By Al Cross
Kentucky Health News
Improving healthcare and health in rural Kentucky will require more people in the healthcare workforce, especially at the top and bottom of the salary scale, two key lawmakers and the one of the main hospital administrators in the state.
Kentucky needs more healthcare workers overall because it could lose some of them to the pandemic, said Mark Birdwhistell, vice president of health services administration at the University of the Kentucky and UK HealthCare chief of staff, during a Kentucky Chamber of Commerce webinar on rural areas. – urban health disparities.
“Get out of the Covid. . . many of our clinical staff are tired and questioning, “Is this the career path I want to pursue?” “They’ve been in combat for a year and a half now,” Birdwhistell said.
State Representative Kim Moser, a Republican from Taylor Mill in northern Kentucky, agreed. “Burnout is real,” she said, noting that her husband is a pulmonologist who has treated Covid patients.
The need for more community health workers, who are not health care providers but can educate people about care and help them get it, arose when Birdwhistell, a former secretary of State Health, discussed the 2014 expansion of the federal state’s Medicaid program for low-income Kentuckians.
“Just because you have coverage doesn’t mean you have access” to the health care you need, Birdwhistell said, because “a lot of providers don’t take Medicaid”. He and Baptist Health Louisville president Larry Gray said health insurance tends to cost more in rural areas due to lack of competition, so people buy policies with copayments and high deductibles.
The expansion of Medicaid has made it clearer how the “social determinants of health” leave rural areas with poorer health, Birdwhistell said. A resident of an urban area is twice as likely to complete high school or college as a resident of a rural area, he said, so health literacy is lower. in rural areas. And that extends to health insurance, he said, giving an example: “Deductible. It’s hard to explain in English.
Moser, a retired nurse who chairs the state’s health and family services committee, said it would help to expand the limited reimbursement in government and business insurance for community health worker services. “This is a policy that we are considering eventually expanding,” she said.
Birdwhistell said it would be “very, very profitable” because “in many communities people don’t know how to access care and come to emergency rooms. And that’s probably the worst place someone ever shows up with a high fever, strep throat, whatever. They do not benefit from a continuum of care. . . . They will listen to someone they grew up with, someone they go to church with, someone they see on the football field with their children.
Eastern Kentucky already has the third largest concentration of community health workers in the country, behind Alaska and northwestern Mississippi, according to the Bureau of Labor Statistics.
This is likely due to Kentucky Homeplace, a 27-year program at the UK’s Center of Excellence for Rural Health in Hazard. He says he helps people in the area with “lifestyle choices, environmental factors, inadequate health insurance and a general lack of understanding of the health system.”
Nationally, CSAs pay an average of $ 46,000 per year, but in Kentucky, the average is $ 37,320.
The webinar discussion also touched on the need for more physicians in rural Kentucky.
Birdwhistell said a major obstacle to increasing the number of doctors in rural areas of the state was the limits on federally funded residency places in UK medical schools and the University of Louisville. “Reversing that switch could quite instantly change the number of professionals we have to come,” he said.
Republican Senator Ralph Alvarado of Winchester, a physician, agreed, saying residents tend to settle within 80 miles of where they live. Moser also endorsed the idea.
Alvarado, chairman of the Senate Committee on Health and Welfare, noted that some rural areas suffer from a shortage of health care providers, which he blamed on state laws that make insurance against costly malpractice.
Gray said the shortage is particularly severe in eastern Kentucky, which needs providers ready to come to the area with “a sense of mission and vocation.” But even with enough providers, transportation to get some patients there remains a barrier in some areas, he said. The expansion of telehealth has helped, he said, but some areas still do not have fast enough internet access for this.
And even with telehealth, a shortage of specialists is blocking care. For example, Kentucky has only 59 child psychiatrists, and half of them “just use money, don’t take insurance,” Alvarado said.
The panel began by discussing some of the state’s poor health statistics. Alvarado said tobacco use is higher in rural areas, leading to all kinds of health problems, and obesity is more common, leading to “more negative outcomes”.
The news isn’t all bad, he said, noting how Kentucky has increased its colon cancer screening from 47th to 19th in the country. “It’s going to rub off on our death rates. . . in 10 years, ”he said. “There is a little hope. But he also noted that testing rates in eastern Kentucky remain relatively low.