In today's blog I want to discuss some insurance and medical practices that are hard to believe but may be harmful to your health!
Through the years of my functional nutrition practice, I've worked with thousands of really dedicated but frustrated people looking for answers to be able to take back control of their health. Some;
- felt shame about their body and appearance,
- others concern for their future with poor life expectancy,
but each had one thing in common, limited options guiding them to optimize their health and live their best life without the use of medication.
Not long ago a woman came to me to lose weight, she struggled her entire life. Tried every diet that came along spending thousands of dollars and decades looking for the answer. We did her initial lab and found out quickly she was diabetic; she had no idea. It explained her thirst, fatigue, hunger, especially for sweets and constant weight gain.
In 2 months, she was able to almost completely reverse her diabetes with guided dietary, lifestyle changes and no medication. She is currently barely prediabetic and I have no doubt as hard as she's working that she'll soon have perfectly normal blood sugar levels and HbA1c.
As a functional nutritionist a primary focus is on cleaning up someone's eating habits. the labs reveal any metabolic roadblocks keeping them stuck, but I had a plan for her. It's amazing to see such profound results in only two months.
Because I know and believe in the power of food and changing someone's diet I wanted to share the following article with you. I hate the thought that our medical system is broken but it's unconscionable to me that doctors are getting paid more by insurance companies to keep them on medication, to keep them ill.
I hope you keep this in mind as you read the article below. This letter was written by Padmaja Patel, MD - President-Elect, American College of Lifestyle Medicine. It's a fascinating 6-minute read and well worth it.
By Padmaja Patel, MD - President-Elect, American College of Lifestyle Medicine
Lifestyle First
Clinical practice guidelines for many chronic diseases recommend lifestyle intervention as the first and optimal treatment.
A growing body of evidence supports lifestyle behavior interventions to treat and, when used intensively, even reverse common chronic conditions such as cardiovascular disease, obesity, and type 2 diabetes, while also providing effective prevention for those conditions.
However, no current quality measures consider lifestyle interventions.
In fact, some quality measures unintentionally penalize physicians for successfully treating or reversing disease through lifestyle behavior interventions while rewarding clinicians for meeting process measures — usually adherence to medication — regardless of whether health outcomes improved.
Rewarding medication adherence for the treatment of diseases in which lifestyle is a primary therapy (such as high blood pressure), combined with other healthcare constraints (lack of lifestyle education, time to spend with patients, and infrastructure support) incentivizes physicians to skip the conversation about lifestyle changes and go straight to medication prescription.
Meanwhile, the clinician who takes the extra time to guide a patient toward lifestyle interventions that could treat their current disease and prevent future diseases — without side effects — is penalized.
Reimbursement Barriers
Lifestyle medicine is a growing medical specialty that uses therapeutic lifestyle interventions as a primary modality to treat chronic conditions. Since certification began in 2017, almost 2500 US physicians and 1000 non-physician health professionals have earned certification.
Health systems, including the US military, are increasingly integrating lifestyle medicine.
There have been advancements since one survey found that more than half of lifestyle medicine clinicians reported receiving no reimbursement for lifestyle behavior interventions.
Penalizing Successful Outcomes
Despite the fact that lifestyle behaviors are top contributors to health and, conversely, contribute to up to 80% of chronic diseases, few quality measures focus on screening for lifestyle factors or treating diseases with lifestyle interventions.
An example of an existing quality measure is screening or treatment for harmful substance use.
Specific quality measures that penalize lifestyle medicine approaches include pharmacotherapy for type 2 diabetes, dyslipidemia, osteoporosis, and gout as well as approaches to rheumatoid arthritis.
Statins offer a useful example of the conundrum faced by clinicians who want to offer lifestyle interventions.
A lifestyle medicine primary care physician had a patient covered by Medicare Advantage who was diagnosed with hyperlipidemia. The patient had a total cholesterol of 226 and a triglyceride level of 132. Instead of prescribing the routine statin, the physician prescribed lifestyle behavior modifications. Within 3 weeks, the patient's total cholesterol improved to 171 and triglycerides to 75. This was a great success for the delighted patient.
However, the CMS 5-Star Rating System assigned the primary care physician a grade of C rather than A, which put the physician's 5-star rating at risk.
Why? Because the system bases its score largely on medication compliance.
The physician was penalized despite achieving the optimal health outcome, and at a lower cost than with medication.
Medicare risk adjustment incentivizes physicians to manage rather than reverse disease.
How much Medicare pays health plans is determined in part by how sick the patients are; the sicker the patient, the more Medicare pays, because those patients' costs are expected to be higher.
This ensures that health plans are not penalized for enrolling sicker patients. But a physician utilizing diet alone to achieve remission in a patient with type 2 diabetes is penalized financially because, when the risk is adjusted, diabetes is no longer listed among the patient's conditions.
So, Medicare pays the physician less money.
(Is the current system set up to keep you ill therefore the doc gets paid more? I wonder... this is Dr. Plank's comment and interjection)
It is vital that lifestyle behavior interventions — optimal nutrition, physical activity, restorative sleep, social connections, stress management, and avoidance of harmful substances — become the foundation of universal quality measures.
This will ensure that every clinician is incentivized to discuss lifestyle behaviors with patients and pursue the first clinical step recommended by clinical practice guidelines for most chronic diseases.
Only then can we truly deliver high-value, whole-person, person-centered care and achieve the quintuple aim.
Did you know this?
Shop for the person you seek medical advice from wisely, it's your health depends on it!
