Legislature eases physician assistant rules; nurse practitioners' prescription power, Medicaid prompt-payment bills, others linger

By Molly Burchett and Al Cross
Kentucky Health News

The Kentucky General Assembly has joined other states in easing the restrictions on physician assistants’ medical practice, but has held up a similar move for advanced registered nurse practitioners. Both issues relate to the shortage of medical practitioners in many Kentucky counties, and the quality of medical care.

The Senate added the physician assistant language of Senate Bill 43 to House Bill 104, an art-therapy bill, in order to preserve an agreement between the Kentucky Medical Association and the Kentucky Academy of Physician Assistants. It will repeal the law that bans PAs from practicing for their first 18 months unless a physician is on site; one will still have to be available by telephone. The amended bill has been sent to Gov. Steve Beshear for his signature or veto.

The amendment was used because the House had tacked onto SB 43 an amendment from advance practice registered nurses that would have repealed the need for them to have a collaborative agreement with a physicians to prescribe non-narcotic drugs. The KMA opposes that idea.

"It's looking like the doctors win," said Sen. Julie Denton, R-Louisville, who favors the repeal. "I'm not hopeful" it can pass, she said, but added that some physicians also favor it: "With Obamacare coming in, we're going to need all the front-line physicians we can get." Leading opponents of the measure, Republicans Katie Stine of Fort Thomas and Carroll Gibson of Leitchfield, didn't return a call seeking comment.

Nurse practitioners say that SB 43 is necessary to allow them to fill health-care gaps in rural Kentucky and address the state's shortage of primary-care providers. The Kentucky Coalition of Nurse Practitioners and Nurse Midwives says in an article prepared for Kentucky newspapers that NPs have never been required to practice under physician supervision and 17 states allow full prescribing authority for non-scheduled medications.

The Medicaid prompt-payment bill, HB 5, went to a conference committee after the House refused to go along with Senate changes, and may be considered when the legislature returns later this month, ostensibly to consider any bills Beshear vetoes. The bill would apply prompt-payment laws to managed-care organizations and would move Medicaid late-payment complaints to the insurance department; those are now handled by the Cabinet for Health and Family Services, which administers Medicaid.

In the final crunch to pass legislation before the veto recess, lawmakers attached seven health care-related bills to HB 366, which had focused on identifying congenital heart disease in newborns. It had 10 additional measures "hung on it like a Christmas tree before the free conference committee of House and Senate members," reports Ryan Alessi of cn|2's "Pure Politics."

The bills still hanging on the measure, dubbed the "healthy Christmas tree," are:

• HB 187, addressing a free prescription-drug program for under-insured Kentuckians.
• HB 79, which would exempt licensed health care providers from being disciplined for prescribing naloxone in the event of an overdose.
• HB 387, which aims to provide nutritional supplements for low-birth-weight newborns.
• SB 201, which addresses licensed diabetes educators.
• SB 38, to require Medicaid to accept provider credentialing by a Medicaid managed-care organization.
• SB 108, relating to managed-care contracts with the IMPACT Plus program, a behavioral health program for children.

Kentucky Health News is an independent news service of the Institute for Rural Journalism and Community Issues at the University of Kentucky, with support from the Foundation for a Healthy Kentucky.

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

Legislature sends fix of last year's pill-mill bill to Beshear

"After more than a year of debate, a bill that would revamp Kentucky’s prescription-drug law to more strictly focus on pill abuse and ease requirements on patients is heading to the governor’s desk," Mike Wynn reports for The Courier-Journal. On a 36-0 vote, the Senate sent House Bill 217 to Gov. Steve Beshear, who said he will sign it tomorrow.

The chief lobbyist for the Kentucky Medical Association said the physicians' group did not get all the changes it requested in last year's law but is satisfied with the bill. It "would exempt hospitals and long-term care facilities from many of the requirements that doctors must follow before prescribing drugs," Wynn writes. "It also creates a 14-day exemption for surgery patients and gives doctors more discretion in examining patients before a prescription is given." (Read more)

Improving Kentucky's mental health calls for the action of schools and doctors to identify children's mental health needs early

Many people may think that addressing mental health needs in Kentucky relies mostly on more funding, but its effectiveness hinges more on the ability to identify children who need help and make sure they get it early, two experts said on cn|2's "Pure Politics" Tuesday.

