MEDICAL NEWS The business of healthcare

$2.50 January 2016

News in Brief page 2 | People in Brief page 5 | Event Calendar page 6 | Commentary page 18

Stites & Harbison’s Trademarkology blog THE recognized Read more on page 2

Physician STARK Spotlight Meet Guru Pattar, MD, PhD, ophthalmologist at the Eye Care Institute in Louisville, Ky. LAW Read more on page 4 Capitol events Congress looks to reform calendar A number of health the Stark Law in 2016. advocacy organizations host events at the Capitol during the upcoming 2016 Regular Session of the By John Williams Kentucky General Assembly. Stark Law Addressing Disparity Read more on page 6 A compliance To address this disparity, the officer received an Stark law, actually three Stark Administrative Simplification separate provisions, email notification Act (H.R. 776) was introduced in Kentuckians’ views on the governs physician self- that said it was the House of Representatives by Rep. Affordable Care Act (ACA) referral for Medicare and time to renew the Charles Boustany, M.D. (R-LA) and Poll data released in December by the Foundation hospital’s electronic Medicaid patients. The law is named for United States Rep. Ron Kind (D-WI). The bipartisan for a Healthy Kentucky and Interact for Health health records Congressman Pete Stark, who bill defines “technical noncompliance” indicate half (50 percent) of Kentuckians report contract with a large sponsored the initial bill. with the Stark Law as an unwritten, the Affordable Care Act (ACA) has not had an WILLIAMS cardiology group. unsigned or lapsed agreement that is impact on them or their families, down from When the contract otherwise compliant with federal fraud 66 percent in 2013. was pulled from the hospital’s contract hospital from billing Medicare for any and abuse law. Read more on page 11 database, the compliance officer services ordered by a physician that is The penalty for a technical discovered something that caused her to covered by the arrangement. violation disclosed through the existing panic: the hospital’s CEO hadn’t signed In cases where the hospital has Self-Referral Disclosure Protocol IN THIS ISSUE the contract before it was filed away two already billed Medicare for the physician’s (“SRDP”) within one year of the date of years earlier. services, the government is entitled to noncompliance would be $5,000. The After consulting with the hospital’s recoup all monies paid during the period penalty for those disclosed more than HEALTHCARE attorney, the compliance officer learned of noncompliance. This can result in one year after the date of noncompliance LEGISLATION the missing signature was a violation of excessive and disproportionate monetary would be $10,000. the Medicare physician self-referral law, penalties, even when there has been no The bill also gives CMS 90 days Happy New Year! Medical News kicks off 2016 more commonly known as the Stark overutilization of healthcare service and to determine whether a disclosure of with our annual legislative issue. Kentucky Law. She also learned the hospital faced a no harm to the Medicare program. technical noncompliance qualifies for lawmakers return to the state Capitol this month potential penalty in excess of $2 million. a lower penalty using only the criteria to begin their 2016 legislative session. From This and similar scenarios play out While these changes are certainly set forth in the legislation. If CMS fails the need for tort reform for long-term care in countless times each year in hospitals to act on a disclosure within 90 days, Kentucky to a proposed law ensuring every and health systems across the country. welcome, they fail to achieve it would be deemed to be accepted. In student is trained in hands-only CPR before they While unintentional violations like a the level of predictability and order to clear the backlog of over 400 graduate, we’ve got it covered. missing signature or lapsed contract certainty providers need because disclosures still waiting for review, Read more on page 13 are generally minor and technical the statute has not changed. the proposal would retroactively in nature, the Stark Law prohibits a Continued on page 3

Serving Kentucky and Southern Indiana PAGE 2 MEDICAL NEWS • JANUARY 2016

NEWS in brief Stites & Harbison’s Trademarkology UnitedHealthcare offers Critical blog recognized Illness Protection plans

Editors of the ABA Journal an- By Will Shanley especially for people enrolled in high- nounced that Stites & Harbison blog, deductible health plans. Approxi- Trademarkology, has been selected to UnitedHealthcare has introduced mately 35 percent of large and mid- new Critical Illness Protection plans the ninth annual Blawg 100 as one current trademark issues. size employers now offer critical illness that provide a cash benefit for covered coverage, up from 12 percent in 2002, of the top 100 best blogs for a legal The ABA Journal is the flagship health events to help fund employees’ according to a Towers Watson survey. audience for 2015. This is the second magazine of the American Bar As- out-of-pocket expenses after a major Employers that offer their em- time that Trademarkology has made sociation, and it is read by half of illness, such as deductibles and copays, ployees UnitedHealthcare medical the list. the nation’s 1.1 million lawyers every as well as helping cover lost income. plans can integrate their benefits with The goal of Trademarkology is month. It covers the trends, people several ancillary products such as criti- to provide readers with insight and and finances of the legal profession cal illness, accident, dental, vision and guidance regarding selecting a brand from Wall Street to Main Street to disability insurance. name or logo and protecting it with a Pennsylvania Avenue. The ABA Jour- UnitedHealthcare’s integrated ap- federally registered trademark. It is in nal’s Blawg 100 reviews nominations proach, called Bridge2Health, gener- no way meant to replace legal services from readers on the top legal blogs ates a wide range of data that provides but to educate readers on a variety of and then selects the top 100 blogs. a more complete profile of employees’ health and, as a result, allows for more customized interventions that can help Seven Counties Services announces employees reduce costs and achieve better overall health. grand opening of TAYLRD Research shows that adding these types of voluntary benefits to a core Transition Age Youth Launch- medical benefits offering can help Critical illness coverage provides ing Realized Dreams, or TAYLRD, improve companies’ bottom lines by crucial support to employees recover- is a new Seven Counties program born increasing productivity and employee ing from a major illness, such as can- from the Federal Government’s Healthy engagement. According to a 2014 re- cer, heart attack or stroke, which ac- Transitions Grant program called “Now port by LIMRA, a worldwide associa- count for more than 75 percent of all is the Time” and the Kentucky Depart- tion of insurance and financial services critical illnesses. ment of Behavioral Health’s recom- companies, voluntary benefits can help people in setting goals and realizing Following the diagnosis of a cov- mended TAYLRD model. attract and retain employees while im- dreams, all on site. ered health event, plan participants TAYLRD will have drop-in cen- proving morale. The drop-in centers, named “The receive a lump sum payment ranging ters set up for teens and young adults Employers offering both medi- Taylorsville Drop” and “The Louisville between $5,000 and $40,000, which ages 16-25 in Louisville and Taylors- cal and voluntary plans from Unit- Drop,” are staffed by Youth Peer Sup- can be used to pay medical bills or ville. The Louisville location officially edHealthcare also enjoy streamlined port Specialists (YPSS) and Youth cover normal living expenses. opened on December 10 with remarks administration that enables a greater Coordinators who are in the transi- The new plans offer greater from Metro Council President David focus on the overall health of plan par- Tandy and Seven Counties Services tion age group and have had some flexibility for employers and em- form of system involvement them- ployees, including: TAYLRD program director Anita Research shows that adding these Roper along with a live remote with selves. Supports and services offered – An expanded list of covered illness- B96’s Tropikana. through the TAYLRD drop centers es, including advanced conditions types of voluntary benefits to a TAYLRD is a place where young include life skills, vocational services, such as amyotrophic lateral sclero- core medical benefits offering can academic support, therapeutic support, sis (ALS), Alzheimer’s disease and people can come to build communi- help improve companies’ bottom ty and find the support and services case management and court support. Parkinson’s disease. needed to help make their dreams There will be pool tournaments, magic – Coverage for child-only conditions lines by increasing productivity come true. The drop-in centers are tournaments, open mic nights; Tai Chi such as cerebral palsy, cystic fibro- and employee engagement. inviting places, equipped with pool classes, drum circles; the possibilities sis and muscular dystrophy that are tables, video gaming, board games, are limited only by the imagination of diagnosed from birth to age 26. books and snacks. They are supportive our young people. TAYLRD is open – Additional benefit payouts for dif- ticipants across all benefits offered by places, with a computer lab and laun- Monday – Friday from 3-6 p.m. with ferent conditions as well as second the company. dry facilities to help with basic needs. additional hours available based on payouts for the same condition, if UnitedHealthcare’s Critical Ill- The sites will offer services by bring- need. For more information find them the recurrence of the same condi- ness Protection plans are currently ing in service providers to assist young facebook.com/TAYLRDSCS. tion occurs within 12 months of available to businesses with 51 or initial diagnosis. more eligible employees in 44 states – Flexible coverage options for em- and Washington, D.C. Voluntary Kynect will sell health insurance ployees, spouses and children. benefit plans are available as stand- – Variable funding arrangements pro- alone products, as well as in addition through Jan. 31 viding cost certainty for employers to medical coverage. and the ability for employees to UnitedHealthcare also offers criti- Kynect, the online marketplace more advertising for it. purchase the additional coverage cal illness plans to individuals who buy where Kentuckians can buy feder- The new administration of Gov. they need. their own health insurance, as well as ally subsidized health insurance, will Matt Bevin directed Louisville adver- More employers are offering criti- term life insurance products that have cal illness protection plans as a way to remain open for enrollment through tising agency Doe-Anderson Inc. on a critical illness feature. add financial certainty for employees, Jan. 31. But you will see little if any Dec. 18 to cancel pending advertising. - Will Shanley is with UnitedHealthcare. MEDICAL NEWS • JANUARY 2016 PAGE 3

