Get a prescription before buying decorative contact lenses for Halloween, optometrists recommend

Many people incorporate decorative contact lenses into their Halloween costumes, and not all of them are purchased legally. They can be found on the Internet, beauty salons, convenience stores and some national retailers.  The Kentucky Optometric Association recommends that you never buy lenses from these sources.

Wearing decorative contact lenses purchased illegally and without a prescription can lead to serious health issues and potentially damage your eyesight, the association said in a news release.

The Food and Drug Administration classifies all contact lenses as medical devices, whether they correct vision or not. When considering decorative contact lenses as part of your costume, the optometrists say you should obtain a prescription from a doctor, who can also teach you how to properly care for your eyes while wearing contacts.

“Even though these are non-corrective lenses, they still pose the same potential health and safety risks as other contact lenses,” said Dr. Bill Reynolds, an optometrist in Richmond and a trustee of the American Optometric Association. “When purchased over the counter, decorative contact lenses can put people at risk for bacterial infections, allergic reactions or even significant damage to the eye’s ability to function with the potential for irreversible sight loss.”

School nurses are an unfunded mandate for schools, which are picking up more of their cost as health department budgets shrink

Marion County nurse Renee Schooling helps
Levi Hardin, a Marion County first grader with
diabetes, check his blood sugar. (Lebanon
Enterprise Photo by Stevie Lowery)

Kentucky school nurses are stretched thin across the districts they serve and the budgets to pay for  them are stretched even thinner, because of budget cuts in the state Department of Public Health.

School districts are picking up the load, but often not all of it, because of their own financial challenges. "Basically it's one of the many unfunded mandates," Editor Stevie Lowery writes for The Lebanon Enterprise.

Lowery reports that the Marion County Schools currently share the cost of nurses with the Lincoln Trail District Health Department, with the schools paying 58 percent, or $161,000 a yera, and the department paying 42 percent, $116,000.

In some counties, schools are bearing the entire cost, which in some cases has reduced the availability of nurses, but Thursday night, the Christian County school board voted to hire another nurse, giving it one at every school, Editor Eli Pace reports for the Kentucky New Era in Hopkinsville.

Marion County Supt. Taylora Schlosser told Lowery that while her district values the services nurses provide, she and the school board will need to keep evaluating who pays for that service. The district plans to compare the cost of its contract with the health department and the cost of hiring its own nurses, with a commitment to not allow the level of service to change, Lowery reports.

“We will always have school nurses because we are going to take care of our kids,” Schlosser told Lowery. “How we pay for school nurses might change.”

In Kentucky, if a student requires medical care in order to attend school, state law requires school districts to provide the care.  Districts may hire nurses, contract with the health department, or use the medical supervision and delegation of medical tasks to district staff by local medical professionals, Lowery reports.

School nurses take care of students and staff who are injured or not feeling well, care for students with special medical or dietary needs, administer medications, conduct screenings, give flu shots, provide nutrition and wellness education, certify and give immunizations, and train staff in CPR, first aid and emergency administration of medication, Lowery reports.

“We’re not just boo-boos and Band-Aids,” Keown told Lowery. "Our main goal is to keep kids in school and keep them healthy so they can get a better education. Healthy kids make healthy students.” (Read more)

In Christian County, nurses have been called on almost 13,000 times this year, nurse coordinator Megan Kidd reported to the school board Thursday night. She said many students in the district don't have primary-care physicians and are told by their parents to see the school nurse, Pace reports.

"Kidd said 11 out of the district’s 15 schools have at least one diabetic student who depends on insulin," Pace writes. "In addition to insulin injections, other common reasons for trips to the nurse include allergic reactions requiring EpiPens and asthma attacks. Seizures also seem to be on the rise, Kidd said.

