Observer: Merger of KentuckyOne’s parent would complicate UofL dispute Tuesday, Oct 25 2016 

Screenshot from KentuckyOne Health website.

KentuckyOne Health said the proposed merger of its parent company could bolster health care innovation, but a local observer said he worries the deal will complicate the local health system’s fiscal and organizational challenges. KentuckyOne’s parent, Catholic Health Initiatives, said Monday that it had signed a letter of intent to explore a merger with Dignity […]

Kynect To Be Disconnected Next Week Tuesday, Oct 25 2016 

Kentuckians trying to get health insurance through the state-based marketplace will use instead of Kynect starting Nov. 1.

Personal information of those who previously used Kynect to get insurance will not be transferred to the federal platform, so consumers will have to reapply on the federal website.

Gov. Matt Bevin’s administration says the move will save the state about $10 million per year in operating costs.

“Health insurance is a vital piece of maintaining health and well-being,” said Health and Family Services Cabinet Secretary Vickie Yates Brown Glisson in a statement. “We want to make sure Kentuckians interested in purchasing a qualified health plan know where to shop. Anyone with questions or who encounters difficulty with enrollment is encouraged to contact a call center for assistance.”

The state call center is 855-459-6328 and the federal call center, open 24 hours a day, seven days a week, is 800-318-2596.

Bevin promised to dismantle Kynect and scale back the state’s Medicaid expansion during his race for governor last year. He said the state-run exchange was “redundant” and “adds no value” because Kentuckians could simply sign up for health insurance through the federal platform.

Earlier this month, the Centers for Medicare and Medicaid Services approved Bevin’s request to transition from Kynect to

This year, 74,640 people were enrolled via Kynect.

The state’s health cabinet says those who previously got health insurance through Kynect will receive a mailed or emailed notice with details about enrolling in

Glisson said the Kynect website will be maintained as a landing page that will tell people how to enroll on

“It’s important to remember that Kynect was not insurance,” Glisson said in the statement. “It was a website used for enrollment.”

The variety of health insurance plans available in Kentucky has decreased in recent years. Recently, Aetna, United HealthCare and Baptist Health Plan withdrew from the state’s insurance market, leaving 59 counties in the state with only one health insurance option on the exchange.

Health insurance prices are increasing, too — federal officials announced Monday that premiums for mid-level plans on the federal marketplace will go up about 25 percent this year.

Though individuals will start applying for coverage on the federal exchange starting Nov. 1, small business owners, those wishing to add a family member and other special cases will be able to use the Kynect website until Mar. 31, 2017.

KentuckyOne’s parent is in merger talks Monday, Oct 24 2016 

Screenshot from KentuckyOne Health website.

The parent company of KentuckyOne Health is in merger talks with another giant health care system. According to a letter by Catholic Health Initiatives CEO Kevin E. Lofton, CHI and Dignity Health have signed a letter of intent “to explore aligning our health ministries.” CHI is the parent company of KentuckyOne Health, which includes Jewish […]

Yarmuth Calls On Bevin To Withdraw Medicaid Waiver Request Tuesday, Oct 18 2016 

U.S. Rep. John Yarmuth is calling on Gov. Matt Bevin to withdraw his request for a Medicaid waiver, saying that the federal government will never approve it.

Bevin has applied for the waiver to allow Kentucky to charge monthly premiums to Medicaid recipients earning more than $11,880 a year and remove vision and dental coverage, among other changes.

The proposal also includes a ‘rewards’ account that would allow people to earn vision or dental benefits by doing things like volunteering, applying for jobs or earning a GED.

Yarmuth says he’s communicated with officials at Centers for Medicare and Medicaid services and they told him the waiver would not be approved as-is.

“The bottom line is under Medicaid rules, the only way a Medicaid waiver can be granted is if it expands coverage and improves access and care,” Yarmuth said. “This does neither.”

