Obesity Counseling - Medicare To Add Coverage

Medicare beneficiaries will be able to get coverage for preventive obesity counseling, CMS (Centers for Medicare and Medicaid Services) announced today. The CMS says this is part of the widening range of preventive services CMS has been adding to its coverage since the signing of the Affordable Care Act. Covering the costs for preventive obesity counseling complements the Million Hearts initiate, CMS explained in a communiqué.

CMS Administrator Donald M. Berwick, MD., said:

“Obesity is a challenge faced by Americans of all ages, and prevention is crucial for the management and elimination of obesity in our country. It’s important for Medicare patients to enjoy access to appropriate screening and preventive services.”

Approximately one third of Medicare beneficiaries are thought to be obese.

Obesity can raise the risk of developing the following conditions and diseases:

• Abnormal periods
• Coronary heart disease
• Diabetes mellitus type 2
• Gallbladder disease
• High blood cholesterol
• High blood pressure
• High triglyceride levels
• Infertility
• Liver disease
• Metabolic syndrome
• Osteoarthritis
• Respiratory problems
• Several cancers
• Sleep apnea and other sleep disorders
• Stroke
• The risk of a cancer being a rapidly progressive one

According to the CDC (Centers for Disease Control and Prevention), the medical care costs of obesity in America in 2008 amounted to $147 billion.

The CMS says that such chronic diseases as diabetes type 2 and cardiovascular diseases affect some racial and ethnic minorities disproportionately. If obesity-related disparities can be addressed beforehand, the chances of significantly reducing obesity rates is much greater, as well as closing the wide health disparities that currently exist among Medicare beneficiaries.

Under this new benefit, eligible patients who receive obesity screening and counseling at primary care centers will be covered.

If the screening shows that the patient is obese, i.e. has a BMI (body mass index) of at least 30, the following would be covered by Medicare:

• Four weekly counseling sessions (one per week)
• One face-to-face counseling session every fortnight for a further five months
• If the patient manages to reduce enough weight (6.6 pounds or 3 kilos in six months), they would be covered for further once-monthly counseling sessions for six months (providing a total of 12 months)

CMS Chief Medical Officer and Director of the Agency’s Office of Clinical Standards and Quality, Patrick Conway, MD, MSc, said:

“This decision is an important step in aligning Medicare’s portfolio of preventive services with evidence and addressing risk factors for disease. We at CMS are carefully and systematically reviewing the best available medical evidence to identify those preventive services that can keep Medicare beneficiaries as healthy as possible for as long as possible.”