"But even though most of the visits were related to fairly common issues, Kidd told a story of a school nurse who once saw a student starting to show signs of leukemia. The nurse didn’t diagnose the child with cancer — that’s something a school nurse would be not allowed to do anyway, Kidd said — but the nurse pushed the child’s parents to go to the doctor, and the child did in fact turn out to have cancer." (Read more; subscription required)

GOP claim that Obamacare will hike Kentuckians' premiums 34 percent is 'mostly false,' Herald-Leader says in an analysis

A Republican Party claim that Obamacare will raise Kentuckians' health-insurance premiums 34 percent is mostly false, the Lexington Herald-Leader said in a news analysis Saturday.

The National Republican Senatorial Committee made the claim in a news release attacking Democratic U.S. Senate candidate Alison Lundergan Grimes. It said, "In Kentucky, individuals will see a 34 percent increase in their health-care premiums," citing a March report by the Society of Actuaries.

But the report itself cautioned, "We suggest readers carefully consider possible variations in outcomes and the actions of competitors and regulators when using this report. We suggest that actual per-member, per-month figures generally should not be used."

And one author of the report told Herald-Leader reporter John Cheves, "We didn't even try to predict the future of premiums in that study." Randy Haught, senior scientist at Dobson | DaVanzo, a health-care consulting firm, said the study "is a heck of a lot more nuanced than that."

Read more here: http://www.kentucky.com/2013/10/25/2894759/campaign-watchdog-gop-claim-that.html#storylink=cpy

Cheves cited other health-care experts in writing, "Because there are so many variables involved and changes coming to the marketplace, it's impossible to accurately predict the law's impact on premiums."

The study did make some projections. "The NRSC picked one number from one of many charts in the 83-page report," Cheves reports. "That chart dealt with the small subset of Kentucky's population that would not be covered by employers' insurance plans or Medicaid," about 7 percent of Kentuckians. Using several variables, it estimated premiums for individual policies would average $398 a month, up from $297.

"Though premiums may rise for some Americans, particularly young adults who typically avoid big medical bills and therefore have enjoyed lower rates, different factors will push costs up and down," Cheves writes. "For example, Americans with existing medical problems now will be allowed to buy insurance, which will increase prices overall. At the same time, young people who have avoided insurance are expected to enroll, helping offset that impact. In addition, the law provides for subsidies and tax breaks to lower the final costs for many consumers."

The newspaper's "mostly false" label in its "Campaign Watchdog" series is the next-to-worst on its rating scale, between "false" and "half true."

FDA wants to limit number of hydrocodone refills available without another doctor visit; approves pure version of drug

"The Food and Drug Administration on Thursday recommended tighter controls on how doctors prescribe the most commonly used narcotic painkillers, changes that are expected to take place as early as next year," Barry Meier reports for The New York Times. "Drugs at issue contain a combination of hydrocodone and an over-the-counter painkiller like acetaminophen or aspirin and are sold either as generics or under brand names like Vicodin or Lortab." (Associated Press photo by Toby Talbot)

"Doctors use the medications to treat pain from injuries, arthritis, dental extractions and other problems," Meier writes. "The change would reduce the number of refills patients could get before going back to see their doctor. Patients would also be required to take a prescription to a pharmacy, rather than have a doctor call it in. The new regulations would reduce by half, to 90 days, the supply of the drug a patient could obtain without a new prescription."

On Friday, the FDA announced it had approved a stronger version of hydrocodone, Zohydro ER, for patients who require 24-hour, long-term pain medication. "The new version is the first pure hydrocodone drug approved in the U.S.," ABC News reports. "Hydrocodone is currently sold in combination pills like Vicodin to treat pain from injuries, surgery, arthritis and migraines." Activists against prescription-drug abuse criticized the decision.

U.S. Rep. Hal Rogers of Kentucky's 5th District "said on Friday that top FDA officials had recently assured him they would only approve new opioids like Zohydro if they were marketed in formulations intended to deter abuse," Meier and Eric Lipton report. "OxyContin is now formulated that way, but Zohydro, which is contains hydrocodone without acetaminophen, is not. Its producer, Zogenix, says it will closely monitor use of the drug." Rogers told the Times, “It is like the original OxyContin, so that is real problematical.”        

More than 6.1 million Americans abuse prescription pills, and last year there were 22,133 prescription drug deaths. The problem is most rampant in Central Appalachia, including Eastern Kentucky.

