Cookbook medicine...PODay 344

Copied from a news article:

")The U.S. Department of Health and Human Services (HHS) on Thursday announced a new payment model that aims to prevent one million strokes and heart attacks by 2017. Speaking at the White House Conference on Aging regional forum in Boston, HHS Secretary Sylvia Mathews Burwell announced the "Million Hearts" model, which seeks to reduce the nation's 610,000 deaths a year from strokes or heart attacks, as well as the $315.4 billion annual cost, according to the announcement. Research last year also found that cardiovascular events are the leading cause of death worldwide. Under the current model, the Centers for Medicare & Medicaid Services (CMS) pays providers based on specific goals relating to patient cholesterol, blood pressure or other factors. The new model rethinks this one-size-fits-all approach, opting instead for a data-driven predictive model that creates personalized risk scores for individual patients. Providers that participate in the initiative will collaborate with beneficiaries to determine a percentage that represents their heart attack or stroke risk within the next 10 years. Providers also will identify risk reduction steps that work best for an individual patient, such as taking cholesterol-lowering drugs, reducing blood pressure or quitting smoking, to create a personalized plan. CMS will pay participants that cut their high-risk patients' absolute risk of stroke or heart disease, according to the announcement." I understand the trend toward tying payment to results in the new afforable  health care paradigm. But I guess I am a bit of a fatalist in that I don't believe that a financial incentive can solve all the medical problems in the world. Is it really that simple...that paying the doctor or the hospital better or  penalizing them less will  incentivize the patient to  follow  the diet, loose weight, exercise more, all to make them healthier? Aren't there just people who are going to be sick, going to have high blood pressure, going to suffer a stroke or a heart attack in spite of sincere attempts to follow doctor orders? Is it the doctor's fault that the patient doesn't want to take a statin drug for his cholesterol? Should the doctor be penalized if the patient just cannot  stop smoking? It is said to be more addictive than heroin! If the doctor is going to paid less (or not at all?) for patients who are unable or unwilling to turn their medical situation around, won't that result in practices being unwilling to enroll chronically ill or unhealthy persons? Perhaps there is something that I don't get.