Kentucky receives an F grade for its low funding of mental-health services; supply falls short of demand

Kentucky's supply of mental-health services is much lower than demand for those services, in terms of state funding, and the state spends only 45 percent of the national average in mental-health funding per person.

In 2010, Kentucky dedicated about $232 million to mental-health services, according to the Kaiser Family Foundation, which is $54 per person, compared with a U.S. average of $121 that year. That ranks Kentucky among the bottom 10 states without including individual mental health reimbursements for Medicaid, reports Chris Kenning of The Courier-Journal.

The state's Medicaid rates for mental-health services haven't been raised substantially in years, and only a fraction of mental-health facilities offer residential treatments, reports Kenning. He also reports the most recent “Grading the States” report of the National Alliance on Mental Illness gave Kentucky an F in 2009. The group considered measures such as the number of programs using evidence-based practices and the number of psychiatric beds.

Kentucky officials cite new efforts to improve care, such as partnering with the University of Kentucky at a new Eastern State Hospital that will open soon, and pursuing a change to allow Medicaid funding of community outpatient teams, reports Kenning. Kentucky also funds 14 regional community mental-health centers, which served 160,000 people last year, and there are 179 mental-health facilities, which include 40 offering residential care, reports Kenning.

Yet, these efforts fall short of providing mental health services for those Kentuckians in need.  In 2011, a surprisingly high 42 percent of Kentucky adult females and 31 percent of Kentucky males reported having poor mental health. Experts estimate that one in four people will suffer from some form of mental illness in a given year, which is nearly 1.1 million people in Kentucky, Kenning reports. 

It is critical for Kentucky officials to examine this issue in light of the Department of Health and Human Services rule that included mental-health benefits and treatment of substance-abuse disorders as part of the 10 "essential health benefits" insurance plans must provide when federal health reform takes full effect next year. HHS estimates it will expand mental-health and substance-abuse treatment benefits to 62 million Americans, and there is already a shortage of such services in Kentucky.

Kentucky hospitals gave $1.96 billion to communities in 2011, including $576.7 million cover of Medicare, Medicaid shortfalls

In 2011, despite economic and financial obstacles, Kentucky hospitals' estimated value of benefits to their communities up 17 percent from the year before, to $1.96 billion. So says the Kentucky Hospital Associated 2011 Community Benefits Report, compiled by the Kentucky Hospital Association with data submitted by hospitals. (Chart gives a breakdown of hospitals' total community benefits and services expenditures in 2011.)

Kentucky hospitals say they absorbed $576.7 million in 2011 shortfalls from Medicaid and Medicare, which cover 19 and 55 percent of Kentucky hospital patients; those losses were 26 percent larger than 2010, and may nearly double under federal health reform, to an estimated $852 million by 2019.

Bridging gaps created by Medicaid and Medicare underpayment is only one example of how the 131 Kentucky hospitals demonstrate their commitment to local communities by investing in community needs, the report says. In addition to covering government shortfalls, community benefits include providing charity care, forgiving bad debt and supporting medical research.

In 2011, the reports says, Kentucky hospitals financed $451 million in charity care, which means they cared for the sick and injured even if those patients could not afford care.

In Glasgow, T.J. Sampson Community Hospital and Dr. Bharat Mody (left), a general surgeon, have teamed up to fulfill the unmet health care needs of low-income, working, uninsured or under-insured adults of Barren County through a charity program called Community Medical Care. The program provides assistance with basic coverage for those who qualify, in addition to helping cover the cost of medications, glasses or hearing aids.

In 2011, Kentucky hospitals absorbed $426.5 million in bad debts, losses due to patient non-payment that often occur in hospital emergency rooms. Dennis Manners, who had a $500,000 medical bill and sometimes visited the ER 25 times a month, is one patient out of the total 22 percent of University of Louisville patients who cannot afford care and often cannot even afford their $15 co-pay. Highlighting its efforts to give back to the community, the reports says U of L developed a new treatment plan for Manners, which included sending him to a treatment center outside of Cincinnati.

