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February 2015 | Read this issue and more at www.healthandwellnessmagazine.net |
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INTEGRATIVE MEDICINE
The Ornish Program
By John A.
Patterson MD,
MSPH, FAAFP
“Joy of living is a
much better motivator than fear of
dying”- Dean Ornish, MD
The Ornish Program first gained
national attention in 1990 when the
Lifestyle Heart Trial was published
in The Lancet, one of medicine’s
most prestigious journals. Dean
Ornish’s non-profit Preventive
Medicine Research Institute used
one of the most respected research
designs known to medicine- the
prospective, randomized, controlled
trial.
Researchers found that many
people with coronary heart disease, including some who needed
coronary artery bypass surgery,
could reduce their coronary symptoms and medication use and
delay or completely avoid surgery.
Interestingly, not only did symptoms such as chest pain and shortness of breath improve, but other
medical conditions improved as
well. Rather than the many undesirable “side effects” experienced
with medications and surgery, this
behavioral lifestyle approach had
many desirable “side benefits”, such
as reductions in weight, blood pressure, blood sugar and cholesterol.
Irrefutable evidence of the ‘reversal of heart disease’ was provided
by PET scans (positron emission
tomography) of the coronary arteries before patients began the Ornish
Program and after they had been on
it for one year.
The Ornish Program consists of
four primary components1) a very low-fat vegetarian,
whole foods nutrition plan (less
than 10 percent of daily calories
from fat compared to roughly
Joy of living is a much better motivator than
fear of dying” —Dean Ornish, MD
40 percent in the standard
American diet))
2) physical and aerobic conditioning through light, low-impact
exercise, including yoga
3) relaxation techniques to help
cope with and reduce stress
4) group support to enable participants to deal with the emotional
issues that contribute to, or result
from, heart disease.
Medicare began covering the
Ornish Program in January of
2010 due to the high quality of the
research, showing effectiveness
in reversing coronary blockages,
improving other medical conditions
and saving money over the expected
lives of coronary patients. Medicare
only pays for medical services that
have evidence for both effectiveness
and cost savings. It was determined
that the Ornish Program was indeed
the first scientifically proven, noninvasive approach to the reversal of
established coronary artery disease.
Coronary artery bypass surgery
costs approximately
$40,000 dollars. Since many
patients require a repeat bypass procedure in 5-10 years, there is clearly
a lot of money to be saved using the
Ornish Program. As of last spring,
Medicare was reimbursing providers $6,176 for the Ornish Program
($68 per hour, 4 hours per week for
18 weeks). Some private insurers
reimburse at a rate between $80-90
per hour.
In order for Medicare to pay for
the Ornish Program, the patient
must be a Medicare recipient and
have either had a heart attack in the
previous 12 months or a history of
coronary bypass surgery, current
stable angina, heart valve repair or
replacement, coronary angioplasty
or stenting, or a heart or heart-lung
transplant. Medicare established a
new procedure code for the Ornish
Program that may only be used
by medical providers who have
been trained and authorized by the