Under the Medicaid expansion, Kentucky has added about 440,000 people to its Medicaid rolls, helping reduce the state’s uninsured population from more than 20 percent in 2013 to 7.5 percent at the end of 2015.

But next year, Kentucky will begin paying a portion of the Medicaid costs that the federal government was previously covering — about $1.2 billion over the next four years, according to the Bevin administration.

Bevin’s waiver proposal estimates the state would save about $300 million between the 2017 and 2021 fiscal years, if approved. Over the same period, the administration estimates the changes would lead to 17,833 fewer people on Medicaid in 2017 and 85,917 fewer in 2021.

“We want the governor to reconsider and at least to negotiate with CMS the terms of the waiver provision, so that many of the onerous provisions that are in the waiver would go away,” Yarmuth said.

Yarmuth and others have pointed out that the federal government has denied similar proposals in Ohio, Arkansas and Arizona.

Amanda Stamper, Bevin’s press secretary, said that Yarmuth was playing politics in the run-up to the November election.

“Gov. Bevin and his team have spent several months developing a transformative and financially sustainable Medicaid plan that will actually improve health outcomes for Kentuckians and encourage self-sufficiency,” Stamper said in a statement. “U.S. Department of Health and Human Services (HHS) has full authority to approve everything in [the waiver].”

Stamper said Bevin remains committed to working with the Centers for Medicare & Medicaid Services “as long as it takes to transform Kentucky’s Medicaid program to achieve these vital goals.”

Bevin submitted the final proposal for a Medicaid waiver in late August and a comment period on the proposal ended last week.

The Department of Health and Human Services is now reviewing public comments on the waiver and will begin negotiating with the Bevin administration, a process that takes about seven months.

Jewish Hospital’s robotic laser therapy gives new hope to brain cancer patients Tuesday, Oct 18 2016 

A screenshot from a Monteris Medical video that shows how a laser is used to destroy brain cancer cells.

Jewish Hospital is offering a new robotic laser therapy that is giving new hope to some brain cancer patients. Laser interstitial thermal therapy, or LITT, uses heat to kill cancer cells in areas that previously were considered inoperable because of the tumor’s location and complexity, or both. “This really increases the number of options that patients […]

Are Kentucky Doctors At A Disadvantage Under New Medicare Reg? Monday, Oct 17 2016 

Whether or not your doctor stays in business over the next few years could hinge on their ability to adapt to a new regulation changing how Medicare pays doctors and clinicians.

The game-changing regulation aimed at paying medical providers for quality instead of quantity is known as MACRA. It’s based on legislation passed last year by Congress to overhaul how Medicare pays doctors.

There are two routes medical providers can take: Medical practices can earn higher reimbursements if they learn new ways of doing business. That includes being willing to accept financial risk and reward for performance, reporting quality measures to the government, and using electronic medical records. The majority of medical practices will go this route, according to the Kentucky Medical Association.

Or they can join a network of medical providers and hospitals that shares financial and medical responsibility for providing coordinated care to patients in hopes of limiting unnecessary spending.

How it works

Every time a medical provider bills Medicare for a patient, the provider gets paid a lump sum regardless if the patient gets better. Most insurers pay this way. Under the new regulation, the federal government will give bonuses to providers if they use electronic medical records and report quality measures that patients are improving.

Patrick Padgett, executive vice president for the Kentucky Medical Association, said some doctors might already be doing some of the what the rule sets out, but for many, it will be a complete shift.

“It’s asking the medical system to essentially a adopt a new way of operating and documenting and reporting completely different from what they’ve done traditionally,” Padgett said.

Doctors will still be paid for every visit. The bonuses will start out at 4 percent and increase to 9 percent by 2022. At the same time, providers that do not follow the MACRA regulations will get penalized the same percentage.

A 4 percent dock in pay might not sound like a lot but that amount could make or break an independent medical provider’s office. That’s according to Trudi Matthews, managing director of the Regional Extension Center, a federally funded organization that helps hospitals and doctors across Kentucky comply with federal regulations.

