Press Release For Thursday July 5, 2012

MDPrevent & Consumer Reports Agree 
On The Need For Preventive Medicine

MDPrevent Offers The “Prevention Attention” 
Advocated For By July 2012 Issue

MDPrevent, a primary care medical practice focused on preventive medicine and wellness offers the full range of preventive medicine and wellness services desired by patients.

Delray Beach, FL July 3, 2012

According to Consumer Reports on Health (CR), “Immunizations, cancer screenings, lifestyle counseling, and other wellness measures can save lives. But your doctor may be falling short when it comes to making sure you’re up to date on the services you need.” CR cites a January 2012 study published in the American Journal of Preventive Medicine to support is conclusions.

CR is spot on. In 2011, Medicare implemented new coverage for Annual Wellness Visits (AWV) as part of a growing menu of preventive services. As with many other preventive services, the AWV requires no co-payment or deductible.  Yet, in 2011, only 6% of patients received this service from doctors who performed it and many did not receive the proper service. Why? As CR writes, “wellness gets squeezed” because “it doesn’t pay for doctors” to do it, for many doctors “its awkward territory,” and “most doctors don’t have the time.” Wellness, according to CR, when even done, is typically not the “focal point”; rather, “wellness gets squeezed into visits when people have a problem.”  

Working within Medicare’s guidelines for AWV, MDPrevent, a primary care, preventive medicine, and wellness center was launched to fully address the wellness needs of Americans. MDPrevent’s innovative medical practice combines in one location the expertise needed to provide the full spectrum of wellness services. With a team consisting of a physician, nurse practitioner, nutritionist/registered dietitian, health psychologist, fitness and yoga instructor, and health educator, MDPrevent can uniquely help patients enjoy life to the fullest, free of disease.

The MDPrevent model is sure to become the future of integrative medicine enabling patients to draw on the full expertise and guidance they need from their primary care office to avoid, delay, or mitigate chronic diseases and improve their current quality of life.

As one part of MDPrevent’s offerings, it custom developed the LEAN program, a medically supervised 12 week personalized lifestyle modification program that includes initial medical assessment, coupled with private consultations with a nutritionist/dietitian, psychologist, fitness and yoga instructor, and health educator, and rounded out with a final medical assessment. Patients then continue with private consultations as needed or join support group and educational group sessions. The program aims for slow, but steady and sustainable lifestyle modification and weight loss by focusing on healthy living and well-being. In addition, MDPrevent is also a Certified Diabetes Education Center catering to the nutritional and educational needs of diabetics.

MDPrevent was founded by Dr. Steven Charlap, a pioneering physician with an MD from New York University, an MBA from Harvard, and general surgery training. In 1989, he founded HealthDrive, which grew it to be the largest U.S. medical and dental practice serving the extended care industry. Over twenty years, HealthDrive cared for over 5 million seniors and Dr. Charlap witnessed first-hand what happens to people who don’t take adequate care of their health, are institutionalized and become dependent on the kindness of strangers. According to Dr. Charlap, “It is sad to see people end their lives in a nursing home. You realize that in such a setting relatively little can be done to improve health at that point. Even more frustrating was that one couldn’t even try because Medicare and Medicaid basically shunned preventive services.”

In 2010, after Dr. Charlap learned that Medicare was initiating coverage for wellness services that can positively impact people’s lives while saving Medicare money, he founded MDPrevent to create an innovative preventive medicine, primary care, and education center focused on providing community based services to help people change their lifestyles to avoid and mitigate chronic diseases. Dr. Charlap states, “The scientific evidence shows that the longer you live, the healthier you’ve been.” After extensive research and consultations with the experts in the field of primary prevention, an interdisciplinary dream team of Preventioneers was assembled.

Testimonials from patients include comments like, “I finally have my head on straight” or “it’s changed my life.” (See www.mymdprevent.com, Testimonials). According to Dr. Charlap, “I see the smiles on people’s faces when they complete a session for the day. They feel empowered and for the first time in a long time, in control of their health and their weight. I know we are really on to something that can change the future of healthcare.”

About MDPrevent

MDPrevent is a new concept in primary care that seamlessly integrates primary care, preventive medicine, and wellness. The healthcare practice helps American’s prevent problems before they happen, reduce healthcare costs, stay healthy, and enjoy a life well lived through free Annual Wellness Visits (paid 100% by Medicare and most major insurances) The Annual Wellness Visit includes a comprehensive health risk assessment, biometric measurements, review and analysis of prescription, supplement and vitamin use, nutrition review, and development of a five- to 10-year prevention plan.

