Thursday, August 23, 2012
Why health care is so expensive

By Dr. Anthony Policastro
When I was a resident, I used to provide weekend coverage for a pediatrician. I saw patients that could not wait until Monday to be seen for their illnesses. I scheduled them to meet me at his office. I carried a black bag full of my examining tools. I carried a pad with carbon paper. I wrote a few lines about the complaint and what I found on exam. I also wrote my diagnosis and the treatment given. I left the original copy of the note for the pediatrician to file. I kept the carbon copy for my files. The patients paid me $10 cash for the visit. There was no insurance company to go through. I didn't need to pay someone to bill the insurance company. The insurance company did not have to hire someone to get the mail or to pay the bill. I did not have to hire someone to collect the payment. The insurance company did not have to hire someone to come and check my medical records to make sure the documentation was correct. If I saw a patient with an earache, I could check their ear. I could document the ear findings and I could treat them for it. However, the insurance companies require a minimum of 6 things to be checked for any office visit. They then have to hire someone to go out to physicians' offices to see if there are six things documented in the medical record. It doesn't really matter if you could make a diagnosis with less than six things. If less than six things are documented on the physical exam, the insurance company can elect to not pay the bill. If you think the insurance company missed something in the medical record, you can appeal the decision. You can make that appeal to the company's appeals department. All of the extra people involved in this process have salaries. All of those salaries have to be paid. Those payments come in the form of insurance premiums for those individuals with traditional insurance. They come in the form of taxes for Medicaid and Medicare. Just like any other business, the highest costs in medical care are due to salaries. Sometimes those salaries are necessary. That includes the receptionist and the nurse in the physician's office. However, there are many other salaries in the system that did not exist at one time. These include the salaries for the entire appeals department of the medical insurers, the salaries for the entire medical records checkers of the medical insurers and the salaries of the full time billers in the physicians' offices. Hospitals need to hire entire billing departments to deal with insurers. There are many reasons that medical care is so expensive. One of them is related to the salaries that we need to pay individuals to produce the red tape associated with the billing process. We have come a long way from the $10 office visit that I used to do in the 1970's.

Diabetes educational program Nanticoke Memorial Hospital, Seaford, will be holding a four-session diabetes educational program on Aug. 28 and Sept. 4, 11, and 18 from 9:30 to 11:30 a.m. to be held at the hospital. Registration for this class is required. The cost of the four-session program may be reimbursable by insurance. This four-session program includes weekly education sessions and individualized meal planning for diabetes self-management. The goal is to give you the self-management skills to control your diabetes. Family members/significant others are welcome to attend the weekly sessions. Pre-registration is required prior to attending classes. To register and to obtain additional information, contact Nanticoke Memorial Hospital's Diabetes Education department at 629-6611, ext. 2446.

Ferrer earns national certification Alina Ferrer, Spanish language medical interpreter at Beebe Medical Center, has been credentialed as a Certified Healthcare Interpreter (CHIª) in Spanish by the Certification Commission for Healthcare Interpreters (CCHI). Ferrer has been the Spanish language medical interpreter at Beebe Medical Center since 2003, and was the first to hold such a position at a hospital in the state of Delaware. Ferrer also coordinates the language service for the deaf at Beebe Medical Center, and developed the Spanish-language Patient Safety Satisfaction Survey. Before becoming a Spanish Language Medical Interpreter, she worked with patients in a Hospice organization and at Beebe's Tunnell Cancer Center. Ferrer holds a master's in social work. In 2011, she was elected as a director to the national board of the National Council for Interpreters in Healthcare (NCIHC). She is a member of Beebe Medical Center's Patient Relation's Department. For more information about the services that Ferrer offers, or that are available through the department, call 645-3300, ext. 5367.

Recovery Response Center opens Recovery Innovations, funded by the Delaware Department of Health and Social Services, will begin providing comprehensive recovery-based behavioral health services from its renovated facility in Ellendale for individuals in Kent and Sussex counties who are experiencing a behavioral health crisis. The new program, referred to as the Crisis and Psychiatric Assessment Center, opened on Aug. 20 as the Recovery Response Center at 700 Main St., Ellendale. The center is a 23-hour crisis assessment and engagement program for individuals 18 and older with significant mental health and/or substance use challenges. The goal of the Recovery Response Center's services is to divert from hospitalization and higher levels of care by rapidly getting to know the person's needs, engage in a voluntary recovery opportunity, and connect to community services and supports. For more information about the center, contact Gene Johnson, president/CEO, at 424-5660.

New procedure for varicose veins They cause swelling, aches and pain - and they also cause a dilemma for patients considering surgery. Varicose veins are veins that have become enlarged due to the backflow of blood down into the lower leg. Veins have valves to prevent blood from flowing backwards and leg muscles pump the blood from the lower leg up to the heart against the effects of gravity. However, when veins become varicose, the valves do not work and blood flows back down and pools in the lower leg. "It's a dilemma for many patients since traditional treatment calls for a surgery where the veins are cut out of the leg. Many patients would balk at such a procedure because of the pain they knew they would experience, and the prospect of a long recovery," said Bayhealth General Surgeon Brandt Feuerstein, MD, FACS.

