Nursing-home referral service, A Place for Mom, is funded by nursing homes and has no information about their violations

Image from home page of A Place for Mom website

Kentucky Health News

The nation's largest nursing-home referral service, A Place for Mom, does not inform users about citations of facilities for neglect or other substandard care, The Washington Post reports.

A Place for Mom charges no fees to people seeking senior housing, but "is paid large fees by assisted-living facilities and does not independently assess their records," the Post reports. "More than a third of its most highly recommended facilities in 28 states were cited for neglect or substandard care in the past two years, many of them repeatedly."

Those 28 states put nursing-home inspection reports online, enabling the Post to easily research them. Kentucky is among the 22 states that do not put inspection reports online. Medicare's Nursing Home Compare website, which ranks facilities on a five-star systen, is based on those reports.

"A Place for Mom does not include these reports in its profiles of facilities, even in cases where poor care has led to death," the Post reports. 

Some places cite for substandard care have received a “Best of Senior Living” award from A Place for Mom for providing “exemplary care and support to aging loved ones.” The company says the awards are based on user reviews, "which are often anonymous," the Post reports.

"Current and former staff of some large chains told The Post that these reviews are often manipulated by the care providers; some claimed they were encouraged to obtain fake reviews from their own friends and relatives. . . . None of the sources suggested that A Place for Mom itself is involved in generating fake or manipulated reviews. But they say the site’s prominence creates incentives for facilities to push for favorable ratings."

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15% fewer med-school grads applied for residencies in Kentucky this year; med-school association attributes that to abortion ban

Photo by Phallin Ooi, Creative Commons

By Sylvia Goodman
Kentucky Public Radio

The Association of American Medical Schools says 15 percent fewer U.S. medical-school graduates applied to Kentucky residency programs in the 2023-24 academic year, part of a trend related to states' strong anti-abortion laws enacted after the federal right to abortion was abolished. The decline was even greater in programs for obstetricians and gynecologists.
 
The study found that U.S. medical students were less likely to put in an application in states with abortion bans in place. The state's near-total abortion ban only allows exceptions if the mother is in imminent risk of death or permanent injury to a life-sustaining organ.

Dr. Atul Grover, executive director of the AAMS Research and Action Institute, found that 15% fewer U.S. medical students applied to residency programs in Kentucky during the last academic year compared to the 2022-23 school year. That’s 1,050 fewer applicants across specialties.

In OB-GYN programs, there was an even sharper 23% decline, Grover said. “We do see these trends across specialties, though,” he said. “People get a little jittery around the idea that the state government is going to come in and tell you what is not appropriate care for a patient when you know otherwise.”

Grover noted that medical students overall applied to fewer schools, meaning students got pickier in where they applied. That accounts for some of the decrease in applications across states, but the remaining deficit, he said, is cause for concern — particularly to states with abortion bans.

“Health-care shortages, across specialties, across a lot of states, are already being felt by patients,” Grover said. “If I think about Kentucky, Alabama, Mississippi, these are states that already have trouble attracting and recruiting, retaining physicians.”

Kentucky hospitals are already dealing with an “acute shortage” of health care workers, with nearly 13,000 job vacancies in hospitals at the end of 2022, says the Kentucky Hospital Association.

Grover said medical-residency application numbers are one of the fastest ways to measure where doctors are moving or interested in moving. Other metrics are harder and take longer to track. Residents have a tendency to stay in the state where they train.

Grover said lawmakers should understand the full implications of abortion bans, especially in a state that already suffers from several physician shortages, including in women and reproductive health fields. According to the U.S. Health Resources and Services Administration, more than half of Kentucky’s 120 counties didn’t have a single OB-GYN specialist in 2022-23.

Louisville pediatrician Dr. Michelle Elisburg said many doctors entering residency are in their mid-to-late 20s, and may be considering having children themselves. The bans may keep those women or their partners from considering moving to the state either.

“You wouldn't come if you're a young woman and know that if something happens to you, you might die because they aren't gonna let you get the health care you need,” Elisburg said. “That's where you are going to lose the doctors.”

