Dr. Steven Charlap founded MDPrevent, a preventive healthcare clinic in Florida. He wrote a detailed obituary of his startup for The Atlantic. He built a team that included a health psychologist, registered dietitian, exercise physiologist, yoga instructor, health educator and nurse practitioners. The plan was for a physician to complete an initial health risk assessment, make the appropriate internal and external referrals, and then monitor the patient’s progress.
He said the three pillars of the American healthcare system were to blame for the practice’s demise: doctors, payers and patients. It’s worth your time to read the entire post but here are the reasons he blames each group.
First, few primary care and internal medicine doctors would refer to us. Some local specialists told us they would not refer to us because of fears of offending their primary care and internal medicine referral sources. The hospitals were no better.
Then there were the payer problems. Most of the third-party insurance companies in the area did not cover our services at all. Medicare was the exception, but reimbursement was insufficient to cover our costs. But the final, and possibly most important, factor was a Medicare contracted audit we went through.
The final contributors to our demise were the patients themselves. When it came to pharmaceuticals, we didn’t rush to prescribe if there were a non-drug alternative. This approach was a turn-off to many patients who expected a prescription or emphatically clung to beliefs in supplements.
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Charlap tried to take advantage of the aspects of the ACA that encourage wellness but that was a bureaucratic nightmare. His story is a perfect illustration of how hard it will be to transform a healthcare system that “makes money by treating disease, rather than by preventing it.”
[Image from flickr user Andrew Dyson]
