Page 9 - Delaware Medical Journal - January/February 2019
P. 9
PRESIDENT’S PAGE
ANDREW W. DAHLKE, MD
MSD President Andrew W. Dahlke, MD is a Neuroradiologist who practices with Southern Delaware Imaging Associates in Lewes.
Working Together
to Slow Growth in Health Care Spending
When Gov. John Carney assumed
state budget was mired in red ink. Money being spent on Medicaid
consuming too large a share of the state budget. This out-of-control health care spending limited budget allocations for necessary infrastructure investments
like education and roadways, leading
to the benchmarking process where an all-claims database will be stored on the Delaware Health Information Network (DHIN).
Health Secretary Kara Odom Walker, MD and Health Care Reform and Financing Director Steven Costantino have led
the way in the benchmarking process,
and soon Delaware should have a better understanding of how much we spend on health care. Understanding how much we spend is a start, but the real solution to the health care spending crisis will come from the physicians at MSD and our partners.
The biggest saving in health care can be achieved by embracing ethical palliative care using evidence-based medicine to suspend futile medical interventions in the last two weeks of a patient’s life.
My residency director, Jay MacMoran, MD, would quote that 75% of Medicare spending occurs in the last two weeks of a patient’s life, and the problem
the last two weeks. At MSD, we are fortunate to have John J. Goodill, MD serve on our Committee on Ethics and lead palliative care efforts across the state. As all Delaware hospitals fully embrace and implement palliative care, futile medical expenditure at the end of life should decrease and the rate of increase of the total cost of health care in Delaware will slow.
The second-biggest saving in health care can be achieved by embracing primary care and understanding that primary care is the keystone in the medical pyramid. The lack of primary care access for Delaware citizens has directly produced
poor patient health care outcomes.1 MSD member James M. Gill, MD was the primary care physician leader behind Senate Bill 227, the Improving Access
to Primary Care bill. This bill increases commercial insurance reimbursement for primary care services and chronic care management to Medicare levels (previously, insurance companies were paying 65% and 85% of Medicare to primary care physicians).
This underpayment was driving PCPs out of business, out of state, into retirement, or into concierge medicine. Unfortunately, Medicare rates are much too low to compete with surrounding states or to draw new physicians to our state, but this
Del Med J | January/February 2019 | Vol. 91 | No. 1 9
