Beshear increases Medicaid reimbursement rates for home and community-based services and long-term care facilities

By Melissa Patrick

Kentucky Health News

Gov. Andy Beshear has raised Medicaid reimbursement rates for home and community-based services and long-term-care facilities to help them deal with inflation, workforce shortages and the effects of Covid-19.

"We have a duty to make sure those who need in-home care, community-based care and long-term care get the services they need and the services they deserve," Beshear said at his weekly news conference Thursday. "This increase will provide some interim financial relief for organizations that take care of our parents and our grandparents. And right now they need our help, and we need to be there for them."

The main lobbying group for nursing homes and assisted-living facilities told Kentucky Health News that it is expecting an overall adjustment of about 8 percent, and that it will vary from facility to facility. 

Betsy Johnson, president of the Kentucky Association of Health Care Facilities and Kentucky Center for Assisted Living, praised the governor's action, calling it "welcome relief" for struggling long-term care facilities that have been sounding the alarm about the skyrocketing costs required to keep their residents and patients safe and healthy. 

Betsy Johnson

“We are grateful for Gov. Beshear and his administration," Johnson said. "The pandemic had devastating effects and worsened the staffing crisis we were already facing. This funding will be paramount to providing quality care to residents and patients as well as building the foundation for a brighter future.”  

John Muller, chief operating officer for Carespring Healthcare Management in Northern Kentucky, thanked Beshear and his team at the news conference. Muller is also a KAHCF board member. 

“Nursing facilities were on the front lines of the Covid pandemic. The last number of years have been very, very difficult," Muller said. "And as we are coming out of the pandemic, the aftershock is the workforce challenges that we're facing. Nursing facilities are lagging far behind on catching up in the workforce. These much-needed funds will go a long way for the residents we serve . . . as well as the team members we need to retain and the new ones we need to recruit.”

David McKenzie, administrator and owner of The Jordan Center in Louisa, conveyed an urgent need for these increased funds in a letter to Health and Family Services Secretary Eric Friedlander on March 28, 

McKenzie painted a picture of his facility's dire financial situation and asked for a "funding bridge" to allow nursing homes to survive until July 1, 2024, when their rates are scheduled to be recalculated. 

"Our facility will not make it if we don't receive a funding bridge July 1, 2023," he wrote. "We have never seen price increases like this in our 49 years of business! In February 2022, we had to close half of our facility because we only had enough staff to operate 60 beds and maintain our 5-star staffing rating." 

Beshear said the rate adjustments, which are retroactive, will make up for underestimated inflationary increases that were provided in the last three years. The rates are adjusted for inflation every year. 

The adjustment for home and community-based services will be for services that were delivered from Jan. 1, 2022, to May 1, 2023, at an addiitonal cost of $13 million, according to a news release.  

For long-term care, the release says Medicaid is maximizing the annual rate adjustment for inflation and will retroactively adjust rates going back three years. This will result in $99.6 million more for nursing homes in the next fiscal year, which ends June 30, 2024. Medicaid is funded mainly by the federal government; the state's share will be $18.9 million. 

Emily Webber, KAHCF director of communications, said the additional funding will go a long way to help pay for supplies, operational costs and staffing, noting that long-term care facilities are still one of the health-care sectors that have not recovered from the staffing shortages caused by the pandemic. 

Beshear has also committed to rebasing the Medicaid rate effective July 1, 2024, but that would require appropriations from the General Assembly next year, and Beshear's term will end late this year unless the voters given him a second four-year term in the Nov. 7 election.

"We're dealing with an election. We're dealing with a budget session. So there are lots of things for us to address," Johnson said. "But as you just stated, right now, where it stands, we understand that the current administration and the Kentucky legislature are very sympathetic to our challenges and we believe that we can all work together so that this money will be appropriated." 

Johnson her members are "thrilled" because they have not seen a Medicaid raise since 2008 and are now operating in a completely different world. 

