Stanton Elementary School, closed almost three weeks because of bat infestation, is scheduled to reopen Wednesday

By Melissa Patrick
Kentucky Health News

Stanton Elementary in Powell County will reopen this week after being closed for almost three weeks because of a bat infestation, school officials said Monday.

"They are moving everything back into the building today," Arliss Crowe, secretary to the district's director of pupil personnel, told Kentucky Health News on Monday. "Students will be back in the school on Wednesday." Schools in the county were dismissed Monday and Tuesday while crews moved furniture serving students who were moved to alternate facilities.

The state Department for Public Health closed the school Nov. 14 after bats were reported frequently entering the building, county School Supt. Mike Tate told The Clay City Times. An animal-removal company found three to five bats initially and did not see any more after they began their work, he said.

The company completed its work last week and told the school system to monitor the building for a week and if no bats are sighted it "could be safe to move back in," Tate told the weekly newspaper.

Tate told the weekly newspaper that he met with state health officials Friday, Nov. 29, to determine what needed to happen next. "We want to be careful and not act too quickly," he said then. "We want to get back, but we want to make sure the school is safe." (Read more)

Increased contact with bats leads to more rabies vaccinations in N. Ky.; health officials say all encounters should be reported

Fruit bat roosting in a home

Northern Kentucky health officials are warning residents to be more wary of bats after an unusually high number of residents have made contact with bats inside their homes and have had to receive the rabies vaccine. They are asking them to report any encounter with bats to the health department.

Bats are commonly infected with rabies and have very small teeth, and so someone who wakes up with a bat in their bedroom might not realize it has bitten them, Northern Kentucky Health Department spokeswoman Emily Gresham-Werle told Brenna Kelly of The Kentucky Inquirer.

It is crucial to vaccinate against rabies after contact with a bat, if the bat cannot be captured to receive testing for rabies. "If someone is exposed to the rabies virus and not treated, the result is neurological disease and death," Kelly notes.

Each year, tens of thousands of people are successfully protected from developing rabies through vaccination after being bitten by an animal like a bat that may have rabies, says the Center for Disease Control and Prevention. "There are usually only one or two human rabies cases each year in the United States, and the most common way for people to get rabies in the United States is through contact with a bat," says the CDC. Some of these reported cases resulted from known encounters with bats.

The problem In Northern Kentucky may be due to development in the area that has caused bats to lose their natural habitat. So far this year, 13 people who were exposed to bats have decided to get the vaccine. Usually only two to three people a year in the area have to get the vaccine because of a bat, Gresham-Wherle said. "Local and state health officials speculate that the weather and loss of bat habitat have contributed to the high number," reports Kelly.

"The rabies vaccine, which is nearly 100 percent effective against the virus, involves four rabies shots and one antibody shot over a period of two weeks. The vaccine, which is given by shots in the arm, can also be expensive, with costs ranging from $2,000 to $6,000 for the series, with additional fees for doctors or emergency room visits," Gresham-Werle told Kelly.

All exposure to bats and all bites by mammals must be reported to the local health department. In some instances the animal may be captured for rabies testing so that the bitten individual will not need to be vaccinated against the deadly disease. You can't tell if an animal carries the rabies virus just by looking at it, because rabies can only be confirmed in a laboratory, warns the CDC.

Harlan County Schools look for school-nurse help after county health department, which had done it for free, asks for $10,000

http://www.harlandaily.com/view/full_story/23219874/article-Board-tackles-nurse-issue?
Update: http://www.harlandaily.com/view/full_story/23250170/article-School-district-asked-to-pay-for-nursing-services?

School boards across Ky. realign school-nurse programs, squeezed by budget cuts and Medicaid payment issues

School districts in Kentucky have long relied on county health departments for school nurses, but state budget cuts and problems with Medicaid reimbursements have squeezed the health agencies, and they in turn have put the squeeze on the schools for more money and other measures.

Despite some concerns, the Russell County Schools board voted to approve a contract with the Lake Cumberland District Health Department to provide school nursing services. Corbin Independent Schools did not continue its normal contract with the Whitley County Health Department for these services, and has employed its own nurses this year instead. Fayette County Schools will coordinate a hybrid, scaled-back program with the Lexington-Fayette County Health Department, rather than relying solely on the department for services.

The Russell County board had tabled its contract with the Lake Cumberland department last month due to concerns about a lack of provisions allowing for reimbursement if the nurse ever had to take time off, reports John Thompson of The Times Journal in Russell Springs. Superintendent Michael Ford said the health department was unwilling at this time to accept such provisions, but that it has not been a problem in the past.