In 2011, about 131 million prescriptions for 47 million patients, or about five billion pills, were written for medications containing hydrocodone, Meier notes. "Prescription drugs account for about three-quarters of all drug overdose deaths in the United States, with the number of deaths from narcotic painkillers, or opioids, quadrupling since 1999, according to federal data." (Read more)

Beshear says his managed-care plan is saving money and improving health outcomes; state points finger at hospitals

Six months ago, Gov. Steve Beshear applied an intensive plan to solve Medicaid managed-care implementation issues. On Thursday, he said the system is working more effectively for both providers and managed care organizations. He also said hospitals' complaints were overstated and some of them need to adapt to the new system, which will be two years old Nov. 1.

Gov. Steve Beshear

"There will still be a few—be they hospital or individual medical providers—who will say the program doesn't work, but it's tough to refute the facts," Beshear said at a news conference and in a press release. All but three states use managed care to save money and improve health.

Beshear asked each managed-care organization (MCO) to meet with every hospital in their networks to look over their accounts receivable to resolve billing disputes. "The final analysis—the MCOs and hospitals agreed that what was actually disputed and owed was a tiny fraction—just 2 percent of the original $346.6 million claim," the release says in boldface type.

The Kentucky Hospital Association said in a news release Friday, "The overwhelming majority of hospitals still report significant dollar amounts owed to them by the MCOs in unpaid claims. . . . While hospitals have seen a slight improvement in current claims processing and a slight decline in overall accounts receivables since the Governor issued his directive to the MCOs to clean up these claims, the amount of unpaid claims actually owed to hospitals (not billed amounts) is 60 to 70 percent higher compared to unpaid bills in October 2011 before managed care was implemented."

Beshear ordered that complaints about MCOs' payments be handled by the Department of Insurance instead of the Department for Medicaid Services. He said it has closed or nearly closed two-thirds of the 1,935 complaints it received. "Most complaints were related not to prompt pa y— which is what hospitals alleged — but instead related to claim denials, prior authorization disputes or unsatisfactory settlement offers," the release says.

The Insurance Department said MCOs often failed to offer a good explanation for denying claims. The Medicaid agency "sent corrective action plans to Coventry and Wellcare," the two MCOs operating outside the Louisville region. They will report progress each quarterly.

In general, the reviews didn't find that MCOs were holding payments on a regular basis, but concluded that Coventry Cares did not follow the state law requiring prompt payment if insurance claims. The Insurance Department has proposed that the company pay a civil penalty of $9,000.

Managed care has reduced "unnecessary ER use and inpatient hospital days in favor of more consistent disease management and prevention," Audrey Tayse Haynes, secretary of the Cabinet for Health and Family Services, said in the release. Kentucky has many people who go to the ER 10 times or more in a year, contributing to total ER expenses of $340 million for Medicaid. Unfortunately, Haynes said, some hospitals have used ERs to create revenue to support operations, "even advertising the average wait time in their ERs on their websites. For some communities, the ER has been the de facto primary care center." Haynes said hospitals have to put together a new business model that "dovetails with the goal of preventive care and wellness instead of high-cost emergency treatment."

The hospital association said it supports the state's efforts to reduce ER abuse, but "That project does not and will not solve the ongoing problem of WellCare and Coventry continuing to pay hospitals only $50 for emergency room care by reclassifying, on average, 50 percent of all ER patients, as non-emergency — under criteria they refuse to share with hospitals."

The implementation of the managed health care plan has saved money and improved health care, Beshear said. Per-patient costs are below predicted amounts and new enrollment is the same or declining. In November 2011, budget analysts predicted that the state would save $1.3 billion in the next two years, and "to date, Kentucky is still on target to meet that savings amount," the release said.

Statistics about health show the improvements to the system. For example, there has been a 93 percent increase in consultations to stop smoking, a 33 percent increase in flu vaccines for children, huge increases in mammograms and screenings for heart problems, and a 17 percent decrease in amputations (often because of untreated diabetes), and nearly an 11 percent decrease in CT scans.

