Covering Obesity Counseling

December 15, 2011

Nearly a third of the Medicare population is obese, which leads to more serious health problems that are expensive to treat. The Centers for Medicare & Medicaid Services (CMS) have decided to cover obesity screening and counseling as a preventative measure, but are primary care physicians equipped to provide such services?

Nearly a third of the Medicare population is obese, which leads to more serious health problems that are expensive to treat. The Centers for Medicare & Medicaid Services (CMS) have decided to cover obesity screening and counseling as a preventative measure, but are primary care physicians equipped to provide such services?

The benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months. Medicare patients who lose at least 6.6 pounds (3 kilograms) during the first six months of counseling would be eligible to receive addition face-to-face counseling once a month for an additional six months for up to a total of 12 months of counseling.

For already time-strapped primary care physicians, that equates to a lot of face time with patients.

“Physicians are extremely busy focusing on diagnosis and treatment, and somewhat on prevention,” says Esther Nash, MD and vice president of Clinical Innovation and Strategy at OptumHealth. “In general primary care provider access is already a problem in the U.S. because of a shortage of primary care physicians. Taking on intervention is not high on their priority list.”

However, Dr. Nash expects the CMS announcement to eventually lead to more primary care physician expertise in prevention services.

“It’s a case of the chicken and the egg,” she says “When Medicare decides to expand a service, it is an important driver to increase services in the primary care setting. Up until this point, there has been no reason for primary skill providers to develop a prevention-focused skill set.”

In the meantime, there may be a lifestyle counseling services void in the marketplace that could be filled by outside providers who have experience with prevention services.

“Whatever CMS does, it does eventually cascade into the commercial marketplace,” Dr. Nash says. “We've been a problem-focused medical system for a long time - like dogs chasing our tails reacting to problems. It's a terrific thing to see CMS covering more prevention services.”

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