Ford also said the district would get the same services if it hired its own school nurse. So, in the face of concerns from many members, the board voted last week to continue providing school-nurse services through the department, Thompson reports.

On the other hand, Corbin is hiring its own nurses. Its health-department contract ended in May because the department went months without receiving Medicaid reimbursements for school-nursing services, and the department had no financial resources to continue them, reports Jeff Noble of The Times Tribune.

Citing cuts in federal funding, Fayette County Schools has scaled back its school-nurse program. The joint program between the school system and the local health department will go from having 30 registered nurses for school services to operating with 13 registered nurses and 14 licensed practical nurses, reports Jim Warren of the Lexington Herald-Leader.

Fayette Superintendent Tom Shelton said last week that the plan is to supplement the nurses with other health care providers or additional help from the department; school personnel will also help by administering some medication.

This is a temporary solution to meet school nursing needs to give the schools time to develop a permanent solution, Shelton told Warren. Shelton said he wants to develop a completely new model for providing nursing services after next year.

Seven Ky. communities get grants to reduce risks for chronic diseases among children and 'Invest in Kentucky's Future'

Seven diverse Kentucky communities are getting money to reduce the risk of chronic disease among Kentucky's youth. The initial grants announced Thursday are part of the Foundation for a Healthy Kentucky's new Investing in Kentucky’s Future initiative, a five-year, $3 million program.

“The health of our next generation is at stake,” said Susan Zepeda, CEO and president of the foundation. “Our goal is to help communities make positive changes in policies and service access that will help our children grow into healthy, productive adults. Regardless of the challenges, we want to help communities find new pathways to positive solutions.”

Community groups will use their initial grants to collect and analyze local health data. That analysis will guide development of innovative strategies for effective, sustainable measures to improve children's health. Those communities chosen for the initiative are:

• Clinton County School District, Albany: initial grant of $27,755 for the Clinton County Healthy Hometown Coalition. “We are thrilled that our community was chosen to participate in this important initiative,” Asst. Supt. Paula Little said. “The members of the Healthy Hometown Coalition are committed to helping children grow up in a physical, social, and cultural environment that supports good health habits. With help from the foundation, we can develop our capacity to make a lasting, positive change in our community.”

• Fitness for Life Around Grant County, Williamstown: initial grant of $21,643 for FFLAG and the Northern Kentucky Health Department. “We are pleased and excited to be given the opportunity to work with the Foundation for a Healthy Kentucky,” FFLAG Chairman Jeff Walters said. “We are a small group that has been working on improving the health of our community and we believe we’ve had a positive impact thus far. This grant will accelerate the process and the work that’s been started.”

• Foundation for Appalachian Kentucky, Hazard: initial grant of $32,558 for Perry County Wellness Coalition. “We’ve been working for several years to improve the menu and encourage better eating habits in and out of school,” said Linda Campbell, nutrition director at Perry County Schools. “It’s not as easy as changing a menu or just buying whole wheat bread. We’re changing a culture, and that’s not a simple thing. Working together, as a community, we can really start to make a difference. This grant from the Foundation for a Healthy Kentucky allows us to take the next steps toward helping our kids to become healthier.”

• Green River Area Development District, Owensboro: initial grant of $40,483 for Partnership for a Healthy McLean County. “The Partnership for a Healthy McLean County realizes the impact community organizations, schools, work sites and health care have on the health of families,” said Jiten Shah, executive director of the district. "Obesity is a major factor for many chronic diseases which can begin in childhood and continue into adulthood. "

• Kentucky Heart Foundation Inc., Ashland: initial grant of $19,245 for Healthy Kids, Healthy Communities in Ashland. “Investing in Kentucky’s Future is a perfect fit for the work of the Healthy Kids Coalition and gives us the opportunity to continue to work on policy, system and environmental changes to improve the health of children in Boyd and Greenup counties,” said Laura Patrick, coordinator of Healthy Kids, Healthy communities. “We know that this approach will help sustain change for years to come and what is great about it is that it is sustainable.”

• Kentucky River Community Care, Inc., Jackson: initial grant of $34,156. “This foundation grant will help Breathitt County plan more opportunities for youth and families to participate in healthy lifestyle activities,” said Bridget Turner, KRCC director of clinical services. “We need to develop a strategic plan to specifically address the many barriers that face our children and threaten their future. Education, prevention, behavioral health, physical health, nutrition, employment, substance abuse are a few of the issues that we are trying to deal with in our county.”