About half of mental illnesses begin to appear before a person turns 14, reports cn|2's Ryan Alessi. Mental-health experts say it’s often more effective and efficient to treat children, and it’s easier for parents to make sure their children get help than it is for someone to convince or coerce an adult exhibiting symptoms that he needs treatment, said Dr. Allen Brenzel, a child psychiatrist.


Encouraging school officials and doctors to identify children with these needs can be a challenge, Brenzel said, because it is difficult for a teacher to have tough conversations with parents about this topic. Also, while doctors may be most important in this process, obstacles exist because our current "system of care doesn't promote the amount of time and effort and importance on these issues," he said.

When a primary-care doctor's offices are jammed with sick patients and a parent comes in to discuss problems their child is having in school, "That’s a challenging environment in primary care,” Brenzel said. “But people trust their primary care providers very often, and that is where they go. So some of what we need to look at is co-location of services.”

Brenzel said we need a system with a single point of access, where a family can be greeted, there is a period of engagement and a reimbursement structure that supports the time and efforts required by behavioral health.

"We need to integrate behavioral health into the overall health care system," he said. "We have a very fragmented and inefficient system that leads to confusion when a family identifies that their child needs help and this isn't going to be fixed by a medical model.  We now know that the kinds of services need to be much more comprehensive and supportive. A system that allows a comprehensive mental and behavioral health assessment of needs will allow us to triage many kids out of the juvenile justice system."

Benzel said this is a societal issue and for every $1 that we spend in supportive services, we can avoid spend $5 later on adult incarcerations and adult prison. On average, it was more than $2,000 cheaper per person to treat a child than an adult. It amounted to $4,328 per child compared to more than $6,500 for each adult treated, Alessi reports.

Families may be fearful of the cost of mental-health services, but there are resources for people without mental-health insurance coverage at the 14 mental health centers in Kentucky, said Steve Shannon, executive director of the Kentucky Association of Mental Health/Mental Retardation Programs.

In terms of resources, Kentucky spent nearly a half billion dollars on mental health for people under 21 in the 2010-11 fiscal year. For adults, the state spent more than $730 million, according to figures from the Cabinet for Health and Family Services. (Read more)

Report: Electronic health records haven't cut health costs

The conversion to electronic health records isn't producing savings in health-care costs predicted by a 2005 report, and it's had mixed results in improving efficiency and patient care, according to a RAND Corporation report. The company's 2005 predictions helped drive growth in the EHR industry and encourage billions of dollars in subsidies from the federal government to hospitals and doctors to implement such systems, Reed Abelson and Julie Creswell of The New York Times report.

The 2005 report predicted that widespread use of EHRs could save the U.S. health care system at least $81 billion a year. "But evidence of significant savings is scant, and there is increasing concern that electronic records have actually added to costs by making it easier to bill more for some services," Abelson and Creswell write. Health care costs have risen $800 billion since the 2005 report, according to federal data.

Authors of the new report, published in this month's issue of Health Affairs, said they didn't attach dollar amounts to how much electronic record keeping has helped or hurt efforts to reduce costs. "But the firm's acknowledgement that its earlier analysis was overly optimistic adds to a chorus of concern about the cost of the new systems and the haste with which they have been adopted," Abelson and Creswell report.

There are several factors why the switch has not created significant savings, report authors said. Those factors include use of commercial record systems, slow rates of system adoption, and the fact that electronic records "do not address the fact that doctors and hospitals reap the benefits of high volumes of care," Abelson and Creswell report. (Read more)

Group of 550 doctors in Central Ky. leaving Medicaid's Coventry

A Lexington-area network of doctors says it will no longer contract with Coventry Cares, a Medicaid managed-care company, after Coventry said "it would begin to pay less than the established Medicaid rate in reimbursements — as much as 10 percent less for care from specialists," Cheryl Truman reports for the Lexington Herald-Leader.

