Dollar General gets into health care with three mobile clinics near southwestern Kentucky, says it will expand if successful

Cunningham, Tenn., is the site of one of three Dollar General mobile health-care clinics. (Google Maps)

Dollar General Corp., a Scottsville, Kentucky-born company that moved its headquarters to suburban Nashville but has become ubiquitous across the commonwealth, has expanded into health care.

The retailer has established two mobile clinics just south of Clarksville, Tenn, which sits on the Kentucky border at Fort Campbell, and one at Cumberland Furnace, Tenn., between Clarksville and Dickson.

The clinics are operated by DocGo, which says it operates in 26 states as a "last-mile" health-care provider. It "sends clinicians to locations to provide care that would typically require patients to visit a physical clinic," reports Advisory Board, a health-care consultancy. "If the pilot is successful, the company said it will likely expand the mobile clinics to additional locations."

The company has created a DG Wellbeing brand of health-care products. Its website says the mobile clinics will offer urgent care services, physical exams and routine checkups, vaccinations and immunizations, screening and lab testing, and care for chronic conditions, including hypertension and diabetes.

The clinics accept Medicaid, Medicare, and some private insurance. They bill at urgent-care rates. 

"Dollar General is not the first retailer to launch a 'retail health care' business," Advisory Board says. "However, some experts believe the company could be uniquely poised to expand access to care in rural, underserved communities. Dollar General's widespread presence in rural areas could serve as a competitive advantage."

The company estimates that 75 percent of the U.S. population lives within five miles of one of its stores, and "Many of its retail locations are in areas that are far from traditional healthcare options and other ;retail health care' companies," Advisory Board says.

"Still, as Dollar General continues expanding its health-care presence, some experts have noted that the retailer may face staffing issues like those that exist in the larger healthcare sector. Jeff Goldsmith, president of the consultancy Health Futures, told Advisory Board, "Anybody that wants to do something new is going to have to figure out how to staff up. . . . The fundamental question is, why work for them? What's the value proposition for the health-care worker?"

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Covid-19 cases increase and flu cases decrease in Ky.; Biden says he will end public health emergencies for pandemic May 11

N.Y. Times graphs of infection rates with top 3 jurisdictions, excluding Virgin Islands; click to enlarge.

By Melissa Patrick
Kentucky Health News

New coronavirus cases in Kentucky increased by 23 percent last week, continuing an up-and-down pattern that creates a rough plateau. Meanwhile, influenza cases decreased for the seventh week in a row. 

“We have not seen the substantial increases in hospitalization or cases that we saw after the holidays last year,” Gov. Andy Beshear said at his weekly press conference Jan. 26. “We’re kind of bumping up and down a little bit (from) month to month, but nothing like we previously lived through.”

The state Department for Public Health's latest weekly report showed 6,369 new cases of the coronavirus from Monday through Sunday, or nearly 910 cases per day. That's up from 701 a day the week before. Nearly 19% of the cases were in people 18 or younger. 

The share of Kentuckians testing positive for the coronavirus in the past seven days was 10.05%, down slightly from 10.27% the week prior. These numbers do not reflect at-home testing. 

The weekly new-case rate was 12.98 cases per 100,000 residents, up a bit from 12.54 the week before. The top 10 counties were Barren, 33.9 cases per 100,000; Adair, 29.8; Cumberland, 28.1; Wolfe, 27.9; Boyd, 26.6; Perry, 25.5; Metcalfe, 24.1; Clay, 23.7; Woodford, 23.5; and Breathitt, 22.6.

The New York Times ranks Kentucky's new-case rate second among the states, with a 2% increase in the last two weeks. Tennessee ranked first for this measure. The Times's numbers often differ from state numbers because they use different methodologies. 

Covid-19 hospital numbers continue to drop. Kentucky hospitals reported 294 patients with the disease, down 24; 56 were in intensive care, up one; and 24 were on mechanical ventilation, down three. 

The state attributed 52 more deaths to Covid-19 last week, up from 45 the week before. Data from the last four state reports show Kentucky is experiencing about 48 deaths per week from Covid-19. The state's pandemic death toll is now 17,890. 

The end is near: Meanwhile, President Biden told Congress Monday that he will end the twin national emergencies for addressing Covid-19 on May 11, which will restructure the federal response to treat the virus as an endemic threat to public health that can be managed through agencies’ normal authorities.