Shortages of insurance providers and hospitals lead to higher insurance premiums under Obamacare in rural areas

The Patient Protection and Affordable Care Act was designed to make it easier for uninsured Americans to buy insurance at an affordable rate. But the exact opposite is happening in rural areas in many states, where a lack of insurance providers has eliminated competition between insurance companies, leading to higher prices, Reed Abelson, The New York Times reports. In the roughly 2,500 rural counties served by the federal exchange, 58 percent have plans offered by only one or two providers, and people in 530 counties only have one choice for a provider. A state-by-state interactive map is available by clicking here. (NYT photo by Rich Addicks: Shopping for insurance)

In Kentucky, all counties have at least two providers, but the Times found that in other states, competition among three or more providers is needed to make a substantial difference in premium rates.

"In rural regions, several factors combine to create a landscape that is inhospitable to newcomers," the Times reports. "Developing relationships with doctors and hospitals can be costly where cities and towns are widely scattered and the pool of potential customers is small." States such as Wyoming, with a population of 600,000, are in a difficult situation. Tom Hirsig, Wyoming’s insurance commissioner, told the Times, “I think the problem was that the Affordable Care Act was designed for where the majority of the people live, in the big cities where there’s a lot of competition among health care providers. You’ve got to have some bargaining chips, and we don’t have that much."

Many rural areas only have one hospital, "giving insurers little leverage when negotiating reimbursement rates," the Times reports. "Only one Wyoming county is served by more than one hospital, said Stephen K. Goldstone, the chief executive of WINHealth. In southwest Georgia, another rural region, Blue Cross and Blue Shield of Georgia is the dominant carrier, and it is the only insurer operating in 54 of the state’s 159 counties. Only one carrier, Highmark Blue Cross, is offering coverage in West Virginia, which has high rates of obesity and chronic diseases like diabetes." (Read more)

Ovarian cancer screening is critical in detecting tumors that don't show up on clinical exams, and increases chance of survival

Kentucky First Lady Jane Beshear joined some of the state's female legislators to highlight the importance of screening for ovarian cancer, which can be done for free through the University of Kentucky Markey Cancer Center's ovarian cancer screening program.

Ovarian cancer is fifth among cancer killers of American women and accounts for more cancer-related deaths, causing more deaths than any other cancer of the female reproductive system, says the federal Centers for Disease Control and Prevention.

SYMPTOMS OF OVARIAN CANCER (CDC)

When ovarian cancer is found in its early stages, treatment is most effective, but most women with ovarian cancer don't have symptoms of it until the disease progresses into a more advanced stage. As it progresses, survival rates drop sharply, making screening and early detection critical. Data from the screening program at UK shows that regular screening increases survival rates, says a UK news release.

"This preventative ovarian cancer screening is free, quick and confidential – an easy way for women to protect themselves from this life-threatening illness," Jane Beshear said. "This simple procedure is available to women in all parts of Kentucky, not just the Lexington area, and I encourage all who are at-risk for the disease to participate in the program."

Dr. John van Nagell, professor of obstetrics and gynecology at the Markey Cancer Center, said "While regular pelvic examinations are important and can detect many other abnormalities, including cervical cancer, they are not effective in detecting ovarian cancer in its earliest and most treatable stages."

Van Nagell started the screening program in 1987 to test the use of transvaginal sonography to detect ovarian tumors that are too small to be detected during an annual exam, says the release. Over the program's 26 year period, more than 241,000 free screening examinations have been provided to more than 41,000 Kentucky women, and 558 ovarian tumors and 86 malignancies have been detected.

Women from every county in the state have participated in this program, says the release. Screenings through the program are now being performed in Lexington, Elizabethtown, Somerset, Prestonsburg, Maysville, Paducah and Greenup County.

All women are at risk for ovarian cancer, but older women are more likely to get the disease. About 90 percent of women who get it are older than 40, says the CDC.

The UK screening program is free and open to women age 50 or older, or women over the age of 25 who have a family history of ovarian cancer. For more information, call (859) 323-4687 or (800) 766-8279. Click here for more CDC information.