Many health-improvement services in Kentucky communities, such as health fairs, screening programs, immunization clinics, health needs assessments and community planning, are financed by Kentucky hospitals. According to the report, $43.7 million was spent by these hospitals on such outreach programs that serve all ages and a number of special needs populations. For example, Northern Kentucky's St. Elizabeth Healthcare is fighting against cardiovascular disease, diabetes and stroke with its Cardiovascular Mobile Health Unit that brings vascular services to the community for easy access, screenings, risk appraisals and education.

Hospitals also spend a lot of money, an estimated $127.5 million in 2011, to ensure health professionals are properly educated -- a great need in Kentucky, where 59 of the 120 counties are designated as health professional shortage areas. One effort, the Rural Physician Leadership Program on the campus of St. Claire Regional Medical Center in Morehead, addresses this shortage by training physicians to serve in rural areas of Kentucky and the nation.

Other community benefits include subsidized health services, estimated at $32.3 million, to support programs like Highlands Regional Medical Center's Highlands Center for Autism in Prestonsburg (left). The center is the first of its type in the state and was created in 2009 to address autism in Kentucky, which is estimated by the Center for Disease Control to be diagnosed in one out of every 88 children, says the report. Each child at the Highlands center has a customized treatments plan involving psychologists, educators, behavior analysts, speech pathologists, pediatricians and neurologists, who collaborate to help children with autism reach their full potential.

The annual KHA report reminds people what hospitals do for the state and provides education about ongoing efforts. A more recognizable contribution is that Kentucky hospitals had a combined spending of $6.4 billion in 2011 on staff salaries, purchases or supplies and services that create a‘ripple effect” in the overall economy to generate state businesses, jobs, and tax revenue. The reports says St. Joseph Mount Sterling, for example, provided 213 jobs and generated about $12 million in annual local payroll in 2011. Kentucky hospitals' compensation comprises 5.8 percent of all wages and salaries in the state.

The reports says hospitals are more important than ever to the overall economic health of Kentucky communities. This is the fourth year for the report, generated by the voluntary KHA survey and other data sources, including the annual survey by the American Hospital Association; Kentucky Hospital Statistics, 2013; and Kentucky Hospitals’ Economic Importance to Their Communities, 2011. The KHA report covers community benefit expenditures made in 2011, which is the most recent year for which statewide data is available.

Poll shows Kentucky health-care providers often fail to discuss HIV testing with patients

A new poll suggests that most Kentucky health-care providers follow guidelines for discussing HIV screening with their patients, despite the the importance of early treatment to prevent its progression to AIDS.

Although the Centers for Disease Control and Prevention recommends routine HIV screenings for most patients, just 32 percent of Kentucky adults aged 18 to 64 report discussing HIV testing with their medical provider, according to the Kentucky Health Issues Poll.

About 40 percent of Kentucky adults reported they had never been tested for HIV. It’s estimated that 4,500 Kentuckians are living with HIV infection and it is estimated nationally that one in five people who have HIV do not know they do.

“It made headlines earlier this month when a little girl - the second person in history - was cured of HIV. As exciting as this development was, for most people, HIV remains a life-long condition that must be managed through medication to keep it from progressing to AIDS. The CDC’s recommendations are meant to improve the overall population health by detecting HIV so treatment can begin,” said Dr. Susan Zepeda, president and CEO of the Foundation for a Healthy Kentucky, which co-sponsored the poll.

“It appears that Kentucky providers are either not adhering to the routine screening recommendations or not communicating this message clearly to patients,” she said.

The poll, co-sponsored by the Health Foundation of Greater Cincinnati, was taken Sept. 20 through Oct. 14 by the Institute for Policy Research at the University of Cincinnati. A random sample of 1,680 adults throughout Kentucky was interviewed by landline and cell telephones. The poll's margin of error is plus or minus 2.5 percentage points

Conway, other AGs ask FDA to require generic prescription pain pills to be abuse-resistant, tamper-resistant

Generic versions of popular pain relievers must be made harder to abuse, in order to curb prescription drug abuse that is epidemic in many states, Attorney General Jack Conway and 47 other attorneys general said in a letter sent to federal officials Monday.

