Why I Had to Close My Preventive Healthcare Clinic

Our system was predicated on integrated health, including cooking, exercise, nutritional therapy, and mindfulness meditation. Care models in the U.S. still reward treatment, though; not prevention.
Lucy Nicholson/AP

On December 27, I closed MDPrevent, the preventive-medical practice that I co-founded three years ago in Delray Beach, Florida. The practice was created with the premise that patients would be better off if doctors focused their attention more on preventing disease than simply treating it. In clinical parlance, “primary prevention” means preventing disease occurrence, while “secondary prevention” means early diagnosis and treatment of existing disease before it causes significant harm.

The thrust of MDPrevent was primary prevention: to help patients identify their risk factors for the major chronic diseases and leading killers, such as diabetes, heart and lung disease, stroke, and cancer, and to help them make lifestyle changes to prevent these factors from evolving to illness. I focused on lifestyle counseling, rather than diagnostic tests meant for early detection.

But ultimately, the three major healthcare industry players—the providers, the payers, and the patients—all shared some responsibility for our failure.

Some may say that most start-ups fail. But what happened to MDPrevent is a cautionary tale. My incentives for creating this new model were more altruistic than financial. I previously cofounded, built, and sold a successful healthcare-services company. After spending years involved with the care of institutionalized elderly past the point where prevention makes any real difference, my ultimate goal became demonstrating that doctors could afford to focus on prevention without sacrificing their livelihoods. Of course, to start focusing on primary prevention, most doctors would have to undergo further re-education, as few have training in nutrition, exercise, sleep, stress, and the like.

MDPrevent realized this and assembled a team that included a health psychologist, registered dietitian, exercise physiologist, yoga instructor, health educator, and nurse practitioners. Our system was predicated on an integrated model of care in which the physician would complete an initial thorough health risk assessment, make appropriate internal and external referrals, and then monitor progress by reviewing records and periodically meeting with the patient. In addition to personalized care, our custom facility, which included a teaching kitchen, a gym, and classrooms, allowed us to also offer our patients group classes focused on healthy cooking, exercise, nutritional therapy, diabetes education, and mindfulness meditation.

We knew that for the model to be scalable, it had to be based on insurance reimbursement rather than out-of-pocket payments. We hoped that once we demonstrated the value of primary prevention in a setting that derived its revenue primarily from insurance, the rest of the medical establishment would see the merit and follow suit. Of course, in my mind, at that point we would also be well along in creating our own successful financial endeavor based on the premise of doing well by doing good.

First, the good news: On the personal front, after reading 50 books and more than 30,000 abstracts and studies, I reversed my own health issues. I dropped 25 pounds, brought my cholesterol under 200 and stopped taking medication for it, eliminated my irritable bowel syndrome and heartburn, markedly decreased my left hip osteoarthritic pain, and started running again for the first time in 10 years.

On the practice side, more than 1,000 patients came through our doors. Many people told us they loved the program, and we received many positive testimonials. Dozens of our patients sustained marked weight loss without drugs, supplements, or surgery. We successfully discontinued our patients’ statins, lowered or discontinued blood pressure and blood sugar medications, and watched people finally take control of their health. We religiously followed an insurance-based reimbursement model.

We lost money.

The bad news was that for every dollar we collected, our expenses equaled three dollars. I didn’t need my MBA to know that this was unsustainable, so I started cutting our costs. At the end, we were left with a health psychologist, a registered dietitian, and me. Even though I never took a paycheck, the Medicare reimbursement we received for our services still could not cover our costs. I even abandoned the offices we had built-out and moved to less expensive quarters we shared with an internist. It still made no difference.

So what had gone wrong?

First, few primary care and internal medicine doctors would refer to us. When I first met with a few dozen of them to introduce myself and the model, they raved about the concept and assured me they would make referrals. They said there was nothing like us, and they were right. Yet, other than for a small handful, they did not refer. When I asked several of these doctors why they had not referred, the most common explanation was that they simply forgot, or that they had made a referral, but their patients chose to not come. 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. One local hospital initially asked us to open a Certified Diabetes Education Center because the hospital was shutting down its own program for financial reasons. As opening the center was consistent with our educational focus, we exerted much time and money to get certified so we would be open by the time the hospital shut down its program. The hospital initially told us they would refer diabetics to us, but then someone reversed the decision and the hospital decided to refer to its sister hospital instead. We also met with another local hospital and asked them to allow us to incorporate our prevention model into their primary care practice, and they also turned us down.

Presented by

Steven Charlap is a medical doctor based in Delray Beach, Florida. He was the founder of HealthDrive, a medical and dental practice, and MDPrevent, a preventative-healthcare clinic.

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