In Ky. and elsewhere, elections may decide Medicaid expansion

In Texas, Brandi DeFrank's Medicaid
coverage ended when her baby, Gabriel,
was born. His coverage continued.

Voters' choices on Tuesday about who sits in statehouses may matter more in the long run than who they have chosen for president. Two of the biggest provisions of the Patient Protection and Affordable Care Act -- offering Medicaid to more people and setting up state health exchanges -- are in the hands of state officials who can either disrupt implementation of the law or move it forward. In Kentucky, Republicans are pressing to take over the state House and their leader, Rep. Jeff Hoover of Jamestown, has said the expansion would be too expensive, even with heavy federal subsidies.

Maggie Fox for NBC News contrasts the approach of Texas, which has refused $76 billion in federal matching funds to help it expand Medicaid in the next five years, to that of Vermont, which is wholeheartedly embracing the expansion. Texas has 6.3 million uninsured, reports Fox, a quarter of the state's population and the highest percentage of uninsured people in the country. "We're not going to part of socializing health care," said  Texas Gov. Rick Perry, a Republican.

“There are states referred to as ‘Hell, no’states,” said David Smith, an analyst at Leavitt Partners, a health-care consulting firm. And while 11 governorships are on the ballot on Tuesday, “a lot of those states don’t necessarily have governors who are up for election,” said Smith. In those states, voters have to decide whether to help governors by electing members of the same party to the state house.

In other states, it's more straightforward. Alabama, Florida, Montana and Wyoming have ballot measures asking residents whether they want to block the mandate requiring people to get health insurance.  (Read more)

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)

Franklin County health department lays off 5; blames Medicaid managed health claim denials for budget shortfalls

The Franklin County Health Department has laid off five employees effective today, four of those are part-time workers. The layoffs are being made in the midst of a $1.7 million drop in revenue from last year. The staff reductions should save the agency $120,000 annually, health department director Paula Alexander told The State Journal. The news comes only two weeks after the Madison County Health Department announced it has been forced to lay off seven workers because of budget shortfalls. Those cuts affected home-health workers in Madison, Estill and Powell counties.

In both instances, department directors have explained that they had expected to receive reimbursements from Kentucky's three Medicaid managed care organizations. A massive increase in those denied claims were reasons both directors gave for their sudden inability to meet budget goals. Earlier in the year, the Fayette County Health Department lost 25 employees. Faced with similar Medicaid payment issues, several Kentucky counties have tried to cut costs by cutting to a four-day workweek.

Study: Smoke-free workplace leads to fewer heart attacks

Mayo Clinic researchers have found a 33 percent drop in heart attack rates in a Minnesota county after public smoking bans were enacted. This, while rates of hypertension, diabetes, high cholesterol and obesity remained the same or even increased after the ban was put in place, reports The New York Times. The conclusion: “I think the bottom line is this should turn the page on the chapter discussing whether or not secondhand smoke is a risk factor for heart attacks,” said Dr. Richard D. Hurt, an author of the study and a professor of medicine at the Mayo Clinic in Rochester, Minn.

The study, published in Archives of Internal Medicine, was conducted in Minnesota's Olmstead County where medical records were examined 18 months before the county's 2002 public ban went into effect and 18 months after it extended the ban to all workplaces in 2007. (Read more)

Passport Health claims state violated bidding process and will make Medicaid overpayments in Jefferson County as a result

Passport Health Plan has charged that the state of Kentucky has violated its own bidding process and will spend as much as $80 million more than necessary per year under its new Medicaid managed-care contracts for the Jefferson County region. Tom Loftus of The Courier-Journal reports that the formal letter of protest of the bidding process was filed Thursday. It is the company's response to the recent division of the services of Jefferson County's 170,000 Medicaid recipients to four Medicaid managed-care companies that were once served only by Passport. Loftus writes that Passport is questioning how the region's recipients have been reapportioned. The company says it anticipated a 41 percent share of the region's Medicaid business, but was notified Wednesday that it initially will be assigned only 27 percent. The Cabinet for Health and Family Services released a statement explained that all bidders were aware of the conditions of the contract during negotiations. (Read more)

Baptist Health buys Trover Health in Western Kentucky, making Baptist Kentucky's largest health-care provider by licensed beds

Following the nationwide trend of large hospitals taking over smaller ones in light of health care reform demands in a slow economy, Louisville-based Baptist Health added an eighth hospital to its statewide network this week by acquiring Trover Health System in Western Kentucky. Andy Sears, vice president of planning and system development for Baptist Health,  told Laura Ungar of The Courier-Journal that Trover contributed its total assets to Baptist Health, which took over its liabilities, making the deal worth about $120 million.

Ungar reports the Trover acquisition is especially understandable in the context of the times. "Experts," writes Ungar, "say one big reason for the surge is that larger, wealthier organizations can buy what they need at higher volumes for cheaper prices. Bigger health care organizations also have greater might when negotiating reimbursement rates with insurers." Sears agreed, saying standalone hospitals "don't have the resources to compete."

The deal makes Baptist Health that state's largest health care provider by total licensed bed capacity and by geographical coverage. Trover is located in Madisonville. It will now be called Baptist Health Madisonville. (Read more)