The National Association of Attorneys General letter encourages the Food and Drug Administration to adopt standards requiring manufacturers and marketers of generic prescription painkillers to develop tamper- and abuse-resistant versions of their products, because the attorneys general are concerned that non-medical users are shifting to non-tamper-resistant formulations of generic opioids.

“Prescription drug abuse is an epidemic that kills more than 1,000 Kentuckians each year,” Conway, who co-chairs NAAG’s Substance Committee, said in a news release. “The development of tamper-resistant and abuse-deterrent opioid drug products is a valuable aid to the law enforcement, legislative and public awareness initiatives many of us have implemented in our states to combat prescription drug abuse.”

Prescription drugs can be deadly when abused, and fatal drug overdoses are now the leading cause of death due to unintentional injury in the United States and Kentucky, exceeding even motor vehicle deaths, according to the Centers for Disease Control and Prevention. Federal data show that U.S. drug overdose deaths totaled 38,329 in 2010, rising for the 11th straight year, and accidental deaths involving addictive prescription drugs overshadow deaths from illicit narcotics.

In Kentucky, the number of drug-overdose deaths in Kentucky rose a staggering 296 percent from 2000 to 2010, according to the Kentucky Injury Prevention and Research Center. Kentucky is one of the most medicated states in the country, and has the sixth highest overdose rate. Last year, 220 million doses of the highly addictive painkiller hydrocodone were dispensed in the state -- that’s 51 doses for every man, woman and child in the state, says the AG release.

The news release from Conway's office said he led the effort to reach out to the FDA, along with Attorneys General Luther Strange of Alabama, Pam Bondi of Florida and Roy Cooper of North Carolina. Click here to read the letter; for a news release, click here.

Bill encouraging schools to stock EpiPens to stop deadly allergic reactions will become law

A bill encouraging Kentucky schools to stock EpiPens, or epinephrine auto-injectors, to stop anaphylaxis, a life-threatening allergic reaction, has passed will soon be signed into law by Gov. Steve Beshear.

When someone has anaphylaxis, the sooner you use an EpiPen, the better the outcome can be, said Thomas Sternberg, an allergist at Graves-Gilbert Clinic in Bowling Green, told Alyssa Harvey of the Daily News.

Under House Bill 172, schools could keep at least two EpiPens in case of emergency, and school boards would develop and approve policies and procedures for managing a student’s life-threatening allergic reaction, reports Harvey.

The bill also helps schools receive or buy the auto-injectors through local health departments and directs the state Department for Public Health to develop clinical protocols for using the auto-injectors in schools. Harvey reports that EpiPens can be donated to schools, and the EpiPens for Schools Program will provide up to four free auto-injectors per school year; if more are needed, they can be purchased at a discounted rate.

"You don’t know when someone could have an anaphylactic reaction,” Rep. Addia Wuchner, R-Florence, who sponsored the bill, told the Daily News. She alluded to an incident in Virginia, where a 7-year-old student died last year after an anaphylactic reaction, and no medications were available at the school to treat her. "There could be a hero in the school who was able to reach for that epinephrine pen and save a child’s life and not a tragedy like in Virginia,” Wuchner said. She filed the bill late in the 2012 session, but the language has been revised for this year's session to encourage rather than mandate schools to stock EpiPens.

Amy Wallace, treasurer and former president of the Bowling Green area's Food Education Allergy Support Team, told Harvey she was disappointed schools will not be required to make necessary provisions, but said advocates of the bill are happy to see that the problem is being addressed. (Read more)

Feds letting Arkansas privatize Medicaid expansion; idea could spread like wildfire, as in Florida, but cost questions remain

Arkansas has turned heads nationally with its preliminary plan to expand Medicaid using the private insurance market, showing that the Obama administration is willing to give states more flexibility than expected in expanding the program.

