Big-Change or No-Change in Post-Election Kentucky Healthcare?

I have been out of the country these last two weeks and am trying to catch up. Perhaps the biggest news item while I was away happened just as I left town – the election of Matt Bevin as our next Governor.  I had only just learned of this fact when I was contacted by an out-of-state reporter who asked whether people in Kentucky who gained coverage through Medicaid expansion or through our KYNECT state insurance exchange should be concerned.  If so, why would people who only so recently obtained healthcare coverage vote for Mr. Bevin – as they obviously did in winning fashion?

Of course they should be concerned!
I responded that based on Mr. Bevin’s campaign promises and comments alone, as reported by our local press, current KYNECT and Medicaid expansion recipients have every reason to worry about their future coverage and access to healthcare.  I would certainly worry if I were in their shoes and not the satisfied Medicare beneficiary that I am.  In the heat of the campaign, and to appeal to virulent anti-Obama haters, Tea-Partiers, and other conservative voters; Mr. Bevin unequivocally promised to undo as much as possible of the Affordable Care Act (ACA) implemented in Kentucky by Governor Steve Beshear.  At least that is what I heard.

Real promises or campaign maybes?
Campaign promises included unwinding Kentucky’s successful KYNECT insurance plan, or switching it from a state-run plan to a federally plan.  It also seemed clear to me that Mr. Bevin promised to end or roll back the Medicaid expansions that have numerically provided the most coverage to previously uninsured Kentuckians. (Mr. Bevin later apparently hedged his promise to something short of a full roll-back.)  Much was made during the campaign of Mr. Bevin’s possible confusion of Medicare and Medicaid, and statements about whether beneficiaries of publicly-financed healthcare should be required to submit urine tests for illegal drugs.  I took some of this to be red-meat stuff thrown Trump-style by both parties to their admiring crowds.  I would rather see Governor-elect Bevin improve what we have rather than walk away from it to satisfy his political base. Continue reading

Free Bound Medical Journals.

Prepare yourself for medicine in the post-apocalyptic world!bound-journals-1The evolving interface with the medical literature.

They were once one of my most prized possessions, but now I can’t even give them away.  Beginning in 1967 with the New England Journal of Medicine (NEJM), I began to bind my medical journals. The fact that the practice was begun for me by my late father-in-law only increased my emotional attachment to these physically and intellectually handsome books. As my career progressed, I added all the major general internal medicine and rheumatology journals to my collection. I was on the editorial board of two of these, wrote articles appearing in them, and reviewed countless articles submitted for publication by others.  I carried these books from one institution to another for over 40 years until, following my active medical retirement, they ended up in a Stor-All facility.  As I attempt to further downsize now because I no longer physically have room for them, I discover to my naive surprise and disappointment that no one else wants them.  My current dilemma stems from the fact that I cannot bring myself to throw them away.  Perhaps one of my readers can help me.  Details about the collection can be found at the end of this article. Continue reading

Medicare Releases On-Line Application To Map Opioid Prescriptions.

Both “hot- and cold-spots” of opioid prescription are easily found.  The business address and volume of opioid prescriptions written by Medicare prescribers correlates very well with the volume of opioids consumed by non-Medicare patients and predicts where where they live.  The Medicare Part-D Prescription Drug Database can be a useful instrument for medical professional, public health, and law enforcement organizations in dealing with America’s exploding prescription drug and opioid drug epidemic.

In its efforts to make our healthcare system more transparent, affordable, and accountable, the Cabinet for Medicare and Medicaid Services (CMS) has just released an on-line website tool map Medicare Opioids that allows anyone to create maps showing the distribution of prescribing for opioids at the state, county or 5-digit ZIP Code level.  The underlying data comes from the same initial release of 2013 Part-D Medicare prescription data and is therefore geographically organized by the business address of each individual prescriber but is limited to the subset of patients covered by Part-D Medicare.

However, data accompanying the mapping application includes information not available in the earlier release including the number of prescribers in a given geographic area, and the percentage of all prescriptions written that were for opioids. (Who else could do this!)  With this additional information, the number of opioid prescriptions per-prescriber within a given geographic region can be calculated.  A few minutes of browsing easily demonstrates major geographic variation and “hot-spots” of both high- and low opioid prescribing at the five-digit ZIP Code level.  Continue reading

Temporary Annoyance Or Tactical Setback For Louisville VA Hospital Replacement Process?

Several news outlets recently noted a decision by the Department of Veterans Affairs in Washington DC to conduct full environmental impact studies (EIS) on the previously proposed sites for a replacement VA hospital at the first-choice Brownsboro Road and Waterson Expressway site, and the runner-up on Factory Lane near the Jefferson Expressway and  Old Henry Rd.  This latter location is adjacent to Jewish Hospital Northeast Medical Center.  This latter was also been called the “St. Joseph Site” because the original large acreage was owned my the St. Joseph Catholic Orphans Society. Earlier less rigorous (and correspondingly less expensive and time consuming) EIS assessments did not uncover unmanageable obstacles to proceeding.  Accordingly, planning for the favored Brownsboro Rd. site is well along with ground-breaking anticipated in 2017.  I commented on the playing of the EIS card by opponents in my report on the public hearing held last September.  Just this week I received the attached notice from the VA giving a few more details.