• Louisville Metro Department of Public Health and Wellness: initial grant of $34,160. “If we are ever going to realize a healthier future for our citizens, we must improve the health of our young people,” said Dr. LaQuandra Nesbitt, director of the department. “These funds from the Foundation for a Healthy Kentucky will facilitate a coordinated, systemic approach to overcome the health barriers that many of our youth face. The grant will allow us to formulate policies and strategies to improve health that are based on accurate data with buy-in from stakeholders across the community.”

Reducing chronic diseases to improve Kentuckians' health
 
Chronic diseases such as cancer, diabetes and heart disease, are those that last over time, decrease quality of life, increase the risk of early death and occur at higher rates in Kentucky than in surrounding states; substance abuse and some mental illnesses are also chronic diseases.

Kentucky’s children are at greater risk than most for chronic diseases, including high rates of obesity and smoking. When children grow up, they are at an increased risk for heart disease, cancer or stroke, and Kentucky is above the national average in deaths from these diseases.

The Investing in Kentucky's Future initiative will help Kentucky communities confront this cycle of problems. The foundation is encouraging local leaders to identify how best to engage the community in order to have the biggest impact.

“This is the first step in our multi-year approach, which will lead to implementation of permanent solutions for healthier communities,” said Zepeda. “We believe that by working together on the local level, civic leaders with vision can develop innovative strategies to improve the health of our children.”

More than 50 interested organizations responded to the foundation’s request for proposals in October last year, and 22 were invited to submit a full proposal. The foundation’s board of directors approved funding for seven as part of the initiative. Click here to read more about the foundation.

The school health services gamble: Ky. health departments could win on the state's bet against Kentucky Spirit's appeal of ruling

By Molly Burchett
Kentucky Health News

Kentucky’s health departments may soon get money for school nurses, based on a court ruling in May that said Medicaid managed-care firm Kentucky Spirit must pay for treatments provided by the nurses. The money wouldn't be coming from Kentucky Spirit, at least immediately, but from funds the state is withholding from the company, betting the payments on a court victory.

Circuit Judge Phillip Shepherd of Frankfort ruled in May that Kentucky Spirit must pay $8 million for services provided by school nurses, and the state has been withholding payment to the managed care company until it complies with the ruling, reports Ronnie Ellis, Frankfort correspondent for Community Newspaper Holdings Inc. On Monday, Shepherd told attorneys for the Cabinet for Health and Family Services and Kentucky Spirit that he is “inclined” to order the state to pay the health departments out of those withholdings.

The cabinet wants Kentucky Spirit to post bonds to cover the disputed payments during the company's appeal process. If the state made payments directly to the health departments, it would be gambling at its own risk, reports Ellis. If Kentucky Spirit wins its appeal of Shepherd’s earlier ruling, the state would have to refund the money, and the health departments would keep the payment.

This lawsuit originally came about when Kentucky Spirit stopped providing coverage for school health services last summer. The company said its state contract didn't require payment for such services, even though the state's Medicaid program has always paid for these services and other managed care companies were providing coverage for them. The court ruled that Kentucky Spirit must pay health departments, and the company appealed the decision.

Regardless of the source of funds, health departments and school districts could find some relief if payments are made because many school nurse programs were threatened by cutbacks and closings as a result of Kentucky Spirits failure to pay for school services.

Shepherd will allow attorneys for the state to respond to the motion and hear arguments on July 25, Ellis reports.

Free HIV testing available from health departments and community-based health groups in June; key to AIDS prevention

In honor of National HIV Testing Day on June 27, community-based organizations and local health departments are hosting free HIV testing throughout the month of June. HIV is an infection that can lead to AIDS, and early screening and detection of HIV are critical to fighting the disease, avoiding further health complications and ensuring it isn't unknowingly transmitted to others.

“Routine testing ensures HIV-positive individuals are made aware of their status early before the disease progresses to AIDS,” said Dr. Stephanie Mayfield, commissioner of the state Department of Public Health, which is promoting the HIV testing and awareness events through mini-grants. “Testing remains one of the most critical and effective strategies for preventing transmission, ensuring good health outcomes, keeping service costs low and keeping infected individuals healthy.”

About 20 percent of people with HIV don't even know they are infected, which is very problematic because these individuals are believed to transmit HIV to more than half of the people who become newly infected each year, and one-third of the people is diagnosed so late that they develop AIDS within one year, says the federal Centers for Disease Control and Prevention.

