to do: He implemented electronic health records that can be assessed from anywhere in the United States during an emergency.

Because the process is expensive, and Smith works in rural, isolated Harlan County, he earned a trip to Washington, D.C. for this year's White House Health IT Town Hall meeting. The assembly was gathered to discuss progress and barriers on the road toward a national health IT system, reports Nola Sizemore of the Harlan Daily Enterprise.

At the meeting, senior White House officials and Department of Health and Human Services staff asked him about how he was able to accomplish the change from paper records. Smith, a pediatrician, explained how the system works: “Because of this technology, we can send the patient’s prescription electronically by secure email to pharmacies. We can check medical histories, what diseases or medical conditions are trending in the area, and I can voice activate details of the patient’s visit into their record. We can also give patients clinical summaries when they leave our office. We have proved to national governing bodies we can and are doing this.”

Smith added that with the use of electronic records, doctors will be able to access your medical history to see what medications you take, allergies and other pertinent information about your health should you be in an auto accident or suffer injury anywhere in the United States. He said this will especially be helpful if the patient were unable to provide information.(Read more)

Cardiologist: Kentucky needs better way to get heart attack patients to dedicated catheterization centers in time

Because cardiovascular disease kills more Kentuckians than anything else, and because what mostly kills them is a heart attack, and because if you can get help within 90 minutes of that heart attack your chances improve dramatically, this state needs a vastly improved way to get heart attack patients to the right hospital in a short amount of time. So explains Dr. William Dillon, an interventional cardiologist in Louisville, who writes an guest column in the In The Prime health blog of The Courier-Journal. He punctuates his point with a graph, right, that shows that Kentucky now ranks 49th of 50 states in acute myocardial infarction (AMI) deaths. AMI is doctor-speak for heart attacks. (American Heart Association graph)

Dillon's medically reasoned plea is for a more systematic regional network -- like one that have saved lives in North Carolina -- is "to transfer AMI patients to dedicated (heart catheterization lab) centers throughout the state." But Dillon also knows that many Kentuckians are not listening to their bodies as closely as they might. He writes that "another source of delay in AMI treatment is that, on average, patients wait more than 90 minutes before seeking medical attention. Furthermore, 50 percent of AMI patients drive to a hospital or clinic without calling EMS. Every year, a significant number of these patients needlessly die en route to the hospital." He adds then that health education -- in this case, early notification of needing EMS help -- is an important component in saving Kentuckians' lives. (Read more)

Statewide trauma system established; called 'most significant advancement in health of Kentuckians for the last 20 years'

Dr. Andrew Bernard, chair,
State Trauma Advisory Committee

Ten Kentucky hospitals have been recognized as part of the state's first official statewide trauma system. The announcement came during the 2012 Statewide Trauma and Emergency Medicine Symposium Friday in Lexington. Dr. Andrew Bernard, a University of Kentucky trauma surgeon and chair of the State Trauma Advisory Committee, called this "the most significant advancement in the health of Kentuckians in the last 20 years and lives will be saved because of it."

More than half of the states have such systems.  "The goal of the state trauma system is getting the right patient to the right place at the right time," said Bernard, explaining that the system provides education so that proper assessment can be made of severely injured patients, so that they are taken to the most appropriate facility as quickly as possible.

Trauma centers are graded I through IV, with Level I hospitals able to treat the most severely injured and most at risk.  Level I trauma centers are UK Chandler Hospital (Lexington), Kentucky Children's Hospital (Lexington), Kosair Children's Hospital (Louisville), and University of Louisville Hospital.  Level III  are Ephraim McDowell Regional Medical Center (Danville) and Taylor Regional Medical Center (Campbellsville). Level IV are Ephraim McDowell Fort Logan Hospital (Stanford), James B. Haggin Memorial Hospital (Harrodsburg), Livingston Hospital (Salem) and Marcum & Wallace Hospital (Irvine).

Volunteer emergency medical squads becoming less numerous

Belfry Fire and EMS responds to an accident.
(Rachel Dove-Baldwin, Williamson Daily News)

Volunteer emergency medical service squads appear to be dying out around the nation as rural populations change and EMS evolves, and Kentucky is no exception.

Volunteer squads have long been the sole emergency responders in many rural areas, reports Candi Helseth of the health-oriented Rural Assistance Center, but according to a 2010 study, "Rural Volunteer EMS: Reports from the Field," 69 percent of 49 local EMS directors in 23 states reported problems recruiting and retaining volunteers.

The North Carolina Rural Health Research and Policy Analysis Center study reported three main reasons for loss of EMS volunteers: high numbers of retirees or elderly in rural areas are unlikely to have physical strength required for EMS, many working-age individuals leave rural areas to find jobs elsewhere, and volunteers have too many obligations to cover weekends. Almost three-quarters of the all-volunteer EMS agencies hosted fundraising events to get necessary funding, requiring further time commitments. (Read more)

Volunteer fire departments have reported similar problems, but volunteer firefighters are called out less often and often receive stipends for attending meetings and training, said Michael Poynter, executive director of the Kentucky Board of Emergency Medical Services. He told Kentucky Health News that that state is part of the national trend away from volunteer EMTs, but still has 17 services that are fully volunteer and 35 that use a mixture of paid EMTs and volunteers. Kentucky has more than 250 licensed emergency medical services.

