Medicare’s decision to cover weight-reduction efforts is a good move, but details still matter

January 3, 2012 – 11:49 AM | By Jim Stommen | No comments yet


Medical Device Daily Contributing Writer


Talk about eating from the public trough: The folks who run Medicare are putting their money where our collective mouths are.

The nation’s largest health insurance plan reported awhile back that it will pay for screenings and preventive services aimed at helping recipients battle obesity and its attendant medical ailments. For those who screen positive for obesity, the newly covered benefits include initial weekly counseling for the first month, followed by five months of every-other-week appointments. Presuming weight loss continues, another six months of once-monthly sessions may follow.

My initial response is that it’s a good move by the Centers for Medicare & Medicaid Services in recognizing the role that unchecked obesity plays in development of other medical problems such as heart disease, stroke and diabetes.

It sure seems like a good idea on the surface, but that’s also true – as we’re most definitely reminded in these first few days of 2012 – of New Year’s resolution-centered diet plans. As with many well-intentioned initiatives, it’s absolutely true that the devil is in the details.

One of those details is that many, or more likely most, Medicare recipients receive the bulk of their health care from primary care physicians (PCPs), and at least on the surface, it appears that many of those physicians and their staffs aren’t really prepared to deal with counseling obese patients.

Those of us who have spent years seeing doctors’ offices bedecked with “healthy eating” posters, handouts and similar propaganda, as well as hearing our doctors pass along platitudes on watching our weight and eating better, may be surprised to hear that many physicians have no training in weight-loss counseling, nor do their staffs.

Christy Ferguson, director of the STOP Obesity Alliance, which was among the groups pushing for such Medicare coverage, was cited in a USA Today article, saying that a recent survey of primary care physicians indicated that fully 78% of them – almost four in five – had no prior training on weight-related issues. And of those, 72% said no one in their office had such training.

So getting from approval of coverage to actually accomplishing something in obesity screening and weight-loss counseling will take some doing.

Nonetheless, as Ferguson noted, “I don’t think we have spent enough time thinking about that. But things change in increments, and this is a step in the right direction.”

Yes, it seems to be just that. Hopefully the existence of a substantial potential number of Medicare patients paying for weight-related counseling will provide impetus for PCPs and/or their staffs to seek out the necessary training.

Lord knows, there is a sizable (unavoidable pun) prospective pool of patients for the services those physician offices can provide. Statistics rolled out by the STOP Obesity Alliance indicate that just under 35% of all U.S. adults are overweight to the point of being classified as obese, bringing with them substantial additional medical costs.

Christy Ferguson, director of the alliance, said even modest improvements in the overweight population – as little as 5% to 7% – “can lead to a huge health improvement.”

The latter likely is at the heart of the Medicare decision – better obesity prevention should translate into lower overall treatment costs in the Medicare population as a whole, and certainly in those who already are overweight. In the population it covers, CMS puts the percentage of those who are obese at 30%. Citing the increased risk of Type 2 diabetes, heart disease and many types of cancer for those overweight clients, the agency’s outgoing director, Donald Berwick, said last month that obesity prevention “is crucial for the management and elimination of obesity in our country.”

Obesity educators are pushing for further CMS reimbursement of additional options such as telephone- and Internet-based programs. Thomas Wadden, director of the Center for Weight and Eating Disorders at the University of Pennsylvania, said such programs can be delivered “at a far lower cost than having physicians or nurse practitioners deliver lifestyle counseling.”

By whatever method or combination of methods, it is clear that having the nation’s largest insurance program get behind weight-loss counseling is an important step in battling the obesity epidemic that has gripped America in over the past few decades. Medicare’s reimbursement of those efforts hopefully will influence those private insurance carriers who do not yet provide for such coverage to do so.

Then all it will take is sticking with those New Year’s resolutions – always a Herculean task, but one that may be made easier by having such efforts covered by Medicare and hopefully other insurers.

(Jim Stommen, retired executive editor of Medical Device Daily, is a freelance writer focusing on healthcare issues.)


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