Health agencies in Rockcastle, Jackson, Clay, Harlan to lose 14 employees, some environmental and food-safety inspections

In the latest example of Medicaid changes' impact on local health departments, environmental and food-safety inspections will be reduced by layoffs in four counties served by the Cumberland Valley District Health Department, Nola Sizemore of the Harlan Daily Enterprise reports. Health departments in Harlan, Rockcastle, Clay and Jackson counties will lose a total of 14 employees later this month. (Enterprise photo: Harlan County Health Department)

Health Department Interim Director Lynett Renner told Sizemore said the layoffs, along with furlough days, are a result of decreased funding and the "advent of managed care organizations" in November 2011. The agency has almost $1 million in outstanding accounts because payments from those organizations have been slow to come in. "Also, one of the things that affected the health departments tremendously is we’re the only provider in the state required to pay a Medicaid match, which means for every service we provide for a client who has Medicaid, we have to pay the state back 20 percent and that recently increased to 28 percent," Renner said.

Renner told Sizemore that environmental services and restaurant health inspections would be most affected, adding that public health is often taken for granted by the local community. "So much is done behind the scenes to ensure the health and safety of every citizens," she told Sizemore. "My fear is they're reducing the ability of the public health infrastructure to be able to maintain that level of service that provides protection." (Read more)

Health care is strong second to economy among concerns of Ky. registered voters; candidates compared on handling of issues

Health care ranks high among the concerns of Kentucky voters, according to the latest Kentucky Health Issues Poll taken for the Foundation for a Healthy Kentucky.

The poll, taken Sept. 20 through Oct. 14, asked registered voters to name the two most important issues in the Nov. 6 presidential election. The economy was mentioned by 65 percent; health care was second, with 42 percent. Foreign policy was a distant third, at 21 percent. The error margin on the sample of 1,160 voters is plus or minus 2.88 percentage points.

The poll did not ask voters whom they favored for president, but did ask which candidate they trusted to do a better job on certain issues. Romney, who is considered certain to win Kentucky, had a clear advantage on two issue areas, listed first:

• Dealing with the federal budget deficit: Romney 49%; Obama 36%

• Dealing with the economy and jobs: Romney 48%; Obama 36%

• Dealing with the future of the health reform law: Romney 45%; Obama 40%

• Addressing terrorism: Romney 43%; Obama 42%

• Dealing with the situation in Afghanistan: Romney 42%; Obama 40%

• Improving education: Obama 45%; Romney 40%

• Looking out for the best interests of women: Obama 42%; Romney 40%

• Making decisions about women's reproductive health choices and services: Obama 41%; Romney 38%

"This poll gives us a reliable snapshot of the issues most important to Kentucky voters as they decide who they will vote for on Nov. 6," said Dr. Susan Zepeda, president/CEO of the foundation. "Regardless of the outcomes of the election, our foundation believes it is essential for our elected officials to know what Kentuckians think about these issues." To download the full report by the Institute for Policy Research at the University of Cincinnati, click here.

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)

Federal cuts, financial instability and competition leave many rural hospitals fearing the future

Many rural hospitals could be forced to close because of cuts to the Critical Access Program and the fact that, according to the National Rural Health Association, , 41 percent of critical-care hospitals are losing money, reports Jenny Gold of Kaiser Health News. This would be devastating to many rural communities, with a great impact felt by low-income and elderly residents. "A small hospital is often one of the biggest employers in a rural town, and closures 'can have an outsized economic impact,'" Eric Zimmerman, a health care lawyer and Washington lobbyist, told Gold.

More than 1,300 U.S. hospitals and nearly one in four acute-care facilities are designated as "critical access," giving them slightly higher Medicare and Medicaid reimbursements in return for limits on care they can provide. Many such hospitals like Hood Memorial, about an hour outside New Orleans, are dealing with uninsured patients, inability to collect payments from patients, and fewer funds from federal and state agencies, Gold reports. Many of these hospitals "tend to provide lower quality care" and are "less financially efficient than other facilities, according to a 2010 study published in the Journal of Health Politics, Policy and Law. Hood, for example, had $700,000 in losses last year despite the higher reimbursements. "It's a lot of variables, and all of them right now are working against us," CEO Hoppie Jones told Gold.

To prevent closures of rural hospitals and ensure "Americans in in isolated areas would still have access to health care," the federal government started the critical access program in 1997. To qualify, hospitals had to have 25 or fewer beds and be at least 35 miles away from another facility. However, states could waive the distance requirement, and many did, leaving hospitals like Hood with at least four other competing hospitals "within a 26 mile radius," Gold reports.

Passport to lose exclusive contract for Louisville-area Medicaid at end of 2012; more choice needed, federal agency says

The exclusive contract the state has with Passport Health Plan, which provides Medicaid coverage for 170,000 people in Jefferson and 16 neighboring counties, has been extended until the end of next year. But after that, the state must adopt a different "delivery model that ensures adequate choice for Medicaid beneficiaries" in that area, a letter from the federal Centers for Medicare and Medicaid Services reads.

Since 1997, Passport has exclusively provided coverage for that population, reports Tom Loftus of The Courier-Journal. Gov. Steve Beshear said Tuesday the state will start looking at alternatives for how to provide choice for the area. In the rest of Kentucky, Medicaid recipients can choose from three managed care organizations.

Sen. Julie Denton, R-Louisville, said she is "very concerned" about the major changes that will be involved. "We don't know what's going to happen," she said.

A year ago, Passport received a scathing report from state auditor Crit Luallen, who found wasteful spending "and said it had improperly transferred millions of its reserves to the health care provider organizations represented on its board," Loftus reports. After an investigation by Attorney General Jack Conway, those providers paid $26.4 million to pay for the transfers. (Read more)

Nonpartisan budget office says Republican's Medicare plan would make those now under 54 pay more

A proposal meant to reduce the federal deficit and cut spending would have future retirees paying more for health care, the non-partisan Congressional Budget Office estimates. The proposal by House Budget Committee Chairman Paul Ryan would repeal many of the much-touted benefits of the new health care law but is likely to die in the Senate, Ricardo Alonso-Zaldivar of The Associated Press reports.

Under Ryan's plan, future retirees now 54 and younger would be enrolled "in a different kind of health care program when they retire," Alonso-Zaldivar reports. "Instead of coverage for a set of benefits prescribed from Washington, they'd get a federal payment to buy private insurance from a choice of government-regulated plans." That would mean those retirees would pay more than they would under the current program, the nonpartisan Congressional Budget Office estimated.

Ryan, left, of Wisconsin, proposes repealing health-insurance expansion, which is expected to cover 30 million people who don't have coverage now; bringing back the coverage gap or "doughnut hole" in the Medicare prescription drug benefit; gradually raising the Medicare eligibility age (starting in 2022, it would rise by two months each year until it reaches 67 in 2033); and the amount of money juries could award in medical malpractice suits would be limited. (Photo: AP's J. Scott Applewhite)

The proposal would reduce spending by about $5 trillion over the next 10 years, but would not balance the federal budget. Ryan's plan "would shift more of the risk from rising health care costs from federal taxpayers to individual beneficiaries, medical service providers and states, giving them all a powerful incentive to avoid waste and aim for quality and efficiency," Alonzo-Zaldivar reports. "If it doesn't work, as the budget office suggests might happen, future Medicare beneficiaries, providers and states will feel the pain directly. That could send them right back to Washington clamoring for more subsidies." (Read more)