Elisburg was part of the lobbying effort by Kentucky Physicians for Reproductive Freedom to end the state’s abortion bans this year.

She said the bans keep students from receiving all the training they need to provide abortion care or require them travel out of state to get it. “If there's such a ban, that restricts the kind of training that people are able to do,” she said. “They're not going to want to come to a state where they can't be completely trained in all the techniques in their field.”

Blair Wooten, who attended the University of Louisville medical school, said the state’s abortion ban was one of the reasons she decided to leave the state. She ended up going to a program in Ohio for the last year. She said abortion medical training “is paramount to me. It's something I want to be in my practice.”

Wooten is moving to a residency program in Indiana, which has its own abortion ban, but that program gives students the opportunity to receive abortion training in a Detroit-based program, which eased some of her fears — and clinics in Ohio are just a few hours drive away.

Wooten said she’s not sure if she’d consider setting up a practice in a state without abortion access. She said the inability to immediately provide the care she believes is necessary would be painful, but she also wants to provide services in health care deserts.

“Family planning is something I want to be a big part of my practice, so I usually say, ‘No’,” Wooten said. “But I'm also keenly aware that people need resources in every place, especially places that are maybe a little more hostile. And they need providers who care and can help them even with limited resources.”

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As new Covid-19 variants become dominant, misinformation about vaccines continues; here are the facts

By Sarah Ladd
Kentucky Lantern

In the last month, new Covid-19 variants emerged as the dominant strain in the United States.

Covid-19 vaccines are still recommended for protection against the virus, according to the Kentucky Department for Public Health. Kentucky currently has low levels of emergency-department visits and hospitalizations for Covid-19, according to the Cabinet for Health and Family Services.

A CHFS spokesman told the Lantern that the KP.2 variant has already been confirmed in the state. Kentucky does not have any KP1.1 cases, spokesman Brice Mitchell said. These variants are in a group called FLiRT, after letters in the names of the individual mutations.

“These variants are not thought to cause more severe disease but do have some mutations in the spike protein that may make them more resistant to immunity conferred by vaccines and prior infections,” Mitchell said.

Still, the department “continues to recommend that all Kentuckians six months of age and older remain up-to-date with their Covid-19 vaccinations.”

Despite that advice, not everyone is convinced. In the fourth year of Covid-19 — and about 3.5 years since the vaccines came to Kentucky — vaccine misinformation persists, even among elected officials.

During the 2024 legislative session, vaccine misinformation — specifically around the Covid-19 shots — found its way onto the Kentucky Senate floor and into committee meetings.

A spokesperson for the Centers for Disease Control and Prevention told the Lantern that the CDC “continues to encourage Americans to get vaccinated, as the Covid-19 vaccination continues to be the best way to protect against serious illness.”

The Lantern consulted the CDC, the Food and Drug Administration and other sources in response to several vaccine claims made by lawmakers this year:

 
Claim: “Covid-19 vaccines caused “unprecedented rise in sudden cardiac events, miscarriages and stillbirths, blood clots, myocarditis in youth, and sudden deaths among all ages.”

Response: Receiving the shot does not increase the risk of death from non-Covid causes. That conclusion is based on safety monitoring after more than 675 million doses of vaccine have been administered.

Covid-19 vaccination during pregnancy is safe and not linked to an increased risk of miscarriage or stillbirth, according to CDC safety monitoring and research. It has identified four rare but serious types of adverse events following Covid-19 vaccination. Two of them — thrombosis and Guillain-Barré Syndrome — were associated with vaccines that have been discontinued in the U.S. and are no longer available.

About 5 people per 1 million doses of vaccine have experienced anaphylaxis, a severe, potentially life-threatening allergic reaction that requires immediate emergency medical treatment. It can occur after any medication or vaccination.

Also, an increased risk of myocarditis – inflammation of the heart – is associated with the Pfizer and Moderna vaccines. Varying by age and sex, the rates of myocarditis after vaccination range from zero to 188 per 1 million doses. Research has found that the risk of myocarditis is higher following a Covid infection than after a Covid vaccine, according to the CDC.

