Thursday, December 04, 2008
The current health care system needs repair
By Anthony Policastro, M.D

Prior to the election, I wrote a column about how expensive our current medical care system is. I recently found out about the "two pill rule" that Delaware Medicaid has. It is an example of why medical care in this country is so costly. I had two patients recently. One was on a medication that came in 5mg, 10 mg, 15 mg, 20 mg, 25 mg and 30mg doses. He was taking 45 mg daily. He was receiving one 30 mg tablet and one 15 mg tablet. I needed to increase his dose to 50 mg. I gave him a prescription for two 25 mg tablets. Medicaid would not fill it because they will not fill a double dose of a single pill. When I called them about it, they told me that I could rewrite the prescription. I could prescribe one 30 mg tablet and one 20 mg tablet. However, I could not prescribe two 25 mg tablets. The second patient was on a medication that came in 18 mg, 25 mg, 40 mg and 60 mg doses. He was on 40 mg. I needed to increase his dose. I gave him a prescription for two 25 mg tablets. Medicaid would not fill it because they will not fill a double dose of a single pill. When I called them, they told me I could write the prescription for 60 mg. They would fill that even though I felt that dose was too high for the patient. The sequence of events was the same for both patients. I wrote the prescription. They took it to the pharmacy. The pharmacy tried to fill it as written. The prescription was refused as written. The pharmacy contacted the patient. The patient contacted me. I called Medicaid. I worked my way through their complicated phone system. The person I spoke to told me that I could write the prescriptions for 30 mg plus 20 mg for the first patient or for 60 mg for the second patient. Then I would not need an approval.

I indicated getting approval was what I needed. I should not be writing a prescription differently just to get around the system. They agreed to approve it. I then had to call the pharmacy to tell them that the approval would be in the system within 24 hours. I then had to call the patient to tell them the same thing. Both situations wasted the patient's time. Both situations increased the time the pharmacist spent filling the prescription. That time would ultimately wind up in the cost of the medication that Medicaid would pay the pharmacy. Both situations increased my time on the phone. That time would ultimately wind up in the costs that Medicaid would pay to my employer. Medicaid had to pay people to be able to answer phone calls like these. All of those costs would come from taxpayers. This is just a minor example of the excess costs in the current system that we have in our country. However, when these kinds of things go on every day, it makes the system far too expensive for us to have any kind of national health coverage. We need to fix the system first.

Use portion control
By Karyl Rattay, MD, MS

This time of year can be the most challenging when it comes to healthy eating. It starts right after Halloween as you and the kids munch on the leftover candy. Then Thanksgiving rolls around with pumpkin pie, stuffing and all the other "fixings". Now, we're in December and all bets are off - Christmas cookies, holiday feasts, eggnog and New Year's Eve celebrations. Then you make the resolution that the whole family will eat better in the New Year. It's okay for you and your family to enjoy your favorite holiday meals as long as you eat sensible portions. But in today's "super-sized" world, how much is too much? You may be surprised to see what a healthy-sized meal for your kids really looks like. Let's break it down by age: Toddlers (ages one to three) - one ounce of protein (meat, poultry, fish, or alternate protein product); quarter cup of grains (rice, pasta, noodles, or cereal); and a quarter cup each of fruits and vegetables Kids (ages three to six) - one and a half ounces of protein; quarter cup of grains; and a half a cup each of fruits and vegetables Kids (ages six to 12) - two ounces of protein; a cup of grains; and a half a cup each of fruits and vegetables If you practice portion control at home, think how much easier it will be when you eat out, especially at a buffet-style restaurant! So, enjoy the holidays and all the meals that go along with them, but take control with portion control. Karyl Rattay, MD, MS, is a senior program and policy analyst and an expert in obesity prevention for Nemours Health and Prevention Services, based in Newark.

Information sessions at Del Tech Become a member of the rapidly expanding health care field by taking the evening nurses' assistant training program, offered through Delaware Technical & Community College, Owens Campus, Georgetown. Free information sessions about this program will be held on Dec. 1, 8 or 15 from 6 to 8 p.m. at Delaware Tech. This 150-hour course teaches students to safely perform basic nursing skills under the supervision of a licensed nurse. Course begins on Feb. 2 at LifeCare at Lofland Park in Seaford; or April 6 at Atlantic Shores in Millsboro. Classes meet Monday through Thursday from 5 to 10:30 p.m. Free training is available to qualified applicants. For complete information or to register, contact Delaware Tech's Corporate and Community Programs at 302-854-6966.

New Program for Dietary Assistants The Sussex Tech Adult Division is offering a new Dietary Assistants program to help prepare workers for the institutional food service profession. Specific emphasis will be on hospital and long-term care facilities. Classes in this certification program will start Jan. 5, and be offered two nights each week at the Georgetown campus. Students will learn about the medical profession, nutrition, food service and gain computer skills. The industry-recognized ServeSafe certification is included in the program. Students will learn the skills necessary to get a job in institutional food service (primarily health care) to help dietary staff provide healthy, safe, and nutritious food. Duties of a Dietary Assistant usually include interacting with clients and/or patients and performing various food production and service tasks. The demand for dietary assistants is increasing. Individuals currently working in a related field may choose to schedule the 60-hour portion of the class to earn ServeSafe certification. To register for the program, contact the Sussex Tech Adult Division at 302-856-9035, or visit the website at

Ready to be "The Biggest Loser?" Healthy U of Delmarva at Salisbury University, the Wicomico County Health Department and the YMCA Activate America sponsor this 12-week guided exercise and nutrition program starting January 9. Individuals or teams of 4-6 may participate. The program features seminars, classes and events about nutrition, body image, stress eating, nutritional labels, recipe tips and fun physical activities. It is designed to promote positive lifestyle changes and improved habits. Participants will receive Biggest Loser T-shirts, prizes, nutrition and fitness tips, YMCA or University Fitness Club access, confidential monthly weigh-ins, body measurements, exclusive classes and a session with the Fitness by Design team. Registration is $35; $20 for members of Healthy U or the mid-shore Family YMCA, and SU students or staff. Deadline is Thursday, Jan. 8. For more information contact Deanna Harrell, YMCA community projects director at 410-749-0101 x16 or, or visit the and click the Activate Delmarva link.

Stroke and Osteoporosis Screening Life-Line Screening will be at the Nanticoke Senior Center on Dec. 10. The site is located at 310 Virginia Ave. in Seaford. Appointments will begin at 10 a.m. Screenings are non-invasive. They help identify potential health problems such as blocked arteries and irregular heart rhythm, abdominal aortic aneurysms, and hardening of the arteries in the legs, which is a strong predictor of heart disease. A bone density screening to assess osteoporosis risk is also offered and is appropriate for men and women. Register for a Wellness Package with Heart Rhythm for $149. All five screenings take 60 to 90 minutes to complete. For more information regarding the screenings or to schedule an appointment, call 1-877-237-1287 or visit us on the web at Pre-registration is required.

Nanticoke raffles game system The Look-In Glass Shoppe at Nanticoke Memorial Hospital will raffle a Wii gaming system console that includes a CD with five sports games, two nunchucks and two remotes (retail value $350). Tickets are on sale at The Look-In Glass Shoppe (located within Nanticoke Memorial Hospital) from now until Dec. 15 at noon. Tickets cost $5 each or five for $20. The drawing will be held at noon on Dec. 15. All proceeds from The Look-In Glass Shoppe benefit Nanticoke Health Services. For more information about the raffle, call 302-629-6611, ext. 4955.