ED visits, hospitalizations for respiratory disease decline in state

State Department for Public Health graphs, adapted by Kentucky Health News

By Melissa Patrick
Kentucky Health News

Kentucky's influenza levels remain elevated, but are declining, and hospitalizations for overall respiratory illness are moderate and declining, according to the state Department for Public Health.

In the week ended March 9, emergency-department visits for the three main respiratory diseases showed a 16% drop in visits for Covid-19, flu and RSV, to 2,734. Of those, 79% of the visits were attributed to the flu. 

Hospital admissions for the diseases dropped 28% in the week ended March 9, to 387. Of those admissions, 216 were for the flu, 154 were for Covid-19 and 17 were for RSV (respiratory syncitial virus).

In the week ended March 9, 10 Kentucky counties had a Covid-19 hospital admission rate between 10 and 19.9 admissions per 100,000 people, a rate that is considered "medium" by the Centers for Disease Control and Prevention. 

Those counties were McCracken, Marshall, Lyon, Livingston, Hickman, Graves, Crittenden, Carlisle and Ballard, in West Kentucky, and Letcher, on Kentucky's southeastern border.

The state reported 2,762 laboratory-confirmed cases of the flu in the week ended March 9 and 1,605 lab-confirmed cases of Covid-19. Both of these numbers have dropped for four weeks in a row. 

Since the flu season began in October, the state has recorded 439 Covid-19 deaths, 110 flu deaths and two co-infection deaths, both reported in recent weeks. One Covid-19 victim and one flu victim were children.

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U of L will open its new hospital in Bullitt County on Monday

University of Louisville photo illustration

The University of Louisville is opening its UofL Health –South Hospital Monday, March 18, with a community breakfast, open house and ceremonial ribbon-cutting.The hospital will accept its first inpatients that afternoon, a university news release said.

"The $78 million acute care hospital opens with 40 inpatient beds, and shell space for an additional 20 beds," the release said. "The new hospital fills an access gap in Kentucky’s 10th most populous county, allowing local patients to get their care closer to home. Bullitt County was previously the largest county without an inpatient hospital." Bullitt is on the southern border of Jefferson County.

The hospital is on Interstate 65 at the Brooks exit  (#121), "South Hospital is ideally positioned to support one of Kentucky’s fastest growing regions," the release says. "In addition to inpatient beds, including a 10-bed intensive care unit, the new full-service acute care hospital is bringing more providers. It will also provide enhanced heart-care services . . .for faster treatment of acute heart attacks, expanded emergency capabilities including a ‘fast track’ area for quicker treatment and discharge, expanded cardiopulmonary services, state-of-the art pharmacy, laboratory and sterile processing areas and increased surgical suites for inpatient and outpatient procedures."

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Medical-cannabis 'cleanup' bill passes House; critics disappointed more qualifying conditions not added and say it increases hurdles

By Melissa Patrick

Kentucky Health News

In what the sponsor calls a bill to "clean some things up," more restrictions are being added to the state's medical-marijuana law and provisions were added to allow local school districts to opt out.

State Rep. Jason Nemes

One of the key provisions in House Bill 829, sponsored by Rep. Jason Nemes, R-Middletown, would allow public and private schools to opt out of the program.

Public school boards are required to establish policies related to the use of medical cannabis no later than Dec. 1, 2024. The policies must either prohibit the use of medicinal cannabis on school property, or permit the use with several options for administration, as outlined in the bill. 

The measure would also allow local governments to apply a small local fee to compensate for any additional costs caused by the operation of cannabis businesses; prioritize Kentucky hemp businesses for state contracting; and clarify the powers that the state Cabinet for Health and Family Services has when it comes to inspectionse. 

It would also abolish the provisional license, which allows someone who makes an application for a license to sell medical marijuana to get the product while the application is pending. Nemes said this "put the cart before the horse."

When the House passed the bill 66-30 on March 12, it added a floor amendment to allow the state to move the dates up for licensing, which would allow product to be obtained when the program starts Jan. 1, 2025. 