COVER STORY

Continued from cover The Stark Law apply to any technically noncompliant of contemporaneous documents is used to settled for tens of millions of dollars will arrangement that has been disclosed meet the writing requirement, at least one continue to grow. through the SRDP, but not reached document must have a signature. For this reason, it is important settlement, at the time the bill is signed that Congress pass H.R. 776. It should Issues Still Loom into law. also pursue comprehensive Stark Law In response to support for the While these changes are certainly reform, in general. Lawmakers recently legislation on Capitol Hill, CMS recently welcome, they fail to achieve the level took a step towards such reform when made several regulatory changes to the Unless Congress changes the of predictability and certainty providers the Senate Finance Committee and Stark Law. First, the agency recognized need because the statute has not changed. statute, a provider can still House Ways and Means Committee that lapsed agreements that are otherwise Only Congress can change a statute. convened a roundtable of outside experts be sued in court for technical compliant cause no risk of harm to the CMS has simply changed the regulations. on Capitol Hill to explore areas of the Medicare program and it changed violations of the Stark Law and the This means a lapsed agreement is Stark Law that should be changed. The the regulation so that, in most cases, number of whistleblower lawsuits still a Stark Law violation, even though experts will provide written comment providers no longer have to disclose such being settled for tens of millions CMS says it causes no harm to the to congressional staff that will be used an agreement through the SRDP. to help draft legislation that would be of dollars will continue to grow. Medicare program and no longer needs CMS also acknowledged that a introduced this year and congressional to be disclosed through the SRDP. Unless formal written contract is not necessary to hearings on Stark Law reform could Congress changes the statute, a provider meet the Stark Law’s writing requirement. it met this element of the law. Finally, come as early as this spring. can still be sued in court for technical Instead, a provider can use a set of providers now have up to 90 days to — John Williams is with Hall Render contemporaneous documents to prove obtain the signatures of all parties to an violations of the Stark Law and the Killian Health & Lyman in Indianapolis, Ind. agreement. In those situations where a set number of whistleblower lawsuits being

She’s one reason We can give you 23,483* more. Passport is the Passport Health Plan is the only provider- top-ranked sponsored, community-based Medicaid plan operating within the commonwealth. So, it’s Medicaid MCO no coincidence that Passport has the highest in Kentucky. NCQA (National Committee for Quality Assurance) ranking of any Medicaid MCO in Kentucky.

Our providers make the difference. *Passport’s growing network of providers now includes 3,720 primary care physicians, 14,014 specialists, 131 hospitals, and 5,619 other health care providers.

Ratings are compared to NCQA (National Committee for Quality Assurance) national averages and from information sub- mitted by the health plans.

MARK-51677 | APP_11/16/2015

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PHYSICIAN SPOTLIGHT NEWS in brief Meet Guru Pattar, MD, PhD, Proposed increase to salary levels ophthalmologist at the Eye Care for white collar exemptions

Institute in Louisville, Ky. By Shannon Antle Hamilton panel discussion at the recent Ameri- can Bar Association’s Labor and Em- On June 30, 2015, the United ployment Conference, DOL Solicitor Why did you States Department of Labor (DOL) Patricia Smith indicated that the fi- become a doctor? FAST FACTS announced its proposals for updating nal rules will not likely be published I knew from its regulations to increase the base sal- before late 2016. The delay was due a very young age Hometown: Greenwood, Indiana ary levels for the overtime exemptions to the volume of the comments, and that I wanted to (Home of the Woodmen) for white-collar employees, such as the complex nature of the proposed become a doctor. Family: Wife, Kiley and one executives, administrative and profes- changes. This delay will give em- Before my mom year old daughter, Mira sional employees. Because the DOL ployers additional time to determine retired, she was a invited interested parties to submit medical technolo- what changes need to be made within written comments on the proposed gist/microbiologist and worked in a the organization. came from India with a few dollars in laboratory in a hospital in Martins- rules by September 4, 2015, it was Sign up at the regulations.gov web their hands. They have worked harder ville, Ind. When I was in fourth or widely anticipated that any new regu- site to receive email alerts when any- in this one lifetime than I could in fifth grade, she would take me to lations would go into effect as early as thing is added or modified to Docket multiple lifetimes. Now, they have the hospital and show me how she January 2016. However, the DOL re- WHD-2015-001, “Defining and De- financial security and have the means analyzed blood samples which abso- ceived more than 290,000 comments limiting the Exemptions for Executive, to not only support me, my sister and lutely fascinated me. I had the op- on the proposed rules, requiring a Administrative, Professional, Outside brother growing up; but they also sup- portunity to meet the pathologist more thorough examination of the Sales and Computer Employees.” port their families in India. Seeing and look in microscopes. possible impact of the proposed rules. - Shannon Hamilton is a member at the “American Dream” in person, it On November 11, 2015, the Wall Stites & Harbison in Louisville, Ky. has truly allowed me to see firsthand Street Journal reported that during a “There is no substitute for that life is not handed to you, you hard work.” My father would have to go out and take life yourself. often utter those words to KAHCF honors caregivers me as I was growing up. What is your motto? Several caregivers from the Nazareth Home, PR Award. This comes from a song that was writ- Nazareth Home ten by Mumford and Sons. I listen to Louisville Metro area were hon- Michael Buchman it before I head into the operating ored by the Kentucky Association accepts the PR Why did you choose this room in order to get my mind right. of Health Care Facilities during Award from KAHCF Terry Skaggs. particular specialty? But I do believe that it is applicable as the Quality Awards Banquet. The I didn’t choose ophthalmology until a good motto for me. “Keep my eyes to honorees are: my fourth year in medical school. This serve and my hands to learn.” Essex Nursing and Rehabilitation is unusual because most of my other Center, Facility of the Year Finalist. Sam Swope Care Center/Masonic Home Louisville, PR Award. classmates had begun the residency Robert Flatt and If you weren’t a doctor, what Linda Wagoner, application process and knew what staff accept would you be? the Facility Masonic Home, specialty they were interested in. I I am not sure if there is anything of the Year accepts the had narrowed down my options to else that I could imagine doing in Finalist Award. PR Award from a surgical subspecialty because of KAHCF Terry life. For some reason, aviation fas- Skaggs. the ability to use my hands to make cinates me. So I guess I would have Arthur Brock, Masonic Home an instantaneous difference in the to say that I might have been an air- Shelbyville, Overall Statewide management of a disease process. I also Jackie Singleton, Highlands Health line pilot if I wasn’t a doctor. Caregiver Winner and Rehabilitation, Kentucky Health particularly enjoyed “traditional” clinic Arthur Brock Care Foundation Scholarship. based medicine in that you can grow Favorite daytime beverage? Jackie Singleton with your patients and see them year That’s easy. Coffee. No sugar, no cream. after year. I really enjoy being able to When I did bench science, my lab mates converse with patients and hear stories and I would constantly be making cof- about their lives. fee to get through the day. I have since Jessica Simmons, Georgetown slowed down my coffee intake from Manor, Volunteer of the Year What’s the best advice you ever about one pot a day to two cups a day. Lisa Fortwengler, Georgetown received? Who gave it to you? Jessica Simmons Manor, Caregiver Top 10. “There is no substitute for hard accepts the More Online Award from Lisa work.” My father would often utter KAHCF Chris Fortwengler those words to me as I was growing To read the full interview, visit medicalnews.md. Page. up. He and my mother serve as a con- stant source of inspiration. They both MEDICAL NEWS • JANUARY 2016 PAGE 5