The Physicians' Network is a group of 550 independent physicians, headed by Dr. Ralph Alvarado of Winchester. He said the cuts will mean that some doctors will be paying to treat Medicaid patients.

d more here: http://www.kentucky.com/2012/12/20/2450679/central-kentucky-doctors-cut-ties.html#storylink=cpy

Coventry issued a statement saying, "This decision would not take effect until March 7, and we do not expect any network access issues for our members. That said, Coventry would like our members to continue enjoying access to this group of providers. We remain committed to continuing negotiations . . . " (Read more)

Managed-care doctor creates process to steer pregnant Medicaid recipients who are using dangerous drugs into treatment

When Dr. Jeremy Corbett of Lexington found that "nearly one in five pregnant women enrolled in the Medicaid managed-care program where he works were using narcotics or other harmful drugs," he tackled the problem. As medical director of the Kentucky Spirit Health Plan, "He designed a new program combining high-tech health information with case management to tackle the problem of addicted babies, which is exploding statewide," reports Laura Ungar of The Courier-Journal. (C-J photo by Tim Webb)

Ungar describes how Corbett's program works: "Employees examine patient records for pregnant Kentucky Spirit members. The pharmacy department uses an analytics report, coupled with the Kentucky All Schedule Prescription Electronic Reporting System, or KASPER, to cross-check for drugs that could be dangerous during pregnancy, including narcotics. Department employees also look at the pattern of prescriptions, which could point toward doctor-shopping for pills. . . . Kentucky Spirit sends letters to the prescribing doctor and the obstetrician the woman is seeing, letting them know she is pregnant and has received a prescription for dangerous drugs. Corbett said sometimes the prescribing doctor doesn’t know the woman is pregnant, and the obstetrician doesn’t know she’s taking narcotics. Corbett said they also send letters outlining the dangers of taking certain drugs during pregnancy, and case managers reach out to women at risk of giving birth to addicted babies."

The program started three weeks ago. Corbett said two women have asked to get substance-abuse treatment, for which Kentucky Spirit pays — "even residential treatment, which is not required by Kentucky law — because it saves money in the long run," Ungar reports. "Kentucky has seen its hospitalizations for addicted newborns climb from 29 in 2000 to 730 last year — a 2,400 percent increase that far outpaces the national increase." Corbett told her, “When these babies wind up in the neonatal intensive care unit, it’s a huge loss, emotionally, and it’s also a huge loss of state dollars.” (Read more)

Republican legislators keep hammering state officials and managed-care companies about Medicaid payment delays

Republican lawmakers reitarated this week that the companies managing Medcaid in Kentucky are still not paying health providers promptly. According to Sen. Joe Bowen, R-Owensboro, in the year since the state moved more than a half a million people to managed care, the amount owed to hospitals has doubled, Beth Musgrave of the Lexington Herald-Leader reports. The state switched to managed care to reduce costs in the federal-state program that pays health care costs for the poor and disabled.

According to state Medicaid Commissioner Lawrence Kissner, WellCare and Kentucky Spirit have been cited by the state Department of Insurance for failing to meet their obligation to the state and the hospitals. A third managed care company, Coventry, has not been cited. The two companies, notes Musgrave, have submitted plans of correction to the insurance department.

None of the companies testified at Tuesday's meeting of the Interim Joint Committee on Health and Welfare where Bowen and other Republicans voiced their complaints. Despite the payment problems, Kisser said the move to managed care has helped stem rising costs. As of October, he said, Medicaid was $40 million under budget. (Read more)

Medical licensure board changing rules to focus more on painkillers; fewer urine tests for patients, fewer reports for doctors

Patients in long-term treatment with controlled substances won't have to have their urine tested for drugs unless they are on painkillers, and doctors will have wide discretion over how often to do the tests, under new rules being drafted by the Kentucky Board of Medical Licensure.

