Region served by Lexington hospitals ranks low in health but beats expectations in lowering rates of uninsured

By Danielle Ray
Kentucky Health News

The region served by Lexington hospitals, most of the eastern half of Kentucky, has the worst health ranking of any such area in the state and one of the poorest in the nation.

However, it is among the best in the nation in beating expectations when it comes to lowering the number of people without insurance, thanks to the state’s expansion of Medicaid eligibility.

So says The Commonwealth Fund, a foundation that aims to promote a high-performing health-care system.

Adapted Dartmouth Atlas map shows hospital referral regions.

The foundation’s Scorecard on Local Health System Performance includes measurements of health and the efficacy of hospitals and other parts of the health-care system.

Lexington’s hospital-referral area ranks 268th of 306 such regions in the U.S. That ranking is six spots higher than in 2011, the last time the foundation produced its scorecard.

Because there is relatively little difference between closely ranked regions, the rankings are also expressed as groups. The Lexington region ranked in the bottom fifth, the same grouping it had in 2011. When divided into 10 groups, it ranks in the next-to-last tenth. Also, the new scorecard shouldn’t be viewed as a precise update to the last version, because changes in underlying data sources or definitions of measure required researchers to make some changes to their measurements, The Commonwealth Fund says.

Albert B. Chandler Hospital Pavilion, Lexington

Hospital referral regions are health-care markets with at least one hospital where complex surgeries are performed. Such hospitals are at the apex of a regional health system, which includes smaller hospitals, doctor’s offices and so on. HRRs, developed by the Dartmouth Atlas of Health Care, are widely used in health-services research and policy analysis.

The overall rankings are divided into four dimensions: access, prevention and treatment, healthy lives and avoidable trips to the hospital (including hospital costs).

The Lexington region improved its ranking in only one dimension, rising to 137th from 179th in access and affordability. Factors that affect access include uninsured children and adults, adults who went without care because of cost in the past year and adults without routine doctor or dental visits.

Among 33 individual health indicators, the Lexington region worsened in two categories, insurance reimbursement and obesity, but improved in 10, including deaths from colorectal cancer and adults without health insurance.

Scatterplot of regions shows Lexington area
did better than its low income would indicate.

Other regions of Kentucky showed similar declines in the uninsured, but the Lexington region was among the best with low incomes at getting people covered.

Sara Collins, vice president of health-care coverage and access for The Commonwealth Fund, attributes the improvement in Kentucky’s uninsured numbers to the 2014 expansion of eligibility for Medicaid and the creation of Kynect, the state health-insurance marketplace where Kentuckians enrolled for Medicaid or federally subsidized private insurance.

“I do think the decline we’re seeing [in the uninsured] is a direct result of both of those programs,” she said. “Medicaid has been a very important source of coverage for the state.”

The Lexington region’s rankings fell slightly in the other three major dimensions: to 237th from 236th in prevention and treatment; to 300th from 295th in preventable hospital visits; and to 292nd from 290th in the healthy-lives dimension.

Factors for prevention and treatment include instructions given to hospital patients about home recovery, adults with a regular source of care, and adults with age-appropriate vaccines. Factors that influence avoidable hospital visits include readmissions of Medicare patients within 30 days and potentially avoidable emergency-room visits by Medicare patients. The healthy-lives dimension is influenced by factors such as obesity, smoking and deaths from certain types of cancers, including breast and colorectal.

Honolulu ranks first in the nation in performance by dimension. Owensboro ranks best in Kentucky at 173rd. Paducah is just ahead of Covington at 225th and 227th, respectively. Louisville ranks slightly ahead of Lexington at 233rd. Nashville, which is the referral region for much of the western portion of Southern Kentucky, ranks 245th. Cincinnati is 196th. The entire interactive scorecard is available here.

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