Health reform should make Medicaid and Medicare more interested in preventing chronic diseases in young, expert says

Dr. Wayne Myers

While some rural areas may not have enough doctors (or those who accept Medicaid patients) to treat new patients generated by federal health reform, the key to healthy living is more education, not more physicians, rural medical expert Dr. Wayne Myers opines in The Rural Monitor. As an example, Myers points to Hazard and Perry County, where he once worked. The Appalachian county leads the nation in shortest average life span for women (72.65 years) and is third shortest for men (66.52 years) despite having an abundance of doctors and health facilities. The reason, Myers says, is bad habits that lead to unhealthy lives, something no amount of medical attention can cure.

"In Perry County, as in much of America, medical care is losing to unhealthy behavior," Myers writes. "Clinicians aren’t trained, nor is our clinical system structured, to accomplish changes in long-term cultural behavior, or to respond to the needs of groups of people. Certainly the 15-to-20-minute acute-care visit is a poor situation to try to work with a person on diet, level of activity, his/her addictions. We can’t modify family and social patterns with tools developed to treat strep throat, sprained ankles or breast cancer."

Myers, who headed the federal and Kentucky rural-health offices, said the solution is education at the local level, with "a lot more health educators, community health nurses and nutrition educators" that are trained within the community. Areas with community colleges can build partnerships with schools to receive training, he suggests. His hope is that the Patient Protection and Affordable Care Act will provide the resources and motivation necessary to bring about changes.

As the law generates enrollees, the Center for Medicare and Medicaid Services’ "book of business will shift from old people on Medicare toward younger people on Medicaid," he writes. "When the main business of CMS was Medicare, the rational business strategy was to seek the most economical quality care for those with only a few years to live. As the business shifts toward Medicaid and subsidized private insurance customers, the rational business strategy for CMS shifts toward preventing chronic disease. From an insurer’s point of view, a 70-year-old obese hypertensive diabetic is a self-limited problem. She’ll die soon. A 30-year-old with the same diagnoses will be a very long-term financial drain.  It will be good business for CMS to keep their 'covered lives' healthy."

This, he said, is kind of forward thinking we need to ensure young Americans get healthy. "We need new approaches to keeping people healthy, instead of trying to heal them after they get sick," Myers writes. "Clinicians can’t change the way people live and raise their kids, even if some of the choices the parents make turn out to be pretty dangerous for the kids. These are sensitive life and death issues. We need to tackle them." (Read more)

Newspapers large and small inform readers (and even non-subscribers) about the complexities of health-care reform

By Al Cross
Kentucky Health News, Institute for Rural Journalism and Community Issues

In about two months, states and the federal government will open online marketplaces for health insurance, which will also offer subsidies based on income and the opportunity for the poor to enroll in the Medicaid program in states that have expanded it above the poverty level. By March 31, almost all Americans will be required to have health insurance or pay a penalty.

These steps will implement the health-reform law that Congress passed in 2010 and that even the White House calls Obamacare. It will be one of the most complex and challenging changes in American society since World War II, and newspapers are starting to help their readers get ready for it. Sunday's Lexington Herald-Leader had a story by Mary Meehan titled "What you need to know about Kentucky's health-reform plan."

But such reporting is not, and should not be, solely the province of metropolitan newspapers. Last week the Adair County Community Voice in Columbia published a 10-page special section on health-care reform. The front page had an overall story on the Patient Protection and Affordable Care Act, based on information gathered at a Kentucky Chamber of Commerce informational meeting, and a sidebar on the penalties and subsidies, with a box on each. Inside were several other stories, mainly from Kentucky Health News, and lots of ads from health-care providers.

The really special thing about the special section was that Editor and Publisher Sharon Burton sent the edition containing it to every household in Adair County, using the postal regulation that allows newspapers to send 10 percent of their annual circulation to non-subscribers at subscriber rates. At the Institute for Rural Journalism and Community Issues, we have long urged local newspapers to do this with their health sections, because we think there is a big overlap among people who most need such information and people who do not subscribe to their local newspaper. Newspapers can sell enough ads to cover the extra printing and postage costs, or even sell a sponsorship for the additional circulation.

"Information about health care reform has come in bits and pieces and most of us probably really don't understand it with any depth," Burton told us in an email. "I jumped at the opportunity to attend the Kentucky Chamber of Commerce Health Care Reform Summit because the agenda looked excellent and it has been difficult to get a good overview of how health care reform will impact our local businesses and individuals. We originally planned a total-market issue in June but had to delay it until July. We decided to delay the health care reform section as well so that it could go to everyone. We've had numerous compliments from readers who had said it was the best compilation of information they have seen in one place."

To download the Community Voice's health-care reform section, as a PDF of approximately 10 MB, click here.

Molly Burchett is new chief writer for Kentucky Health News

Kentucky Health News welcomes a new reporter, writer and blogger: Molly Burchett, a master's student in health communication at the University of Kentucky.

Burchett graduated from Transylvania University in 2009 where she studied business and communication.  She was president of the Student Government Association and a yearbook editor.  Her jobs before UK included development director for a Lexington medical practice. She started her master's program in August 2012 and is focused on raising awareness about community health issues in ways that can encourage positive changes in health behavior.

She is from Prestonsburg, where her father and mother are the lead physician and manager of Prestonsburg Primary Care. She is a graduate of Prestonsburg High School. At KHN she follows Tara Kaprowy and Amy Wilson, who have both returned to freelance journalism.

Kentucky Health News is funded by the Foundation for a Healthy Kentucky but is independently reported and edited by UK's Institute for Rural Journalism and Community Issues.

Study finds doctors often overestimate how well they communicate in English as a second langauge

A study appearing in Health Services Research shows physicians who speak English as a second language, an increasing phenomenon in the U.S. and parts of Kentucky, often overrate how well they are communicating with patients.

The finding is the result of a language scale adopted by the Palo Alto Medical Foundation, which rates language proficiency in five levels: poor, fair, good, very good and excellent.

After the new scale was introduced in 2009, out of four of physicians who participated changed their rating. Of the 258 participants, 31 who had considered themselves "fluent" downgraded to "good" or "fair." Just 11 percent deemed their proficiency "excellent." "Seventeen percent used 'very good' and 38 percent said they were 'fair,'" reports Glenda Fauntleroy of research-reporting service Newswise. "Being 'fair' was defined as 'can get the gist of most everyday conversations but has difficulty communicating about health care concepts.'"

"This is a very tricky area as this demonstrates how many providers overestimate their proficiency in another language," said Joseph Betancourt, director of the Disparities Solutions Center at Massachusetts General Hospital in Boston. "This can lead to miscommunication and even medical errors." (Read more)