Move to managed care on track for Oct. 1, secretary says

Despite a recent request to delay by an advisory council, and a low number of signups by hospitals so far, the move to managed care for Kentucky's Medicaid patients should be completed by Oct. 1.

"We are prepared to proceed with an Oct. 1 timeframe," said Janie Miller, secretary of the Cabinet for Health and Family Services, right, as she updated the Medicaid Oversight and Advisory Committee Monday. "I know it is quick and it is coming."

The advisory council had asked the cabinet to delay, saying the Oct. 1 deadline did not give providers enough time to review contracts. Several legislators also feel the move is happening too quickly. "Oct. 1 just seems a little scary for some of us," said Sen. Julie Denton, R-Louisville. She said "doctors, pharmacists and other providers have contacted her to voice concerns that they don't have enough information about which managed care company to sign on with," Deborah Yetter of The Courier-Journal reports.

As of last Wednesday, "Only 15 or so of the state’s [109] hospitals had signed on with one of the three managed care providers," according to Miller, Ronnie Ellis reports for CNHI News Service. "She said she wants to see about 89 hospitals join one or more of the three networks but the contracts provide for “out of network” services if enough hospitals don’t join in rural or isolated areas." (Read more)

The move to managed care organizations is the state's answer to plug a $139 million hole in the Medicaid budget. Privatizing the program by using managed care will mean providers will be paid on a per-patient, per-month basis, which Gov. Beshear said will save $1.3 billion over three years. Right now, providers are paid on a fee-for-service basis, meaning they bill for each service that is provided. The move will affect more than 730,000 Kentuckians and will be run by four MCOs statewide, including Passport. As it has for several years, Passport will continue to provide managed care for 170,000 Kentuckians in Jefferson County and the surrounding area.

Within two weeks, 560,000 Kentuckians outside of the Passport jurisdiction will receive information packets about which of the other three companies will handle their care. Membership cards will be mailed in September, Yetter reports. Before the new program can be launched, the state must showed the federal Centers for Medicare and Medicaid Services it is ready. Miller said that if the program is not deemed to be ready, there would be a delay, Yetter reports. (Read more)

UK Extension Service launches online challenge to improve physical and financial wellness

The University of Kentucky Cooperative Extension Service has created an online challenge designed to help people improve their health and financial status. The Kentucky Fall 2011 Small Steps to Health and Wealth challenge starts Sept. 4 and runs to Oct. 2.

The free program asks participants to track daily choices they make about nutrition, physical activity and saving money. As they enter data into 10 categories, participants will earn points and see a comparison of their progress to other participants. Top finishers will receive prize packs. The first 150 people to complete the challenge will get a UK water bottle.

"As individuals work toward improving both their health and personal finances, it is important to realize that small changes do make a difference," said Jennifer Hunter, UK assistant extension professor for family financial management in the UK College of Agriculture. "Adopting only one of the 10 recommended daily practices is a step in the right direction."

To register, click here or call a local extension office.

Stumbo asks for records pertaining to pain pill tracking efforts; Herald-Leader supports move

Update, Aug. 29: The Kentucky Board of Medical Licensure may not be tracking the prescribing practices of the state's doctors, but that's because it can't, asserts a past president of the Kentucky Academy of Family Physicians in an op-ed piece in the Lexington Herald-Leader.

"Although the board may use KASPER to observe a given physician's prescribing history for a period of time, it may do that only if provided a name," Dr. E.C. Seeley writes. "By law, the board may not identify a physician by any means, including KASPER, unless receiving a grievance. Consequently, if the board lacks that capacity, the agency administering KASPER or the legislature should receive the criticism, not the medical board." (Read more)

House Speaker Greg Stumbo has filed an open records request to find out why the Kentucky Board of Medical Licensure hasn't been more aggressive in tracking physicians that are over-prescribing pain medication, The Courier-Journal's Mike Wynn reports.

The request asks for documents, e-mails, letters and related files that show information on the board's use of KASPER, the state's drug-tracking system. "After wanting to make an issue, after wanting help, why did they disband the effort," said Stumbo, right. "I want to see what they said, what they talked about, what their motives were."

Stumbo broached the issue with the board Tuesday in a legislative Program Review and Investigation committee meeting. He pointed out the board had shown signs it was interested in pinpointing physicians that were overprescribing medication. In 2003, the licensing board asked to be able to analyze data collected in KASPER. That same year, the legislature passed a law allowing the Cabinet for Health and Family Services, which maintains KASPER, to release geographical data about prescriptions to the board so it could perform its analysis.

But the board's attorney said Tuesday the data collected is not specific enough and the board doesn't have the staff to perform the detailed analysis that would be required.

Stumbo suggested the board increase its fees if it needs more staff.

KASPER can produce by-county trend reports, Wynn reports. Though less than 30 percent of the state's physicians use the system, Stumbo said the data is complete enough to be able to identify suspiciously high prescription rates. (Read more)

In an editorial Thursday, the Lexington Herald-Leader supported Stumbo's move, saying it's obvious some Kentucky doctors are over-prescribing. "It's obvious because Kentucky sees the results daily. Drug overdoses, property crimes, swollen prison populations, crowded court dockets, waiting lists for addiction treatment, ruptured families, etc., etc.," the editorial reads.

"As Stumbo said, it's obvious we have a problem," the editorial reads. "In KASPER it's also obvious that Kentucky has a tool that could direct investigators to doctors who might be prescribing too many pain pills. It seems equally obvious that using that tool to address a problem that's destroying lives and costing our state dearly is not only reasonable but essential." (Read more)

CDC hands out $49 million in public health grants; Kentucky gets more than $800k

The Centers for Disease Control and Prevention have issued $49 million in grants to improve public health, $815,000 of which is earmarked for Kentucky.