“A lot of folks would say they make just enough money to cover the cost of patients,” Matthews said. “They may only have a margin of 2 to 4 percent, so if they’re going to lose 4 percent, that’s a big hit. There aren’t many health care organizations that could take reductions year over year and stay in business.”

Medicare is by far the biggest payer of health insurance claims in Kentucky. The Department of Health and Human Services sets rules for how and how much doctors are paid, and other insurers follow suit.

“Most commercial insurers have announced that they’ll be tying spending to value,” Matthews said. “It’s not just Medicare, it signals a trend in the [health insurance] marketplace.”

Comparing states

Under MACRA, providers can earn bonuses for reporting quality measures. The government will use this as a means of gauging how well a medical provider is improving a patient’s health outcome. For example, providers can earn bonuses for keeping track of patients who have schizophrenia and whether or not they take their medication on a daily basis. Or measuring a hyperglycemia patient’s blood glucose levels.

Most quality measures adjust if a patient is very sick in the beginning but improves. They also adjust based on age and gender. But most measures don’t take into account if a patient lives in a bad neighborhood, far from a pharmacy or doesn’t have reliable transportation to the doctor for follow-ups. In 2015, Kentucky ranked in the bottom five states with the most people living in poverty at 19.1 percent.

These factors can put Kentucky doctors at a disadvantage. And Padgett said the government will score doctors on these quality measures against every other state.

“We have a population base that’s less healthy than the rest of the country. And I don’t think that’s a big secret,” Padgett said. “Some of the measurements Medicare will use could be based on national bench marks, and if they are, we could potentially be ranked lower, and therefore the providers get penalized.”

Health care providers next year will have to report this information and 50 percent of that bonus or penalty will based on the how well patients do. Another 25 percent will be based on the use of electronic health records, 15 percent on professional education courses and 10 percent on the cost of care.

State Lawmakers Consider Whether To Let Physician Assistants Prescribe Drugs Friday, Oct 14 2016 

As a shortage of primary care physicians looms across the nation and Kentucky, state lawmakers are considering whether to expand the role of physician assistants by allowing them to prescribe controlled substances.

Kentucky is the only state that doesn’t allow physician assistants to prescribe controlled substances, though it allows nurse practitioners to do so.

Christie Hall with the Kentucky Academy of Physician Assistants said the legislation would help resolve a shortage of healthcare providers in Kentucky.

“Expanded PA prescriptive authority will allow our physician-PA teams to better serve the needs of their patients in a more efficient manner,” Hall said.

Much like doctors, physician assistants diagnose and treat patients, but they only have to complete a two year master’s program and are required to be supervised by a physician in the area.

Currently, physician assistants are only allowed to prescribe drugs that aren’t on the list of substances that the federal government deems to have a risk of abuse.

The legislature passed a law to allow nurse practitioners to prescribe controlled substances in 2014.

Nicholasville Rep. Tom Buford and Gravel Switch Rep. Daniel Elliott, both Republicans, have proposed bills that would expand the prescriptive authority of physician assistants. But other lawmakers are skeptical of the idea as opiate addiction to prescription drugs and heroin continues to ravage the state.

“Is it really necessary that a PA be able to prescribe methadone, opium, codeine, morphine, fentanyl, Percocet, oxycodone,” Louisville Republican Rep. Jerry Miller asked during the hearing.

“We all need to think, at least I need to think about expanding prescriptive authority when we have a historical crisis going on in Kentucky with pharmaceutical and street-based opiate products,” said Union Republican Rep. John Schickel.

The U.S. Health Resources & Services Administration has recommended expanding the roles of physician assistants and nurse practitioners to help alleviate a shortage of primary care physicians in coming years.

According to the study, the country will be short about 20,400 primary care physicians if the current system for delivering primary care remains the same.

Now That The Comment Period Is Closed, What’s Next For Kentucky Medicaid? Friday, Oct 14 2016 

Kentuckians are one step closer to learning what changes will be made to their Medicaid benefits.