In 2010, 32 percent of Kentucky's 7,751 HIV cases led to an AIDS diagnosis within 30 days of the initial infection, says a Cabinet for Health and Family Services release. This highlights the importance of routine testing, which the CDC recommends for everyone, regardless of risk factors, especially for all people age 13 to 64.

"A delay in diagnosing HIV is a life and death issue, with many individuals receiving a concurrent diagnosis of HIV/AIDS upon initial testing. Early intervention and linkage to care is critical to enhance the quality of life and reduce costs for treatment,” said Gayle Yocum, HIV/AIDS prevention section supervisor, in the CHFS release.

In Kentucky, HIV disproportionately affects racial minorities, particularly the African-American and Hispanic populations. Although African-Americans represent 7 percent of the state’s population, they account for 34 percent (2,884) of new HIV infections. Individuals who are at a higher risk for infection should be tested at least annually, including those with multiple sex partners, injection drug-users and their sex partners, people who exchange sex for money or drugs, men who have sex with men and sex partners of someone with HIV, says the CDC.

Kentucky testing sites

The Department of Public Health's statewide network of HIV testing sites provide risk reduction counseling and helps individuals develop a behavior-change plan to reduce the risk of getting or spreading HIV. Here's a list of the statewide events providing free HIV rapid testing in the next two weeks:

◾ June 17, free testing and education, 10:30 a.m. to 2 p.m., Salvation Army of Bowling Green, 400 W. Main Ave., Bowling Green.
◾ June 20, afternoon gospel fest, noon to 5 p.m., New Beginnings Church, 4127 Flintlock Drive, Louisville.
◾ June 22, church health fair, 10 a.m. to 5 p.m., Faith Fellowship, 727 S. 15th Street, Louisville.
◾ June 25, free testing, 11 a.m. to 3 p.m., 2106 St. Louis Ave., Louisville.
◾ June 28, free testing and education, 10 a.m. to 3 p.m., Housing Authority of Bowling Green, 247 Double Springs Road, Bowling Green.
◾ June 28, neighborhood test fest, 10 a.m. to 4 p.m., Nia Center, 2900 W. Broadway, Louisville.
◾ June 29, free testing, 11 a.m. to 1 p.m., Walgreens, 110 Town Center Dr., Lexington.
◾ June 29, free testing, 11 a.m. to 1 p.m., Crossings, 117 N. Limestone, Lexington.
◾ July 3, free testing, 8 p.m. to midnight, The Bar Complex, 224 E. Main Street, Lexington.

Click here for more information about HIV and AIDS, about the National HIV Testing Day/Month Campaign or other programs and services.

Knox County converting ambulance tax, taking 3/8 of health tax and asking library for same in order to save hospital

The Knox County Fiscal Court and the Knox County Board of Health reached a deal Monday to aid its debt-laden county hospital's recovery from bankruptcy by diverting, at least temporarily, 37.5 percent of local health tax revenue to the hospital, asking the local library to do likewise and converting an ambulance tax into a hospital tax.

The proposed agreement is "revenue neutral" and would not create any additional tax for Knox County residents while allowing the Knox County Hospital in Barbourville to stay open, writes Jeff Noble of The Times-Tribune in Corbin.

To save the hospital, the hospital board needs a tax of about 8 cents per $100 worth of property, County Judge-Executive J.M. Hall said. The deal would convert a 5-cent ambulance tax to a hospital tax, and the county health board has agreed to shift 1.5 cents of its 4-cent tax to the hospital. The library board is considering similar action, which would make up the total 8 cents, Hall told Noble.

Health Department Director Susan Liford said the two-year deal with the health board will begin in January 2014 and will be re-evaluated at the end of that period. The health department will be diverting $300,000 to $400,000 a year to the hospital, Noble reports.

"The board felt like we needed to help the hospital, and they were very adamant they did not want to put the health department in jeopardy and have no one here lose their jobs," Liford told Noble. "I think it’s the moral thing to do. And we need our hospital."

The hospital has a debt estimated at $23 million, though the Knox County Fiscal Court purchased it out of bankruptcy by in 2004 for just $7.2 million, according to documents analyzed by the Barbourville Mountain Advocate, Knox County's weekly newspaper. Last July, the fiscal court took over hospital operations of the hospital, borrowing $6 million to fund them, after the former owners filed Chapter 11 bankruptcy. (Mountain Advocate graphic; click on it for larger version)

Health departments raise, or try to raise, tax rates to offset state cuts, higher benefit costs and Medicaid payment problems

Some county health departments are trying, and others may try, to increase property-tax rates to make up for Medicaid shortfalls, program cuts and the rising costs of employee benefits so they can continue providing essential public health services for their communities.