Biden's move came "as lawmakers have already ended elements of the emergencies that kept millions of Americans insured during the pandemic. Combined with the drawdown of most federal Covid-19 relief money, it would also shift the development of vaccines and treatments away from the direct management of the federal government," reports Zeke Miller of The Associated Press. 

The World Health Organization said Monday that Covid-19 remains a "public health emergency of international concern," but the pandemic is at a "transition point." 

Department for Public Health graph; click it to enlarge.

Flu cases keep decreasing

Flu cases in Kentucky continue to decline, but as long as there is any flu activity, the Centers for Disease Control and Prevention recommends a flu shot for anyone 6 months and older. Flu season runs through May. 

"Remember, the flu shot works really well against this strain," Beshear said at the news conference. 

The state's latest weekly flu report shows 309 new cases of the flu were confirmed in the week ended Jan. 21, down from 633 the week prior, a drop of 51%. 

The number of confirmed cases this season is 41,413, a number that includes the new cases as well as a backlog of cases from UK HealthCare that had not been previously reported. The prior report, with data from the week ended Jan. 14, reported 39,425 confirmed flu cases this season. 

Kentucky's flu activity level remains "regional," meaning cases have been confirmed in at least two, but fewer than half, of the state's 16 regions.

The report says flu has killed eight children and 122 adults this flu season, with four of the adult cases due to the flu and Covid-19 coinfection. There was no change from the prior week's report. 

By far the highest number of cases is among children 10 and younger, followed by people 11 to 20.

Counties with the highest number of flu cases were Jefferson, 151; Jessamine, 46; Madison, 35; Scott, 32; and Woodford, 24.

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CDC: Only 5 Ky. counties have high risk from coronavirus; FDA panel recommends one annual Covid-19 vaccination for everyone

Centers for Disease Control and Prevention map

By Melissa Patrick
Kentucky Health News

Only five Kentucky counties, all but one along the Virginia border, have a high level of Covid-19 risk, according to the latest weekly map from the Centers for Disease Control and Prevention. The map showed only slight shifts among medium-risk and low-risk counties.  

Gov. Andy Beshear noted at his weekly news conference, held before the CDC report was released, that new corinavirus cases in Kentucky continue to move up and down a bit, continuing the recent plateau, but the recent increase in Covid-19 hospitalizations is subsiding. 

Again, he made a plea for Kentuckians to get the new Covid-19 booster shot and encouraged Kentuckians to make "wise decisions" when it comes to other preventive measures, like masking. 

"You know, masking when you choose to is a safe and effective tool," he said. "So please consider it when you believe that you need it." 

The CDC map, which is based on Covid-19 cases and hospital numbers to determine transmission and risk, shows number of high risk counties, shown in orange, dropped 54.5 percent from the prior week when the state had 11 counties in this category. 

All the high-risk counties continue to be in the eastern part of the state: Wolfe, Pike, Letcher, Harlan and Bell counties. 

In high-risk counties, the CDC continues to recommend that you wear a well-fitting, high-quality mask in public indoor spaces, and if you are at high risk of getting very sick, consider avoiding non-essential indoor activities in public where you could be exposed.

The map shows 49 Kentucky counties at medium risk, shown in yellow; and 66 at low risk, gown in green. 

If you live in a medium or high-risk county, the CDC advises those who are at high risk of getting very sick to wear a well-fitting mask when indoors and in public and to consider getting tested before having social contact with someone at high risk for getting very sick and consider wearing a mask when indoors when you are with them.

Centers for Disease Control and Prevention map

The CDC also has a transmission-level map, largely used by researchers and health-care facilities, that shows the level of virus spread in each county, at one of four levels. For the first time in a while, it shows one county with a low level of transmission: Todd. Twenty-six counties had with a moderate level of transmission, up from 15 in the prior week, and the rest had either substantial or high levels of transmission.

State officials have encouraged Kentuckians to use the other CDC map to guide their preventive measures.

On Thursday, Jan. 26, a U.S. Food and Drug Administration advisory panel voted unanimously Jan. 26 in favor of moving to an annual Covid-19 vaccine made up of one formula, with every person getting the same vaccine whether they are already vaccinated or not.

Dr. Peter Hotez, dean of the National School of Tropical Medicine at the Baylor College of Medicine in Texas, "said he prefers a twice-a-year routine to account for the anticipated summer and winter surges each year," The Houston Chronicle reports.

