health

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Whether or not your doctor stays in business over the next few years could hinge on their ability to adapt to a new regulation changing how Medicare pays doctors and clinicians.

The game-changing regulation aimed at paying medical providers for quality instead of quantity is known as MACRA. It’s based on legislation passed last year by Congress to overhaul how Medicare pays doctors.

There are two routes medical providers can take: Medical practices can earn higher reimbursements if they learn new ways of doing business. That includes being willing to accept financial risk and reward for performance, reporting quality measures to the government, and using electronic medical records. The majority of medical practices will go this route, according to the Kentucky Medical Association.

Or they can join a network of medical providers and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending.

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Ten months after completing a smoking cessation class, Terrence Silver started smoking cigarettes again. It was his first attempt at quitting after smoking for 40 years. His biggest motivation to quit: cost.

“That was the primary reason I was going to quit, the money,” Silver said. “It wasn’t health, wasn’t that I didn’t like it. It was the money.”

Silver lives across the river in Jeffersonville, Indiana, where the tax on cigarettes is 99 cents per pack. So he comes to Kentucky to buy his cigarettes, where the tax is 60 cents.

Silver said when he took the smoking cessation class in April of 2015 — offered through the Metro Department of Public Health — he learned about his triggers: every time he gets in his car, he reaches for a cigarette.

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A new study shows fewer Kentucky adults are delaying or skipping medical care because of cost concerns.

The report from the Foundation for a Healthy Kentucky says a little more than 20 percent of Kentuckians who are 18 and older put off treatment this year because they couldn’t afford it.

That’s a big improvement over the 32 percent who skipped or delayed medical care in 2009.

“It’s still too high a figure, and we’re still higher than the national average,” said Foundation President and CEO Ben Chandler. “But it’s certainly better than what it was, and it’s a good sign and a step in the right direction.”

Chandler says the increasing number of Kentuckians who have health coverage under the Affordable Care Act has made a big difference. He points out income level is also a big predictor of whether Kentuckians had to put off getting medical care.

Kentucky Cabinet for Health and Family Services

Kentuckians who’ve purchased health insurance via Kynect will have to re-enroll on the federal exchange starting Nov. 1.

The Centers for Medicare and Medicaid Services on Tuesday told Gov. Matt Bevin that all major milestones for the switch had been met. As of this year, 74,640 people were enrolled via the state health care exchange, Kynect.

This means if you currently have coverage that was acquired on the state exchange, you will have to re-enroll on the federal exchange at healthcare.gov. Officials said that’s due to consumer information not being transferred from Kynect. 

Adam Meier, Bevin’s chief of staff for policy, said people can be screened for Medicaid eligibility or a plan on the federal exchange via the Benefind website, which operates as the umbrella portal for Kentuckians to apply for nearly all entitlement services.

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If you go to the hospital this year, there will likely be a small decrease in your bill from previous years.

That’s because hospitals in Kentucky saw the lowest rates of charity care in 2015 since before Medicaid expansion went into effect four years ago.

But it might not last.

Charity care refers to the services hospitals provide patients who can’t pay because they don’t have insurance. Hospitals get paid back for this partially by the state and federal government, but they pass the remaining cost on to insured people.

In 2015, Kentucky hospitals had $552 million in charity care costs, compared with $2.4 billion four years ago.

The findings on uncompensated care come from a new report from the Foundation for a Healthy Kentucky report out last week.

A big reason for the dip is likely from the state’s expanded Medicaid program.

Baptist Health Plan To Stop Selling Insurance In Kentucky

Oct 3, 2016
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Baptist Health Plan says it will not sell policies in Kentucky next year, meaning about 7,000 people will have to find a new insurance provider.

Kentucky’s fourth-largest insurer notified state officials in a letter. In a news release, state officials say company President James S. Fritz said Baptist Health Plan had enrolled more people than it planned and said federal risk assessments imposed by the federal Affordable Care Act are “unsustainable.”

The company’s insurance plans sold on the state’s health exchange will be good through Dec. 31. Plans sold off the exchange will expire March 31, 2017.

The news means next year people in 59 counties will have one insurance provider selling plans on the state health exchange. Off the exchange, most counties will have two options, state officials said.

Kentucky Cabinet for Health and Family Services

Gov. Matt Bevin’s administration says HealthCare.gov will be up and running in Kentucky in time for Kynect customers to reapply for their health insurance later this year.

But roughly one month from the beginning of open enrollment on Nov. 1, some of those who work on the ground to help Kentuckians sign up for coverage are concerned about whether exchange customers will know when, where and how to re-enroll. That’s in part because education and outreach efforts have thus far been minimal.

Kentucky is moving from its state-based marketplace to the federal HealthCare.gov this year, after Bevin decided to dismantle Kynect and roll back Medicaid expansion in the state. Consumers must reapply this year for 2017 coverage even if they were auto-enrolled last year because eligibility information from Kynect won’t be transferred to the federal system.

The window for open enrollment is Nov. 1 until Dec. 15. Amanda Stamper, press secretary for Bevin administration, said they’ve hit milestones to make the switch in time.

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A new report says some Kentuckians could be drinking a cancer-causing chemical called chromium-6.

The Environmental Working Group, a public health advocacy group, analyzed data collected from samples of drinking water from all 50 states by the Environmental Protection Agency. Of the 85 Kentucky counties tested, the highest levels of chromium-6 were found in the samples from Daviess County.

The average level of chromium-6 found in Daviess County was 1.12 parts per billion, which according to Bill Walker, EWG managing editor, equates to a drop of water in an Olympic-sized swimming pool.

