Department of Member Engagement & Administration, American College of Lifestyle Medicine, Chesterfield, MO 63006, USA.
Health Policy & Management, Indiana University Richard M. Fairbanks School of Public Health, Indianapolis, IN 46202, USA.
Int J Environ Res Public Health. 2021 Nov 5;18(21):11632. doi: 10.3390/ijerph182111632.
Lifestyle medicine (LM) is a rapidly emerging clinical discipline that focuses on intensive therapeutic lifestyle changes to treat chronic disease, often producing dramatic health benefits. In spite of these well-documented benefits of LM approaches to provide evidence-based care that follows current clinical guidelines, LM practitioners have found reimbursement challenging. The objectives of this paper are to present the results of a cross-sectional survey of LM practitioners regarding lifestyle medicine reimbursement and to propose policy priorities related to the ability of practitioners to implement and achieve reimbursement for these necessary services. Results from a closed, online survey in 2019 were analyzed, with a total of = 857 included in this analysis. Results were descriptively analyzed. This manuscript articulates policy proposals informed by the survey results. The study sample was 58% female, with median age of 51. A minority of the sample (17%) reported that all their practice was LM, while 56% reported that some of their practice was LM. A total of 55% of practitioners reported not being able to receive reimbursement for LM practice. Of those survey respondents who provided an answer to the question of what would make the practice of LM easier ( = 471), the following suggestions were offered: reimbursement overall (18%), reimbursement for more time spent with patients (17%), more support from leadership (16%), policy measures to incentivize health (13%), education in LM for practitioners (11%), LM-specific billing codes and billing knowledge along with better electronic medical record (EMR) capabilities and streamlined reporting/paperwork (11%), and reimbursement for the extended care team (10%). Proposed policy changes focus on three areas of focus: (1) support for the care process using a LM approach, (2) reimbursement emphasizing outcomes of health, patient experience, and delivering person-centered care, and (3) incentivizing treatment that produces disease remission/reversal. Rectifying reimbursement barriers to lifestyle medicine practice will require a sustained effort from health systems and policy makers. The urgency of this transition towards lifestyle medicine interventions to effectively address the epidemic of chronic diseases in a way that can significantly improve outcomes is being hindered by current reimbursement policies and models.
生活方式医学（Lifestyle medicine，LM）是一门快速发展的临床学科，专注于通过强化生活方式治疗来治疗慢性疾病，通常能带来显著的健康益处。尽管有充分的证据表明，LM 方法可以提供循证护理，并遵循当前的临床指南，但 LM 从业者发现报销存在挑战。本文的目的是介绍对 LM 从业者进行的生活方式医学报销横断面调查的结果，并提出与从业者实施和获得这些必要服务报销能力相关的政策重点。对 2019 年一项封闭式在线调查的结果进行了分析，共纳入 = 857 名参与者。对结果进行了描述性分析。本文阐述了基于调查结果的政策建议。研究样本中 58%为女性，中位年龄为 51 岁。少数（17%）参与者报告他们的全部实践都是 LM，而 56%的参与者报告他们的部分实践是 LM。共有 55%的从业者报告无法对 LM 实践进行报销。在对这个问题提供答案的调查受访者中（= 471），提出了以下建议：整体报销（18%）、为与患者相处的时间更长而报销（17%）、更多领导层的支持（16%）、通过政策措施激励健康（13%）、对从业者进行 LM 教育（11%）、LM 特定的计费代码和计费知识以及更好的电子病历（EMR）功能和简化的报告/文书工作（11%），以及为扩展护理团队报销（10%）。建议的政策变化主要集中在三个方面：（1）通过 LM 方法支持护理过程，（2）强调健康结果、患者体验和提供以人为本的护理的报销，以及（3）激励产生疾病缓解/逆转的治疗。纠正生活方式医学实践的报销障碍需要卫生系统和政策制定者的持续努力。目前的报销政策和模式阻碍了向生活方式医学干预的转变，以有效应对慢性疾病的流行，从而显著改善结果，这一转变的紧迫性日益增加。