Another floor amendment, filed at the request of the Kentucky League of Cities, was also approved to allow cities to be able to opt out of the medical cannabis program before Jan. 1, 2025, even if a licensee had been approved before that date.

The committee substitute for the bill would require a patient to consult with a pharmacist annually to make sure the medical cannabis does not have a negative interaction with the patient's other prescriptions.

That prompted five Democrats to object in the floor debate, saying the new requirement , with a potential cost of up to $40, imposes another hurdle in accessing medical cannabis.

"It seems like we're adding even more hurdles to make this medicine harder to receive, more expensive for folks to access. . . . I really wish we were back here today to make this medicine more accessible to the people of Kentucky who have been asking us to do this for years," said Rep. Rachel Roberts, D-Newport. 

Rep. Rachel Roarx, D-Louisville, said allowing public school districts to opt "puts barriers in place" for students who benefit from medical cannabis for conditions such as epilepsy. 

Rep. Josh Bray, R-Mount Vernon, disagreed and supported the opt-out provision for schools, saying that he recognizes the need for this because some schools are concerned about the liability of administering a drug that is not authorized by the U.S. Food and Drug Administration.  

Rep. Cherlynn Stevenson, D-Lexington, said she was disappointed that the bill wouldn't expand the list of qualifying conditions that could be treated with medical cannabis, as was recommended by at "statutory advisory board of doctors and nurses appointed by the state licensing boards."

Stevenson said she hoped these conditions would be added in the Senate, where the bill has not been assigned to a committee.

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Kentucky Children's Hospital at UK opens center to treat children who are harmed by abuse and neglect, in which Ky. ranks 14th

University of Kentucky and Kosair for Kids representatives celebrate opening of the Kosair for Kids Center for Safe & Healthy Children & Families at Kentucky Children's Hospital. (Photo by Adam Padgett)

By Hilary Brown
University of Kentucky

Representatives from Kentucky Children’s Hospital and the nonprofit foundation Kosair for Kids cut the ribbon recently on the Kosair for Kids Center for Safe & Healthy Children and Families, a new clinic space for the treatment of children harmed by abuse and neglect at KCH, part of the University of Kentucky. This center was made possible by a $2 million gift from Kosair for Kids.

“I’ve spent the better part of my career looking at the challenges that Kentucky faces, especially when it comes to the ability of vulnerable Kentuckians to get care they desperately need,” said Mark D. Birdwhistell, vice president for health system administration and chief of staff, UK HealthCare. “I’ve seen how hard it can be to effect change for Kentucky’s vulnerable citizens, and that’s why I’m so proud of this new center and of what we’ve been able to accomplish with the partnership of Kosair for Kids.”

Kentucky ranks 14th in the country for child abuse and neglect; according to the state Cabinet for Health and Family Services, in 2022, 11,002 children experienced neglect, 1,146 suffered physical abuse and 756 were victims of sexual abuse. Those numbers have decreased over the years, due largely to the efforts of Kosair for Kids and their partners across the state.

“Today we celebrate opening a center dedicated to giving the best to children who have experienced the worst, said Barry Dunn, Kosair for Kids president and CEO. “Our goal, our aspiration, is that this center serves as a beacon of hope for children who have experienced unfathomable trauma. We stand with them, united in purpose, on the road to healing. We are proud to call them a Kosair Kid, and we want to show them the love and care they deserve. Kosair for Kids is proud of this place, the skilled and dedicated staff on the front lines of this epidemic, and the growing alliance we have formed to protect all children.”

“I’m an ardent believer that you can’t separate physical health from mental and emotional health,” said Dr. Scottie B. Day, physician-in-chief at Kentucky Children’s Hospital. “Maltreatment and childhood trauma have effects that ripple out into adolescence and adulthood and continue to inform patterns of behavior for generations. Through our partnership with Kosair for Kids, we can disrupt generational cycles of abuse and make Kentucky much safer for kids.”

KCH is home to one of only two pediatric forensic medicine programs in Kentucky. Of the five child-abuse pediatricians practicing in Kentucky, four are at KCH’s Division of Pediatric Forensic Medicine along with specially trained advanced nurse practitioners, social workers and psychologists.