Anderson County Health Department Director Tim Wright has proposed a 33 percent rate increase from 3 cents per $100 of assessed property value to 4 cents per $100. The increase would add an estimated $150,000, which Wright says he would use to end employee furloughs and make up for $200,000 that has not been paid by the Kentucky Spirit managed-care company, reports Editor Ben Carlson of The Anderson News.

Many departments have already cut positions and implemented furloughs to compensate for Medicaid shortfalls, state program cuts and employee benefit costs, said Scott Lockard, past president of the Kentucky Public Health Association and director of the Clark County Health Department. Most departments have done everything possible to increase efficiency of the departments' resources, he said.

A recent tax increase in Boyle County will make property owners pay a little more to help fund the county health department. The fiscal court recently voted to raise the county's health tax from 2.4 cents per $100 to 2.5 cents.

As funding streams have changed, departments need additional revenue sources, said Brent Blevins, director of the Boyle County Health Department. Blevins said without the rate increase, the already short-staffed department would have to cut services.

Declining property values during the recession have decreased tax revenue, said Marcia Hodge, director of the Garrard County Health Department. It proposed a tax rate increase from 4 cents to 4.25 cents in September that was estimated to bring in about $21,000, but the fiscal court did not approve it, she said.

Another problem that health departments face, Hodge said, is that they are required to participate in the state's insurance and retirement system. Over the 12 years she has been at the department, retirement contributions have increased from 4 percent to 25 percent, while costs of fringe benefits have more than doubled while salaries have only increased 10 percent, she said.

The Floyd County Health Department increased its tax rate last September for the first time in 20 years, primarily because of increased costs of employee benefits and department funding cuts, said Thursa Sloan, director of the department.

Sloan said she anticipates a big change in the services that health departments provide over the next 10 years.  Primary care will take a much more preventive approach, she said, and health departments will have to pull back in such services and go back to the basics.

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

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)

State Health Department gets diabetes prevention funding; will focus on prediabetes detection and lifestyle changes

The state Department for Public Health has been awarded a $134,380 federal grant to help reduce high rates of prediabetes and Type 2 diabetes in Kentucky.

“Diabetes is a tremendous public health concern that is both horrific for the individual, if unmanaged, and costly in terms of medications, various complications and long-term hospitalizations that are so often associated with the disease,” Audrey Haynes, secretary of the Cabinet for Health and Family Services, said in a press release.

In 2009, Kentucky's rate for diagnosed diabetes was the fourth highest in the nation at 11.4 percent of the population, compared to a national median of 8.3 percent. The rate means an estimated 366,000 adults in Kentucky have diabetes. An additional 266,000 Kentuckians are estimated to have prediabetes, according to the CFHS website.

Prediabetes often leads to Type 2 diabetes, the most common type, within a few years, but lifestyle changes promoted by the federal Diabetes Prevention Program can decrease the risk of developing diabetes by almost 60 percent, according to a recent study published in the Journal of Preventive Medicine.

“We must act now to begin reversing the devastating impact of diabetes on our state,” Haynes said. “We are excited to continue our work with the Diabetes Prevention Program to help more Kentuckians start making healthier lifestyle choices so they can avoid developing diabetes and lead longer, healthier lives.”

The DPP specifically targets individuals with prediabetes and works with them to reduce their risk of developing Type 2 diabetes. The risk factors for both are: being older than 45, being overweight or obese, physical inactivity, having a family history of diabetes, ever having gestational diabetes, high blood pressure, abnormal cholesterol, having a history of cardiovascular disease and being African-American, Hispanic/Latino, Native American, Asian American or Pacific Islander. Click here to take the diabetes risk test.

The federal Centers for Disease Control estimates that national efforts to prevent Type 2 diabetes could save $5.7 billion in health care costs by preventing 885,000 cases in the next 25 years. Kentucky will focus on three diabetes prevention strategies that involve raising awareness among health care providers to improve detection and treatment of prediabetes and encouraging both state/local government and business to add lifestyle change programs to the list of covered services under health plans, says the news release. (Read more about diabetes and prevention in Kentucky).