"This funding is a good first step toward getting us back on our feet," she said, adding later, "If you ask any one of our member providers, when we say, 'Oh, post-pandemic world or post-Covid,' they will look you in the eye and say, 'Betsy, we're still in it' because the struggles are real. It has forever changed the way they operate and the staff that they need. It's very, very important that we should all, as Kentuckians, be invested in this taking care of our elderly, and our most vulnerable citizens."

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Parkinson's disease: What to know about it, what to do about it

By Dr. Julia Stasich, Ochnser Health

Parkinson’s disease is named after James Parkinson, the English physician who described this degenerative disease of later life. Here are the history, symptoms, causes and treatment options for Parkinson's.

What characterizes Parkinson’s disease?

• Slowness of movement with slow, shuffling gait, short steps
• Rigidity or stiffness of the limbs and trunk
• Impaired balance and coordination
• Head held forward, and body stooped forwards
• Drooping eyelids, open mouth, drooling

What are some of the biggest misunderstandings seen in Parkinson’s disease? Not all Parkinson’s patients have tremor, and Parkinson’s disease does not shorten lifespan, but the symptoms can affect quality of life.

Who first identified Parkinson’s disease? The disease we call Parkinson’s was known to ancient eastern Indians as “Kampavata.” A man by the name of Charaka is known to have described this disease as “kampa” meaning shaking and “vata” meaning decreased muscle movement or weakness. About 500 years later in Greece, Galen, a student of Hippocrates, also described a “shaking palsy.” But it wasn’t until the 1800s when Dr. Parkinson described the criteria of patients with the “shaking palsy” and separated out other diseases that may shake or have weakness. We actually still call the syndromes that look like Parkinson’s disease by the name “Parkinsonism.”

What are the brain changes we see in Parkinson’s disease? Parkinson’s patients experience a slow, progressive loss of cells that make dopamine in the brain. Dopamine, in the right amount and right places, plays a vital role by making our bodies move faster, including arms, legs, mind and even bowels. It also makes us feel good when it is released, like during social events, eating or sex. It is also released as a reward during events such as fishing, hunting, shopping or gambling.

What are the early signs of Parkinson’s? Early Parkinson’s disease is easy to miss by doctors because the symptoms can mimic common ailments:

• Feeling “dizzy” or easily off balance
• Loss of sense of smell
• Loss of arm swing on one side of the body
• Daytime sleepiness
• Depression
• Constipation

What are some of the symptoms of Parkinson’s disease? As the disease progresses and more dopamine-producing cells are lost, more symptoms arise and may include muscle stiffness, tremor, choking and excess saliva.

What causes a loss of dopamine? We don’t know. Certainly, there are familial forms of Parkinson’s, but these are much less common than the sporadic type.

How do we treat Parkinson’s disease?

• Promote the release of dopamine
• Replace dopamine with medication
• Alternatives/additions to dopamine treatment
• Deep brain stimulation surgery

What you can be doing to increase your own dopamine levels? You can do this through regular exercise such as dancing, walking or activities such as Tai Chi. You will also feel better if you sleep better and are well-rested. Massage makes everyone feel good, but there is research that suggests that massage may reduce the symptoms of Parkinson’s disease. A loving, supportive relationship improves both lives, but the Parkinson patient may even notice improved physical effects.

What your doctor can do for you to help increase dopamine? We can directly replace that dopamine with a dopamine precursor, Levodopa. Levodopa was found to be effective in the 1950s by a Swedish scientist, Arvid Carlsson, who later won a Nobel Prize for that work. It is now available in several formulations and is always paired with carbidopa to help absorption.

We can mimic dopamine with drugs called “dopamine agonists.” Pramipexole, ropinerole and rotigatine patch are all in this category.

We can limit the breakdown of your own dopamine using drugs belonging to a family called the MAO-B inhibitors. Two examples are selegiline and rasagiline.

As with some medications, there can be side effects, so be sure to talk to your doctor about a treatment plan that is going to be right for you.

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As a whole, Kentucky seniors are the third most unhealthy in the nation, ranking better than only Louisiana and Mississippi

Photo from Getty Images via Kentucky Lantern

By Sarah Ladd

Kentucky Lantern

New data shows Kentucky among the worst states for key health points among senior citizens, including tooth extractions, food insecurity, insufficient sleep and more.