However, a new minimally invasive procedure could bring relief to those patients without having to go through open surgery. Endovenous ablation allows a surgeon to perform a needle puncture in the leg and insert a catheter that seals off the leaking veins. Closing the vein is similar to shutting off a valve so that blood no longer pools in the lower leg. "Because the venous blood is immediately redirected back to the normal circulation and away from the varicosities, the results are often dramatic," said Dr. Feuerstein.

Pursue your passion by volunteering Bayhealth encourages you to "pursue your passion" by volunteering at the hospital. "Everybody has a passion. Whether you bake cookies, whether you read, whether you play a musical instrument, you can share your passion with patients by becoming a volunteer," said Bayhealth Manager of Volunteer Services Terry Schrenker. "By sharing your special gift, you're making people feel better during a difficult time. According to Schrenker, Bayhealth has 400 adult volunteers year round, and 100 student volunteers during the summer. The volunteers come from all walks of life, and perform a wide variety of functions at the hospital. This runs the gamut from baking and serving cookies, to sharing their pets, to being a good listener. Find out more by calling Bayhealth Kent General Volunteer Services at 744-7153 or Bayhealth Milford Memorial Volunteer Services at 430-5635 or by visiting

Bayhealth emphasizes prevention September is Healthy Aging Month, and Bayhealth is emphasizing the importance of health screenings and preventive healthcare to help you avert serious illnesses. You can take charge of our own health by taking a few simple steps:
  • See your doctor - Whether you are trying to resolve that ache in your abdomen or just have an important question, maintaining a relationship with your doctor allows your physician to help you manage existing health issues and prevent future health disparities.
  • Get your screenings - Screenings help detect potential health issues in the earliest, most treatable stages. Whether it's a mammogram for women over age 40, or a prostate screening for a man over age 50, these screenings are literally lifesavers!
  • Educate yourself about your health - In today's cyber age, an infinite array of health information is available at your computer. Pick up a book from the library or attend one of the myriad of free health seminars available in your community.
One valuable resource is Bayhealth's Steps To Healthy Aging Program which is a free membership program for any person age 50+ in the Bayhealth service area. Steps To Healthy Aging provides weekly blood pressure clinics, and monthly education seminars in which members can learn about a variety of health issues and get answers from a physician or health professional. For more information visit

ALA hosts skydiving fundraiser Take a leap to make the air cleaner and healthier. The American Lung Association in Delaware is sponsoring the Third Annual "Fighting for Air at All Extremes," a skydiving fundraiser. The event will take place from 8 a.m. to 8 p.m. Friday, Sept. 7 and Saturday, Sept. 8 at Skydive Delmarva on 32524 Aero Dr., Rt. 24 West, Laurel. Lung disease is the third leading cause of death in the U.S. According to the Lung Association's State of the Air 2012, more than 140,000 Delawareans suffer from asthma, chronic bronchitis and emphysema - all forms of lung disease. The ALA-DE hopes to raise $40,000 to support lung health research, education and advocacy efforts. Participants of Fighting for Air at All Extremes can join the jump as an individual, team, volunteer or sponsor. There is a registration fee of $25 per participant. All skydivers must be 18 or older. A fundraising minimum of $300 is required to receive a tandem jump. All fundraisers will receive gift bags and t-shirts. The top fundraiser will take home a special prize and all participants who raise $500 or more will be entered into a raffle for some great prizes. To register, contact Kelli Burris at 302-737-6414, ext. 14 or at or visit

Breast cancer support group Delaware Breast Cancer Coalition, Inc. (DBCC) has expanded its Beginning Your Pink Ribbon Journey, a program for women newly-diagnosed with breast cancer, by partnering with Nanticoke Memorial Hospital Cancer Center in Seaford. The free, monthly program is offered at the Cancer Center located at 801 Middleford Road, Seaford, the third Thursday of each month from 3 to 4 p.m. To learn more, call Lois Wilkinson at 672-6435. Registration is required and light refreshments and small gifts are provided.

HIV/AIDS Support Group A new support group for HIV/AIDS will meet every other Wednesday, at 7 p.m., in the Branford Lounge at Epworth United Methodist Church at 19285 Holland Glade Rd., Rehoboth Beach. The group is sponsored by Epworth UMC, CAMP Rehoboth, the AIDs Delaware and Delaware HIV Consortium. For more information, contact David at

Stroke Support Group Nanticoke Memorial Hospital's next Stroke Support Group meeting is Tuesday, Sept. 18, at 1:30 p.m. at the Seaford Library. The support group is designed for individuals who have survived a stroke as well as their families and caregivers. The two-hour support group meetings will consist of guest speakers and breakaway sessions, in which caregivers and stroke survivors will meet in two groups to discuss concerns, provide support, and allow for networking. Refreshments will be provided. Pre-registration is not required for this free support group. For more information, contact Nanticoke Memorial Hospital at 629-6611, ext. 8626.