New law will allow officers to make arrests in emergency-room assaults that they do not witness

Emergency-room workers who treat individuals under the influence of drugs or alcohol will have greater legal protection, and those who misbehave in ERs will have less protection, under a law that will take effect next month.

The measure, sponsored by Sen. John Schickel, R-Union, will allow peace officers to make an arrest or issue a citation for a fourth-degree assault that occurs in a hospital emergency room, even if the officer didn’t witness the crime, as long as the officer has probable cause to believe the offense occurred.

“Hospital emergency personnel treat individuals in the worst of conditions – and sometimes that means putting themselves at risk, if a patient comes in intoxicated or high,” Gov. Steve Beshear said at a ceremonial signing of the bill today.  “This law gives medical staff the security of knowing that an offender will be held accountable for an assault that takes place when they’re brought in for care.”

Under current law, a hospital worker has to swear out a warrant alleging assault. Fourth-degree assault is a Class A misdemeanor, punishable by up to a year in jail.

Medicaid recipients displaced by tornadoes can get emergency 30-day refills of prescriptions

Kentuckians on Medicaid who were displaced by last week's storms can get a 30-day supply of needed medicine from their pharmacy, the Department of Medicaid Services announced yesterday.

The right to receive an emergency refill applies to residents living in Ballard, Bath, Carroll, Campbell, Grant, Grayson, Hardin, Johnson, Kenton, Laurel, Lawrence, McCracken, Magoffin, Martin, Menifee, Montgomery, Morgan, Muhlenberg, Ohio, Owsley, Pendleton, Rowan, Russell and Trimble counties. Those counties have declared a state of emergency.

The state's four managed-care organizations are informing pharmacies of the policy, which was part of an executive order signed by Gov. Steve Beshear last weekend. Medicaid recipients who are not enrolled with an MCO can also receive replacement medications at their pharmacy. Co-payments will be waived.

"Many Kentuckians depend on regular maintenance medications, like blood pressure pills, and skipping a few days could cause unnecessary hardship or possible poor health outcomes for some citizens," Beshear said. "This order will allow people to contact a pharmacist to restore their regular medications." (Read more)

Rural emergency rooms frequented by the poor and uninsured

A new report from the federal Agency for Healthcare Research and Quality shows that low-income adults accounted for 56 percent of the 8 million rural emergency room visits in 2008. In nonrural hospitals, low-income adults accounted for only 30 percent of emergency room visits. According to the report, 44 percent of adult visits to rural emergency departments were paid for by Medicaid, were uncompensated, or billed to uninsured patients. Only 31 percent were paid for by private health plans. In nonrural hospitals, 37 percent of adult visits were paid for by private health plans, and 42 percent were paid for by Medicaid, uncompensated or billed to uninsured patients.

Emergency business is mainly just that for rural hospitals. Only 8.3 percent of rural emergency department visits resulted in a hospital admission, compared to 16 percent of non-rural emergency department visits.

The report also noted the lack of rural hospitals with trauma-level emergency departments. Nationally, only 2.4 of rural emergency departments held any level of trauma designation. Among non-rural emergency departments, 35.5 percent had a trauma designation. Read more here.

In Kentucky, approximately 75 of the state's 130 hospitals are in rural areas, according to the Kentucky Hospital Association. The state has been working to improve its trauma system and will soon begin designating level IV trauma centers in some of the state's smallest hospitals, said Dick Bartlett, emergency preparedness and trauma coordinator for the Kentucky Hospital Association. Already, Marcum & Wallace in Irvine and Livingston Hospital in have met requirements for the designation and will be certified, once the state approves the new level IV designation. (The national report focused on levels I-III; in Kentucky, level I-III are certified by the American College of Surgeons.)

The new designation is part of an effort by Kentucky to improve trauma care statewide. Having a level IV trauma center means better trauma care for Kentuckians injured in rural areas, Bartlett said. "It improves your potential for survival," he said. These hospitals have committed to providing certain levels of staffing, including a board-certified emergency room physician, and to following protocols to quickly decide whether a patient can be treated at their facility or if a patient should be transported to another, higher-level facility.

A map showing Kentucky's current trauma hospitals and those hospitals seeking trauma certification is available here.

Ambulance providers raising fees to deal with rising costs

Ambulance services are being forced to raise their fees in order to pay the bills, USA Today's Greg Latshaw reports. "Ambulance providers nationwide are coping with rising costs, decreased support from local government, low Medicare reimbursement rates and a jump in the number of uninsured Americans," Stephen Williamson, president of the American Ambulance Association, told Latshaw.

Medicare reimbursement rates were between 6 and 17 percent below cost, a 2007 report by the Government Accountability Office showed. Since, that gap has grown even wider. Moreover, in the past 18 to 24 months, far more people are using ambulance services who don't have health insurance. "We're having to raise the rate on everyone else because of the people who don't have insurance," said Steve Weigland, director of servicing for the International Association of EMTs and Paramedics. (Read more)