That is just one example of the changes that the board is making in regulations authorized by the "pill mill bill" the General Assembly passed this year, reports Mike Wynn of The Courier-Journal. Other changes will put more focus on medicines with the painkiller hydrocodone and exempt some medicines that have only small amounts of painkillers.

"While the bill focused largely on pain pills, the board’s regulations covered a wider range of medications, including the sleep aid Ambien and the anti-anxiety drug Xanax," Wynn notes. "The regulations also called on doctors to perform a much broader array of administrative tasks to determine the appropriateness of prescriptions and a patient’s risk for abuse or diversion." Now they will have to do less, making follow-up reports to the state drug-tracking system only when prescribing painkillers.

The board's director, Michael Rodman, told Wynn it is responding to complaints by physicians and lobbying interests who say the the rules are too complex and go too far. The board filed the new rules last month for approval by legislative committees, but says it is already using them to make enforcement decisions. House Speaker Greg Stumbo, who sponsored the bill, has endorsed the changes.

The doctors' lobby, the Kentucky Medical Association, has voiced its pleasure with the changes but says others are needed, such as parts of the law that require specific medical practices such as standards for prescribing. (Read more)

U of L doctors wary of KentuckyOne's promise of autonomy

Doctors at Louisville's University Hospital are expressing concerns that the partnership with KentuckyOne Health and the Catholic health rules that come with that merger might affect patient care. Assurances that their concerns are unfounded have been coming from KentuckyOne's majority owner, Denver-based Catholic Health Initiatives. Anxiety over doctors' medical freedom to treat patients as they feel is necessary is being fueled as staff and physicians are being asked to "respect" Catholic health directives, The Courier-Journal reports.

Sheila Reynertson, advocacy coordinator for the New York-based MergerWatch Project, who tracks secular-religious hospital mergers, told The C-J's Laura Ungar that such language puts doctors in "a difficult position." For instance, she explains, "cancer doctors may wonder about prescribing birth control to prevent pregnancy, she said. Catholic directives include a ban on sterilization, abortions, and euthanasia and say Catholic health institutions can't "promote or condone contraceptive practices." Gary Mans, spokesman for the U of L Health Sciences Center, said he doesn't believe doctors and staff will feel constrained by the directives. (Read more)

State officials appear to be overstating successes of new prescription-drug law, The Courier-Journal reports

There's new criticism from Kentucky's doctors in an analysis of the state's four-month old prescription drug law, showing that a lot of what state officials have touted as the law's successes were already in the works before the law went into effect.

The Courier-Journal of Louisville reviewed state records after Gov. Steve Beshear released figures last month that showed the Kentucky Board of Medical Licensure had disciplined 33 physicians for violating professional prescription standards. Reporter Mike Wynn writes that he "found that 16 of the cases were resolved before the new law took effect on July 20, and 13 others involved investigations or actions that were well under way before the law’s implementation. The administration also reported last month that 18 of the 44 known pain-management clinics in Kentucky have closed or discontinued pain management services, including 10 after House Bill 1. Still, state records are unclear if all the clinics were suspected of illegal prescribing."

“They’ve taken a situation that required a scalpel to cut out the disease and instead they have used a machete,” Gregory Hood, governor of the Kentucky chapter of the American College of Physicians, told Wynn.

Beshear's announcement last month about the bill's almost overnight success also included crediting it for drops in prescriptions being written for pain killers, most notably for oxymorphone, which had a 38 percent falloff.  But, writes Wynn, "Critics of the law say that at least part of those declines are due to doctors denying needed prescriptions to patients because of problems with HB 1." Experts told the paper that oxymorphone, commonly prescribed as Opana, was not readily available in the market during the applicable period because of a reformulation by its manufacturer. (Read more)

Doctor's rejection of the willfully obese makes exercise expert ask: Who's responsible for your health? Who should pay for it?