PEOPLE in brief

Clark Physician Group Smoke-Free Kentucky Coalition University of Louisville UofL School of Nursing Karen Boha has Senator Julie Professor of M . C y n t h i a joined Clark’s Just Raque Adams pharmacology and Logsdon, PhD, for Women Health (R-District 36, toxicology John has won the Solutions. Louisville) was Pierce Wise Sr., 2015 Elizabeth honored with the PhD, will be honored McWilliams Miller 2015 Smoke-Free by the Society of Award for Excellence Kentucky Leadership Toxicology with in Research from Award. a 2016 Education Sigma Theta Tau Award in March, International 2016. (STTI), the honor BOHA ADAMS WISE LOGSDON society of nursing. Goodwill Industries of Kentucky UK Healthcare University of Louisville Uspiritus Lori Collins Michael Dobbs, Lewis Jones, David Finke, has been named MD, has been DMD, MD, PhD, has joined vice president of named associate recent ly joined Uspiritus as vice Program Services, editor for the the University of president of East Region. publication, Quality Louisville School Residential Services. Management in o f D e n t i s t r y Health Care. as an assistant professor of oral and maxillofacial surgery (OMS). COLLINS DOBBS JONES FINKE PAGE 6 MEDICAL NEWS • JANUARY 2016

NEWS in brief Event calendar Capitol events calendar 21st Annual Kentucky Chamber Day Jan. 7 A number of health advocacy organizations host events at the Date: January 7 Capitol during the upcoming 2016 Regular Session of the Kentucky Time: 5 p.m. Registration and Reception; 6:30 p.m. Dinner General Assembly. Location: Heritage Hall, Lexington Convention Center, 430 W. Vine St., Lexington, Ky. 40507 January 11 Kentucky Mental Health Coalition Advocacy Training Information: At the opening of the 2016 General Assembly, you Kentucky Mental Health Coalition (KMHC) was established in 1982 are cordially invited to join hundreds of business leaders from across by nine mental health organizations to support collaboration and to speak Kentucky as the governor and the state’s top four legislative leaders with one advocacy voice for the prevention and treatment of mental illness (all invited) share their visions for Kentucky’s economy, government and the promotion of mental health. In 2003, the KMHC membership ap- and politics in the year ahead at Kentucky Chamber Day. proved a reframed and broadened mission: To bring together the collective To register: Visit kychamber.com/events/events-list voices of consumers, family members, advocates and providers to educate the public, to engage policy makers and to increase the resources necessary to address the Commonwealth’s human service needs while improving the Jan. KHA Physician Leadership Forum mental health and well-being of all Kentuckians. For more information, 14 Date: January 14 visit advocacyaction.net. Time: 11 a.m. – 2 p.m. Information: This forum is comprised of chief medical officers from January 14 Kentucky Youth Advocates Children’s Advocacy Day hospitals across Kentucky and meets regularly to address issues that impact Kentucky Youth Advocates (KYA) believes all children deserve to be physicians and hospitals. To register: For additional information, contact Kim Dees at KHA at safe, healthy, and secure and works to ensure decision makers create policies [email protected]. and make investments that are good for kids. Children’s Advocacy Day at the Capitol began in 2004 as an effort to unite advocates from across the state to raise their voices on behalf of children’s safety, health, education, Jan. MCO Meeting and economic well-being. Hundreds of advocates from counties across Ken- tucky now gather at the Capitol in Frankfort every year to ask legislators 15 Date: January 15 to prioritize children. Children’s Advocacy Day played an essential role in Time: 9 a.m. – 3 p.m. Information: KHA hosts monthly meetings between three key Blueprint for Kentucky’s Children wins for kids this year—and hospitals and Kentucky’s Medicaid managed care in numerous other wins in the previous 10 years. Expect an all-day event organizations (MCOs) to address issues. that will kick off with a rally in the Capitol rotunda at 10:00 a.m. For more Location: KHA Headquarters, information, visit kyyouth.org. 2501 Nelson Miller Pkwy., Louisville, Ky. 40223 To register: No registration is required. For additional information (including February 2 874K Disabilities Coalition Advocacy Day dial-in details), contact Debbie Bonn at KHA at [email protected]. The United 874K Disabilities Coalition (874K) seeks to bring together and strengthen the voices of the growing number of Kentuckians (874,000- System Presidents Meeting plus) who are identified as having a disability which interferes with activi- Jan. 21 ties of daily living. The 874K Disabilities Coalitions is comprised of orga- Date: January 21 nizations representing individuals with disabilities, their family members, Time: 11 a.m. – 2 p.m. advocates, providers and concerned citizens. The advocacy events sponsored Information: A meeting open to all presidents by 874K are held in Frankfort during the legislative session with the goal of healthcare systems in Kentucky. of giving individuals affected by disabilities the opportunity to meet the To register: To register or for additional information, Governor and key Cabinet officials, their state legislators and staff, and contact Pam Kirchem at KHA at [email protected]. the media. For more information, visit advocacyaction.net.

Other Events Jan. HEN Whose Data Is It Anyways? 21 February 9 NAMI Kentucky Advocacy Day Date: January 21 Time: 5 – 8 p.m. February 9 American Heart Association Advocacy Day Location: Kosair Charities Clinical & Translational Research February 10 Kentucky Academy of Physicians Assistants Legislative Day Building (KCCTRB), 505 S. Hancock St., Louisville, Ky. 40202 February 10 Kentucky Medical Association Physicians’ Day at the Capitol Information: Join Health Enterprises Network (HEN) and Health Information Systems Society (HIMSS) for an all-inclusive February 17 Kentucky Nonprofit Day at the Capitol look into the world of data security from the perspectives of the February 17 ACLU Day & Rally for Statewide LGBT Non-Discrimination patient, the provider, billing/reimbursements and security. February 24 Kentucky Mental Health Coalition Legislative Update To register: Visit healthenterprisesnetwork.com March 1 Live United Day (United Way) MEDICAL NEWS • JANUARY 2016 PAGE 7

NEWS in brief THIS IS AN ADVERTISEMENT

America’s Health Rankings annual report PREPARE FOR YOUR FUTURE IN Building a healthier tomorrow for HEALTH CARE WITH Kentucky, today. A FIRM THAT IS By Julie Daftari, MD Kentucky DEEPLY ROOTED In an annual check up of our nation’s Highlights IN THE INDUSTRY. health, Kentucky ranked 44th among all 50 states in 2015. Those findings come - In the past year, HPV Thriving in a constantly changing from United Health Foundation’s Ameri- immunization among environment requires strength and females aged 13 to 17 years ca’s Health Rankings Annual Report, which knowledge. With more than 200 health increased 40 percent from has been measuring national and state lawyers in nine offices across the 26.8 percent to 37.5 percent. health for just over a quarter of a century. United States, including our newest As the state medical director for - In the past two years, locations in Dallas and Seattle, Hall UnitedHealthcare, I always look forward lack of health insurance Render is your source for practical to the America’s Health Rankings Annual decreased 24 percent and strategic legal counsel. Report because it offers an overview of from 15.0 percent to 11.4 where we stand in health both as a nation percent of the population. Hall Render is the largest health and relative to our peer states. The report - In the past year, diabetes care-focused law firm in the provides a reflection of Kentucky’s health increased 18 percent country and has represented that is at once sobering and encouraging. from 10.6 percent to 12.5 more than 1,500 hospitals and percent of adults. Kentucky’s Strengths health systems in general and special counsel matters. Low violent crime rate: Kentucky - In the past 10 years, cardiovascular deaths has the 5th lowest violent crime rate Learn more at hallrender.com. decreased 21 percent in the U.S., with 210 offenses per from 378.7 to 298.1 per 100,000 people. 100,000 population. Low prevalence of excessive drink- ing: 13.6 percent of the adult population - In the past 20 years, violent reports drinking excessively, ranking crime decreased 55 percent Kentucky 6th nationally. from 463 to 210 offenses High rate of high school gradu- per 100,000 population. ation: Kentucky ranks 12th, with 86.1 percent of incoming ninth graders gradu- This year’s data show that as a na- ating in four years. tion, Americans are smoking less and living less sedentary lifestyles; however, Kentucky’s Challenges our country is facing complex health chal- High rate of cancer deaths: Ken- lenges that threaten Americans’ health tucky ranks last in the country, with near- and quality of life. Obesity and diabetes ly 229 cancer deaths per 100,000 people. are at all-time highs, and rates of drug High rate of preventable hospital- deaths – including illegal and prescrip- izations: The state also ranks last for pre- tion drug abuse – and children living in ventable hospitalizations, with 85.1 dis- poverty are on the rise. charges per 1,000 Medicare beneficiaries. Understanding trends in health and High prevalence of smoking: More wellness makes it clear where we need to than 26 percent of Kentucky adults smoke, focus our resources and attention. When which ranks the state 49th in the U.S. it comes to the future of Kentucky’s 614 West Main Street | Suite 4000 Measuring and monitoring our na- health, and America’s health, we are all Louisville, KY 40202 | (502) 568-1890 tion’s health has never been more impor- in it together. Let’s commit now to mak- tant, and the results of this year’s America’s ing the changes necessary to ensure that DALLAS | DENVER | DETROIT | INDIANAPOLIS | LOUISVILLE Health Rankings Annual Report show how we build a healthier tomorrow, today. MILWAUKEE | PHILADELPHIA | SEATTLE | WASHINGTON, D.C. far we’ve come in the last 26 years – and — Julie Daftari, MD, is medical direc- how far we still have to go as a country. tor at UnitedHealthcare of Kentucky.