Features of the new clinic include:

• Secure and private space to provide trauma-informed care, including three exam rooms and two therapy services rooms
• Proximity to the Makenna David Pediatric Emergency Center and other services such as radiology and sedation with private entrance and egress to those sites
• Space for therapeutic interventions, evidence storage and consultation with law enforcement and other partners
• Technology to consult virtually with the child’s care team which may include state child protective services, guardian ad litem and law enforcement.

The pediatric forensics staff also provides regular education to medical students, family medicine providers as well as community organizations. They developed a core curriculum for the Department of Community Based Services in the Cabinet for Health and Family Services that includes 16 one-hour lectures. Forensics providers lead a multi-hour training to each new class of Kentucky State Police cadets, as well as continued education to healthcare providers in the community.

Children who are abused and neglected may suffer immediate physical injuries, but also may have emotional and psychological problems, such as anxiety or posttraumatic stress. Over the long term, children who are abused or neglected are also at increased risk for experiencing future violence victimization and perpetration, substance abuse, sexually transmitted infections, delayed brain development, lower educational attainment, and limited employment opportunities. Chronic abuse may result in toxic stress, which can change brain development and increase the risk for problems like posttraumatic stress disorder and learning, attention, and memory difficulties.

All Kentuckians are mandated reporters of child abuse and neglect. If you believe a child is being abused or neglected, call the Child Protection Hotline at 1-877-KYSAFE1 or 1-877-597-2331 or report online.

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State Senate restores most Medicaid cuts made in the House

Dr. Bill Collins treats a patient at the Red Bird Mission dental

clinic in Clay County. The Senate budget would increase

dentists' Medicaid fees. (Ky. Lantern photo by Deborah Yetter)

By Deborah Yetter

Kentucky Lantern

The state Senate has largely eliminated cuts to Medicaid that were proposed in the House budget. A top state official had warned the House plan would create a hole next year in the federal-state health plan that covers 1.5 million low-income Kentuckians, a third of the state's population.

“We are pleased that the Senate’s proposed budget restores funding to Medicaid so patients can continue to access the necessary health care services they’re accustomed to,” said a statement from the Cabinet for Health Services, which manages the $15 billion a year federal-state program.

Cabinet Secretary Eric Friedlander appeared before the Senate Appropriations and Revenue Committee last month, along with John Hicks, budget director for Democratis Gov. Andy Beshear, asking the Republican-majority Senate to consider restoring the funds the House cut for the fiscal year that begins July 1.

“This creates a hole in the Medicaid budget for Fiscal Year '25,” Hicks told the committee.

Advocates worry the House plan could force cutbacks in Medicaid services through more than $900 million in cuts to the amount sought by Beshear.

Republicans generally have expressed support for the Medicaid program that pumps money into hospitals, clinics, pharmacies and other medical services throughout the state—with 70% to 80% of the funding provided by the federal government. But some have expressed concern it has grown so large.

The Kentucky Center for Economic Policy told the Lantern last month that overall, the House plan cut about $139 million in state funds Beshear sought for Medicaid in fiscal 2025, which would cause the state to forfeit another $783 in federal matching money, for a total of around $922 million.

The Senate moved its budget bills through committee and to a final floor vote on Wednesday. Dustin Pugel, policy director for the center, said Thursday it appeared the Senate had restored most of the funds but made some cuts including a reduction in “waiver programs” for people with disabilities.

The House plan included about $200 million — about $143 million of that in federal funds — for 2,550 new slots in Medicaid “waiver” programs such as "Michelle P." that provide housing, therapy or other supports for people with disabilities.

Thousands of people are on waiting lists for such services, which generally have been increased by only 50 or so each year.

The Senate version reduces the number of slots over the next two budget years to 1,925.

The Senate did not fund proposed “mobile crisis units,” which were also left out of the House budget. They would provide an alternative to police intervention when someone is experiencing a mental-health crisis.

But the Senate did include an increase in Medicaid payments for dental services, which oral-health advocates say is urgently needed to attract more dentists to the program in a state with high rates of dental disease.

Overall, Pugel said, the Senate plan is “good news for the Medicaid budget.”

