An Update on the Pritikin and Ornish Ultra Low-Fat Diet Medicare Boondoggle

In 2016 a huge boondoggle was foisted on Americans who were undergoing cardiac rehabilitation after myocardial infarction or coronary artery bypass surgery. I became incensed about so-called “intensive cardiac rehabilitation” when patients in my previous practice were suddenly being counseled intensively on very low-fat diets and not on the Mediterranean diet I recommended.

My post in response entitled “The Pritikin Diet: Discredited By Medicine But Now Endorsed By Your Federal Government” described in detail the lack of scientific support for the Pritikin diet and the shenanigans that led to it being adopted.

The Cardiac Rehabilitation Incentive Payment Model, was finalized in a rule issued by the CMS. It was part of a package of experimental payment models aimed at reducing healthcare spending while improving outcomes, including the expansion of CMS’ mandatory bundled-payment program to include all care associated with bypass surgery and heart attacks.

This experiment would bring significantly more money into the coffers of the hospital systems that managed to induce patients to sign up.

Under the cardiac rehab payment model, the CMS plans to pay participating hospitals $25 per session of cardiac rehabilitation or intensive cardiac rehabilitation for the first 11 sessions. It would pay $175 per session thereafter, for a maximum of 36 total sessions. Those payments would apply only to Medicare beneficiaries with heart attacks and coronary artery bypass surgery

When I formally objected to this experiment being foisted on my patients I was told that cardiac rehab was losing money and by signing up for this program it would now become profitable.

Indeed, ICR using either the CMS-approved Pritikin or Ornish programs is a big money-maker. Hospitals also like to use it for marketing.

Here’s a typical puff piece from a medical system near me:

UC San Diego Health is the only program in San Diego to offer Ornish Lifestyle Medicine  to intensive cardiac rehabilitation patients. The program includes stress management, support groups and nutrition, focusing on a low-fat, whole foods, plant-based eating plan 

https://health.ucsd.edu/news/features/Pages/2019-03-11-cardiac-rehab-center-celebrates-first-birthday.aspx

We, the American taxpayers are still paying for these unsuspecting patients to be brainwashed into believing (as the Ornish and Pritikin programs believe) that they can prevent and reverse their coronary atherosclerosis only by pursuing these near-vegan, very low-fat diets.

Skeptically Yours,

-ACP

N.B. I’ve gone back and edited my original article on this. Over the years, several readers have commented that they felt that my description of Pritikin’s death was inconsiderate.

I think they were right. I emphasized the fact that Pritikin “slashed his wrists” as his manner of committing suicide and that phrase is gone. In my defense, I have spent a lot of writing time outlining how the death of Robert Atkins has been distorted by vegans. I wasn’t distorting Pritikin’s death but the precise manner of his suicide wasn’t relevant to any points I was making.

Also, (intended humorously) I said that participants in the Pritikin experiments I described were at risk for slashing their wrists and I’ve taken that out.

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8 thoughts on “An Update on the Pritikin and Ornish Ultra Low-Fat Diet Medicare Boondoggle”

  1. Dr. Pearson,

    I first would like to say as a long time reader of yours, I enjoy your writing style and have learned from your posts. However, I have to take some issue with this article. You have tried to insinuate that the government, in particular through the cardiac rehab incentive payment model, is incentivizing cardiac rehabs to teach the flawed Pritikin and Ornish diet plans. If you read the requirements for a hospital to participate, I do not see anywhere were you have to teach these diets to your patients. As a nurse in cardiac rehab in Texas for 9 years, who taught patients on a daily basis, I have never taught the Pritikin or Ornish diet plans. In fact, do to my own individual study and reading knowledgeable people like yourself, I have taught the Mediterranean diet.
    Secondly, I do not see how incentivizing hospital departments to improve patient care is a negative thing, as long as that is what is does. Medicare, aka the government has been doing this type of thing for many years in many different areas. Also, there is a difference in cardiac rehab and intensive cardiac rehab, this article makes it seem like these terms are used interchangeably. At my hospital we can not do intensive CR and honestly with the increased paperwork and additional time commitment from the patient, it is probably not all that valuable. To make it seem like CR is a money money making operation is naive at best. We are considered, at least at my hospital, a non revenue producing department. Meaning, we don’t make money. The average Medicare reimbursement for CR, at my hospital, is about $20 per person per day. Many other departments make much more money, interventional cardiology, cardio thoracic surgery, etc.
    Lastly, I think your issue is more about UC San Diego Health teaching a flawed diet to cardiac rehab patients that you don’t agree with, more than medicare incentivizing cardiac rehabs. I wholeheartedly stand with you on this. They should not be teaching CR patients the Pritikin or Ornish diets or anything of the sort. We don’t do that at my hospital, nor do any of my local hospitals that I am aware of.
    My initial concern with your post was that readers of your website would infer that Cardiac Rehab is only out there to make money and teach things not consistent with science. Because of this, many might choose not to participate in cardiac rehab and not get the much needed exercise, heart monitoring, lifestyle modification education, and yes nutrition counseling they so desperately need. If I have misrepresented or misinterpreted your above thoughts, I apologize. Thank you for your incite and knowledge on these and many other topics.

