The prevention dilemma: No profits

Sure, building a practice around prevention works when you're Dr. Arthur Agatston, the renowned cardiologist behind the South Beach Diet book phenomenon. In a recent interview with a reporter, Agatston said that since he's given his practice a prevention focus, offering frequent personal contact with nurses and visits with a personal nutritionist, he's gotten down the number of heart attacks in his 2,800 patient base to virtually nil. The thing is, his practice loses money, a problem Agatston acknowledges but can only solve by applying the millions he's earned from his literary efforts. The reality, researchers note, that despite some small changes in, say, the way CMS pays for primary care treatment, most insurance plans don't reimburse doctors for preventive efforts. Meanwhile, high-tech procedures pay quite well, with stents, bypasses and other invasive cardiology treatments consuming 5 percent of Medicare's total budget. Disease management programs still aren't getting much funding compared to these high-profile procedures, making it nearly impossible for prevention practices to get the attention they deserve. In short, while the medical case for prevention is extremely strong, it's still not clear who--if anyone--is truly willing to pay for it on a large scale.

Get the details on the latest in prevention efforts:
- read this piece in The New York Times

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