“What they're really doing is balancing the science that says, ideally, semi-annually, with the reality that Americans are not really accepting the boosters barely anyway,” Hotez said. But Pfizer and Moderna "are considering raising the price of a single vaccine dose to $130, and the Biden administration has said it no longer has the Covid-19 funding to make additional purchases," the Chronicle notes.

Meanwhile, a committee of the World Health Organization began meeting Jan. 27, to discuss recommending that the agency declare Covid-19 is no longer a major global health emergency. The WHO said no recommendations would be issued before Monday.

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Ky. Opioid Abatement Advisory Commission subcommittees consider five grant applications, with nly two getting a yes vote

Commission subcommittees vote on grant applications. From left: Dr. Allen Brenzel, Eric Friedlander, Von Purdy, Scott Hornbuckle, Carlos Cameron, State Treasurer Allison Ball, Lorran Ferguson and Rep. Danny Bentley. (Photo by Melissa Patrick)

By Melissa Patrick

Kentucky Health News

Two of the three Kentucky Opioid Abatement Advisory Commission subcommittees reviewed five grant applications asking for funds to fight the opioid epidemic and approved two with caveats, classified two as "maybes" and gave a firm "no" to one on Jan. 24.

The settlement funds come from opioid manufacturers and distributors and are required to be used for reimbursement of prior expenses and the funding of new programs related to the prevention, treatment and recovery of people with opioid-use disorders and co-occurring substance-use disorders, or mental health issues.

So far, Kentucky is getting $842 million from these settlement funds, half of which will be allocated by the state advisory commission, with the other half going to cities and counties. Funds are to be disbursed annually, on various schedules, through 2038.

Members of the Prevention Subcommittee and the Reform and Compliance Subcommittee spent an hour deciding the initial fate of five applications referenced only by an assigned number, to keep them private.

Details from the applications were occasionally and vaguely mentioned during the committee discussion. 

However, it was apparent that one of the two applications that got a "yes" vote, both with caveats and adjustments, dealt with harm reduction, while the other was for unnamed program for a small youth cohort. The "maybe" group included a national organization that would partner with existing programs in Kentucky and an elective class to be offered to younger students. The application that got the "no" vote involved a group from New York that proposed something that is already being done in Kentucky.

Concerns and questions were raised on the "yes" and "maybe" applications that must be answered before they move forward to the full commission.

The main concern with all four applications was money, with a general consensus that they were asking for too much to execute their plans. Other concerns dealt with coverage areas, a need for assurance that the monies would be spent in Kentucky, questions about staffing models and salaries, and a need to know how the programs might overlap with existing programs. 

The committee said all of the applications were different from each other and could not be grouped together. 

Application criteria

Bryan Hubbard, executive director and chair of the advisory commission, opened the meeting by reading the 12 criteria established in an emergency administrative regulation to guide the assessment of the applications. 

 The regulation says the commission, in awarding funds, shall consider: 

• Compliance with applicable law;
• The entity or agency's record and responsibility in utilizing effectively any funds received previously from the commission or local governments, as described in KRS 15.293;
• The geographic reach of the application;
• Amounts received from the commission or local governments;
• The utility and effectiveness of any part of the application;
• The extent to which Kentucky residents are served by the application;
• The extent to which prior allocations from the commission have served similar purposes;
• The extent to which the application proposes to serve a portion of the population that otherwise would not receive such service;
• The extent to which the application proposes to incorporate relevant partnerships that are likely to increase the efficiency and effectiveness of programming;
• The extent to which the application proposes, among other things, to educate the public about opioid misuse and opioid-use disorder, reduce the occurrence of opioid misuse and opioid-use disorder, promote resistance to opioid misuse and opioid-use disorder, promote the effective treatment of opioid-use disorder, and/or combat the effects of opioid misuse, including co-occurring mental-health issues;
• The extent to which the application activities align with accepted evidence-based practices; and/or
• The sufficiency of records to validate the requested amounts.

Hubbard then instructed the subcommittee to place the reviewed applications into a yes, no or maybe category, adding that the maybes should also include a list of questions and concerns that would be addressed by the applicant so that they could then be placed into a yes or no category. 

He said the applications placed in the "yes" category would be assessed for their coverage areas, that like proposals would be grouped together and that unique, stand-alone proposals would remain so. 

"That is our process," he said. 

Later in the meeting, Scott Hornbuckle, a staffer with the commission, clarified what a yes vote for an application meant: "Yes means it's a good idea, we want them to participate at some level, we need to look into it further. It does not mean, yes, we approve their grants at this price point," but the application would move to the next step in the process. 