The statistics, published in the America’s Health Rankings Senior Report in May, show Kentucky seniors have the most tooth extractions.

As a whole, Kentucky seniors rank second for insufficient sleep, exercise and cognitive difficulties; third for food insecurity, and sixth for obesity.

As a whole, Kentucky seniors are the third most unhealthy, healthier only than their counterparts in Louisiana and Mississippi.

Dr. Michael Stockman, a geriatric physician based in Minnesota, said there is a “bright side” of the report: Older Kentuckians, generally, don’t drink too much or have severe housing insecurities, and they consume sufficient fruits and vegetables.

For older Kentuckians not to drink excessively “is great because excessive drinking can lead to things like liver disease, diabetes,” said Stockman, who works for UnitedHealthcare. “It can also interfere with the medications that people are taking as well.”

The United Health Foundation released the report, which examines the health of older adults with 52 measures including social and economic status, physical environment, clinical care, behaviors and more. The rankings are based on data available up to March 8.

Kentucky had higher rates of physical inactivity than the national average, the report showed, which Stockman said can itself lead to poor health.

Nationally, 31% of seniors 65 and older are physically inactive, while the number jumps to 37% in Kentucky.

“It’s important to do those simple daily things like walking 30 to 45 minutes a day to really make a positive impact on overall health and well being,” Stockman explained.

Exercises like walking, stretching, yoga and tai chi can all help strengthen the body and prevent falls, which can lead to fractures, he said.

Social isolation

Kentucky seniors are at high risk of social isolation, the report says, a fact exacerbated by the Covid-19 pandemic. The report ranks Kentucky ranks fifth in social isolation among older adults.

“The pandemic did really create a social isolation amongst all of us. I think seniors were disproportionately affected and it … worsened during that pandemic,” Stockman said. “Being socially isolated puts people in a very vulnerable situation, particularly as they’re going through stressful life events common with aging, such as losing maybe a close friend or a family member, or as they move into retirement. Being socially isolated can lead to, really, a decline in a person’s cognitive functioning. It can increase the risk of depression and decrease the overall quality of life of older adults.”

The bright side to that point, though, is that there are more households now with access to high-speed internet than in 2019. The internet can help seniors gain access to telehealth appointments, stay in contact with family and friends and participate in social activities.

Kentucky seniors seem to be closing the gap in high-speed internet. From 2019 to 2021, 9 percent more of them used broadband, while the national increase was 7 percent.

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University of Louisville gets $6.1 million in federal grants to study possible cause of serious illness and death from Covid-19

University of Louisville diagrams show levels of neutrophil immune cells in various types of patients. Data analysis by Corey T. Watson, Ph.D., David Tieri, Ph.D., and M.D./Ph.D. student Anne Geller.

By Sarah Ladd
Kentucky LanternUniversity of Louisville researchers announced Friday that three federal grants totalling $6.1 million will allow them to further study immune-system dysregulation, which they say causes serious illness and death in some patients who have Covid-19.

The funding from the National Institutes of Health comes after UofL researchers “discovered that a specific type of immune cells, low-density inflammatory neutrophils, became highly elevated in some Covid-19 patients whose condition became very severe,” a university news release said. (Neutrophils are white blood cells in the immune system that play a role in fighting infections). The researchers published those findings in 2021.

“At one time we had over 100 patients with Covid in the hospital. Once they were on a ventilator, mortality was about 50%,” Dr. Jiapeng Huang, an anesthesiologist with UofL Health, professor and vice chair of the Department of Anesthesiology and Perioperative Medicine in the UofL School of Medicine, said in a statement. “We were looking at this issue to see why some people would do well while some developed bad lung disease and did not do well or died.”

Immunologist and lead researcher for the 2021 study, Dr. Jun Yan, said the new federal funding could help with development of a therapy. “That’s why we do this research,” Yan said. “Eventually we want to benefit the patients.”