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NEWS in brief

Four U.S. healthcare systems join Community Leadership Institute Guardian Research Network of Kentucky address Kentucky’s

The Guardian health disparities Research Network (GRN) is rapidly ex- panding with the ad- dition of four partner healthcare systems including Baptist Health (Kentucky), Bon Secours Health System, Mercy and Spartanburg Re- gional Healthcare System, encompass- GRN offers the most compre- ing 76 hospitals in nine states. hensive system that follows strict Guardian Research Network is HIPAA regulations to search and a national consortium of healthcare rapidly identify patients who are eli- organizations that uses a so- gible for clinical trials. This is made phisticated, unparalleled data col- possible with GRN’s unique ability lection and warehousing system to to aggregate clinical, molecular and The Community Leadership Insti- projects in Appalachian Kentucky gather information on hundreds of imaging data from Electronic Medi- tute of Kentucky (CLIK) has graduat- aimed at cancer prevention (e.g., thousands of patients. This data is cal Record (EMR) systems through- ed its second class of participants who nutrition, physical activity, smok- evaluated with the most advanced out the nation. This rapid patient-to- are leading community-based projects ing cessation), reducing obesity and healthcare research and analytic trial identification process will sig- to reduce health disparities. CLIK sedentary lifestyle, prevention and methods that result in bringing nificantly reduce the time it takes to is a three-week, intensive leadership management of chronic diseases (e.g., cutting-edge therapies specifically enroll a patient in the most advanced development program that enhances diabetes and cardiovascular disease) targeted to each patient’s cancer. Pa- clinical trials available. research and capacity-building compe- and prevention and treatment of sub- tients whose hospitals are participat- By 2020, the GRN will encom- tencies in community leaders who play stance abuse. ing with GRN will now have access pass one million actionable patients key roles in data-based decision mak- Participants are supported in de- to leading cancer treatment therapies with full clinical, imaging, laborato- ing related to health and healthcare. veloping and implementing a project close to home. ry and significant molecular profiles. Leaders from schools, health de- with a “real world deliverable” that partments and organizations in rural builds organizational and commu- communities were among those com- nity capacity for sustainable impact. Home care and hospice alignment pleting the program, which is pre- Training sessions were held at the UK sented by the University of Kentucky Center for Excellence in Rural Health with KentuckyOne Center for Clinical and Translational in Hazard, Ky., and were led by UK Science community engagement and faculty and staff and community part- Seton Home Health and Tri- through a team of skilled profession- research program, the UK Center of ners with extensive expertise and ex- County Hospice have aligned their als, such as nurses, physical therapist, Excellence in Rural Health and the perience. In addition to training, each brands to KentuckyOne Health as occupational therapist, social workers, Kentucky Office of Rural Health. participant’s organization received a VNA Health at Home. As part of speech therapists, home health aides, The CLIK program prioritizes $2,500 grant to support their project. the KentuckyOne Health family, this volunteers, and chaplains. Providing alignment will create a stronger, more quality care to the community for over unified structure as VNA Health at 40 years, VNA Health at Home in Frontier diversity program receives Home continues to care for patients London, Ky. serves Pulaski County, and build healthier communities Laurel County, Clay County, Knox national recognition throughout London, Ky. and its sur- County and Whitley County. rounding communities. Local sister agencies, Hospice of M i n o r i t y diversity in nursing and midwifery Working directly with Saint Jo- Nelson County in Bardstown, Ky., Nurse magazine through the FNU PRIDE program. seph London and other community St. Joseph Home Care in Lexington, has selected Each year, the magazine recognizes healthcare providers, VNA Health at Ky. and VNA Nazareth Home Care Frontier Nurs- employers that go above and beyond Home is a full service healthcare or- in Louisville, Bardstown, Camp- ing University to encourage diversity, recruit and re- ganization that believes the best place bellsville, Elizabethtown, Ky. and (FNU) as one of three national 2015 tain minorities and create a coopera- for someone to get better, and faster, Clarksville, Ind. have also aligned Take Pride Campaign winners, recog- tive, inclusive work environment. is in their own home. VNA Health their brands to KentuckyOne Health nizing the school’s efforts to promote at Home provides quality, coordi- as VNA Health at Home as of De- nated home care and hospice services cember 1, 2015. Continued on page 11

MEDICAL NEWS • JANUARY 2016 PAGE 9

NEWS in brief

UK HealthCare re-designated KentuckyOne Health introduces Comprehensive Stroke Center Anywhere Care app

KentuckyOne Anywhere Care, follow up care be KentuckyOne Health’s virtual care required. service that connects patients with Kentuck- primary care providers 24/7 by phone yOne Anywhere or video chat, is now available as a Care providers free mobile app for iOS and Android. can treat com- Using the KentuckyOne Any- mon conditions where Care App, new or established like colds and patients can consult with board-cer- flu, sore throats, rashes, allergies, tified family practice providers on bladder infections and more. Pro- the go. Kentuckians can use the app viders may prescribe medications, to request a virtual visit using their if appropriate, recommend an over- mobile device. The app is free to the-counter medication or provide download via the App Store, iTunes home care options. Providers do not UK HealthCare has been re-des- Stroke Center has an unparalleled or Google Play and works with prescribe or refill prescriptions for ignated a Comprehensive Stroke Cen- amount of resources in infrastruc- iPhone, iPad and Android devices. controlled substances such as nar- ter (CSC) by The Joint Commission ture, staff and training to provide Following the visit, patients can cotic pain relievers. If needed, the (TJC) and the American Heart Asso- state-of-the-art care to all patients. use the app to access and share their KentuckyOne Anywhere Care pro- ciation/American Stroke Association. They offer a neuro-intensive care visit summary information. The app vider will refer patients to a Kentuc- includes geolocation services, allow- kyOne Health primary care provider UK HealthCare was first des- unit for complex stroke patients who ing the user to access nearby physi- or to an emergency department. ignated a CSC in 2014. It is one of require 24/7 care, advanced imaging cians and hospitals should in-person 96 U.S. institutions — and the only capabilities, and participate in stroke one in Lexington — with CSC-des- research. They also coordinate post ignation. This is the highest level of hospital care for patients, use a peer ElderServe, GuardiaCare to merge stroke certification available from review process to evaluate and moni- TJC, reflecting the availability of tor the patient’s care and analyze Two non-profits focused on makes financial sense and will give resources, staff and training when and use standardized performance helping the elderly will join forces. families a “one stop shop” for sup- treating complex stroke cases. measure data to continually improve It was announced in December that port. The change is expected before An advanced Comprehensive treatment plans. ElderServe and GuardiaCare Service June 30, 2016. The merged organiza- would merge. Company leaders say it tion will keep the ElderServe name. Clark Physician Group receives VNA Health at Home named Elite

Press Ganey award VNA Health at Home, a service ous honors as a Top Agency. VNA Clark Memorial Hospital an- satisfaction and engagement. of KentuckyOne Health, announced Health at Home in Louisville, Ky. nounced that the practices of Clark The Press Ganey Guardian of two locations have been named 2015 also made the list as a Top Agency Physician Group have been named a Excellence Award is a nationally- HomeCare Elite, a recognition of for 2015, marking their ninth rec- 2015 Guardian of Excellence Award recognized symbol of achievement in the top-performing home health ognition from HomeCare Elite. winner by Press Ganey Associates, healthcare. Presented annually, the agencies in the United States. Now in its ninth year, the Inc. The Guardian of Excellence award honors clients who consistent- VNA Health at Home in HomeCare Elite identifies the top Award recognizes top-performing ly sustained performance in the top Clarksville, Ind. was name a Top 25 percent of agencies and high- healthcare organizations that have five percent of all Press Ganey clients 500 winner this year for the sec- lights the top 100 and top 500 agen- consistently achieved the 95th percen- for each reporting period during the ond year in a row, with five previ- cies overall. tile or above of performance in patient course of one year. Passport becomes Bellarmine’s Conway settles Oxycontin claim Knights in Action sponsor

Purdue Pharma will pay the state Jack Conway announced Dec. 23. Passport Health Plan has signed cheer squad. The group meets month- $24 million to settle a lawsuit that The settlement calls for Purdue on to be the presenting sponsor of ly to discuss sport-related issues and claimed the drug maker “illegally Pharma to make an initial payment the Bellarmine University Knights concerns affecting student-athletes, misrepresented and/or concealed the of $12 million and eight annual pay- in Action, a group of student-ath- and serves as the direct link between highly addictive nature of OxyContin ments of $1.5 million each, with the letes who participate in community student-athletes, the administration, and encouraged doctors who weren’t money after payment of legal fees to service events. and the NCAA. The members of The Bellarmine University Bellarmine Knights in Action take trained in pain management to over- be used “to expand addiction treat- Knights in Action comprises repre- part in community service projects prescribe the opioid pain reliever to ment in Kentucky. sentatives from each athletic team, throughout the school year and also Kentucky patients,” Attorney General along with the dance team and the raise money for Make-A-Wish. PAGE 10 MEDICAL NEWS • JANUARY 2016

NEWS in brief

Saving Medicare significant dollars Kentucky ACO had high performance numbers across the board for both shared savings and quality score.

