Thursday, November 27, 2014
Doctor's Perspective
Caregivers who save money need rewards

By Dr. Anthony Policastro
We know that our medical care system is expensive. We know that there are many opportunities to save money. What we do not often note is the long term impact of the dollars saved. A small amount of medical care is paid for by patients. A larger portion is paid by private insurance companies. A significant portion is also paid by federal and state governments in the Medicare and Medicaid programs. Health care entities are the recipients of the money that is currently paid. The recipients may include physicians, hospitals, pharmaceutical companies and providers of other health care services. Fixing our current health care system will result in less dollars being spent which means that individuals who pay for their own care will spend less money. It also means that insurers and the government will spend less money. The question then becomes who will be getting fewer dollars. All of the recipients of the money saved will be affected. For example, if a physician does a really good job of taking care of his/her patients, they will not use as much in the way of services. The physician will then get paid less over time. If enough patients are given that same kind of successful treatment, the physician will not make enough money to maintain a practice. The money saved should result in some kind of reward, not less money. That kind of reward system is doomed to failure. We can use the example of a hospital. Every hospital has a group of patients with congestive heart failure. These patients frequently are readmitted for care. Each time the hospital gets paid for service offered to the patients. However, a hospital might decide to case manage this group of patients. They might pay someone a salary to work with these patients on a regular basis. The patients might be admitted less frequently and the result will be a cost savings to the insurer. However, the hospital has to spend money on the case manager's salary. In return the hospital will make less money because patients are not being admitted as frequently. It makes one wonder whether there is any incentive for the hospital to do something like this. It is clearly not cost effective. When the Affordable Health Care Act was being passed, I wrote a series of articles. The gist of them was that the basic idea was good, however, we had a system that needed to be fixed. Just increasing the number of people that used that system was only one step.

It is much more complicated than that. We need to find a way to reward the medical caregivers who are pioneers at saving money for the system. Right now their reward is to save money for the system but lose money for themselves. That is not a recipe for long term success.

First flu death of the season Delaware's Division of Public Health (DPH) reports the first flu-related death of the 2014-2015 flu season. The individual is an 83-year-old woman from Sussex County who died on Nov. 17. Infection with influenza A was later confirmed by the Delaware Public Health Laboratory as part of the state's surveillance efforts. DPH reports a total of 37 cases for the current flu season in Delaware, with the number of cases expected to rise over the next three months. In the 2013-2014 flu season, there were a total of 1,842 confirmed flu cases in Delaware, with six flu-related deaths. Delawareans are encouraged to prevent flu infection by taking the following measures:
  • Get the flu vaccine.
  • Wash hands frequently.
  • Cover coughs and sneezes with a tissue and dispose of the tissue immediately. If a tissue is not available, cough or sneeze into your inner elbow.
  • Stay home when sick and do not return to work until 24 hours after a fever is gone.
For more information on the flu or where to get vaccinated, visit or call 800-282-8672.

Children's Holiday Workshop Children or teens who are coping with the recent loss of a loved one are invited to attend Delaware Hospice's "Children's Holiday Workshop," sponsored by the New Hope Program, which will be held on Saturday, Dec. 6, from 10 a.m. to 12:30 p.m., at the Delaware Hospice Center, Milford. The Children's Holiday Workshop is appropriate for any child between the ages of 6 and 17. The focus of the workshop will be to talk about the difficulty of grieving during the holidays. The group will discuss things to do and ways to cope, and will create a holiday ornament. Refreshments will be provided. Registration is required as space is limited. Register by contacting Robin Murphy, New Hope counselor, at 678-4444 or