My solution to the deficit
I want to talk about Ensure, a nutritional supplement made by the Ross division of Abbott Laboratories.
I read a Wall Street Journal article last week about a hospital in Galveston, Texas (UTMB) that had to watch its budget. One of the ways it cut the budget was by denying a request to send an uninsured patient home with four cases of Ensure, worth several hundred dollars, saying instead, "go buy some carnation instant breakfast".
That seems like a reasonable substition and a good way for the hospital to save money. Ensure is just a beverage loaded with sugar. It costs a lot: $1.50 per serving, while Carnation powder is $0.39 per serving. It looks like a serving of the powder gives somewhat fewer calories but...
Here is what one nutritionist said in her recommendation of ensure:
"...many of my patients use Carnation Instant Breakfast with milk instead. It is 1/3 the cost of Ensure and it provides similar nutrients and calories. "
She said a lot of positive stuff about it and I am sure it is a quality product, but why can't medicare insist that Carnation Instant Breakfast be used instead?
Many patients just get prescribed Ensure and don't question it. I'm not concerned, really, except if medicare is paying for something that isn't needed. Here is a site where Ross lists how much each state reimburses for its various products. For Minnesota it says "every product is reviewed for medical nessessity." What this says to me is that it is up to individual doctors, nurses, and administrators decide whether to give Ensure. Then, if they decide, Medicare pays for it. And I will bet you a tub of your favorite weight gain formula that Ross has its representatives keeping these gatekeepers "informed" about their product.
So my question is, wouldn't it be better if we had a state-wide rule saying "no Ensure.", or if someone who actually knows what they are talking about decides it is not completely replacable with Carnation Instant Breakfast, then a statewide rule saying, " No Ensure unless the patient is really really messed up"?