However, the budget process is far from over. The House will consider the Senate changes, and if it disagrees, as is usually the case, the budget will bedecided by a House-Senate conference committee.

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Anthem loses court fight to keep managing Medicaid for 172,000

Table from Kentucky Medicaid dashboard, which has county-level numbers

Kentucky Health News

 

Anthem Kentucky has failed in its attempt to remain as the manager of Medicaid coverage for about 170,000 Kentuckians, because the Kentucky Supreme Court deadlocked on the insurance company's appeal of a Court of Appeals ruling that upheld the state's decision to give the work to five other insurers.

Anthem had questioned the bidding process, and Franklin Circuit Judge Phillip Shepherd ordered rebidding, but some of the other managed-care companies appealed, and in 2022 the state Court of Appeals overturned Shepherd's decision.  

On Anthem's appeal to the Supreme Court, argued last week, the justices were divided 3-3, meaning that the Court of Appeals decision stands. Justices Angela McCormick Bisig of Louisville, Robert Conley of Ashland and Michelle Keller of Northern Kentucky voted to affirm the appeals court, while Justices Debra Hembree Lambert of Somerset, Christopher Shea Nickell of Paducah and Chief Justice Laurance B. VanMeter of Lexington voted to overturn it.

The seventh justice, Justice Kelly Thompson of Bowling Green, did not hear the case and did not vote. He told Kentucky Health News that he was disqualified because he was involved in the case while on the Court of Appeals.

Anthem had remained a Medicaid manager pending the outcome of the case. The current managed-care contracts expire at the end of 2024, so it will have another chance to get part of the business from the program, which spends $15 billion a year in Kentucky, more than 70 percent of it federal money.

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Baptist settles dispute with Humana, but not United and WellCare

Baptist Health Lexington

By Deborah Yetter
Kentucky Lantern

Baptist Health and Humana have ended a months-long standoff over Kentuckians with health coverage through Medicare Advantage and commercial insurance plans, the companies said Thursday, March 14. But Kentucky's biggest hospital chain is still on the outs with two other major insurers.

Effective April 1, Baptist physicians again will accept those patients as “in network”— meaning they would not be subject to potentially higher costs or limits on services.

The news, which affects tens of thousands of Kentuckians including many state retirees, was announced through separate press releases.

“After several months of productive negotiations, Humana is pleased to have reached a new, multi-year agreement with Baptist Health Kentucky,” Eric Bohannon, Humana Medicare regional president, said in the release.

Baptist hailed the move as good for patient care. “We are committed to improving the health of our communities and our goal is to ensure every patient the high-quality, timely care needed,” said Dr. Isaac J. Myers II, chief health integration officer for Baptist Health.

The releases didn’t explain how the companies resolved differences that led Baptist Health to drop Humana as a network provider for its physicians on Sept. 22.

Medicare Advantage plans, which oversee health care for most Medicare enrollees, including about 102,000 Kentucky state-government retirees, have been a growing source of contention between health providers and the private insurance companies that offer them.

Baptist has cited delays in payments and denial of care by such private insurers as the source of dispute.

“The concerns we face with Medicare Advantage plans are similar to the concerns expressed by many providers across the country and echoed by hospital associations that represent them: coverage criteria applied by the plans result in denials and delays of medically necessary care to our patients,” Baptist spokeswoman Kit Fullenlove Barry said in January.

Effective Jan. 1, Baptist also ended agreements with United HealthCare and Wellcare for Medicare Advantage coverage for services including physician and hospital care — meaning all such care is considered out of network. Barry said Baptist has not reached agreements with United or Wellcare.

The growth of Medicare Advantage plans has been a source of increasing concern to advocates who argue that patients suffer through practices such as denials of care, delays while care is authorized and other restrictions.

Among those advocates is longtime Louisville health reform activist Kay Tillow, who told the Kentucky Lantern in January that such plans are sacrificing the benefits of Medicare for seniors. “The profit motive is destroying patient care,” she said.

Insurance companies that provide Medicare Advantage plans argue they offer better care at less cost and, in some cases, extra benefits to seniors. But they are able to do that through limiting benefits and patient choices.

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