MDPrevent’s Preventioneers, or Prevention Pioneers, include MDs, nurse practitioners, health psychologists, registered dietitians and nutritionists, fitness and yoga instructors, and health educators, offer private consultations and experiential group sessions, medically supervised weight loss (with no pills, injections or surgery - paid 100% by most insurances if you qualify) and other classes on health, diet and nutrition, fitness and exercise, stress management, mindfulness, relationship and social network building, and other key elements of a healthy life. The goal: to improve life and smooth out the effects of aging by identifying, preventing, delaying or mitigating the development of chronic diseases such as heart disease, diabetes, stroke, dementia and some forms of cancer. Learn more at http://www.MyMDPrevent.com. Read Dr. Charlap’s blog at mdprevent.blogspot.com

MDPrevent
5130 Linton Blvd. Suite H1

Delray Beach, FL 33484
(561) 807-2561

Prevention May Be The Best Path

Did you hear the good news? Yesterday, researchers at Duke University using a new model, predicted that by 2030, only 42% of Americans will be obese. Today that number is 36%, but the apparent good news is that a previous model predicted it would be 51%.  At the same time, the researchers predict that severe obesity would rise to 11% instead of the previously predicted 9%. 

The reasons for the discrepancy were described as the researchers taking into account factors such as unemployment rates; prices for alcohol, gas, and fast food; prices of healthy versus unhealthy foods; access to the Internet; and the number of fast-food and full-service restaurants per 10,000 people.

So is this really good news? Should we break out the champagne or the tissues? I find it hard to imagine that nearly half of all Americans will be considered obese in less than twenty years. But what is even more difficult to absorb is that our government is not obsessing about this problem.

This year, the Centers for Medicare and Medicaid Services (CMS) took a big step forward and initiated coverage of Intensive Behavioral Therapy for Obesity. They define obesity as a body mass index (BMI) of 30, which is about a 5 foot 4 inch woman weighing about 170 pounds or a 5 foot 9 man weighing about 200 pounds.  The problem is that if your BMI is 29.9, you are out of luck. At that number, you are entitled to no therapy whatsoever.

I can appreciate that there needs to be a threshold at some level, but I believe it should be several BMI points lower. Why wait until someone is already obese to intervene? Studies show that many things change including our gut bacteria, metabolism, and hormonal balances as we gain weight. Basically, it gets harder to lose weight the more you gain AND it gets harder to keep it off after we gain it and try to lose it again.

The other problem with CMS's obesity initiative is that the reimbursement is approximately $27 for 15 minutes up to 16 times spread across 6 months (6 more spread across the next 6 months if you lose 6.6 pounds after the first 6 months). That extrapolates to about $108 per hour, far below what the average primary care physician, which is the only type of physician that can offer the service, earns before overhead, staff, malpractice insurance, billing costs, etc.

Multiple google searches have failed to identify a single doctor or practice in the U.S. offering this service. I can find no practice marketing it. I also asked dozens of primary care providers and they have said they do not as well.

Is it the low reimbursement? Maybe. Is it the lack of knowledge necessary to provide intensive behavioral therapy? Maybe? Is it the reluctance of doctors to tackle their patients' obesity?  I can only say maybe again because I don't really know any of these answers as to why other doctors choose as they do. But I do know we have a problem and it's not just doctor engagement.

I think the real problem is the patients.  Tackling obesity with just primary care practitioner led therapy, instead of pills and surgery, requires real commitment on the part of patients. Obese patients know they have a health problem and that their long term health prospects are at play. Most also know that obesity is not particularly attractive. Yet, whether you believe it is a disease or a choice, these same people find it difficult to tackle their issue. Few prefer to be so overweight and need help to break out of their weight captivity.

So what do we do about this problem? Some may say financial incentives. I don't think that is a long term solution and I have previously explained why. While short-term incentives may work, weight is often easily regained unless fundamental changes to lifestyle are made and such changes can most of the time only be brought about by a concerted effort.

So how do we do that? I propose an integrated and interdisciplinary approach. In other words, I think it will take a team effort of motivated, committed, and trained practitioners to support, guide and educate patients to bring about real change. About 4 months ago, MDPrevent proposed such a model to CMS. MDPrevent asked for funds, to which I and others would contribute additional funds, to tackle not only the rising epidemic of obesity, but also heart disease, diabetes, dementia, and cancer.