    Sincerely

    Reply
    • Mark,
      thanks for you thoughtful comments.
      I agree with everything you say here: basic cardiac rehab is not a “money maker” for hospitals and it is offered as a service that is for the benefit of the patients and staffed by hard-working, dedicated, and thoughful health care workers.
      When the intensive cardiac rehab was initiated at my prior employer I looked at the details of what Congress had written and studied the way the bill was developed. A lot of this is in my first piece. It was crafted for programs like Pritikin and Ornish and they were the only ones approved. Thus, whereas the bills aren’t mandating a particuular diet, in practice, if Pritikin or Ornish are running the program you are going to get patients watching lots of their dietary videos and getting lots of their printed information.
      Only a minority of hospitals have signed on to this, that is why you havne’t seen it at your facilities.
      I will review my post and see if I can’t clarify this for readers.
      Dr P

      Reply
      • Thank you Dr. P for your reply. I apologize as I had not read your first piece on this matter. I can see now more clearly why you stated things the way you did. Thank you once again for all the time and care you take into helping the general public and even healthcare professionals like myself be more educated in deciphering fact from fiction.

        Reply
  2. My twin brother put himself on the Pritikin diet–probably around 1980. We were avid cyclists, and he had the idea to get back to his weight in high school (5’8″, about 127 lbs.). He eventually got there; with training his resting heart rate got down to about 30 bpm. What I remember best about it was sapsago cheese–apparently the only cheese low-fat enough to get Pritikin’s approval (a believe he thought cottage cheese should be squeezed through cheesecloth to reduce its fat content). I remember the sapsago cheese having a rather fetid odor and came in foil packets the same shape as what Richard Dreyfus did to his mashed potatoes in “Close Encounters of the Third Kind”.
    He didn’t last long on that diet. I told him he wouldn’t live longer, it would only SEEM longer.

    Reply
  3. I had two friends who 10 years ago committed to the Esselstyn Diet, which I call a ”sub vegan” diet as you cannot eat nuts or olives. They were most impressed by his book which promised that if you followed his diet, you would never, ever suffer a heart attack. I told my friend at the time that such a promise was unethical and was not viable anyway, but she was a convert. He became their guru because now, with the sub-vegan diet, they would not only not get a heart attack or stroke, they would never get Alzheimer’s. I was a researcher at the time in a major hospital with an advanced Alzheimer’s program. I told her that so much research had been done and there was no magic solution for avoiding it. She said there was, it was the Esselstyn Diet. Flash forward 10 years and this same couple has lost muscle, hair and has dry skin. She, a graduate of major universities in the US, cannot focus long enough to read a page of writing. She cannot follow a logical argument. Her memory is shot. And yet, they persist in the sub-vegan diet. It has become their religion and Esselstyn their priest. She has tried to convert me, and it hasn’t ended well. I have a lot of anger towards these vegan diets. They are only for rich people in rich countries. People who live in areas with scarce food can hardly be so picky out their foods. And no one can guarantee you won’t have a heart attack, etc. Love life, get friends, exercise, and enjoy a healthy diet, but enjoy. Don’t suffer with this awful diet.

    Reply
    • Jennifer,
      Thanks for sharing your friends’ history with a “subvegan” (I may appropriate that term!) diet.
      I found Esseslstyn’s diet to be particularly misguided and lacking in any scientific credibility which is why I’ve written about it twice.
      “Love life, get friends, exercise and enjoy a healthy diet” is a solid catchphrase for the best we
      ways to minimize Alzheimer’s and cardiovascular disease. To which I would add avoid obesity (which relates to enjoying a healthy diet) and don’t smoke.
      Dr. P

      Reply

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