Continue reading

William Summers, IV Appointed to University of Louisville Board of Trustees.

dream-lives-on-175That didn’t take long!

The day after a slate of three nominees for an open position on the UofL Board of Trustees was presented to him by the Postsecondary Education Nominating Committee, Governor Beshear announced his choice for the appointment – William Summers, IV of Louisville.

Mr. Summers is a distinguished, respected, and long-serving public figure in Louisville. He is a known and knowledgeable quantity and should be able to hit the ground running.  In the announcement from the Governor’s office this afternoon, Mr. Summers comments:

“For over 40 years I have devoted my life to serving my hometown of Louisville, and I appreciate this opportunity by Gov. Beshear to serve on U of L’s Board,” … “My entire life I have always been proud of the University of Louisville and its deep history of helping men and women of all races and nationalities reach their potential. This is a true honor and privilege to serve as a board member with the distinguished faculty, staff and students who have devoted their lives to helping U of L and the city of Louisville achieve greatness.” 

This has been an appropriately fast-track process. The enabling position on the Board that became available upon the resignation of Trustee Steve Wilson only opened on September 29, public notice of the meeting of the nominating committee became known to me only two days ago, and the Nominating Committee met only yesterday!   I would like to believe that the speed of the appointment reflects only its importance to the community, but this was also a distracting matter that had to be settled before the upcoming November elections. Of course, Mr. Summers is also appointed just in time for the November Board meeting.  Hardly a beat missed!

Mr. Summers and the Board a face a significant set of challenges in the year ahead.  We wish for them all a professionally satisfying experience and outcomes of which we can all feel proud.

Peter Hasselbacher, MD
President, KHPI
Emeritus Professor of Medicine, UofL
October 21, 2015

Nominations Offered To Restore Minority Balance on UofL Board of Trustees.

As reported earlier today, the Postsecondary Education Nominating Committee voted unanimously to send three names to Governor Beshear to fill the opening created by the resignation of Trustee Steve Wilson last September 29.  Last June, the same committee sent the Governor a list of 9 nominees to fill the three rotating slots opening at that time.  The governor did not reappoint the eligible African American incumbent on the list or either of two other nominees of African American descent.  For the first time in several years, this left the Board of Trustees without an African American member appointed to one of the 17 positions (15 really) over which the Governor has discretion.  The appointment at that time of a new trustee of Hispanic/Latino descent to satisfy the statutory requirement that appointments to the Board reflect the minority racial composition of the Commonwealth did not satisfy a motivated segment of the minority community which protested effectively at the Board Meeting on Sept 3 and in other venues.

As part of this advocacy, representatives from the West Louisville Ministers Coalition and the Justice Resource Center requested an opinion from the Office of the Attorney General as to whether the appointments reflected the racial composition of Kentucky, whether “Hispanic” counts as a minority for this purpose, and whether U.S. census data requires a governor to appoint more than one racial minority to the Board. Continue reading

Nominating Committee Sends Names to Governor to Fill Opening in UofL Board of Trustees.

The Governor’s Postsecondary Education Nomination Committee met this morning to consider names to present to Governor Beshear to fill the opening on the University of Louisville Board of Trustees that resulted from the resignation of Trustee Steve Wilson in September.  The Nominating Committee voted unanimously to forward the following three names to the Governor. None of the three were on the previous list of nine submitted in June, 2015 for the positions opening at that time.

  • William Summers, IV, of Louisville.
  • Ryan Bridgeman, of Louisville.
  • Kim Barber, of Scott County.

I will add to this article shortly with details about the meeting, the candidates, and to offer commentary on the process.

Peter Hasselbacher
President KHPI
October 20, 2015,  1:25 p.m.

UofL School of Medicine No Longer On Probation.

Oct 15, 2015; 11:45 AM

Good News!
The University of Louisville School of Medicine has just received the good news for which it has worked hard over the past two years.  Its probationary status is said to have been lifted by the LCME.  The Liaison Committee for Medical Education (LCME) is a joint endeavor of the American Medical Association and the Association of American Medical Colleges that accredits North American Medical Schools.

In my view,  the LCME made a needed wake-up call to the University Administration that put educational maters back on track again. In its emphasis on its commercial research agenda, UofL has allowed its educational priorities to receed.  In that respect, although the experience was both painful and embarrassing for all of us, we are now entering a better place.  As pointed out in yesterday’s article, the LCME will likely to have concluded that a few items still require monitoring.  This is not a time to relax or withhold resources. We need to make sure our momentum is not lost.

I will update this article as I learn more.

[It’s official.  Although the status listing on the LCME website had not yet changed as of the writing above, by this afternoon UofL is listed as being fully accredited.]

Peter Hasselbacher, MD
Emeritus Professor of Medicine