optimal health: functional medicine and nutritional genomics

AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS PART 2
2012
of chronic illness. Are we to discount narrative
medicine and systems biology summaries because
the higher priority is to fragment the story, as if it
has no beginning, middle, or end, so we can
shoehorn it into structured database? We are
doing this because we think it will lead us to a
more cost-effective approach to patient care? Are
we spending hundreds of billions of dollars to
digitize a flawed system for assessing, describing,
and treating chronic illness? What was it that
Linus Pauling said about doctors?
Enter ICD-10 – a monstrous set of codes
that physicians, hospitals, and healthcare
organizations around the country are scrambling to
implement by October 1 st of 2013. The ICD-10
codes won’t improve on the ICD-9 system when
it comes to describing chronic illness in narrative
form using a systems biology point of view. Yet
the lion’s share of chronic illness may involve a
few patterns of overlapping losses of functional
integrity that are best described by a mix of
narrative, genetics, lifestyle, environmental
exposures, and metabolic pathway disruptions.
Figuring out how to pick from a list of
hundreds rather than dozens of codes relevant to
one’s medical practice is going to eat into clinical
problem solving time during encounters between
patients and their doctors. This is especially true
for already pressed primary care doctors because
they deal with the widest range of diagnostic code
sets compared to other forms of medical practice,
and they have the least time to spare.
More importantly, to physicians anyway, is the
real possibility that ICD-10 will create rampant
new opportunities for claims processing delays and
denials. What’s needed to get more cost-effective
results out of primary care is less, not more
fragmentation of the physician’s cognitive task;
less, not more intrusion by third parties; less, not
more of physicians having to second guess how
they are being paid.
If you carry the logic of “the more detail, the
better” to its conclusion, we’d need a million
codes to reflect the complexity of chronic illness
and what makes it different for each individual
compared to another. Better to settle for simple
narratives whose words reflect medical evidence,
analysis, experience, and inductive logic in pursuit
of explanatory power. Pay doctors for their time
and factor in an adjustment based on the costeffectiveness
of their results and the clarity of
their documentation. Don’t hold them to CPT rules
that are from the pre-systems biology age of
medicine.
Let the competition in the health care sector
unfold on a level playing field. Don’t use
customary care definitions of medical necessity to
deny claims that reflect a functional medicine
approach when customary care has already failed.
Don’t throw the good medical practice variations
out with the bad. It’ll make it look like health
care reform is just another chapter in a book
about how to kill disruptive innovations before they
eat into the margins or market shares created by
business as usual. Citizen-consumers are getting
wise to that move. They’re getting mad as hell
and won’t take it anymore.
Leaders will discover that hospital-run medical
groups, independent multi-specialty medical
groups, and the newer forms of collaboration
we’re seeing in the health sector—patient centered
medical homes and accountable care organizations
—will better compete if, somewhere within their
conclaves, they’ve made room for a clinical
systems biology-driven solution shop.
Doctors would have more time and freedom to
probe the patient’s narrative for clues as to which
pattern of antecedents, triggers, mediators, and
perpetuating factors applies to this person’s
chronic illness as opposed to that person’s. There
would be less time wasted dressing patients with
codes that explain little and more time devoted to
finding the words and concepts to communicate
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