Thinking About Health: Medicare will pay for obesity counseling, really?
December 19, 2014
It's amazing how much we talk about making people healthier.
Consider all the discussion in America about overweight people who are stigmatized for making poor food choices. Think about the warnings that obesity is a leading cause of preventable death. So, it's puzzling that Medicare offers an obesity counseling benefit that must be one of the best kept secrets outside of Washington.
Three years ago, Medicare announced with some fanfare that it was adding coverage for obesity counseling sessions to help seniors lose weight. Some 30 percent of people in this age group are obese, and studies have shown that regular counseling sessions in a doctor's office increase the chances an overweight person will drop some pounds.
Medicare was eager to add obesity counseling to the growing list of preventive services it covered, and the head of the agency told the press in 2011, "It's important for Medicare patients to enjoy access to appropriate screening and preventive services."
That was then. This is now, and the government doesn't seem interested in promoting or publicizing obesity counseling. Very few seniors are enjoying this preventive service so widely touted three years ago.
My colleague Phil Galewitz at Kaiser Health News has reported that fewer than 1 percent of Medicare's 50 million beneficiaries — about 120,000 — have used the benefit. If 30 percent are obese, that means about 14.8 million seniors are waiting to be counseled.
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Maybe you're one of them.
Seniors with a body mass index of 30 or more are eligible for one, 15-minute, face-to-face counseling session per week for one month, and then every other week for another five months. If you lose at least 6.6 pounds during those six months, you can have a monthly counseling session for another six months.
The benefit sounds like a pretty good deal, but it's darn hard to find out about it. Here's where good intentions collide with the realities of the medical marketplace. Medicare requires that primary care doctors provide the service during a separate visit not at the same time a patient comes in for other services.
Dr. Reid Blackwelder, who chairs the board of the American Academy of Family Physicians, told Galewitz it was a burden to bring patients in for a separate visit.
"It's not the best use of my time," he said.
Medicare pays doctors about $26 for a 15-minute counseling session. Family docs, who are near the bottom of the physician income ladder, can make as much as four times that amount providing other services.
Medicare rules also won't deliver reimbursement to those who know most about the disease, providers like obesity medicine specialists, psychologists and diabetes nurse educators. Go figure!
Whatever Medicare may have been thinking, the agency's solution means the providers most knowledgeable about the problem aren't paid to do the counseling.
Nor does Medicare seem to be interested in letting those millions of overweight beneficiaries know about the sessions. There has been no publicity, nothing on Twitter or other social media, no push similar to what the government has done to get people to sign up for Obamacare insurance.
The only publicity has been a mention in the Medicare Handbook sent to beneficiaries at the beginning of the year, which few probably have read. On page 52 of the 152-page 2014 Handbook, a mere seven lines offer a bare-bones description of the benefit and tell seniors to talk to their doctor.
Since it seems pretty clear doctors aren't going to talk to their patients, I asked Medicare about what plans it had for publicizing the benefit more widely and why it hadn't done more to tell people about it. A communications official said, "We have published quite a bit of information about this benefit" and directed me to a bunch of publications like the "Medicare Quarterly Provider Compliance Newsletter," which is like reading a book in Turkish for you and me.
So, it looks like anyone who qualifies for the benefit has to ask for it. That might be something for your to-do list for the new year.
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