{"id":514,"date":"2023-03-09T10:35:16","date_gmt":"2023-03-09T10:35:16","guid":{"rendered":"http:\/\/almc.purple.lk\/2023\/03\/09\/iusto-nostrum-soluta-voluptatibus-2-copy\/"},"modified":"2023-12-29T05:38:04","modified_gmt":"2023-12-29T05:38:04","slug":"penalized-for-positive-outcome","status":"publish","type":"post","link":"https:\/\/lifestylemedicineasia.org\/es\/penalized-for-positive-outcome\/","title":{"rendered":"How PCPs Are Penalized for Positive Outcomes From Lifestyle Change"},"content":{"rendered":"\n<h3 class=\"wp-block-heading\">Commentary<\/h3>\n\n\n\n<hr class=\"wp-block-separator has-alpha-channel-opacity\"\/>\n\n\n\n<h4 class=\"wp-block-heading\">Padmaja Patel, MD, President-Elect, American College of Lifestyle Medicine<\/h4>\n\n\n\n<!--more-->\n\n\n\n<blockquote class=\"wp-block-quote is-layout-flow wp-block-quote-is-layout-flow\">\n<p>The Centers for Medicare &#038; Medicaid Services (CMS) 2022&nbsp;<a href=\"https:\/\/www.cms.gov\/Medicare\/Quality-Initiatives-Patient-Assessment-Instruments\/Value-Based-Programs\/CMS-Quality-Strategy\">National Quality Strategy<\/a>&nbsp;is described as an \u00abambitious long-term initiative that aims to promote the highest quality outcomes and safest care for all individuals.\u00bb The strategy calls for a multidisciplinary, person-centric approach for individuals throughout the continuum of care, with an emphasis on historically underresourced communities. It is a commendable goal for an overburdened US healthcare system that&nbsp;<a href=\"https:\/\/www.commonwealthfund.org\/publications\/issue-briefs\/2023\/jan\/us-health-care-global-perspective-2022\">spends more<\/a>&nbsp;than other high-income counties yet experiences poorer outcomes. But whole-person, person-centered care cannot be achieved under current misaligned quality measures that fail to measure what we purport to value: the&nbsp;<a href=\"https:\/\/www.ihi.org\/resources\/Pages\/Publications\/quintuple-aim-for-health-care-improvement.aspx\">quintuple aim<\/a>&nbsp;of improved health outcomes, cost savings, patient satisfaction, clinician well-being, and health equity.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Lifestyle First<\/h4>\n\n\n\n<p>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&nbsp;<a href=\"https:\/\/dresselstyn.com\/JFP_06307_Article1.pdf\">cardiovascular disease<\/a>,&nbsp;<a href=\"https:\/\/www.sciencedirect.com\/science\/article\/abs\/pii\/S0899900714004237?via%3Dihub\">obesity<\/a>, and&nbsp;<a href=\"https:\/\/www.thelancet.com\/journals\/landia\/article\/PIIS2213-8587(19)30068-3\/fulltext\">type 2 diabetes<\/a>, 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 \u2014 usually adherence to medication \u2014 regardless of whether health outcomes improved.<\/p>\n\n\n\n<p>Rewarding medication adherence for the treatment of diseases in which lifestyle is a primary therapy (<a href=\"https:\/\/www.ahajournals.org\/doi\/pdf\/10.1161\/HYPERTENSIONAHA.120.15026#:~:text=To%20align%20with%20its%20mission%20to%20reduce%20the,hypertension%20in%20adults%2C%20aged%2018%20years%20and%20older.\">such as hypertension<\/a>), 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 \u2014 without side effects \u2014 is penalized.<\/p>\n\n\n\n<p>Misaligned quality measures like these can&nbsp;<a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMms2200977#:~:text=Metric%20Myopia%20%E2%80%94%20Trading%20Away%20Our%20Clinical%20Judgment,individual%20patients%20and%20from%20larger%20public%20health%20problems.\">stifle clinical judgement<\/a>&nbsp;and risk reducing the practice of medicine to mindless box-checking. In many cases, patients are not even informed that lifestyle behavior change may be a treatment option (much less the first recommended option) for their conditions. This delivery of care is not person-centered and, in fact, may raise questions about the adequacy of informed treatment consent.<\/p>\n\n\n\n<h4 class=\"wp-block-heading\">Reimbursement Barriers<\/h4>\n\n\n\n<p>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 nonphysician health professionals&nbsp;<a href=\"https:\/\/ablm.org\/\">have earned certification<\/a>. Health systems, including&nbsp;<a href=\"https:\/\/www.airforcemedicine.af.mil\/News\/Display\/Article\/2640590\/lifestyle-and-performance-medicine-shows-promising-impact-on-airman-guardian-re\/\">the US military<\/a>, are increasingly integrating lifestyle medicine. There have been advancements since&nbsp;<a href=\"https:\/\/www.ncbi.nlm.nih.gov\/pmc\/articles\/PMC8583485\/\">one survey found<\/a>&nbsp;that more than half of lifestyle medicine clinicians reported receiving no reimbursement for lifestyle behavior interventions. However, barriers, especially in fee-for-service systems, still inhibit many patients from receiving insurance coverage for comprehensive, interdisciplinary, and whole-person treatments called intensive therapeutic lifestyle change (ITLC) programs.<\/p>\n<\/blockquote>\n\n\n\n<p><\/p>\n\n\n\n<p>Weblink : <a href=\"https:\/\/www.medscape.com\/viewarticle\/997218?form=fpf\">Medscape<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Commentary Padmaja Patel, MD, President-Elect, American College of Lifestyle Medicine<\/p>\n","protected":false},"author":6,"featured_media":942,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[3],"tags":[],"class_list":["post-514","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-lifestyle-medicine-opinion"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>How PCPs Are Penalized for Positive Outcomes From Lifestyle Change - 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