Medicare To Cover Weight Loss Counseling

Medicare has announced that it will pay for primary care providers to counsel obese patients on losing weight and maintaining the weight loss. Medicare will pay doctors, nurses and physicians' assistants to help plan weight loss programs.

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The obesity epidemic hits all age groups, from toddlers to teens to seniors. For those in that last category that are 65 and older, and on Medicare, there is a new benefit that might make a difference. It's a government program that covers weight-loss counseling. Federal health officials announced this week that for the 13 million beneficiaries who are obese, helping them lose weight is a priority. NPR's Patti Neighmond reports.

PATTI NEIGHMOND, BYLINE: Medicare will now pay primary care providers - doctors, nurses and physician assistants - to help plan weight-loss programs. Medicare official Dr. Jyme Schafer:

DR. JYME SCHAFER: Dietary assessment, and intensive behavioral counseling and behavioral therapy to promote sustained weight loss.

NEIGHMOND: For obese patients with a body mass index of 30 or above. Now, Medicare isn't recommending a specific diet or exercise. Schafer says that will be up to the individual doctor to figure out what's best for their patient. What Medicare is recommending is lots of time in counseling.

SCHAFER: We have one face-to-face visit every week for the first month.

NEIGHMOND: Followed by visits twice a month. And if patients lose at least six and a half pounds, Medicare will pay for counseling for an entire year. The weight loss, of course, requires lots of changes, which can be difficult after a lifetime of unhealthy habits - which is why Medicare officials looked very closely at research showing what type of weight-loss intervention was most effective.

Obesity specialist Dr. Kathleen McTygue, at the University of Pittsburgh, did some of that research. She found the most effective programs look a lot like the new Medicare benefit.

DR. KATHLEEN MCTYGUE: Those are ones that meet more often than monthly in the first three months of the program, and they included not just dietary advice, but also physical activity advice and behavioral components. So these are strategies and tools to help people actually incorporate the advice into their daily lives.

NEIGHMOND: For example, be aware. Be very aware. And closely monitor behavior when it comes to food and weight.

MCTYGUE: Write down how much you ate. See how many calories, how many grams of fat there was, and keep track of it over time. Step on the scale once a week and see what you weigh, and keep track of it.

NEIGHMOND: And this type of intense focus helped patients lose weight and keep it off. And like other studies, McTygue found just moderate amounts of weight loss resulted in significant health benefits.

MCTYGUE: Improved glucose tolerance, so they were handling their blood sugar better; improved physical functioning, which is very important in an older population; reduced incidence of diabetes.

NEIGHMOND: All important gains in health, which Medicare officials hope to see among older Americans once this new benefit takes hold. And for younger people, good news, too. Private insurers usually follow Medicare's lead in deciding what benefits to offer.

Patti Neighmond, NPR News.

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Medicare Offers Expanded Coverage To Battle Expanding Waistlines

Partner content from Kaiser Health News

The Centers for Medicare and Medicaid Services says it will cover screening and counseling for obesity as a free preventive service for Medicare beneficiaries. i i

The Centers for Medicare and Medicaid Services says it will cover screening and counseling for obesity as a free preventive service for Medicare beneficiaries. M. Spencer Green/AP hide caption

itoggle caption M. Spencer Green/AP
The Centers for Medicare and Medicaid Services says it will cover screening and counseling for obesity as a free preventive service for Medicare beneficiaries.

The Centers for Medicare and Medicaid Services says it will cover screening and counseling for obesity as a free preventive service for Medicare beneficiaries.

M. Spencer Green/AP

Keeping off the pounds is tough at any age. Now seniors are getting a helping hand from the Centers for Medicare and Medicaid Services, which has announced that it will cover screening and counseling for obesity as a free preventive service for Medicare beneficiaries.

Coverage is effective immediately.

Advocates hope that CMS's decision may encourage private insurers and Medicaid to begin covering obesity screening and counseling as well.

"I think it's fantastic," says Dr. Marijane Hynes, a primary care physician at George Washington Medical Faculty Associates Weight Loss Clinic.

"We've been dealing with diabetes and hypertension and working backwards," she says. Now physicians can address obesity on its own, hopefully before related medical problems arise.

Under the new rules, beneficiaries whose body mass index is 30 or higher would be eligible for counseling services. The covered benefits include one face-to-face counseling session every week for a month, then counseling every other week for an additional five months. Beneficiaries who have lost at least 6.6 pounds at the end of six months would be eligible for six more monthly counseling sessions.

The coverage is in line with current recommendations from the U.S. Preventive Services Task Force, which recommends intensive counseling and behavioral interventions for obese adults.

More than a third of Medicare beneficiaries have BMIs over 30, the cutoff for obesity, according to CMS.

Until now, doctors didn't get paid for counseling patients about their weight. "Lack of reimbursement is one of those obstacles to getting physicians and their patients into a dialogue about weight management," says Morgan Downey, publisher of the Downey Obesity Report and former executive director of the American Obesity Association.

Now, at least for Medicare beneficiaries, that barrier is removed.

Many private plans currently cover bariatric surgery for people who are morbidly obese, but don't cover less drastic treatments like counseling before people reach that stage.

"For the earlier stages of obesity, coverage is much more spotty, and that's a problem that most employers and health plans are trying to work through," says Ted Kyle, a pharmacist and chairman of the Obesity Society's advocacy committee.

Medicare covers bariatric surgery in certain instances.

So are most primary care physicians ready to hit the ground running now and begin counseling their Medicare patients about how to change their diets and habits and lose weight? No, says Hynes.

But now that doctors will get paid for taking the time to do so, they can offer a handful of suggestions straight off, like encouraging people to get out and walk more or stop drinking sugary juices, she says.

Patients who've been struggling to drop pounds for years may in fact be more clued in about weight loss strategies than their doctors, at least initially, says Downey. "But hopefully it will be a minority of cases, and [the new coverage] will encourage physicians to seek out information in this area," he says.

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