MDPrevent's program, which we titled, Intensive and Integrated Behavioral Therapy for Lifestyle Modification would combine the talents of a primary care provider, a registered dietitian, a health psychologist, a fitness instructor, and a health educator to work with patients on both an individual and group (group success can be contagious) basis and help them tap into their own motivation to make change.

We anticipated that it would take a full year to bring about meaningful success and expected to be able to do so at a cost of slightly above $600 per patient. For this meager amount, we believe that we can change the course of someone's health and life trajectory.

Can anyone argue that it isn't worth the effort given the obesity and other chronic disease projectories? There is no profit for MDPrevent in the amounts requested because we believe that we must first prove the success of such a program before profits can even be considered.

The goal of the program is to identify and tackle pre-obesity, pre-diabetes, pre-stroke, pre-heart attack, and pre-cancer situations and implement a series of lifestyle changes to prevent, delay or even mitigate the development of these life threatening conditions.

The decision from CMS regarding funding this initiative was originally due March 30. We are in overtime. I am told it will come shortly. This program could be a game-changer for the country at large. Wish us luck!

Just Look In the Mirror

I read an interesting article yesterday on the Fox Business website titled DIY health care: The trouble with direct-to-consumer health screenings. DIY stands for Do It Yourself.

The gist of the article describes the dangers associated with participating in unsolicited screening tests offered by commercial, usually mobile, companies. The article states that if "you get a letter in the mail inviting you to participate in a simple, potentially lifesaving screening to assess your risk for stroke, abdominal aortic aneurysms and other scary stuff, you should probably toss it out with the rest of the junk mail."

The article gives several reasons. One reason is the perils of self-diagnosis. (See my blog from March 14 titled, Are You A Doctient?) The article states, "People might buy direct-to-consumer health screenings for their own self-diagnosis and self-treatment for symptoms of disease. "It's difficult for the lay public to really appreciate the nuances and wholly understand the difference between screening and diagnostic testing. Many patients seek screening tests for symptom diagnosis. These patients can be dangerously falsely reassured by normal results if they have chosen the wrong test, or even led in the wrong direction with abnormal results."

The article adds, "Additionally, many of the medical screening tests are not supported by evidence-based guidelines and therefore expose patients to tremendous and unnecessary harm. "The data has shown that many of these tests [when used for disease screening] will produce far more harm than benefit for most patients." (See my blog on April 5 about unnecessary tests).  

One more consideration. According to Linda Sherry, director of national priorities for Consumer Action, agrees. "These tests have limited or no diagnostic value and may trigger stress [and] fear, and encourage further, more expensive testing to rule out false positives. Insurance won't pay for them unless they are ordered by a doctor for diagnostic reasons, not preventive reasons."

If you're looking to save money, "you can take your own blood pressure at most pharmacy chains and many communities have health screening days designed to educate people about symptoms that might require follow-up," says Sherry.

Read more: http://www.foxbusiness.com/personal-finance/2012/05/02/diy-health-care-trouble-with-direct-to-consumer-health-screenings/#ixzz1toa6ivop

On a personal note, I participated in such a screening program about a year ago offered by Lifeline Screening. I went for the whole megilla. I did so as part research and part curiosity. A routine blood sugar measurement revealed that I had a 105 level. Such a level is construed as elevated. (by the way, I noticed the tech eating a fruit shortly before th test and contact witht eh fruit could have skewed my result.) 

When sharing the blood results with me, the concerned technician told me that I was pre-diabetic and I should "watch" my number. The absurdity of the statement struck me immediately. What did "watch" my number even mean? He didn't tell me to consult with a physician. He just told me to "watch." Did he mean for me to use his services again to see how the number changed? He didn't say, but I suspect as much. Being pre-diabetic is a warning sign that requires intervention before you progress to full blown diabetes. Telling me to "watch" my number was worthless.

So what's a person to do?  I say instead of relying on marketing solicitations for tests that you probably don't need and should generally only be ordered by a physician when you do need them, let me offer some practical alternatives.

First get on a scale. Then calculate your BMI. Here's a good site to calculate it:

http://www.nhlbisupport.com/bmi/  

If your BMI is over 25, you are in unhealthy territory. Over 30 you are in a real danger zone. Over 40, start saying your goodbyes if you don't do something immediately about it.