Health departments in N. Ky. and Franklin County are among the first 11 in the nation to be accredited, a milestone in public health

Three Kentucky departments are among the first 11 in the nation to receive accreditation from the national Public Health Accreditation Board, which announced the achievements Thursday.

The Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties received five-year accreditation.

"I am proud of the departments achieving this public health milestone of national accreditation," said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health. "Before now, there has not been a national system for health departments to demonstrate accountability and quality to their community."

Scutchfield said accreditation means a department is providing a "high quality of public health service, leadership and accountability to its constituents," and is a clear indication of the departments' "passion and dedication to improving and protecting the health" of the community.

The board, funded by the federal Centers for Disease Control and Prevention and the Robert Wood Johnson Foundation, has received 128 total applications for accreditation: 112 from local health departments, 15 from state departments; and one tribal department.

In addition to the three Kentucky departments that have received accreditation, other Kentucky departments have applied and are awaiting site visits. Those are the Lexington-Fayette County, Barren River District, Madison County and Christian County health departments, said Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services.

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year. (Click here to learn more about accreditation)

Three Kentucky health departments in first group up for national accreditation; requires local health assessment, improvement plan

By Molly Burchett
Kentucky Health News

Three Kentucky health departments are among the first in the nation to be considered for national accreditation, a process that could help improve patient care and put the agencies in closer touch with their communities' needs.

The national Public Health Accreditation Board will make its first accreditation decisions next week. Among the first group being considered are the Franklin County Health Department, the Three Rivers District Health Department in Carroll, Gallatin, Owen and Pendleton counties, and the Northern Kentucky Independent District Health Department, in Boone, Grant, Kenton and Campbell counties.

The decision will be a historic one, and this is an exciting time for the board and Kentucky, said board Chair Dr. Douglas Scutchfield, professor of health services research and policy at the University of Kentucky College of Public Health.

The accreditation program was launched in September 2011 after a seven-year development process aimed at advancing quality and performance and value in the departments, and their accountability to stakeholders, Scutchfield said.

Departments are assessed by rigorous standards tested in 30 diverse health departments across the country to ensure essential public health services are provided in the community, according to the board's website. Two of the 12 "domains" of the standards deal with administration and governance. In Kentucky, state law makes county health boards responsible for the health of the county. Counties served by district health departments still have county boards.

Accreditation can help a board and department identify opportunities to improve performance and management, and to improve relationships with the community, since the process requires a community health assessment, a community improvement plan and a strategic plan to address the need of the community, said Scutchfield.

The process, often called "Mobilizing for Action through Planning and Partnerships," can help boards and departments be better prepared to proactively respond to emerging and re-emerging health challenges. For a PDF of Franklin County's MAPP document, click here.

The accrediting board has received 108 applications from health departments around the nation: 13 state health departments, 94 local health departments and one tribal agency. In addition to the three Kentucky agencies being considered in the first group, the other Kentucky departments that have applied for accreditation and are awaiting site visits are Lexington-Fayette County, Barren River District, Madison County and Christian County, Jill Midkiff, chief spokesperson for the Cabinet for Health and Family Services, said in an email.

The accreditation process encourages departments to move away from the "silo" model to collaborate with community programs. In Christian County, it has changed the way department employees view their jobs, because they have to continuously reflect on their methods and brainstorm for ways to improve, Health Department Director Mark Pyle told Nick Tabor of the Kentucky New Era.

"Accreditation will likely open new revenue streams," Tabor writes. "But in a way, the process matters more than the status designation."

Midkiff said, "In addition to benefiting from the process itself, our federal and state resources in public health are increasingly shrinking, we are being asked to do more with less. And there is a need for transparency within agencies."

Midkiff said accreditation "may make the agency more competitive for grants in the future. We are actually seeing quality improvement and performance management requirements being written in many federal grants now, so it is being expected at the national level."

Although accreditation is completely voluntary, it is being encouraged for local health departments by the state Department for Public Health, which is in the process of applying for its own accreditation in 2014. Midkiff said the department just completed its state health assessment, which is now being reviewed, and is beginning to assemble partners to write a state health improvement plan, which should take about a year.

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

Some Christian Co. health board members balk at director's idea of using $100,000 of $2.4 million reserve for recreational trail

The director of the Christian County Health Department urged its board to give $100,000 from reserves to fund a rail-to-trail project to provide residents with new opportunities for exercise.

Coverting old railroad beds to recreation trails could help improve Christian County's infrastructure to promote healthy living, which is needed because a study last year ranked Christian County 116th out of Kentucky's 120 counties in this area, said Health Department Director Mark Pyle.