CDC and FDA have detected no unusual or unexpected patterns indicating Covid-19 vaccines are causing or contributing to any other serious medical conditions.

Vaccination against COVID-19 reduces the risks of dying from Covid and suffering long Covid. The most common vaccine side effects are usually mild, such as soreness in the area where the shot was given.

Claim: “The deaths and adverse events recorded to the Vaccine Adverse Events Report System that are submitted to this (Covid) vaccine total more than all other vaccines combined, since the CDC implemented the reporting system in 1990.”

Response: This claim has been debunked multiple times by multiple sources.

After Covid-19 vaccines became available, adverse reactions reported to the Vaccine Adverse Event Reporting System did increase, the CDC says, in part because so many people — more than 80% of Americans — received the shot. The 675 million doses of Covid-19 vaccine that have been administered in the U.S. are more than other types of vaccines. Also, under the emergency authorization for the Covid-19 vaccine, the FDA required health-care providers to report any adverse reaction in a patient even if it’s unclear the vaccine was the cause.

The Vaccine Adverse Event Reporting System is a voluntary early-warning system. Anyone may enter information about side effects or other adverse reactions after a vaccine; the reports are not verified, but scientists use the data to spot worrisome patterns that merit investigation.

"Anti-vaccination fringe groups have attempted to spin false stories using VAERS data, adding to misinformation about the safety of Covid-19 vaccinations," says the Johns Hopkins Bloomberg School of Public Health.

A study published in the Journal of the American Medical Association in March found that the more likely a state was to vote Republican, the more likely its vaccine recipients or their clinicians reported adverse effects from Covid-19 vaccines. These results suggest that either the perception of vaccine effects or the motivation to report them was associated with political inclination.

Claim: “Pet vaccines are actually safer than people vaccines.”

Response: Animal and human vaccines undergo different approval processes. The U.S. Department of Agriculture’s Animal and Plant Health Inspection Service regulates veterinary vaccines and the Food and Drug Administration regulates human vaccines.

According to a 2014 paper in the National Library of Medicine, the two “differ markedly.” Vaccine effectiveness is more highly studied in human vaccines than in animal ones, that study found.

What the FDA says: The FDA “takes its responsibility for ensuring the safety, effectiveness and manufacturing quality of all vaccines approved or authorized for emergency use in the U.S. very seriously,” a spokesperson said.

All ingredients in new vaccines are looked at for safety and effectiveness. The “rigorous and extensive” approval process includes lab work, animal studies and human clinical trials.

“Highly trained FDA scientists and physicians thoroughly evaluate the information in a marketing application,” the FDA said, before ever approving shots for public distribution. Both pet and human vaccines are safe.

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Health-care industry is most at risk from cyberattack, study says

Health care is increasingly more at risk of cyberattacks than other industries, according to a recent study by Soax, a data-collection platform, reports Cara Smith of Inside Health Policy.

As cyberattacks against Change Healthcare and Ascension, a 19-state hospital system, "disrupted the health-care industry, lawmakers, doctors, payers and other stakeholders are scrambling to prevent future cyberbreaches to protect the health-care system," Smith reports.

"The health-care industry is the most vulnerable sector, topping the ranking with 809 data-violation cases in 2023. This is a staggering surge in incidents from the prior year, with cases totaling 343 in 2022 -- a 136% increase, the study found. Further data revealed that these cases affected 56 million victims."

For teh study, Soax used data from the Identity Theft Resource Center, and says "the health-care industry should be on high alert," Smith reports.

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Online vision retailer Warby Parker will pay Ky. civil penalty for allowing Kentuckians to take its online vision test, illegal in Ky.

Image on Warby Parker's "Get a Prescription" page

Kentucky Health News

Warby Parker, an online retailer of prescription glasses, contact lenses and sunglasses, has agreed to pay at least $55,200 to the Commonwealth of Kentucky for allowing 69 Kentuckians to take its online vision test, contrary to state law, Attorney General Russell Coleman's office said in a news release Friday.