Bryant Stamford, professor and chairman of the Department of Kinesiology and Integrative Physiology at Hanover College in Indiana, wrote in his weekly exercise-and-health column Thursday's edition of The Courier-Journal:

"I caught an interesting news story on TV about a physician who refuses to treat obese patients. That was the headline. In truth, when she was interviewed she made it clear that she had a number of obese patients and she was treating them," if they were willing to lose weight. She referred the other obese patients to physicians who specialized in care of the overweight.

Stamford asked: "Is this approach the rationing of health care? It’s rationing it to those who take responsibility for themselves by managing their weight. . . . I don’t support withholding health care to anyone, and that includes the obese and smokers. But it does raise the issue of who is responsible for your health. We spend far more on health care than other industrialized countries, and we are bankrupting our health-care systems, including Medicare and Medicaid. Why? We follow a health-destroying lifestyle, then we expect to jump into the health-care system and have it perform miracles. And, more often than not, it does, but it costs a fortune for each patient. Does this make any sense?"

He points to ways in which some countries have decided in what order people get heart surgeries -- those who smoke are not first in line. What it could mean in the future for us?  "I believe the writing is on the wall. ... If you engage in health-destroying behaviors, you will be required to pay a lot more for health insurance. It’s the model for life insurance, and there already are rumblings around the country supporting a move in this direction. Stay tuned." Read the column here.

Pill-mill bill causing problems for patients who have long-term prescriptions: expensive drug-screening tests

In July, Kentucky started making long-time holders of certain controlled-substances prescriptions submit to urine tests to determine if they were actually taking the drugs, rather than selling them. Because insurance companies don't consider the tests medically necessary, patients often have to pay for them out of pocket. It can be expensive, reports John Cheves of the Lexington Herald-Leader, citing one couple that had to pay $533.

The tests are required under emergency regulations issued to implement House Bill 1, the "pill mill bill," and Gov. Steve Beshear has said he understands the financial burden the tests can bring on those who are not abusing prescriptions. Changes could happen in January when the emergency regulations expire and are replaced with permanent rules, Cheves reports. The Kentucky Medical Licensure Board is hearing complaints, and has extended a grace period for compliance for doctors until Nov. 1.

"But critics say they warned last spring that HB 1 — intended to crack down on the illicit sale of prescription drugs — would treat everyone like a potential felon, including doctors and patients engaged in legitimate medical care," Cheves reports. Much debate about the bill has revolved around its implication on doctors, with little attention paid to patients. Cheves reports that soon may change.

Under the law, doctors are required to get an initial urine test from patients who have long-term controlled substance prescriptions. They must also get random drug tests once a year for "low-risk" patients who are most unlikely to abuse drugs based on test results, and three times a year for "high risk" patients. The amount of people requiring drug tests is "likely to be in the tens of thousands," Cheves reports. (Read more)

Doctor complaints about bill aimed at reducing prescription drug abuse largely based on misconceptions, health officials say

State health officials say doctors' complaints about House Bill 1, which cracks down on pill mills and doctors who supply the illegal prescription pill trade, result from misunderstandings and misconceptions about the law's language and intent, Mike Wynn of The Courier-Journal reports. Doctors say the bill's regulations are excessive and restrict their ability to write common prescriptions.

Assistant deputy inspector general Stephanie Hold, of the Cabinet for Health and Family Services, said doctors have at least 19 misconceptions about the state's drug tracking system, Kentucky All Schedule Prescription Electronic Reporting, and said checking KASPER before writing prescriptions "should not impede them in any way," Wynn reports. Mike Rodman, director of the Kentucky Board of Medical Licensure, said there's nothing in the law that prevents doctors from prescribing controlled substances. He said many doctors have for years practiced prescription standards similar to those in the bill, but feel uncomfortable with them being written as law.