The Kentucky Cabinet for Health and Family Services will use the funds to expand its epidemiology, lab and health information systems and to detect and prevent healthcare associated infections. Each year, about 100,000 people die nationwide because of these infections, which are often acquired in hospital settings. The funds are meant to help states coordinate HAI prevention, implement multi-facility prevention efforts, improve monitoring of antimicrobial use and enhance electronic reporting.

Every state in the country will receive a portion of the $49 million pot, which is double the size that was handed out in 2010. "This funding will be used to create jobs, enabling the hiring and training of epidemiologists, laboratory scientists and health information specialists in the field of infectious diseases," said Thomas Frieden, director at the CDC. "These grants will also make it easier for health departments to better manage and exchange important information." (Read more)

Kentucky ranks 41st in nation for child welfare, report finds

"In the face of poverty and other economic woes, Kentucky is one of the worst states in the nation when it comes to children's health," reports Jenna Mink of Bowling Green's The Daily News.

The state ranked 41st, according to the Annie E. Casey Foundation's 2011 Kids Count Data Book. "We no longer are close to being a bottom-10 state. We are among the bottom 10 states," said Terry Brooks, executive director of Kentucky Youth Advocates.

Kentucky scored particularly low when it came to child poverty, ranking third highest in the country. The study found 26 percent of Kentucky children live in impoverished homes. Kentucky also ranked low because of its poor economy and because it ranked high in the number of babies that are born with low birth weights, which can cause anything from infant death to behavioral and learning disorders. "While some causes are associated with chronic diseases among mothers, such as diabetes, Kentucky tends to have a high rate due to smoking during pregnancy," Mink reports.

The state also ranked high in terms of the number of children who have at least one parent unemployed. In 2010, about 122,000 Kentucky children had at least one parent who was looking for work. Only four other states and the District of Columbia had higher rates.

Brooks said Kentucky can improve its standing, and improve the welfare of its children, by doing three things. "First, Kentucky families should be given more information about benefits for which they qualify — last year, Kentuckians left $300 million in unclaimed benefits, such as food stamps and tax credits," Mink reports.

Brooks said he is also strongly in favor of passing a state earned income tax credit, which he said would help families make ends meet. Lastly, he recommends cracking down on businesses that advertise payday loans. "Those kinds of predatory practices contribute to the high price of being poor in Kentucky," he said.

The results of the report were not all bad, however. Kentucky improved on the number of teenagers who stay in school. The average number of kids in Kentucky affected by foreclosure was also lower than the rest of the country. Compare 2.3 percent, or 38,000 children, to the nation's average of about 4 percent. Brooks said the disparity is due to the fact that many Kentuckians rent and live in rural areas. (Read more)

UK gets $7 million for Alzheimer's research

The University of Kentucky has received a $7 million grant to continue its research on Alzheimer's disease. The research is conducted at the Sanders-Brown Center on Aging and involves clinical trials and comparing brains diseased by Alzheimer's to those that are not.

"It is the second major grant announcement for UK in two days," reports the Lexington Herald-Leader's Cheryl Truman. "On Monday, UK received a $14.5 million grant to develop pollution-catching technologies for coal-fired power plants."

The grant proves UK "is not only able to compete among the big boys but be one of the big boys" when it comes to Alzheimer's research and treatment, said Michael Karpf, UK's executive vice president of health administration.

At the Sanders-Brown center, more than 700 research volunteers from around Kentucky take part in clinical trails and a brain donation program, which allows researchers to compare Alzheimer's-affected brains to those that aren't. (Read more)

Licensing board needs to step up its game against pain-pill docs, Stumbo says

If the Kentucky Board of Medical Licensure doesn't increase its oversight on doctors who prescribe excessive amounts of pain pills, House Speaker Greg Stumbo said Tuesday he'll find an agency that will. "If the medical licensure board refuses to do its job, then we will try to find some entity in the enforcement community that wishes to do that," said Stumbo, D-Prestonsburg, right.

In 2003, the licensing board asked to be able to analyze data from the Kentucky All Schedule Prescription Electronic Reporting registry — known more commonly as KASPER — so it could identify over-prescribing doctors. That same year, the legislature passed a law "that would allow the Cabinet for Health and Family Services, which maintains KASPER, to provide geographical data about prescriptions for controlled substances. The licensing board could use that data to determine whether doctors were overprescribing controlled substances in areas that had high prescription rates," the Lexington Herald-Leader's Beth Musgrave reports.

But the board had not used the data, Stumbo said.

Lloyd Vest II, the licensing board's general counsel, said the data was not used because it was not specific enough. The cabinet informed the board it did not have the legal right to analyze the data in depth, he added.

Stumbo informed Vest the board is the only agency that had the legal authority to study the information.

Bill Schmidt, the board's executive director, said the board, which does not receive any government funding, does not have the staff to deal with the data analysis Stumbo is asking for. "The board had five investigators to police nearly 10,000 doctors," Musgrave reports. Stumbo said the understaffing issue could be solved by raising licensing fees and assessment prices on doctors.

Board members said they will return to committee in December with suggestions for how the state can better police doctors' prescription practices.

Data show drug overdoses is the leading cause of death for some age groups in Kentucky. Federal statistics show 6.5 percent of Kentuckians have abused prescription drugs. (Read more)