The funding comes from three grants:

• A four-year $2.9 million grant to UofL. Researchers will use this to better understand acute respiratory distress and work to prevent those complications, UofL said.
• A five-year $2.9 million grant to UofL. Researchers will use this to “characterize different subsets of neutrophils and measure their changes over the course of Covid-19 disease progression.”
• A one-year, $306,000 grant to Degranin Therapeutics and UofL. Researchers will use this to study the effectiveness of a compound to reduce immune dysregulation.

“The knowledge gained through these studies may benefit not only Covid-19 patients, but those with other conditions in which immune dysregulation can occur,” UofL said. Those include “other types of viral and bacterial pneumonia and autoimmune diseases, and patients undergoing cancer immunotherapy and organ transplantation.”

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Ky. hospitals generally below average in national patient-safety ratings, and one got an F; raters warn infection rates remain high

By Melissa Patrick
Kentucky Health News

Most of the Kentucky hospitals graded on a nonprofit group's report card for patient safety again got a C.

The Leapfrog Group, based in Washington, D.C., rates nearly 3,000 general acute-care hospitals based on how well they protect patients. Most of Kentucky's 126 hospitals are relatively small, so they are not rated by Leapfrog; it rates 61 Kentucky hospitals.

The group does not grade small hospitals with "critical access" status because they don't have to report quality measures to the federal government; nor does it grade specialty hospitals, government hospitals, or hospitals that don't have enough publicly reported data.

Leapfrog gave A ratings to four Kentucky hospitals; Kentucky's percentage of A grades, 6.6%, ranked it 46th among states. That was down 10 slots from the last report, when it ranked 36th. Leapfrog gave Bs to 15 Kentucky hospitals, Cs to 31, Ds to 10 and an F to one, in Hazard.

The grades are based on more than 30 measures that indicate how well hospitals protect patients from preventable errors, injuries, accidents and infections, and whether hospitals have systems in place to prevent them.

A Leapfrog press release draws attention to a significant national increase in healthcare-associated infections, reporting that the average risk of three HAIs – Methicillin-resistant Staphylococcus aureus (MRSA), central line-associated bloodstream infections (CLABSI) and catheter-associated urinary tract infections (CAUTI) – remain high after spiking to a five-year high in hospitals during the Covid-19 pandemic.

Comparing infection data from late 2021 and 2022 to the safety grades reported in 2021, which covered the period immediately before the pandemic, Leapfrog's analysis found that CLABSI increased 60%, MRSA infections increased 37%, and CAUTI rose 19%.  

“The dramatic spike in HAIs reported in this Safety Grade cycle should stop hospitals in their track. Infections like these can be life or death for some patients,” Leah Binder, president and CEO of The Leapfrog Group, said in the release. “We recognize the tremendous strain the pandemic put on hospitals and their workforce, but alarming findings like these indicate hospitals must recommit to patient safety and build more resilience.”

The Leapfrog site offers details on the measures for each hospital under the heading Infections. It also gives provides detailed information under headings titled Problems with Surgery, Practices to Prevent Errors, Safety Problems, and Doctors, Nurses and Hospital Staff. The information is provided in an easy-to-read, color-coded scale that indicates how the hospital is performing.

The report uses data from the Centers for Medicare and Medicaid Services, Leapfrog's own survey and other supplemental data sources. Leapfrog says hospitals are only graded if they have submitted adequate data for evaluation.

High Scores

Hospitals getting As were Baptist Health Lexington, Clark Regional Medical Center in Winchester, The Medical Center at Bowling Green, and St. Elizabeth Healthcare-Ft. Thomas.

The Bowling Green hospital moved up to an A after getting Cs on the last 14 reports.

Screenshot of Leapfrog page for The Medical Center at Bowling Green, which moved up to an A after 14 Cs. 

Baptist Health Lexington has received an A grade for 11 consecutive grading periods. Clark Regional maintained its A for two consecutive grading periods and St. Elizabeth Healthcare-Ft. Thomas has maintained its grade for three reporting periods. 

Shifts up and down

Seven Kentucky hospitals moved down to a B after getting an A on the last report, including Advent Health Manchester, Deaconess Henderson Hospital and Spring View Hospital in Lebanon.  