Next measure your waist circumference. If you have a bulge around your waste, that typically means you are accumulating the unhealthy type of fat cells called white fat cells. They predict problems and just like with an elevated BMI, you should initiate changes to your lifestyle to improve your health prospects.  I recommend starting with a physician consultation and then moving on to a nutritionist and fitness instructor. If stress and/or sleep are a problem, consult a psychologist as well.

Finally, take a long, hard look at your naked self in the mirror. Do you see a healthy, vibrant, relaxed, age appropriate person in the mirror or a tired, slumped, over- or under-weight, stressed-out individual? Be honest with yourself. If you look good, you probably feel good and you are probably doing well. But if you look worn-out, haggard, depressed, older than your age, I think it's time to get serious about your health and to develop a personal wellness plan.By the way, while you are looking, check for any abnormal growths on any aspect of your body front and back, top and bottom.

Try doing this once a month to take stock of your life and health. It's free, it's easy and it will provide much valuable information that will not lead to unnecessary and expensive testing. So the next time you get a solicitation from a testing company, try making an airplane out of it for fun. Nevertheless, listen to your body and if you have any concerns, consult a physician.

My responses to NY Times Opinion piece.

An "Opinion" piece ran in Monday's NY Times in which six individuals weighed in on what it will take to address the poor eating habits of Americans.

The link to the NY Times piece is at end of this blog.

In the comments section, I posted the following three responses.


Part 1: After reading the views about improving healthy eating, one subject was untouched--the role of physicians, nutritionists, and registered dietitians (RDs) in correcting American's poor eating habits. Most Americans continue to trust their physicians and the advice they receive. A recent study demonstrated that patients are likely to heed nutritional advice when given. Nutritionists/RDs have the most relevant training of anyone to address patients' dietary habits. Yet, most health insurances do not reimburse for such services. Medicare primarily only pays for nutritional therapy for diabetics and end stage kidney disease. Due to no reimbursement for nutritional services, physicians do not employ nutritionists/RDs in their practices. This may be the most shortsighted aspect of our healthcare system. In 2011, Medicare added an Annual Wellness Visit. This visit requires completion of a health risk assessment, and appropriate referral as needed. Often, that need centers on nutritional services. During a July 2011 conference call regarding the Annual Wellness Visit with Centers for Medicare and Medicaid Services (CMS), I asked how is that referral to be successfully made given there is no reimbursement available to cover it. The response was that I had asked a good question that needed to be addressed. During a similar conference call last month, the issue was unaddressed and there is still no solution.

Part 2. Patients developing chronic diseases, i.e. diabetes and heart disease, generally have poor access to a nutritionist or RD. Absent insurance coverage, they must pay out of pocket. As few seek such services, dietitians need to charge more to cover costs. Yet, when diabetes, heart disease or other diet-related diseases, e.g. dementia, cancer, strokes etc., emerge, then the floodgates open and we pay. From 1989 to 2010, I led an organization that provided medical care to over 5 million seniors and saw what happens to many Americans who live an unhealthy lifestyle, get sick, and are institutionalized. Lifestyle intervention could have made a difference because as the CDC states, "the evidence for the power of prevention is now indisputable." In response, I opened in October 2011, MDPrevent, a primary care/preventive medicine/education center committed to helping patients stay and get healthy. We group doctors, nurse practitioners, health psychologists, nutritionists/RDs, fitness instructors, and health educators to facilitate affordable nutritional seminars, weight loss, mindfulness and cooking classes, diabetes education, life-transformation classes, fitness and yoga classes. So while others debate how to get people to eat healthier, we are busy doing it. If insurance companies started covering lifestyle modification programs and nutritional services, we could all start focusing on prevention instead of treatment.

Part 3. Despite this apparently righteous debate about improving diets in America, I fear that this discussion will be put to a more nefarious use--support for dietary supplementation. The marketers of such products, despite the absence of supporting evidence for their value (and most recently evidence of heir harmfulness), often argue that Americans eat poorly and need to supplement to maintain good health. Most Americans despite their obesigenic and otherwise unhealthy diets, get sufficient vitamins and minerals from the numerous fortified foods they consume. Yes, there is a huge problem with the nature of food most people eat, but the answer is not increased supplementation.

Link to NY Times article:

http://www.nytimes.com/roomfordebate/2012/04/15/do-we-need-more-advice-about-eating-well