Health and Human Services Secretary Kathleen Sebelius has agreed to a proposal by Arkansas Gov. Mike Beebe to reject the Medicaid expansion but use federal money to buy private health insurance for the 200,000 people who would have been covered under ordinary expansion, reports Sandhya Somashekhar of The Washington Post.

States that have come down on either sides of the Medicaid-expansion issue may reconsider their decision in light of the Arkansas proposal, said Sara Rosenbaum, a health law professor at George Washington University. "If Arkansas is allowed to do this, I expect it to spread like wildfire," Rosenbaum told the Post.

The first place could be Florida, where a state Senate committee rejected Republican Gov. Rick Scott's expansion plan and proposed a privatization plan like that in Arkansas. Last week, a House committee voted to reject any expansion of the program. Scott "made it clear he was not going to lobby the Legislature on Medicaid," preferring to emphasize other issues, The New York Times' Lizette Alvarez reports. For coverage from the Tampa Bay Times and The Miami Herald, click here.

Could the wildfire spread all the way up to Kentucky?

Gov. Steve Beshear has said he wants to expand Medicaid in Kentucky if the state can afford it, but many Republican lawmakers oppose the idea, saying it would not be fiscally responsible. On the national level, 26 states and the District of Columbia have expressed a desire to expand Medicaid, 17 have said they reject it and seven are undecided, according to the nonpartisan Kaiser Family Foundation.

A more flexibile arrangement could be a game changer because it makes expansion more appealing, especially for states where expanding Medicaid has been politically unpopular and polarizing. in Arkansas, which has a Democratic governor and a Republicna legislature, officials say that from an ideological standpoint, using private insurance appeals to lawmakers from both parties, reports Somashekhar. She reports that even Democratic-led states might prefer this arrangement because it gets rid of some bureaucratic hurdles.

However, there are questions about cost. The Congressional Budget Office estimates that private insurance plans cost $3,000 more per person than Medicaid, reports Somashekhar. On the other hand, Arkansas officials say the move could ultimately save money in administrative charges along with other cost-control measures.

Although the Arkansas proposal is not concrete, it provides proof that the Department for Health and Human Services encourages innovative, state-based approaches to promote expansion. Many states may develop a new route best suited to their specific needs, without having to leave federal money on the table. (Read more)

Deadly, recalled pills still circulating in Pennyrile Region

A pain reliever that has been recalled and declared dangerous by the Federal Drug Administration is still circulating around southern Kentucky.

The drug marketed under the name Reumofan Plus is being distributed in Elkton and the broader Pennyrile Region, despite being recalled, and a local doctor's office says patients on the drug have had dangerous side effects, reports Nick Tabor of the Kentucky New Era.

Dr. Keith Toms of Generations Primary Care told Tabor three of his patients have taken the drug and had bad side effects. One patient had dangerous elevations of liver enzymes, and two diabetic patients had dangerous spikes in blood sugar.

The Food and Drug Administration has received reports of deaths, strokes, severe internal bleeding, dizziness, insomnia, high blood sugar and other problems associated with the drug since June. The manufacturer, operating under the names Reumofan Plus USA, LLC and Reumofan USA, LLC, announced a voluntary product recall last month, reports Tabor.

According to the FDA, undeclared ingredients in the drug, which is used as a treatment for muscle pain, arthritis, osteoporosis, bone cancer and other conditions, could result in serious illness. Tabor reports a FDA laboratory analysis of Reumofan Plus found that it contains diclofenac sodium, a non-steroidal anti-inflammatory drug, and methocarbamol, a muscle relaxant.

Tabor reports the FDA has issued an alert telling consumers to stop taking the drug immediately and consult a health-care professional. The agency also said it may follow up on the Reumofan recall with warning letters, seizure, injunction requests or criminal charges. (Read more)