By Barbara Newton savings payout of over $6 million. In our front office staff about the importance addition to impressive monetary fig- “Everyone involved with our of getting these symptomatic patients in Calendar year 2014 was a success- ures, QIP also received the highest ACO committed themselves to quickly to avoid hospitalizations.” ful year for Kentucky Accountable quality score of all Kentucky ACOs delivering high-quality, high-value, Advance Payment Model Care Organizations and the Medicare that earned shared savings in 2014 at cost-conscious care from the QIP is an Advance Payment Mod- beneficiaries they serve. Eight ACOs 90.89 percent. el participant. Among 353 ACOs in have Medicare beneficiaries residing “Everyone involved with our ACO beginning,” said Quality Assurance the country, only 35 are granted par- in Kentucky assigned to them, and committed themselves to delivering and Improvement Committee ticipation in CMS’s Advance Payment five of these saved Medicare signifi- high-quality, high-value, cost-con- Chair Gregory Hood, MD. Model, a supplementary incentive cant dollars – over $46 million total. scious care from the beginning,” said program that awards partial capital Additionally, some of these organiza- Quality Assurance and Improvement cians and Prescribers’ Letter, who part- needed to fund an ACO. QIP allocat- tions showed improvements in Quality Committee Chair Gregory Hood, MD. nered with us in quality improvement ed these funds to comprehensive case Metrics that CMS measures over previ- Savings for Medicare initiatives in areas such as diabetes, management and a health information ous years. CHF, COPD and controlled substance Accountable Care Organizations exchange (HIE), in addition to other prescribing, as examples,” said Hood. “Our physicians have found the networks of providers and facilities who carefully selected components. “In each category our practices have committed to deliver a standard Not one to rest after a successful ACO model led to higher quality achieved significant improvements. of care that ultimately reduces unnec- year, QIP’s leadership understands the care,” said Greg Ciliberti, MD, These efforts were routinely monitored essary medical spending and addresses challenges faced by ACOs moving for- and discussed with the participating Medical Director and Chair of chronic conditions more effectively. ward. “Our physicians have found the physicians. Ultimately, the engagement the ACO’s Transitional Care When an ACO achieves savings for the ACO model led to higher quality care,” and improvement in these processes al- Coordination Committee. Medicare program, it is awarded a por- said Greg Ciliberti, MD, Medical Di- lowed us to include such efforts in the tion of those savings to be distributed rector and Chair of the ACO’s Transi- ACO’s bonus structure.” at its discretion. tional Care Coordination Committee. Quality Independent Physicians Composed of 41 primary care physi- Continuing Education Process “However, I am concerned about (QIP) an independent, physician-led cians from 20 area offices, QIP’s success Medical Director and Compliance the sustainability of the model since the accountable care organization serving is attributable to thorough communica- and Communication Committee Chair CMS benchmark declines each year as Louisville, Lexington, and Southern tion and a strong desire for continued Michael Harper, MD emphasizes the savings are generated, while the patients Indiana residents, is a leader among improvement, yielding consistently high continuing education process: “We age and inevitably develop more chronic Kentucky ACOs for calendar year 2014 quality performance since 2013. The spent a tremendous amount of time diseases over time. This forces us into a with high performance numbers across ACO’s member offices invested signifi- and effort educating our COPD and situation of needing to constantly add the board for both shared savings and cant energy in helping chronically ill CHF patients on their disease process,” new providers and beneficiaries for any quality score. patients better manage their conditions. Harper said. hope of long term success.” QIP saved Medicare over $13 mil- “This level of dedication attracted “We discussed signs and symptoms - Barbara Newton is the Chief Op- lion in 2014, a number exceeded by only the interest of national organizations of worsening and when to come in and erations Officer at Precision Healthcare one other ACO serving Kentucky resi- and the American College of Physi- see their doctor. We also had to re-train Delivery in Louisville, Ky. dents. This figure generated a shared

ACO Name State(s) where Total Total Savings Per Quality beneficiaries reside Beneficiaries Savings Beneficiary Score

Quality Independent Kentucky, Indiana 12,618 $13,611,421 $1,078.73 90.89% Physicians, LLC Jackson Purchase Medical Kentucky, Illinois 4,845 $4,964,871 $1,024.74 89.56% Associates, PSC Mercy Health Select, LLC Ohio, Kentucky, Michigan 64,739 $15,441,442 $238.52 86.15% Southern Kentucky Kentucky $6,670,157 $1,318.47 78.17% Health Care Alliance 5,059 KentuckyOne Health Kentucky $5,606,961 $205.27 78.07% Partners, LLC 27,315 MEDICAL NEWS • JANUARY 2016 PAGE 11

NEWS in brief

Kentuckians’ views on the Affordable Care Act (ACA)

Poll data released in December views. Views among Independents third (35 percent) reported hearing by the Foundation for a Healthy are split: 42 percent unfavorable a lot about kynect. About two in ten Kentucky and Interact for Health and 43 percent favorable. (22 percent) had heard some and four indicate half (50 percent) of Ken- As part of the ACA, Kentuckians in ten (43 percent) had heard only a KHIP highlights include: tuckians report the Affordable Care can compare and enroll in insurance little or nothing about kynect. • Half of Kentucky adults (50 per- Act (ACA) has not had an impact on plans via kynect, Kentucky’s online The KHIP findings in Kentucky cent) report no personal impact them or their families, down from 66 from the ACA. marketplace for health insurance. are similar to national views of the percent in 2013. • Nearly four in ten (37 percent) They can also use kynect to apply for healthcare law. The September 2015 Nearly a quarter (23 percent) Kentucky adults living at or below expanded Medicaid and the Kentucky Kaiser Health Tracking Poll report- report the ACA has positively af- 138 percent of the Federal Pov- Children’s Health Insurance Program ed that 45 percent had unfavorable fected them (up from seven percent erty Level (FPL) report a positive (KCHIP). In the first year of kynect, views, 41 percent had favorable views in 2013). The number of those re- impact from ACA; 27 percent liv- 413,410 Kentuckians enrolled in new and 14 percent did not know/refused. porting that the ACA has negatively ing between 138 percent and 200 health insurance coverage. KHIP was funded by the Foun- affected them has generally remained percent FPL report positive impact dation for a Healthy Kentucky and and 12 percent above 200 percent steady since 2013 and now stands at The number of Kentuckians with Interact for Health. The poll was 23 percent. FPL indicate positive impact. conducted September 17, 2015-Oc- • Half (51 percent ) report not hav- The number of Kentuckians with a favorable opinion of the ACA tober 7, 2015, by the Institute for ing enough information to under- a favorable opinion of the ACA has has grown since 2010, from Policy Research at the University stand how the law will affect them. grown since 2010, from 26 percent to of Cincinnati. A random sample of This figure is down from 72 per- 26 percent to 41 percent. 41 percent. Nearly half (46 percent) cent in 2010. 1,608 adults from throughout Ken- continue to have unfavorable views • A majority of Democrats (61 per- tucky was interviewed by telephone, of the law while those who say they including landlines and cell phones. cent ) have favorable views of the Responses varied when Kentucky do not know has decreased from 26 The poll has a margin of error of ACA; a majority of Republicans adults were asked how much they had percent to 14 percent. (66 percent ) have unfavorable ±2.4 percent. heard about kynect. More than one-

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NEWS in brief

Governor Bevin outlines plans for Medicaid in Kentucky Names Mark Birdwhistell as Medicaid advisor.