The department has $2.4 million in reserve, but several board members opposed the idea, citing a budget shortfall this fiscal year, financial troubles with the school-nurse program and delays in Medicaid reimbursements, reports Nick Tabor of the Kentucky New Era.

The City of Hopkinsville hopes to raise $400,000 for the first phase of the trail project. A recreational trail would initiate a culture change and residents should have public resources equal to those of other regions, Mayor Dan Kemp told Taylor.

Pyle told Tabor the trail would help the health department accomplish its goal of advancing public health, and the reserve money isn't there for sitting on. He said he believes the board will agree to using the money for the project at its next meeting, April 22, after considering funding priorities.

The New Era endorsed the health department's contribution as a good investment in local health, which by law is the health board's responsibility. For a PDF of the editorial and the news story, click here.

Health departments prepare for challenges posed by health-care reform law

No one really has a clue what changes from the health-care reform law will mean to Kentuckians and public health departments are preparing for the uncertainty, reports Kristy Cox of Business Lexington.

"The Affordable Care Act will have an impact on health departments.  It is going to put a whole lot more people out there on the street on health insurance" of one kind or another, Dr. Rice Leach, head of the Lexington-Fayette County Health Department, told Cox.

"I think how health departments are impacted is going to look a little different depending on what part of the state they're in," Rice said. "The United States has passed a law that creates an entitlement for 30 or 40 million people, and here in Lexington, for 10,000 or 20,000 more people to have health insurance. Now, who is going to take care of them?"

If the private sector can't handle the increased patient load, Leach said, the stress goes onto the health departments, meaning they may be expected to provide a broad "continuum" of care for acute medical needs, including doctors and laboratory services. Leach said he hopes other systems will step up to provide care so health departments can continue to focus on preventative services.

Many factors determine what health departments can and can't do as well as their ability to generate dollars. Leach called  the services mandates by state and federal governments as "mission critical activities," which include preventive health, communicable disease control, public health education, emergency response, sanitary code and restaurant inspection and public health policy, writes Cox. 

Despite the challenging economic environment created by budget cuts and managed-care non-payment issues, Kentucky health departments are trying to stay focused on their big-picture mission.  Some departments are writing grants and others, like the Lincoln Trail District Health Department, has sent nurses into school systems in attempt to increase revenue through expanded clinical services, Cox reports.

School nurses start getting scarcer, due to Medicaid problems

By Molly Burchett
Kentucky Health News

Students in many Kentucky counties will find it harder to see a school nurse due to changes in the state Medicaid program and lack of payment from managed-care companies.

Takirah Sleet, 7, and school nurse Michelle Marra looked at Takirah's
lunch tray to calculate her insulin dosage at Lansdowne Elementary
in Lexington. (Lexington Herald-Leader photo by Pablo Alcala)

In Crittenden County schools, budget woes have forced the Pennyrile District Health Department to request additional money from the school district to keep its school health clinics fully-staffed and open, reports Jason Travis of The Crittenden Press. Allison Beshear, director of the health department, told Travis one reason from the budget crunch is a lack of payment from Kentucky Spirit, which owes the health department $266,000.

Without additional money from the school district, Beshear says, the health department cannot maintain the current level of service at school clinics through the end of the school year.  Proposals have been made to offer services to the district that entail reducing clerical staff without reducing the number of nurses; but in order to do so, trained school staff would have to handle daily medication distribution and help to answer the phones for the clinic.

"Kentucky Spirit has filed two appeals with the Cabinet of Health Services and the Finance Cabinet in which it claims to not be financially responsible for healthcare given in school clinics," reports Drew Adams of WKMS-FM in Murray reports in a story about similar problems in Hopkins County.

Other school districts facing similar problems include those of Bell, Clark and Pike counties. Eleven school health clinics in Bell County could be shut down by the end of this school year, reports WBIR-TV of Knoxville. In Clark County, a lawsuit between the state and Kentucky Spirit has put a halt to reimbursement for health services provided in county schools, reports Rachel Gilliam of The Winchester Sun.

Last month, the Pike County Board of Health filed a lawsuit against Kentucky Spirit because the managed-care firm has stopped reimbursing the Board of Health for school-nurse programs, reports Jordan Vilines of WYMT-TV in Hazard. The money has to be reimbursed in order to provide school nurses.

