The1st meeting of the Subcommittee on Families and Children of the Interim Joint Committee on Health and Welfare was held on Wednesday, August 12, 2009, at 10:00 a.m., at Norton Hospital, in the Norton Health Care Auditorium in Louisville, Kentucky. Representative Tom Burch, Chair, called the meeting to order, and the secretary called the roll.
Guests: Karen Hinkle and Karen Wells for the Kentucky Home Health Association; LouAnn Epperson for Prevent Blindness Kentucky; Marilyn Schleyer and Ben Martz for Northern Kentucky University; Tim Corrigan and Riggs Lewis for the Rotunda Group; Rachel Phelps for Norton Hospital/Government Strategies; Tom Kmetz for Norton Hospital/Kosair Children’s Hospital; Sarah Nicholson for the Kentucky Hospital Association; Shane O’Donnley for the Cabinet for Health and Family Services; Linda Austin for Senate Minority Leadership/LRC; Ellen Kershaw for the Alzheimer’s Association; Eric Clark for the Kentucky Association of Health Care Facilities; Sheila Schuster for Advocacy Action Network; and Molly Dobson for KIPDA.
LRC Staff: Ben Payne, Mike Bossick, Amanda Dunn, DeeAnn Mansfield, and Cindy Smith.
The first item on the agenda was an overview and update on Kosair Children's Hospital from Thomas D. Kmetz, President of Kosair Children's Hospital. The subcommittee learned that Kosair has a proud 117 year history and it is the only free-standing Children’s Hospital in the state and that it is the regional pediatric teaching hospital. Kosair has 1,500 employees and operates 261 hospital beds while annually facilitating 45,000 ER visits, 50,000 outpatient visits, and 11,000 surgeries. Kosair has a strong and wide presence throughout the Commonwealth evidenced by a clinical presence in every county and by providing services to more than 100,000 individuals from all 120 counties.
The members also learned that Kosair is one of the state’s largest Medicaid providers, serving more than 107,000 children through Medicaid and Passport. Kosair serves over 1,000 families each year through the Just for Kids transport, which is a fixed wing airplane used to transport children in need of trauma care. The children’s hospital also operates a telemedicine network and is linked to 20 hospitals throughout the state. Their telemedicine focus is cardiology, neonatology, pulmonary, genetics, and gastroenterology. Kosair focuses on child advocacy through child passenger seat inspections and programs dealing with pediatric obesity, asthma, and childhood diabetes. Kosair also proudly operates the Kentucky Regional Poison Center, which receives calls from more than 70,000 families from all 120 Kentucky counties annually. Kosair is currently focused on the “Just for Kids” Growth Campaign, which is a $208 million growth initiative to ensure Kosair remains a premier children’s hospital. Kosair informed the subcommittee that it has identified key components that are needed to successfully operate a children’s hospital. The key components that Kosair is endeavoring to address are; sustaining the physician workforce, achieving outstanding facilities, promoting academic programs and affiliations, creating clinical care infrastructure, and fostering participation in research.
Representative Glenn asked what drives the high need for care in the winter. Mr. Kmetz said it is mainly from the increase in the flu and respiratory issues. This is due to the fact that kids are more concentrated together inside during the winter, the result is more sickness.
Representative Glenn asked if the hospital is ready for the swine flu if it becomes a problem. Mr. Kmetz said that currently there are several task forces working on the issue to get ready for the swine flu if it becomes a problem.
Representative Glenn asked what the common need seems to be when it comes to recruiting doctors. Mr. Kmetz said that is a challenging issue. He said that tort reform would go a long way in helping with recruitment. Also, higher Medicaid reimbursement would help with pediatrics. He also noted that recruitment of sub-specialists is a huge issue.
Senator Stine asked where the pediatric cardiology clinics are located. Kyle Green of Kosair Children’s Hospital said they are in Ashland, Corbin, Paducah, Owensboro, Bowling Green, Fulton, and other areas across the state. Senator Stine asked if there is one in Northern Kentucky. Mr. Green said there is not a site currently in Northern Kentucky, but he would be happy to look into it.
Senator Stine asked if the poison center phone line operates across Kentucky. Mr. Kmetz said that it is a toll free line that operates from all areas of Kentucky.
Senator Stine asked if there are any current physical activity initiatives. Mr. Kmetz said the School of Medicine is currently working with pediatrics on this issue. They have initiated an obesity clinic with prescribed treatment plans to help individuals overcome their obesity. It is funded by Passport and Kosair. There are also talks going on with other groups to coordinate efforts to do a better job with research and coordination of activities.
Mary Michael Corbett of Kosair Children’s Hospital also added that a website is being developed that will address critical issues important to Kentucky. Obesity is one of those issues. She noted that the hospital supports obesity initiatives.
Representative Burch asked if Kosair owns the baby buggy plane. Mr. Kmetz said they are in a lease agreement for the plane’s usage.
Representative Burch asked how long it takes to get the plane out once a call has been received for aid. Mr. Kmetz said from receipt of a call to the plane’s departure is no more than 45 minutes.
Representative Burch asked what the transport cost is. Mr. Kmetz said air transport is about $11,000.
Representative Housman asked about physician workforce challenges and asked for recommendations to be provided to the General Assembly about what can be done. Mr. Kmetz said they have completed a position paper on access to physicians and he will see that it gets to the members. They are also coordinating with other hospitals to develop regional strategies. He said they are open to exploring many different options at Kosair.
Senator Clark asked about the recent expansion at the University of Kentucky and asked if that will result in too much competition between UK and Kosair. Mr. Kmetz said that Kentucky needs to be careful because certain doctors and specialists are very hard to come by and it would be difficult to get specialists in all areas at both hospitals. He noted that there is currently good dialogue between Kosair and UK.
The last item on the agenda was a presentation about Pediatric Telenursing, presented by Dr. Marilyn Schleyer, Chair of Advanced Nursing Studies at Northern Kentucky University and Dr. Ben Martz, Chair of the Business Informatics Department at Northern Kentucky University (NKU). The presenters discussed the issue and challenges of telenursing services in the Commonwealth and presented the subcommittee with possible solutions regarding the delivery of telenursing services involving NKU as a resource.
The presenters explained that discussions at NKU regarding the growing need for home health visits regarding pediatrics was spurred by the June meeting of the Interim Joint Committee on Health and Welfare held at NKU. Discussions focused on identifying ways to expand the capabilities of the health care system to allow more home health visits was a central point. NKU believes that it can utilize their Masters in Health Informatics and Masters in Nursing programs to help provide a solution to telemedicine in Kentucky. NKU believes that through information systems technology and the utilization of qualified nursing students that telenursing can be successfully accomplished by qualified nursing students being engaged to provide the hands on part of a home health care visit while Registered Nurses and Nurse Practitioner’s continue to supply the advanced practice part of the visit. NKU proposes a pilot telemedicine implementation that will save money, save time, train better nurses, visit more patients, and improve patient recovery. NKU is looking to partner with an entity to develop and implement a pilot telenursing program.
Representative Glenn asked how telemedicine is being used. Dr. Martz said that graduate nursing students are doing visits with the patients through web cams and laptops. There is a hands on approach by the nursing students with a registered nurse as a remote back up.
Mr. Kmetz added that they have met with the Cabinet and the issue has been resolved and they are satisfied. Commissioner Johnson and Ms. Banahan revisited the EPSDT regulations and access will be opened up to additional home care agencies. Also, the Certificate of Need process helped the Home of the Innocents expand.
Representative Burch asked if there was a program set up to train nurses. Dr. Schleyer said at NKU is currently ready for nurse training.
The meeting was adjourned at 11:10 a.m.