During the comment period for Gov. Matt Bevin’s proposed Medicaid changes, a total of 1,643 individual comments were submitted from Kentuckians and people around the U.S. The feedback was released earlier this week, and the Kentucky Center for Economic Policy analyzed it.

According to KCEP, the majority of feedback received during the open comment period was personal stories from individuals or comments from national and regional groups, including the Kentucky Dental Association and the American Lung Association.

“There were a lot of stories about people who got treatment for conditions they hadn’t had looked at for a long time, people who were able to go to the dentist for the first time in 10 years,” said Dustin Pugel, research and policy associate at KCEP.

According to KCEP’s analysis, 90 percent of the comments were in favor of keeping Medicaid benefits the same as they are now, 134 or 8.4 percent of the comments were in favor of the proposed changes, and 25 comments were mixed.

When asked for a response to KCEP’s analysis, Bevin spokeswoman Amanda Stamper. said, “Gov. Bevin campaigned on reforming Medicaid expansion and was shown overwhelming support by Kentucky voters who elected him to do just that.”

The Affordable Care Act was originally designed to extend Medicaid to residents in all 50 states who earn below 138 percent of the federal poverty limit, or $16,394 in 2016. But the Supreme Court famously struck down that provision.

Most states expanded Medicaid as the ACA plan set out several years ago. But a handful of states, now including Kentucky, have applied for waivers to change what the federal government intended for expansion.

Next year, Kentucky will begin paying a portion of the Medicaid costs that the federal government was previously covering. That’s estimated to cost $1.2 billion over the next four years, according to the Bevin administration.

In Kentucky, some 428,000 people have received health coverage through expanded Medicaid.

If Bevin’s changes are approved as-is, Kentucky would put into place monthly premiums for individuals earning more than $11,880 a year, copays for people earning less than the federal poverty limit, and eliminate default vision and dental coverage for able-bodied adults. Bevin is proposing a ‘rewards’ account that would allow people to earn points toward those benefits.

Dania Douglas, state advocacy manager at the National Alliance on Mental Illness, said one of their big concerns is the proposed elimination of non-emergency medical transportation. The service allows people without their own transportation to get to medical appointments including dialysis and mental health therapy.

Douglas said the service is critical for people — especially those with mental illness.

“In a state like Kentucky where it’s so rural and so many people who are low-income without transportation, it can cause more missed appointments,” Douglas said. “And that would be a concern because ongoing consistent treatment is so important to people with a mental health condition.

The comments will now be analyzed by the Department of Health and Human Services in preparation for negotiations with Bevin. That process on average takes seven months, according to HHS.

Judith Solomon, vice president of health policy at the Center on Budget and Policy Priorities, said what happens next is anyone’s guess.

“The big question is if the governor is going to be willing to negotiate,” she said. There are some things on the table that won’t clearly be approved.”

Solomon said changes unlikely to be approved include adding an open enrollment period for signing up for Medicaid, which has never been allowed for Medicaid in any other state, and locking people out of coverage if they don’t renew.

UofL, Kentucky One exchange barbs over $46M in back payments Wednesday, Oct 12 2016 

Screenshot from KentuckyOne Health website.

In response to an article in The Courier-Journal, which reported Wednesday that UofL demanded more than $46 million in back payments from KentuckyOne Health, officials at KentuckyOne issued a lengthy statement, saying in part, “KentuckyOne Health is committed to making this partnership a success.” KentuckyOne Health, part of Colorado-based Catholic Health Initiatives, was created by […]

Health entrepreneur: Americans pay lots of money for ‘bad deaths’ Tuesday, Oct 11 2016 

Courtesy of Public Domain Pictures.

Americans are spending a lot of money just to experience “bad deaths,” and to change the system, they should get angry and talk about it whenever they can, a health care entrepreneur said. Most Americans die where they don’t want to — away from home — and more than 40 percent lose their life savings […]

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