“I think having someone in the school to ensure that our children are healthy is imperative for the quality of life of our kids, especially in a very rural area," Pike Judge-Executive Wayne T. Rutherford told Vilines.  He said that without reimbursement, school nurses could lose their jobs, which would leave hundreds of kids without immediate medical care.

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

Among health providers having difficulty with Medicaid managed care, Cumberland Valley District Health Department stands out

The financial struggle that recently led to 14 layoffs and an increase in furlough days for the Cumberland Valley District Health Department continues. Other health departments have reported such difficulties, but it may be one of those hurt most.

With its deficit standing at $503,266,  a review of the department’s financial summary from the latter half of last year shows that a large part of the deficit is caused by lack of payments from Kentucky Spirit, a Medicaid managed-care company, according to an article in the Manchester Enterprise.

As recently as September, Kentucky Spirit owed the department over $300,000 for Medicaid services that had been provided. In the December report, Kentucky Spirit had only paid $698 and has since quit cooperating with the state, according to the Enterprise.

Adding to the cash flow problem, another managed-care firm pays a month late, according to department Interim Director Lynett Renner. She said that since 2011, health departments must also pay back to the state a Medicaid match, and are the only health care providers that must do so. 

Those factors, she said, are why the layoffs plus an increase in furlough days are necessary. Beginning Jan. 21, employees will be on a 32-hour workweek. In addition to those two money-saving actions, the department has also eliminated two positions, director of nursing and director of environmental services, the Enterprise reports. 

"What we do touches the lives of everyone in our country,” said Renner and the district will provide its services however it can.

Health agencies in Rockcastle, Jackson, Clay, Harlan to lose 14 employees, some environmental and food-safety inspections

In the latest example of Medicaid changes' impact on local health departments, environmental and food-safety inspections will be reduced by layoffs in four counties served by the Cumberland Valley District Health Department, Nola Sizemore of the Harlan Daily Enterprise reports. Health departments in Harlan, Rockcastle, Clay and Jackson counties will lose a total of 14 employees later this month. (Enterprise photo: Harlan County Health Department)

Health Department Interim Director Lynett Renner told Sizemore said the layoffs, along with furlough days, are a result of decreased funding and the "advent of managed care organizations" in November 2011. The agency has almost $1 million in outstanding accounts because payments from those organizations have been slow to come in. "Also, one of the things that affected the health departments tremendously is we’re the only provider in the state required to pay a Medicaid match, which means for every service we provide for a client who has Medicaid, we have to pay the state back 20 percent and that recently increased to 28 percent," Renner said.

Renner told Sizemore that environmental services and restaurant health inspections would be most affected, adding that public health is often taken for granted by the local community. "So much is done behind the scenes to ensure the health and safety of every citizens," she told Sizemore. "My fear is they're reducing the ability of the public health infrastructure to be able to maintain that level of service that provides protection." (Read more)

Kentucky's week-long brand of flu now called 'widespread'

What started out early is now full-blown. The Kentucky Department for Public Health informed federal health authorities this week that data it has received from local health departments, hospitals, clinics and private doctors indicates that flu is now "widespread" in the state.

Darla Carter of The Courier-Journal reports that Louisville officials have confirmed nine cases and 127 positive rapid tests since the first week of November. For the status to be "widespread," the state explained it had received numerous reports from throughout the commonwealth. What is being reported is not a 24-hour bug, but a 7-10 day virus.  Health officials are vigorously encouraging flu vaccinations. (Read more)

Home-health agency for Madison, Estill and Powell counties says it has to cut staff because of issues with Medicaid and Medicare

Declining reimbursements from Medicaid and Medicare are behind the Madison County Health Department's layoff of seven home-health employees last week. Director Nancy Crew said the cuts should not mean a reduction in care but that cuts were being made because "we've done all we can do without involuntary layoffs," Bill Robinson of the Richmond Register reports. The department's MEPCO subsidiary, which has offered home-health services in Madison, Estill and Powell counties since 1974, has been under financial pressure for two years despite cutting costs and not filling eight now-vacant positions. It had a deficit last year of $610,000.

Only about 15 percent of MEPCO's revenue comes from private insurance, said David Reed, the health department's financial director. That leaves MEPCO with a disproportionate number of Medicaid patients at a time when those re-reimbursements often are denied by managed-care companies, Reed said. Challenging those denials is a complicated process, sometimes requiring going to court to recover costs. The problem is not all with Medicaid. MEPCO’s Medicare reimbursements began a steep decline from nearly $3.24 million in 2008 to $2.55 million in 2012.  (Read more)