Prevention isn't just more statins

[facetguy]

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An op-ed today from Charles Krauthammer argues that prevention costs too much: http://www.chron.com/disp/story.mpl/editorial/outlook/6574083.html

But his idea of prevention is to give more people statins, for example, which does cost more money and (he's right) isn't worth it due to NNT issues.

It is odd that prevention gets such a bad name in current healthcare reform discussions.

Dean Ornish has a different take:
http://www.huffingtonpost.com/dr-dean-ornish/resuscitating-health-care_b_255224.html

Many here will argue that patients are lazy and lack personal responsibility. I'm not sure it's so simple.

 

[Pharmavixen]

An op-ed today from Charles Krauthammer argues that prevention costs too much: http://www.chron.com/disp/story.mpl/editorial/outlook/6574083.html

But his idea of prevention is to give more people statins, for example, which does cost more money and (he's right) isn't worth it due to NNT issues.

It is odd that prevention gets such a bad name in current healthcare reform discussions.

Dean Ornish has a different take:
http://www.huffingtonpost.com/dr-dean-ornish/resuscitating-health-care_b_255224.html

Many here will argue that patients are lazy and lack personal responsibility. I'm not sure it's so simple.

Charles' view of prevention is too narrow.

And yes; people making the argument that patients are lazy and lacking in personal responsibility are themselves being mentally lazy, forgetting that modifiable risk factors are not the whole picture.

 

[cpants]

"This is a groundbreaking bill, based on the proven idea that lifestyle changes can improve the health of those with chronic disease if people stick with a program that has that goal in mind," said Senator Wyden. "The Take Back Your Health Act gets doctors and patients invested in the success of treatment, since doctors won't be paid unless their patients actually get better."

There's a scary thought.

 

[koopa_troopa]

There's a scary thought.

Yeah, outcome based reimbursements are a dangerous idea. I had hoped people had learned a thing or two after the implementation of No Child Left Behind.

 

[RabbMD]

Charles' view of prevention is too narrow.

And yes; people making the argument that patients are lazy and lacking in personal responsibility are themselves being mentally lazy, forgetting that modifiable risk factors are not the whole picture.

So what would your view of prevention be? I keep hearing this argument, but what can doctors actually do for other types of "prevention" aside from telling patients to exercise, quit smoking, and lose weight?

 

[LeemerDO]

If I bank my money on my patients' ability to comply with my recommendations, that's like the easiest way to lose the shirt off my back. Look, if we're gonna make this interesting, we need to find a way to put some odds on our patients. Healthcare's a gamble anyways. Let's have fun with it. Take any disease or condition and put odds on whether or not they get better. Then take the $ hitty low reimbursement rate and multiply it by the odds ratio. The more complex, the more risk, the more of a long shot that they get better, and if they do, doctors should be paid more handsomely.

Haven't figured out hospice patients. Seems a bit more macabre and goulish to bank on terminal conditions.

And NO, no death pools. That's just not cool.

 

[cpants]

So what would your view of prevention be? I keep hearing this argument, but what can doctors actually do for other types of "prevention" aside from telling patients to exercise, quit smoking, and lose weight?

Not really. There are a few not so desirable medical and surgical options, but when it boils down to it, education and guidance is basically all we can do. I'm sure the docs will be lining up to see these obese patients when they find out they don't get paid unless the person loses weight.

 

[Instatewaiter]

Why not have the patient pay a co-pay based on risk factors.

So if obese you add $10, if you smoke $10 more. If you do drugs $10 more. Do you just sit around? $10 more. Non-compliant? $10 more. You see the point. It would force people to be compliant and actually do some work themselves.

 

[st0w]

Why not have the patient pay a co-pay based on risk factors.

So if obese you add $10, if you smoke $10 more. If you do drugs $10 more. Do you just sit around? $10 more. Non-compliant? $10 more. You see the point. It would force people to be compliant and actually do some work themselves.

This seems very dangerous to me, actually. Most patients would lie about the things they do, in order to not pay the co-pay. Granted you can't lie about obesity, but you can lie about smoking, drugs, sedentary lifestyle, etc. And we can't test them all to be sure they're telling the truth, because that gets to be expensive pretty quickly.

The additional problem that creates is that not only do patients lie to avoid paying the fees, but it creates an impetus for patients to not be truthful about bits of information that are critical to providing proper care. I don't think there should ever be a penalty for being truthful with a doctor about health habits. As is, patients routinely lie about compliance and all sorts of things. We don't need to give them more of a reason to lie.