By Ben Keeton nor Bevin. “Our state vide my expertise to this effort.” is financially in trou- “Our state is financially in Mark Birdwhistell has served the Governor Matt Bevin and Health ble and cannot afford trouble and cannot afford to Commonwealth of Kentucky for over 35 and Family Services Secretary Vickie to continue down the continue down the current years as a former Secretary of the Cabi- Yates Glisson announced plans to develop current Medicaid path net for Health and Family Services of Medicaid path that we are on.” a transformative Medicaid program for that we are on. We Kentucky, Health Plan CEO and Med- Kentucky. Governor Bevin has requested have an opportunity — Governor Matt Bevin icaid director. Birdwhistell has a special Mark Birdwhistell, a former Secretary of to develop a transfor- expertise in the field of Medicaid policy. the Cabinet for Health and Family Ser- BIRDWHISTELL He is currently vice president of Health mational program that of our resources and use all options avail- vices, to assemble a team of experts to assist Affairs for UK HealthCare at the Uni- improves health out- able to us to benefit the health and well- in the drafting of a Medicaid waiver solu- versity of Kentucky. comes, encourages personal responsibility ness of all Kentuckians.” tion for the Commonwealth that addresses Birdwhistell was awarded an honor- and does both in a fiscally sustainable man- “The people of Kentucky deserve a sus- the financial unsustainability of the current ary Doctorate of Humane Letters from the ner. This is exactly what we intend to do.” tainable Medicaid program that balances Medicaid program. Pikeville College of Osteopathic Medicine “Leading Kentucky economists agree accountability and long-term affordabil- “Mark Birdwhistell is one of the most in May 2008. He earned his Master of that the healthcare jobs predicted by the ity,” said Birdwhistell. “I am honored to knowledgeable individuals in the country Public Administration from the Univer- Deloitte study have not materialized, be asked by Governor Bevin to continue on this issue. With his expertise, we are sity of Kentucky Martin School for Pub- rendering the suggestion that Medicaid my career’s work in serving the people of going to develop a viable solution that is lic Policy and undergraduate degree from expansion pays for itself invalid,” said Kentucky by transforming Medicaid. I ap- tailored for Kentucky’s needs,” said Gover- Georgetown College in Georgetown, Ky. Glisson. “We need to be better stewards preciate UK making me available to pro-

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HEALTHCARE LEGISLATION

Improving end of life care CMS has made an important decision to begin reimbursing providers for advance care planning conversations.

By Liz Fowler CPT Code Description Approximate Reimbursement as other important provisions. To learn 99497 First 30 minutes of face-to- $81.58 in Non-Facility more on this important piece of legisla- On October 30, 2015, the Centers face discussion with patient $75.96 in Facility tion visit: congress.gov/bill/114th-congress/ for Medicare and Medicaid Services and/or surrogate to discuss senate-bill/1549. (CMS) released the final 2016 Physi- advance care planning Research has shown that individuals cian Fee Schedule which includes the who have discussions about end-of-life historic reimbursement for two Current 99498 Use for each additional 30 $71.44 in Non-Facility care have less invasive medical treatments, Procedural Terminology (CPT) codes minutes of conversation $71.13 in Facility improved patient and family satisfaction for advance care planning. These codes and higher quality of life. The implemen- are effective for use for services provided tation of these codes is an important step Second, Medicare beneficiaries The benefit would provide a team-based to encourage dialogue between providers, on or after January 1, 2016. In funding will have deductible and copay for ad- discussion of goals of care and values, these codes, CMS is acknowledging the patients and families and to ensuring that vance care planning services unless the explanation of disease progression and patients receive care that aligns with their importance of voluntary patient-provider conversation occurs during the Annual treatment options, a documented care goals and preferences and receive care that consultations about personal goals, values Wellness Visit and the documentation of plan based on an individual’s goals and is wanted or coordinated. and treatment preferences. the advance care planning conversation preferences, care coordination services, — Liz Fowler is president and CEO of supports the CPT code billed. education, resource development, as well Still Gaps Hospice of the Bluegrass. Third and most importantly, facili- Unfortunately, there is a sizeable tating high quality advance care planning gap between the care Americans say is a skill that requires education, training they want in the last phase of life and and support. Hospice of the Bluegrass is 2016 EDITORIAL CALENDAR what actually occurs. While the reasons committed to supporting medical pro- for this disconnect are complex, physi- fessionals who want to learn more about MONTH FEATURE SECTION cians, health policy makers, and others in advance care planning. our health system agree that encouraging New Initiative January Legislative Issue/Nonprofit voluntary and informed patient and fam- Improving care for those facing se- ily decision-making is the basis of high- rious illness is all of our responsibility. February Workforce Development quality, person-centered care. There is no substitute for good policy and March Behavioral Health The Institute of Medicine’s report on CMS has taken an important first step Dying in America highlights many bar- in reimbursing providers for advance care April Strategic Planning/Pharmacy riers to effective advance care planning: planning conversations. − A natural reluctance to explore issues May Architecture (Building/Design) of dying. Research has shown − A fragmented health care system that that individuals who have June Rural Health/MediStar makes end-of-life discussions someone discussions about end-of- else’s issues. July Healthcare Law − Poor quality and rushed communica- life care have less invasive tion when conversations take place. medical treatments, improved August Healthcare Finance − Inadequate support for advance care patient and family satisfaction September Marketing/Brand Building planning which includes clinician train- and higher quality of life. ing, reimbursement and record keeping. October Business of Aging In funding CPT codes for advance care planning, CMS has made an im- While the reimbursement of these November Education portant decision to begin reimbursing codes is important, there is more work providers for advance care planning con- to be done. There is another important December Leadership versations. Below are three things all policy initiative to bring attention to and healthcare professionals need to know that is The Care Planning Act of 2015. For article submission guidelines, about this important decision. This piece of legislation proposes to cre- First, the CPT codes and description ate a Medicare benefit called Planning visit the web at medicalnews.md of the reimbursable services: Services for those with serious illness. or email [email protected]. PAGE 14 MEDICAL NEWS • JANUARY 2016

HEALTHCARE LEGISLATION

Finding a balance Tort reform in long-term care is needed that guarantees the public’s rights to pursue legal remedies when needed, but also to protect healthcare providers from frivolous lawsuits.

By Jerry Hoganson resident. The thought of the family is to balanced approach which guarantees the It’s true that most, if not all, sue the facility, regardless of the circum- public’s rights to pursue legal remedies For years, various bills have been in- healthcare organizations stances surrounding the care of the indi- when needed, but also to protect health- troduced in the Kentucky State legislature carry professional liability vidual. Many facilities, especially the non- care providers from frivolous lawsuits. One to create a means of limiting lawsuits by insurance, but their limits profit variety, have very limited margins approach I would suggest is the creation individuals and groups against nursing may not be adequate or the and resources, and don’t have the ability to of Medical Review Panels in Kentucky. homes, assisted living facilities, and other deductibles may be very large. adequately defend some lawsuits. It’s true A medical review process allowing an service providers for seniors. Many other that most, if not all, healthcare organiza- independent panel of healthcare experts states have implemented such “tort reform” tions carry professional liability insurance, to evaluate whether the standard of care laws, but none of any significance has been facilities would not be as accountable be- but their limits may not be adequate or the was violated in lawsuits against Kentucky passed in Kentucky. Many advocacy groups cause of the reduced number of lawsuits deductibles may be very large. Frivolous healthcare providers would be most benefi- applaud this fact. They say that tort reform and the limits to settlements. lawsuits drain the resources of organiza- cial. The panel could include nurses, phy- would reduce the freedom individuals have However, many operators of long-term tions whose primary reason for existence sicians, hospitals, long term care facilities to sue healthcare providers on behalf of care organizations, and insurance compa- is to care for people. and others whom Kentuckians depend their resident/family members, and that nies, have a different view. Often, there upon for their care. Not So Stellar tort reform would reduce the quality of care is a negative outcome in care in a facility, in those facilities. They argue operators of resulting in sickness, injury or death of a Kentucky hosts major senior care What we need in Kentucky is providers. It is also the home to national a good, balanced approach chains and corporations that provide long- which guarantees the public’s term care services. Kentucky should be rights to pursue legal remedies “I know that I’m in proud of the leadership we provide in this industry. Yet, Kentucky does not have a when needed, but also to the right place” stellar reputation for quality of care in this protect healthcare providers area. For instance, Kentucky has the high- from frivolous lawsuits. est level of Civil Money Penalties (imposed by the Center for Medicare and Medicaid Services) in the entire country. It also has One proposal would be to have rep- a very large number of attorneys who spe- resentatives from each side of a dispute cialize in suing nursing homes and other assigned to review the merits of the case, healthcare providers. This is evidenced by and decide which facts to present to the the frequency of law firms who advertise on judge or jury. These representatives would The Family Health Centers are dedicated to providing local television stations. Our state is a pop- be professionals from the medical field who excellent primary and preventive health care to all, regardless ular one for professional liability lawsuits. would, together, decide what facts should of ability to pay for these services. We serve the working Does this mean that the quality of be used in legal arguments. It would elimi- nate much of the emotional aspects of the poor, the uninsured, those experiencing homelessness, long-term care in Kentucky is poor? Is it worse than other states? I would not doubt case and help establish the facts, hopefully refugees from all over the world, and anyone in need of there are instances in providing care to se- for a fairer settlement or outcome. affordable, high quality health care. niors that violate the standards of care, and This is not a new idea, having been that some bad outcomes happen because of discussed for over 40 years. It is one that To learn more about opportunities in any of our seven poor care or even abuse and neglect. There needs to have a serious discussion again!! are also many of these outcomes that oc- We need to improve the legal climate in Louisville Metro locations, please contact: cur even though the overall quality of care Kentucky, so that we can concentrate on [email protected] ǀ 502-772-8574 is good, and all acceptable protocols have providing high quality care. We need to www.fhclouisville.org fhclouisville been followed. There are many good orga- find a balance that is fair to all. Perhaps a nizations that have only the best quality of renewed conversation with our state legis- care in mind for their residents. lature is in order. — Jerry Hoganson is president of Wesley A New Approach Manor in Louisville, Ky. What we need in Kentucky is a good, MEDICAL NEWS • JANUARY 2016 PAGE 15

