The
Benjamins

October 15, 2023 --

The things that primary care providers (PCPs) can do to get the best outcomes for patients with chronic conditions are disincentivized by our medical-industrial complex. Why? In the deathless words of Rep. Ilhan Omar, "It's all about the Benjamins, baby."

What could PCPs do to improve outcomes? Promote lifestyle change, educate about healthful diet and fasting, and encourage and support regular exercise.

Why don't they? These things don't make money so the system disincentivizes them. In How PCPs Are Penalized for Positive Outcomes From Lifestyle Change, Medscape reports that they are rewarded not when the patient gets better but when the patient adheres to their medication regimen. Yet often the medication is not the best therapy.

"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."

Is this yet another ugly conspiracy? If so, the docs are not in on it. Indeed, according to Medscape, they are among the victims, discouraged from doing what they know to be best.

How do we fix it? Implied by the Medscape article, one obvious solution is to tie MD ratings to outcomes (did patients get better?) not just to process (did they do as they were told?)

But the more effective solution -- surely harder to implement -- is better regulation of Big Pharma and the health insurance industry. It's still about the Benjamins.

Go regulators! Go courageous PCPs! Go positive lifestyle-encouraging nurses!

Table of Contents