In addition, Louisville's Norton Audubon Hospital, Norton Brownsboro Hospital, Norton Hospital, and Norton Women's & Children's Hospital all moved down to a B, after getting As for seven straight periods. 

Three hospitals moved up from a C to a to a B: King's Daughters Medical Center in Ashland, St. Elizabeth Healthcare-Florence and Three Rivers Medical Center in Louisa. 

Other hospitals with B grades are Baptist Health Louisville, Meadowview Regional Medical Center in Maysville, Owensboro Health Muhlenberg Community Hospital in Greenville, St.Elizabeth Healthcare-Edgewood and U of L Health Shelbyville Hospital. 

Three hospitals moved up from a D to a C: Flaget Memorial Hospital in Bardstown, Jackson Purchase Medical Center in Mayfield and Taylor Regional Hospital in Campbellsville. 

Baptist Health Richmond moved down to a C after receiving five straight As. 

Eleven hospitals moved down from a B to a C: Baptist Health Corbin, Baptist Health Deaconess Madisonville, Ephraim McDowell Regional Medical Center in Danville, Middlesboro ARH Hospital, Leitchfield's Owensboro Health Twin Lakes Medical Center, Lexington's Saint Joseph East and Saint Joseph Hospital, Bowling Green's TriStar Greenview Regional Hospital, University of Kentucky Albert B. Chandler Hospital, UK HealthCare Good Samaritan Hospital, and University of Louisville Hospital.

The remaining 15 hospitals with a C list all got Cs on the last report card too. 

Two Kentucky hospitals moved down from C to a D. Kentucky River Medical Center in Jackson got a D after receiving Cs on the last three reports, and Tug Valley ARH Regional Medical Center in South Williamson got a D after receiving four Cs and one B in the last five reports. 

Other hospitals with D grades are Murray-Calloway County Hospital, Pikeville Medical Center, Saint Joseph Mount Sterling, St. Claire Regional Medical Center and UofL Health-Mary & Elizabeth Hospital. 

The only hospital that got an F was Hazard ARH Regional Medical Center, down from a D on the last report. The last time a Kentucky hospital got an F on the Leapfrog report was in the fall of 2019, when Jewish Hospital received one. It got a C on this report card. 

Click here for a list of frequently asked questions about the survey. Click here to see if your hospital was graded.

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Invisible radon gas is the No. 2 cause of lung cancer in Kentucky but only 0.13% of houses in the state have been tested for it

Radon potential is measured in becquerels per cubic meter; a becquerel is one radioactive decay per second. Generally, the rate depends on the geology of a location and how much uranium and thorium are in the rocks, but levels in individual buildings vary depending on construction and exact location.

Three of every seven buildings in Kentucky have elevated levels of a colorless, odorless gas that is a significant cause of lung cancer, reports Bill Estep of the Lexington Herald-Leader. That rate of 42% is six times the national rate of 7%, according to the Kentucky Association of Radon Professionals.

But only 13 of every 10,000 houses in Kentucky have been tested for radon, says Ellen Hahn, a professor in the University of Kentucky nursing professor who runs BREATHE, which stands for for Bridging Research Efforts and Advocacy Toward Healthier Environments.

Kentucky has the nation's highest age-adjusted rate of lung cancer, mainly because it has the nation's second-highest smoking rate, but some people who have never smoked or have little exposure to indoor tobacco smoke get lung cancer. Radon is the No. 2 cause of lung cancer, and a combination of radon and smoking create an even higher risk of the disease, Estep reports.

Lindi Campbell (Breath of Hope KY photo)

"Lindi Campbell, 58, was fit, active and had never smoked, but had to have two lobes of her right lung removed in December 2017 as a result of developing lung cancer. Campbell said she grew up in Lexington in a house where she was exposed to secondhand cigarette smoke and radon," Estep reports. "After she was diagnosed with cancer, she had her childhood home tested. The results showed a radon level that was the equivalent of smoking 40 cigarettes a day, she said."