Coleman's office alleged that from July to October 2021, 69 Kentuckians were improperly given Warby Parker’s online test. "When the attorney general’s Office of Consumer Protection alerted Warby Parker of the problem, the company cooperated with the investigation and took the test offline," the release said. "Following a voluntary settlement process, Warby Parker will be penalized $138,000. If there are no further violations for five years, the amount will be reduced to $55,200."

The "Get a Prescription" page on Warby Parker's website says the online vision test is available to people who "reside in an eligible state, due to state-level regulations," and disqualifies residents of Alaska, Connecticut, the District of Columbia, Georgia, Idaho, Kentucky, New Mexico, South Carolina, South Dakota, Washington and West Virginia, using their two-letter postal abbreviations.

Kentucky consumers may complain about a business operating in the state to Coleman’s office at https://www.ag.ky.gov/Resources/Consumer-Resources/Consumers/Pages/Consumer-Complaints.aspx.

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Parkinson's disease: Its symptoms, causes and management

Photo illustration by Pornpak Khunatorn, iStock/Getty Images Plus

By Dr. Zain Guduru

University of Kentucky

Parkinson's disease is a progressive neurological disorder that affects movement. Named after Dr. James Parkinson, who first described it in 1817, this condition currently affects millions of people worldwide. While there is no cure for Parkinson's disease, understanding its symptoms, causes and management strategies can significantly improve the quality of life for those living with the condition.

What is Parkinson's disease? PD primarily affects the brain's nerve cells responsible for producing dopamine, a neurotransmitter involved in movement regulation. As these cells degenerate or become impaired, dopamine levels drop, leading to the characteristic symptoms of PD.

Symptoms of Parkinson's disease:

• Tremors: Involuntary shaking, usually starting in the hands or fingers.
• Bradykinesia: Slowed movement and difficulty initiating movement.
• Muscle rigidity: Stiffness in the limbs or trunk, causing difficulty with movement.
• Postural instability: Impaired balance and coordination, leading to falls.
• Non-motor symptoms: These can include depression, anxiety, cognitive changes and sleep disturbances.

Causes of Parkinson's disease: The exact cause of PD remains unknown, but it's believed to involve a combination of genetic and environmental factors. Some potential factors that may contribute to the development of PD include:

• Genetic mutations: Certain genetic mutations have been linked to an increased risk of Parkinson's disease.
• Environmental factors: Exposure to toxins like pesticides, herbicides and heavy metals may increase the risk.
• Age: The risk of Parkinson's disease increases with age, typically affecting individuals over the age of 60.
• Brain changes: Abnormal protein deposits in the brain, such as alpha-synuclein, are associated with Parkinson's disease.

Managing Parkinson's disease: While there is no cure for PD, several treatment options can help manage its symptoms and improve quality of life:

• Medications: Dopamine replacement medications, such as levodopa, can help alleviate motor symptoms.
• Physical therapy: Exercise programs designed to improve flexibility, balance, and mobility can be beneficial.
• Speech therapy: Speech therapists can help with communication difficulties often associated with Parkinson's disease.
• Deep brain stimulation: In advanced cases, DBS surgery may be an option to help control motor symptoms.
• Lifestyle modifications: Eating a balanced diet, staying physically active, and managing stress can all contribute to better symptom management.

Parkinson's disease is a complex condition that requires a multidisciplinary approach to management. While there is no cure, early diagnosis and appropriate treatment can significantly improve the quality of life for individuals living with PD. By raising awareness, supporting research, and implementing effective management strategies, we can work towards a better understanding and treatment of Parkinson's disease.

Zain Guduru, M.D., is a neurologist with the Kentucky Neuroscience Institute and assistant professor in the University of Kentucky College of Medicine.

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AMA president-elect, from Louisville, lays out his ideas for getting more physicians in rural areas, reforming prior authorization

By Melissa Patrick
Kentucky Health News

With about 46 million people in the U.S. living in rural areas and new research showing they are more likely to die early from the five leading causes of death than their urban counterparts, the American Medical Association is sounding the alarm. 