The co-chair of the state oversight committee, Democratic Rep. John Tilley, said there are some legitimate concerns about the bill "that need discussion after we can distill what is fact and what is myth," but lawmakers could likely address all of them without changing the statute. (Read more)

Pikeville newspaper spotlights local doctors and pharmacists charged in prescription pain-pill epidemic, forecasts more action

The Appalachian News-Express, the thrice-weekly newspaper in Pikeville, has turned the spotlight on Pike County physicians and pharmacists who are aiding and abetting the abuse of prescription painkillers. We have to wonder if more reporting like this from local news media wouldn't help fight the problem, which has become epidemic in Kentucky, especially in the east.

"Prescription drug abuse has dominated news headlines across the state over the last several weeks and new cases are leading officials to believe that more and more cases will be filed against physicians in and around Eastern Kentucky," the 2,200-word story begins. "Officials on both the state and federal level have been busy over the last year in taking action against a number of medical professionals, both in and around Pike County."

The full story by Chris Anderson is available only to subscribers, but is available to members of the Kentucky Press Association who subscribe to its Kentucky Press News Service.

41 percent of the time, Americans go to specialists instead of primary-care doctors for basic health needs, study finds

More than 40 percent of the time, Americans are turning to higher-paid specialists instead of primary-care doctors to deal with their basic health needs, including colds and fever, a new study has found.

Researchers at Mount Sinai Hospital in New York looked at data from more than 20,000 doctor visits in 1999 and 2007 that included information about why the patient had come to the doctor’s office. “Fifty-nine percent of those with primary care needs, the runny-nose group, were seen by a primary care doctor,” reports Sarah Kliff for The Washington Post. “Forty-one percent sought out care at a specialist.”

Researchers included gynecologists and internal medicine physicians in the specialists group, though they tend to have heavy primary care loads. But even without those two specialties, 27 percent of primary care appointments happened in specialists’ offices.

A 2010 study found primary care doctors earn a $69 hourly rate, compared to $92 per hour and $85 per hour that surgeons and ob-gyns earn, respectively. (Read more)

New health law and aging baby boomers' anticipated strain on the system is about to make chronic doctor shortage worse

Kentucky's persistent physician shortage is hardly new. Almost a century ago, the Frontier Nursing Service came to Hyden on the presumption that doctors wouldn't. A report from the Health Resources and Services Administration in 2005 found that 81 of 120 of the commonwealth's counties were officially health professional shortage areas. Now comes news that areas in the United States with growing and dense urban populations are feeling the considerable pinch of also not having enough doctors to provide care.

New York Times reporters Annie Lowrey and Robert Pear report that with the expansion of insurance coverage and aging baby boomers driving up demand, we shouldn't expect the shortage to get better anywhere before it gets worse everywhere. (NYT chart)


"The Association of American Medical Colleges estimates that in 2015 the country will have 62,900 fewer doctors than needed. That number will more than double by 2025," report Lowrey and Pear. "Even without the health care law, the shortfall of doctors in 2025 would still exceed 100,000." In addition, Medicare officials predict their enrollment will surge to 73.2 million in 2025, up 44 percent from 50.7 million this year because of the baby boomer demographic hitting their golden years. “Older Americans require significantly more health care,” said Dr. Darrell G. Kirch, the president of the Association of American Medical Colleges. “Older individuals are more likely to have multiple chronic conditions, requiring more intensive, coordinated care.”

Medical school enrollment is increasing, but not as fast as the population. The number of training positions for medical school graduates is lagging. Younger doctors are on average working fewer hours than their predecessors. And about a third of the country’s doctors are 55 or older, and nearing retirement. (Read more)

Doctors shifting from private practice to large hospitals for more security under health-care reform

Associated Press photo by Michael Schennum.

The days of hanging up a shingle and opening shop are becoming more and more unusual for doctors. Afraid of being left without protection in the face of changes caused by federal health-care reforms, doctors are leaving their private practices and moving under the shelter of large hospitals.

The shift is "driven largely by growing regulatory and administrative burdens, rising malpractice costs and declining reimbursements from insurers," reports J.D. Harrison for The Washington Post. In general, large hospitals have more financial security and are more equipped to keep track of new regulations.