Campbell is president of Breath of Hope KY, which tries to raise awareness about lung cancer, reduce stigma surrounding it, and raise money for research.

Radon is a product of the natural decay of uranium and thorium, another radioactive element. "As it breaks down, it releases radioactive particles that can be inhaled and damage lung tissue over time," Estep notes. Newer homes are more likely to have a buildup because are more tightly sealed.

Estep offers ways to take action to protect yourself: "Radon information is available through several sources, including BREATHE; the Kentucky Geological Survey; the Kentucky Radon Program; the U.S. Environmental Protection Agency; and the American Lung Association. Health officials also recommend testing your home."

“Everyone needs to test,” Hahn said. “There’s no risk-free level of radon.”

"Free test kits are available at many county health departments, and people can also request a kit through the Kentucky Radon Program," Estep reports. "People in Pulaski, Rowan, Logan and Christian counties can check out test kits at public libraries, with a valid library card, as part of an on-going study by BREATHE. People can also buy test kits at home-improvement stores or online. Companies that install systems to pull radon out of homes can also test for the gas."

And how much do those systems cost? "Tracy Howard said it cost $1,300 to have Alpha Radon Remediation install an exhaust system in the basement of her house in Stanford on May 24," Estep writes. "Howard got a free test kit from the local health department and the results showed a radon level of 4.2, just over the limit at which the EPA recommends installing a system to reduce the radon level. Howard, a nurse who works from home to do remote patient monitoring, shares the house with her husband and their daughter and 4-year-old grandson. She wanted to reduce their risk of exposure to the cancer-causing substance. To her, it was worth $1,300 to accomplish that."

“I know how dangerous it is,” Howard told Estep. “Consider the cost of installing the system vs. the cost of getting lung cancer later in life.”

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Lt. Gov. Jacqueline Coleman announces $40 million in federal funds for Kentucky schools to provide mental-health services

Lt. Gov. Jacqueline Coleman (Image from Facebook)

Lt. Gov. Jacqueline Coleman announced $40 million in federal funding is coming to Kentucky schools to support and expand access to school-based mental health services, Tom Latek reports for Kentucky Today. 

Coleman said this is important because "Students are six times more likely to access mental-health services when they are offered in schools." 

Coleman was speaking May 30 in the Capitol rotunda, where she and and other advocates gave an update on the student mental-health initiative that she began nearly two years ago. 

Coleman said the plan is for regional educational cooperatives, comprising school districts, to give the money to "major universities" in their area to be used to recruit, train and educate mental health professionals for grade school children in each region, Munashe Kwangwari reports for WLKY.

"We are building the workforce while providing services to the kids who do not have access right now," Coleman said, adding that the issue remains important in Kentucky and across the rest of the nation. She pointed to several studies to back up this claim, Latek reports, quoting her at length:

“A Pew Research internet poll reported earlier this year, 40% of U.S. parents of children under 18 say they are extremely or very worried that their children may struggle with anxiety or depression, while 36% indicated they were somewhat worried about this," Coleman said. 

She also quoted from a 2021 Kentucky Incentives for Participation program survey: “Twenty-two percent of the students in grades 6, 8, 10, and 12, reported serious psychological distress in the past 30 days. In a 2021 Kentucky Youth Behavior Risk survey, 9.8% of Kentucky middle school students, and 9.5% of Kentucky high school students attempted suicide, over the previous 12 months.”

The issue of youth mental health is so prevalent that U.S. Surgeon General Vivek Murthy issued a public-health advisory in December 2021 that said there is an urgent need to address a mental-health crisis among the nation's youth. In may, he issued another advisory drawing attention to the dangers of social-media use to children's mental health. 

Coleman also noted that all three branches of state government have put forth initiatives to prioritize student mental health, including a three-day mental health summit held by the Kentucky Supreme Court this week, Latek reports. 

Coleman added, “Now is the time to act. It is incumbent upon all of us to work together on this critically important issue, the number one issue here and across the country. This isn’t about right or left, it’s about doing what’s right, to make sure no student gets left behind.”

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