AMA President-elect Bruce Scott (AMA photo)

"Rural health is America's health," Dr. Bruce Scott of Louisville, AMA president-elect, told reporters in a May 9 press conference in conjunction with the National Rural Health Association annual conference in New Orleans. "We need policymakers to understand that the American Medical Association is deeply concerned about the ever-widening health disparities between urban and rural communities. disparities that are at the root of why rural Americans suffered disproportionately high rates of heart disease, cancer, stroke, respiratory illness, diabetes, and unintentional injuries." 

Scott, who is board-certified in both otolaryngology and facial plastic surgery, served as the Kentucky Medical Association's president in 2018-19. He will become AMA president in June. 

Scott pointed to several environmental, economic and social factors factors that put people who live in rural communities at a higher risk of death from these often preventable conditions. But the AMA's focus, he said, is on the health-care worker and the physician shortage and how this affects rural people's health. 

He added that these shortages are hitting rural areas the largest and are "creating health-care trends that are simply unacceptable. We need to reverse these trends for all individuals to live a long, healthy and active life."

Scott said rural areas have about 30 physician specialists for every 100,000 residents, compared to 236 per 100,000 in urban communities, and he noted that more than 130 rural hospitals closed from 2010 to 2021, with many more on the verge of closing today. 

Also, he said that in 2023, 65% of rural communities had insufficient access to primary-care physicians, including pediatricians. And, he said there are not enough residency spots to train doctors in rural areas. 

"History has shown us that residents, 80% of the time, tend to wind up practicing within 80 miles of where they've done the residency," Scott said. "So residency location becomes very important. In addition, medical schools are receiving fewer and fewer applicants from individuals from rural areas."

Call for Medicare reform

Scott said the AMA is working to build a stronger physician workforce, which he said starts with supporting physicians who are already in practice, to keep them practicing.

"AMA is focused on fixing the systemic issues of our health-care system that are known to be driving physician burnout, and contributing to early retirement and physicians leaving practice altogether," he said. "Highest among these problems are the broken Medicare physician payment system and the administrative burdens." 

The problem, said Scott, is that Medicare payments to doctors are not keeping up with inflation. He said that when adjusted for inflation, the payment rate to physicians has dropped 29% since 2001, and private payers and other insurers have linked their payments to the Medicare structure. 

"We need a system that is sustainable, predictable, and provides at least an annual inflation update that encourages patients choice rather than consolidation," he said. "We need Congress to act." 

Administrative burdens

Scott said physicians spend two hours on administrative work for every one hour with patients, contributing to burnout and hindering patient care. 

A key contributor to this is "prior authorization," which requires a physician to get approval from a third-party payer for care that the physician and patient have agreed on before it can be implemented.  

"On average, physicians complete 45 prior authorizations per week and it's even worse in primary care," Scott said. "The prior authorization process is overused, overly burdensome and wastes physicians' time. But I'm even more concerned about the fact that prior authorization hurts patients." 

He added, "We need Congress and payers and the administration to respond, because the result is that physicians are getting burned out and they're leaving practice, not because they don't want to practice medical care anymore, but because the system is making it more and more difficult for them to care for their patients." 

During the 2024 legislative session, Rep. Kim Moser, R-Taylor Mill, again filed a bill to address the prior authorization issue in Kentucky, but health insurers blocked it. It would have exempted from the process health-care providers who have had 90% or more of their claims approved. 

Scott said the AMA is "fighting for legislation fixes" to increase incentives for physicians to work in rural areas, to expand the number of residency spots, particularly in primary care and in rural areas, to make the pandemic's telehealth flexibilities permanent, and to allow qualified international medical graduates to keep practicing in America. 

Asked about the role of advanced-practice registered nurses and physician assistants to help increase access to care in rural areas, Scott said that "there is absolutely" a role for these "physician extenders" in a physician-led team model. 

"The AMA believes strongly in the concept of a physician-led medical team, where every component of the team is working to the highest level of their knowledge base and their experience," he said. "Now, we're not in favor of independent practice for nurse practitioners or PAs. We think that patients, no matter what ZIP code they happen to live in, deserve care by a physician." 

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