In 2000, 57 percent of physicians owned their own firms compared to 43 percent in 2009, research by Accenture shows. The number is expected to fall to 33 percent by 2013. "The classic model of independent, small physician practice still exists today, but it's rapidly becoming a relic of a bygone era," Mark Smith, president of physician-recruiting firm Merritt Hawkins, told the House Small Business Committee last week. "This model is only likely to persist in any numbers in smaller, rural areas where there are few physicians; and even here, physicians will likely need to partner or affiliate with larger entities in some way."

Part of the change stems from the fact that accountable-care organizations are now an official part of Medicare. This health-care model, in which groups of providers "take responsibility for the care for an entire patient group," encourages hospitals to take on physician partners, Harrison notes. "Because of bundled payments and other measures in the law, hospitals want to make sure they have enough primary-care physicians, particularly, as well as specialists that they can have in their accountable care organizations so they can participate," Dr. Jerry Kennett, senior partner at Missouri Cardiovascular Specialists in Columbia, Mo., told lawmakers.

New regulations and non-compliance penalties that are built into the law are also making doctors run for cover. "There is so much more regulation, and the penalties are so great, physicians are very fearful that they'll make an honest mistake and be held financially accountable," Smith said. (Read more)
Hat tip to The Lane Report

Health-care system not ready to deal with baby boomers as they get old, expert says at seminar on aging

When it comes to dealing with aging baby boomers, the nation's health-care system isn't ready to deal with them, Dr. Gregg Warshaw, left, said at the University of Kentucky's Summer Series on Aging in Lexington yesterday. "We've made progress," he said, but "We have a lot more to do, and we are running out of time." (Photo by Jonathan Palmer)

Warshaw's figures show "patients with five or more chronic conditions account for about 68 percent of spending on Medicare," Mike Wynn reports for The Courier-Journal. "Around 141 million people suffered with chronic conditions in 2010, and that number is expected to jump by 30 million in the next two decades."

The shift from primary-care doctors to specialists is another big, expensive problem that is hurting the quality of health care for seniors, Warshaw argued. Ageism and frustrations over health networks are also challenges. "Like a lot of things in American medicine right now, we know the answers to those questions," he said. "We just don't know how to get from here to there."

Warshaw, who is the director of the Geriatric Medicine Program at the University of Cincinnati College of Medicine, was one of more than 350 professionals who attended the seminar, hosted by the UK College of Public Health. (Read more)

Hopkinsville paper examines doctor shortage, reasons for it

Albert Delaney waits for his wife Agnes in Hopkinsville.
(Photo by Kentucky New Era's Tom Kane)

Nick Tabor of the Kentucky New Era examines Christian County's doctor shortage, with the area averaging just one primary care physician for every 2,000 people. It's the latest health story in the small daily newspaper, which is committed to quality health reporting.

The shortage creates problems for residents, who must either travel to another area to see a doctor or go without preventive services because there is no one to see until serious illness occurs. When that happens, that "puts an undue burden" on the local hospital's emergency room.

The shortage is affected by the fact that "primary care physicians, which rural areas need in higher volumers than specialists, are entering the job market at alarmingly low rates," Tabor reports. "More medical students are becoming specialists, as these jobs promise better salaries and hours." Secondly, it is difficult to recruit doctors to rural areas. "Little old Hopkinsville is up against Boston and Chicago and all of these bigger cities," said Teresa Bowers, Jennie Stuart Medical Center's physician recruitment director. "They're not throwing darts at a map and saying, 'I'm going to Hopkinsville.'"

The problem is not a new one. A 2007 report by the Kentucky Institute of Medicine shows there have been shortage issues for decades. "Even if all the barriers that have prevented a sufficient and well-dispersed supply of physicians were suddenly to disappear, the task of recruiting and educating an ample cohort of doctors would take years to accomplish," it reads.

The problem is liken to worsen, however, if the federal health-reform law is upheld by the U.S. Supreme Court, as 30 million more Americans will have insurance to see the doctor. A recent report found medical school enrollment is up by 30 percent, but more residency placements are needed to accommodate the influx. (Read more)