The Centers for Medicare and Medicaid have announced that Medicare will cover the cost for obesity screening. It is also going to cover the intensive behavioral counseling that will go along with the treatment for obesity.
For years, we have all been hearing about how there is an obesity epidemic in the United States (and in several other countries). I think that the fact that Medicare is about to start covering the cost of obesity screening, and the corresponding behavioral counseling, is a clear sign that we truly do have a problem with obesity in America.
Medicare is a public form of health insurance. It is available for people who are age 65 or older, and who are American citizens. People who reach the age of eligibility will automatically be enrolled in both Medicare Part A and Part B. Those who are not eligible for Social Security Benefits will not be eligible for Medicare.
It is expected that more than 30% of the people who have Medicare will qualify to have obesity screening and counseling. Medicare beneficiaries who have a body mass index (BMI) of 30 or more will be able to receive weekly, in-person, intensive behavioral therapy visits.
This will be offered for one month. After that, if the person has lost at least 6.6 pounds, they will receive visits every two weeks, for five more months. All of this will be fully paid for by Medicare. No co-payment will be required. After that, the Medicare recipient can receive monthly sessions, for up to six months. This, too, will be covered. Ideally, these additional sessions should include dietary counseling.
People who don’t lose at least 6.6 pounds in the first six months of the treatment will receive a reevaluation one year after the initial screening. In order to receive another round of counseling, the person has to have shown “readiness to change”, and has to have a BMI that is still at 30 or higher.
All of this counseling has to take place in a primary care setting, (which, generally, means in a physician’s office). Medicare will not cover it if the counseling happens at a hospital, emergency department, outpatient surgery center, hospice, or a skilled nursing facility.
The idea is that the primary care physician can follow up with an individual Medicare recipient’s situation. I think it is assumed that a person will have an easy time finding a primary care physician, and return to that doctor, in order to receive continued counseling regarding obesity.
There are some doubts about how well this new initiative will work. Some doctors have concerns that the people who receive the obesity screening and counseling will be unable to sustain what they have learned from the counseling after the first year is over.
It is possible that the person will slip back into old habits if they no longer have to see a doctor, (who will hold the person accountable for his or her health choices). Other doctors are worried that this program will fail because it relies on helping a senior break a lifetime of bad habits.
Image by Paul H on Flickr