Hubbard told the legislature's health committees Jan. 19 that the commission had received 32 completed applications and 231 more are in progress. He said the total asked by the completed applications is $63.6 million.

Applications are being accepted on a rolling deadline, and the application date is open-ended, at least for now. The commission plans to make the first awards in the spring, with hopes of making three more later this year. 

Members of the subcommittees

Members of the Prevention Subcommittee in attendance were Von Purdy, representing citizens at large and chair of the joint subcommittee; Eric Friedlander, representing the Cabinet for Health and Family Services; and Carlos Cameron, district director for Rep. Hal Rogers, who was appointed by Senate President Robert Stivers. 

Dr. Allen Brenzel, medical director of the Department for Behavioral Health, Developmental and Intellectual Disabilities, who serves if Friedlander is absent, also attended the meeting. 

Members of the Reform and Compliance Committee in attendance were state Rep. Danny Bentley, appointed by House Speaker David Osborne; Vic Brown, representing law enforcement, who attended via telephone; and state Treasurer Allison Ball. Jason Roop, representing victims of the opioid crisis, was absent. 

Also present was Lorran Ferguson, Ball's chief of staff and deputy treasurer.

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How to avoid vision problems from diabetes, which 13.6% of Kentuckians have, 7th in U.S.; 33.8% more have pre-diabetes

Diabetes can cause blindness. (smirart/iStock/Getty Images)

By Joseph Brown

University of Kentucky

Diabetes is a disease so prevalent in the U.S. that it is considered to be an epidemic. In Kentucky, according to the American Diabetes Association, approximately 13.6% of the adult population has diagnosed diabetes, seventh in the nation.

Another 33.8% of Kentuckians have been diagnosed as having pre-diabetes. Diabetes can result in devastating consequences financially and physically for the families and those who have it.

With a diabetes diagnosis, you must be aware of the risk factors you face. One of these risk factors is that you can develop a serious eye condition called diabetic retinopathy. It causes vision loss and blindness in those who have diabetes by causing issues with the blood vessels connected to the retina.

If you have diabetes, it is important to get an eye exam once a year, since you may not notice any symptoms in early stages. Catching this condition early on will be the best course of action in preventing vision loss.

What are the symptoms?

• Changes in vision such as trouble reading or blurred vision
• Fluctuating vision
• Spots or dark streaks floating in your vision
• Dark or empty areas in your vision
• Eye pain or redness
• Difficulty seeing in the dark

What can I do to prevent diabetic retinopathy? The best course of action is managing your diabetes with a healthy diet, regular exercise and following your doctor’s instructions with medications. You should also ensure you get a regular eye screening, and monitor your blood sugar, cholesterol and blood pressure at all times.

What kind of treatment is available? If caught early, your doctor will likely recommend more regular eye exams. However, in the later stages, there are a variety of treatments available to stop your vision from worsening, such as injections, laser treatment or eye surgery. Overall, it is important to see your doctor with any concerns you may have to find the right course of action for you.

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Craft says empty chair at table was a 'close family member' who 'was able to overcome the addiction and move on with their life'

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Flu keeps declining, but shot recommended while activity remains

Kentucky Department for Public Health graph

By Melissa Patrick
Kentucky Health News

Influenza cases in Kentucky continue to decline, dropping again for the sixth week in a row, according to the state's latest weekly flu report. 

"The flu is somewhat declining, but it still remains at an elevated level," Gov. Andy Beshear said at his regular weekly news conference Thursday. "Get your flu shot. It works against the strains that are out there, it's still worth getting the flu shot now." 

A flu shot is recommended for everyone 6 months and older as long as flu activity continues. Flu season runs through May.

The report shows 633 new cases of the flu were confirmed in the week ended Jan. 14, down from 967 the week prior, a drop of  34.5 percent. The number of confirmed cases this flu season is 39,425. 

Kentucky's flu activity level remains "regional," meaning cases have been confirmed in at least two, but fewer than half, of the state's 16 regions.

The report says flu has killed eight children and 122 adults this flu season, with four of the adult cases due to the flu and Covid-19 coinfection. 

By far the highest number of cases is among children 10 and younger, followed by people 11-20.

Counties with the highest number of flu cases in this report were Jefferson, with 151; Jessamine, 46; Madison, 35; and Scott, 32.

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