HEALTHCARE LEGISLATION

Bystander CPR saves lives American Heart Association is working to create a law ensuring every student trained in hands-only CPR before they graduate.

By Susan Smyth, MD ing a cardiac arrest. Most stand idly by, triple the chances of a victim surviving Million students learn CPR every year. waiting for EMS to arrive, watching the cardiac arrest. In only a few short years Imagine the benefit to Kentucky once One minute. That’s all it takes for person they know or love slowly die. we could have hundreds of thousands of we pass our law. a cardiac arrest victim’s chance of sur- Cardiac arrest is a leading cause young adults who know how to respond Get involved and make a vival to diminish by 10 percent, if CPR of death in the U.S., with more than in a cardiac emergency; bringing these difference in CPR education by visiting isn’t administered immediately. When 326,000 out-of-hospital arrests occur- skills into our companies, our neigh- yourethecure.org to contact your State we do the math, we know that if EMS ring every year. Studies also show that borhoods and our homes. This initia- Senator and Representative. You can also arrives eight minutes after a victim the life you save with CPR will more tive will save countless lives across the call 800-372-7181 to leave a message. collapses, the individual has only a 20 than likely be that of a loved one since Commonwealth, but to do so we need Then please consider joining us for our percent chance of survival, if CPR isn’t most cardiac arrests happen at home. the medical community’s support to help Lobby Day on Tuesday, February 9 in administered. Those who receive care For this reason, the American Heart our legislators understand the need for Frankfort where advocates will meet after 10 minutes or more often don’t Association is working in Frankfort to this law. directly with their representatives make it at all. ensure that our future generations know It’s been proven that training costs for a healthier Kentucky. For more As healthcare professionals, most of the basic skill of saving a life. Their goal the school little to nothing, and stu- information or to register, visit bitly.com/ us know how to administer CPR, but is to create a law that would ensure every dents can learn the skill in as little as KYAdvocacyDay. unfortunately the majority of Kentucky’s student is trained in chest compressions, one class period. — Susan Smyth, MD, is a cardiolo- population does not. We’ve trained them also known as Hands-only CPR, before To date, 27 states have passed simi- gist at UK HealthCare and Lexington VA well to call 9-1-1, however 70 percent they graduate. lar laws ensuring their students know Medical Center. of Americans feel helpless to act dur- CPR has been proven to double or CPR basics. These laws are ensuring 1.6

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HEALTHCARE INNOVATION

Navigating the healthcare maze Critical Care Survivors Clinic at UK helps ICU patients navigate the confusing and often frustrating matrix of post-discharge follow up care.

By Laura Dawahare tion. As advances in medicine have reduced mortality rates, critically ill patients fortu- Darrell Raikes waved sleepily to his nate enough to recover and be discharged wife as they wheeled him down to the are suffering cognitive impairment, depres- operating room for a routine knee replace- sion and/or ongoing physical disabilities. ment last May. He woke up in the Critical These conditions, particularly when in Care Unit four weeks later. concert with complex post-discharge care, Raikes had an adverse reaction to his often lead to hospital readmission. Patients anesthesia and began bleeding into his with co-morbidities and those from rural lungs post-operatively. Ashley Montgom- areas are even more vulnerable when their ery, MD, Raikes’ critical care physician, hometown primary care specialist is over- had to navigate tricky territory: the drugs whelmed by their patient’s challenging care that are standard care to prevent blood clots requirements. post-knee replacement would also contrib- “Most doctors are trained to handle ute to Raikes’ bleeding. one organ system at a time, whereas in “We like to think that medicine is ICU we handle multiple organ systems si- an exact science, but there often isn’t a multaneously, and our patients often have ‘yes or no’ answer to a patient’s medical co-morbidities, which complicates things Ashley Montgomery, MD, who started the clinic at UK and now sees problems, particularly in an ICU situa- even further,” said Montgomery. “Their critical care survivors in clinic several times a week. tion where multiple organ systems are in- post-discharge care can be so complicated volved and the treatment for one problem is contraindicated for the patient’s other problems,” Montgomery said. “We talk to the patient, use the best data available and make an informed decision about how to best care for them.” Montgomery and her team in the UK HealthCare ICU were able to stabilize Raikes without compromising his knee replacement by inserting an IVC filter in his inferior vena cava. This umbrella-like device catches circulating clots and pre- vents them from travelling to the lung. Raikes was discharged from the ICU on June 29th and felt well enough to run (al- though he admits it was more of a walk) his first 5K in his hometown of Lebanon, Ky., this past September. A New Journey Raikes’ journey — or “scenic tour,” as he says jokingly — didn’t end with his Darrell Raikes (center left), wife Sarah Raikes (center right), with the ICU team that cared for him. hospital discharge. He now attends Mont- gomery’s Critical Care Survivors Clinic Improving Outcomes UK, immediately recognized the value of (CCSC) at UK. One of only a handful in and disjointed that these patients often end The first CCSC was established in a similar program in Lexington. the country, the CCSC’s purpose is to help up back in the hospital.” Indiana in 2011 with the goal to improve “The population we serve is strongly patients navigate the complicated and of- This, in turn, runs afoul of one of the long-term outcomes, decrease hospital rural and has a high rate of co-morbidities,” ten confusing decision matrix that follows major tenets of the Affordable Care Act, readmission rates and improve quality of Montgomery said. “These people struggle a high-maintenance hospital stay. life for critical care survivors. Montgom- to balance their follow-up care, because Solving one problem often uncovers a where hospitals are penalized for patient ery, who was then in her fellowship here at they typically have a lot of it to keep track new problem, and critical care is no excep- readmissions within a certain timeframe.

Continued on page 17 MEDICAL NEWS • JANUARY 2016 PAGE 17

HEALTHCARE INNOVATION

Continued from page 16

physical therapy and assess whether the “The population we serve is time was right to remove the IVC filter. strongly rural and has a high rate At his second follow-up there was a snafu of co-morbidities,” Montgomery with his CAT scan scheduling, and Mont- gomery’s staff helped resolve the issue. said. “These people struggle Eventually, Raikes will be discharged to balance their follow-up care, from the CCSC, but he and his wife will because they typically have a still keep Montgomery and her staff in their hearts. lot of it to keep track of and a “We come to Lexington often, and ev- long way to travel to get it.” ery time we come we visit the ICU and Dr. Montgomery,” said Raikes. “What these people did — not just the big things, but ily member navigate her care when she was all the little things that kept our spirits up diagnosed with breast cancer. during a horrible time — is a blessing to Raikes has been back to the CCSC us, and we will be thanking them forever.” twice so that Montgomery could chat with - Laura Dawahare is with the University him face to face about his progress with of Kentucky.