The EPA has imposed a limit for chromium of 100 parts per billion. But that includes both chromium-6 and chromium-3. The latter is an essential element for human function. However, too much can cause skin rashes.

Walker said the EPA bases its limit on the toxicity of chromium-3, not the more dangerous chromium-6.

“It’s two things mixed together and dumped into drinking water, and EPA says we have a standard to cover the combination of these things,” Walker said. “But don’t have a standard for the individual one, which happens to be more dangerous.

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The nation's opioid problem comes with staggering physical and emotional costs to patients and families. But the financial burden on the health system has been harder to peg.

A report set to be released Tuesday shows a more than thirteenfold increase in spending by health insurers in a four-year period on patients with a diagnosis of opioid dependence or abuse.

From 2011 to 2015, insurers' payments to hospitals, laboratories, treatment centers and other medical providers for these patients grew from $32 million to $446 million.

While the latest figure represents a small portion of the overall spending on medical care in the United States, the rapid rise is cause for concern, says Robin Gelburd, president of Fair Health, a nonprofit databank that provides cost information to the health industry and consumers.

"That really shows the stress on the health system and the impact on the individuals," said Gelburd.

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The prestigious National Academy of Sciences recently announced a comprehensive study on the health effects of the controversial coal mining practice known as mountaintop removal. For coalfield residents who have long questioned what impact the dust, blasting, chemicals and water contamination was having, the announcement comes as welcome news, if somewhat overdue.  

A decade of efforts to research the health effects of living near mountaintop removal mining have often run into industry opposition, political roadblocks, and bureaucratic delays. After decades of questions and concerns there is now reason to believe that answers are on the way.

Longstanding Concerns

Concerns about how surface mining affects the people of Appalachia are nearly as old as the practice itself. West Virginia first regulated surface mining in 1939, and statements of concern and protest have long been a part of the culture in the central Appalachian coalfields.

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A powerful drug that's normally used to tranquilize elephants is being blamed for a record spike in drug overdoses in the Midwest. Officials in Ohio have declared a public health emergency and the U.S. Drug Enforcement Administration says communities everywhere should be on alert for carfentanil.

The synthetic opioid is 100 times more potent than fentanyl, the prescription painkiller that led to the death earlier this year of the pop star Prince. Fentanyl itself can be up to 50 times more deadly than heroin.

In the past few years, traffickers in illegal drugs increasingly have substituted fentanyl for heroin and other opioids. Now carfentanil is being sold on American streets, either mixed with heroin or pressed into pills that look like prescription drugs. Many users don't realize that they're buying carfentanil. And that has deadly consequences.

"Instead of having four or five overdoses in a day, you're having these 20, 30, 40, maybe even 50 overdoses in a day," says Tom Synan, who directs the Hamilton County Heroin Coalition Task Force in Southwest Ohio. He's also the police chief in Newtown, Ohio.

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Kentucky has the fifth highest obesity rate in the nation.

The commonwealth also has the dubious distinction of being only one of two states that saw an increase in obesity levels between 2014 and last year.

The figures come from a new report by the Trust for America’s Health and the Robert Wood Johnson Foundation.

Read the Full Report Here

The latest data show that 34.6 percent of Kentucky’s adults were obese in 2015. Kentucky had the third-highest rate of obese whites, and the fifth-most African-Americans who were obese.

Only Kentucky and Kansas saw an increased rate of adult obesity. Four states saw a decrease, and the rest were stable.

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Multiracial people in Kentucky are 30 percent more likely to have asthma, according to a new report from the Foundation for a Healthy Kentucky and the University of Kentucky released on Tuesday.

And multiracial “and other” race Kentuckians were more likely to report poor mental health than white or black Kentuckians, according to the report.

Those and other findings show stark disparities across health outcomes for non-white Kentuckians. They come from 11,000 phone surveys with people of all races between 2011 and 2013. The “other” category includes American Indians, Hawaiians and those with unspecified races.

The findings are from before Kentucky expanded Medicaid to include childless adults and people making up to 138 percent of the poverty limit ($11,880).

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Treatment for life-threatening allergic reactions is about to get a little cheaper.

Mylan, the maker of the EpiPen, said Monday that it will launch a generic version of the device for half the price of the brand-name product.

The company says the generic will hit the market in a few weeks and cost $300 for a two-pack. That's less than half the price of a two-pack of brand-name EpiPens, which are available at Target pharmacies for about $630, according to GoodRX.

The move by Mylan comes in response to mounting pressure from consumers and Congress to lower the drug's price. In less than 10 years, the price for a two-pack of injectors has risen from about $100 to more than $600.

"This helps Mylan with its public relations battle against criticism for sharp price increases on the EpiPen," says Larry Levitt, a health policy analyst at the Kaiser Family Foundation. "The introduction of a lower-priced generic version may keep competitors out of the market."

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For at least the next seven months, give or take, there’s no need to worry that the proposed changes to expanded Medicaid benefits will affect your coverage.

Seven months is the average time it takes for the federal government to negotiate with a state over changes to Medicaid. And even then, some of the changes likely won’t happen.

On Wednesday, Gov. Matt Bevin submitted those proposed changes via what’s called a “Medicaid demonstration waiver” to the U.S. Department of Health and Human Services.

The Affordable Care Act was originally designed to extend Medicaid to residents in all 50 states who earn below 138 percent of the federal poverty limit, or $16,394 in 2016. But the Supreme Court famously struck down that provision.

Most states expanded Medicaid as the ACA plan set out several years ago. But a handful of states, now including Kentucky, have applied for waivers to change what the federal government intended for expansion.

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