Ashley Montgomery, MD, (left) speaks to patient Darrell Raikes.

followed longer term if necessary. As advances in medicine Being able to see these patients in a have reduced mortality rates, non-crisis situation often provides op- critically ill patients fortunate portunity to ask important quality of life questions. enough to recover and be “Remember,” Montgomery said, “that discharged are suffering cognitive these people were recently very sick, and impairment, depression and/ for many of them chronic illness is a fact or ongoing physical disabilities. of life. To be able to sit down with them when they aren’t in a hospital bed opens up all sorts of opportunities to ask important quality of life questions, which then inform of and a long way to travel to get it.” our care plan.” Furthermore, Montgomery explained, Examples include life goals (Do you rural physicians and other providers who want to be able to drive again? To work care for these patients back home often are again?) and end-of-life goals (How can we uncomfortable making decisions on how to make you comfortable?) move forward with aftercare. In addition A Detour to seeing the patients face to face, Mont- gomery frequently talks with a patient’s While a career path is rarely a straight hometown providers, advising them and line, Montgomery’s earlier training clearly facilitating services that keep the patient influences her work today. Before medical as close to home as possible. school, she had her own business coordi- “It doesn’t hurt that the CCSC is a fis- nating services for families with autistic cally sound proposition, but in the end for children. “It’s perhaps overly simplistic, me it’s about providing quality of life for and really obvious, but I learned then that these people,” Montgomery said. if you support people, they do better,” said Originally, the clinic met once a Montgomery. month but is now several times a week. It’s especially true in healthcare, she Montgomery typically sees patients for one continues. Even with a medical degree, to six months post-discharge, but some are Montgomery felt lost as she helped a fam- PAGE 18 MEDICAL NEWS • JANUARY 2016

COMMENTARY

Cedar Lake and Home Partial smoke-free of the Innocents laws won’t do A critical and vital partnership. Comprehensive laws are the only ones that significantly improve public health. By Chris Stevenson stitutions are now living meaningful lives in the community; the bad news By Ellen Hahn, PhD, and Holly Brown Cedar Lake and is that there are nearly 500 unused beds fatal diseases and improving public the Home of the in inventory – with no plan to reassign health. People with emphysema who Innocents, two of these beds to those who desperately Not all smoke-free laws are creat- live in Kentucky communities with an Kentucky’s largest need them. ed equal. Effective, or comprehensive, effective smoke-free law are 22 per- nonprofits serving smoke-free laws protect all workers cent less likely to go to the hospital our most vulnerable After years of research and from secondhand smoke and aerosol than those living in communities with citizens with intel- planning, Cedar Lake has from electronic smoking devices by partial or no smoke-free laws. Addi- lectual and devel- developed Kentucky’s first- covering all indoor workplaces and tionally, people living in communi- STEVENSON opmental disabilities ever 4-bed Intermediate Care buildings open to the public, and all ties with comprehensive smoke-free who have intense Home so that individuals with tobacco products that pollute the air. laws are less likely to be hospitalized medical needs, are forging a partner- This means no exceptions—all workers for heart attacks, compared to people ship to deal with a crisis within our intensive nursing needs can and patrons are asked to step outside living in communities with partial agencies. In May of 2012, our agencies fully integrate in neighborhoods away from entryways, windows, and smoke-free laws. In turn, fewer sick began discussing the lack of available in the community. vents when they want to smoke, en- people needing healthcare and missing resources in the community for chil- suring that indoor air remains clean. work means lower healthcare costs and dren aging out of the Home of the In- The answer to this ongoing and These laws ensure that no one is left nocents and for adults on the Cedar higher worker productivity, improving growing problem is for Cedar Lake to out. Comprehensive smoke-free laws Lake waiting list that face limited op- the Kentucky economy. expand its Intermediate Care services covering everyone and all tobacco tions to meet their intense needs. in a unique way. But to do so, we would products that pollute the air are the With limited options and the state’s People with emphysema who need to create a new housing option that only ones that have been shown to be ongoing initiative to reduce the usage of live in Kentucky communities would satisfy the DOJ’s emphasis on effective at significantly improving “intermediate care” beds, our organiza- smaller, more integrated settings. with an effective smoke-free public health. tions have had little choice but to place After years of research and plan- law are 22 percent less likely Partial smoke-free laws fall short these individuals in psychiatric facili- ning, Cedar Lake has developed Ken- to go to the hospital than those of being effective by failing to protect ties, nursing homes, and, at times, back tucky’s first-ever four-bed Interme- all workers. These laws make excep- living in communities with home with their families. All of these diate Care Home so that individuals tions that take away smoke-free protec- partial or no smoke-free laws. choices have devastating consequences. with intensive nursing needs can fully tions from certain businesses or com- More than 30 percent of children integrate in neighborhoods in the com- aging out of their facility have severe munities, leaving workers and patrons munity. This vision has required much Some may want to compromise, negative outcomes, including death, exposed to deadly air pollution from planning and cooperation from the saying a partial law is better than no within 18 to 24 months due to the lack secondhand smoke or aerosol from Cabinet for Health and Family Ser- smoke-free law at all. However, data of available resources in the community electronic smoking devices. Second- vices (CHFS), planning and zoning, show that partial smoke-free laws fail – and Cedar Lake’s waiting list for these hand smoke is a well-known air pol- neighborhood developers and a con- to protect the public health. Sometimes critically needed services has grown to sultant for the DOJ. lutant, containing 69 toxins known to it is argued that a partial smoke-free eight-plus years, leaving aging parents Both agencies will be working cause cancer and emitting tiny par- law is a starting point, and that if the to care for their significantly disabled closely with the new Bevin Admin- ticles known to cause heart and lung public responds well, the law can be sons and daughters at home. istration to seek their approval of our disease. Electronic smoking devices strengthened later. However, research Over the last several years, Ken- request for the expansion of additional are considered a tobacco product by shows that once smoke-free laws are tucky has made a strong effort to shrink ICF beds to support Kentucky’s most the FDA and they are known to pol- passed, they tend to ‘stick.’ Partial laws the size of its public institutions to keep vulnerable citizens. lute the air with toxic aerosol. While are rarely strengthened, making it crit- pace with the Department of Justice’s —Chris Stevenson is president and the long-term effects of exposure to (DOJ) national movement to reduce or ical that policymakers pass an effective CEO of Cedar Lake. electronic cigarette aerosol are not yet close large facilities in favor of smaller, law with no exceptions the first time. known, research shows negative short- more integrated settings. Because of Ellen Hahn, PhD, is professor Full commentary can term health effects. the DOJ’s effort, Kentucky has reduced and director of the Kentucky Center for be found on our web Effective smoke-free laws are com- the usage of its Intermediate Care beds at medicalnews.md. Smoke-free Policy (KCSP) at the Univer- parable to a vaccine for heart disease from 977 to less than 500. sity of Kentucky College of Nursing. Holly and cancer—when given at the right The good news is that hundreds Brown, is a research assistant at KCSP. of individuals previously living in in- ‘dose,’ they are effective at preventing MEDICAL NEWS • JANUARY 2016 PAGE 19

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Compiled by Melanie grant, this therapy will be ready for clini- Wolkoff Wachsman cal development. “Dr. Zhan’s lab is at the leading-edge UK Researcher Developing Over- of cocaine overdose therapy,” said Linda dose Treatment Dwoskin, associate dean for research By Keith Hautala, Dave Melanson at the UK College of Pharmacy. “This Jan 17, 2014 grant is the culmination of the pre-clini- ______cal, innovative and groundbreaking work ______that has been taking place in Dr. Zhan’s LEXINGTON, Ky. (Jan. 24, 2014) laboratory for many years. The next step — Chang-Guo Zhan, professor in the will be to move this potential therapy University of Kentucky College of Phar- into clinical use and make it available to macy’s Department of Pharmaceutical those who need it.” Sciences, received a three-year, $1.8 mil- Z lion National Institutes of Health (NIH) grant to develop a therapeutic treatment for cocaine overdose. The development of an anti-cocaine medication for the treatment of cocaine overdose has challenged the scientific community for years. In fact, there is no current FDA-approved anti-cocaine overdose medication on the market. “According to federal data, cocaine is the No. 1 illicit drug responsible for drug overdose related emergency depart- ment visits,” Zhan said. “More than half a million people visit emergency rooms across the country each year due to co- caine overdose.” This new grant is the fourth in a series of investigator-initiated research project (R01) awards that Zhan has re- ceived from the NIH to continue to discover and develop a cocaine abuse therapy. In previous work, Zhan has de- veloped unique computational design ap- proaches to generate of high activity vari- ants of butyrylcholinesterase (BChE), a naturally occurring human enzyme that rapidly transforms cocaine into biologi- cally inactive metabolites. Zhan and his collaborators have im- proved BChE catalytic activity specifi- cally against cocaine by 4,000 times. The focus of this new grant is to optimize and stabilize these high-activity BChE vari- ants. The hope is that at the end of this

“HANDSTAND”, BRONZE BY TUSKA, LEXINGTON, KY. A DECEASED UK FINE ARTS PROFESSOR, TUSKA WAS FASCINATED WITH THE BEAUTY AND ATHLETICISM OF THE HUMAN FORM.