Medicare’s Flawed Obesity Counseling Coverage

Medicare now covers nutrition counseling for obesity. My first reaction was, “high time!”

With two out of three adults already overweight or obese, weight management is arguably the largest health problem we face in this country.

It amazes me that it took so long for Medicare (and the Congress that funds it) to realize it was paying $50,000 to amputate a diabetic’s leg, but had withheld the few hundred dollars for nutritional counseling that could have saved the limb.

Obesity is a gateway disease. It contributes to, or exacerbates, diabetes, cardiovascular disease and even kidney disease—the three other diseases for which Medicare already covers nutrition counseling—as well as hypertension, arthritis and a host of other nutrition-related conditions for which Medicare won’t provide counseling.

Still, the ruling on nutrition counseling for obesity sounds like a great idea, and it is, until you read the fine print.

Medicare won’t cover patients who get nutrition counseling for obesity from registered dietitians (R.D.s)—unless a physician is physically present in the office or clinic. R.D.s are the professionals most highly trained in counseling people about nutrition-related diseases. What if the physician refers a patient to the office of an R.D.? Not good enough for Medicare.

Under the warped logic of Medicare, an R.D. can provide nutrition counseling for diabetes, renal disease and cardiovascular disease without a doctor on site. But the R.D. cannot talk to you if you come to be counseled about obesity without a doctor present. Imagine having to go to two different R.D.s for different nutrition conditions, when one could handle both?

Many physicians currently refer out to R.D.s because they have neither the time nor the training to do nutrition counseling. They may not have the office space to dedicate to an R.D.—something they’d have to do in order for the R.D.’s services to be covered by Medicare.

The result?

Patients will simply have to wait until they develop one of the other diseases covered by Medicare before they can see the health professional for the counseling that could have prevented, delayed or treated that condition.

Please tell me this is not a sign of health care reform. It’s a sign of stupidity because there cannot be true coverage unless services can be easily accessed. It sounds good on paper, but results in lower-quality care because the people who need it can’t get it.

The silver lining is that groups like the Academy of Nutrition and Dietetics (formerly the American Dietetic Association) are taking steps to petition the White House to see the light on this issue. I’m staying tuned and keeping my fingers crossed. In the meantime, we can all take steps to eat well and be more active, so we won’t need our physicians to refer us for nutrition counseling that might not be covered.

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Keith-Thomas Ayoob, ED.D.

Keith-Thomas Ayoob, ED.D.

Keith-Thomas Ayoob, Ed.D., R.D. is director, Nutrition Clinic, Children’s Evaluation and Rehabilitation Center, Einstein associate clinical professor, pediatrics.

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  • Peggy Gavan, MS April 17, 2012, 3:30 PM

    Dr. Ayoob,

    Excellent article — thanking you for pointing out this absurdity. Having worked in the Medicare industry for the past 6 years, I’m really not surprised, though. What I often tell people when I am explaining their Medicare benefits is, “This all sounds good, but there’s a catch. Of course there’s a catch. This is Medicare.” For example, Medicare will cover a colonoscopy screening — but heaven forbid the doctor actually finds and removes a polyp; now Medicare won’t pay because the “screening” has become “diagnostic.” Many beneficiaries are afraid to take advantage of this free screening because they can’t afford to pay if a polyp is discovered. I wonder when Medicare will realize it’s better to pay a lot less now to remove a polyp than a lot more later on when it becomes full-blown cancer and metastasizes.

    Reply
  • Keith-Thomas Ayoob, ED.D.

    Keith-Thomas Ayoob, ED.D. April 18, 2012, 3:21 PM

    Thank you Peggy for your kind words. The “colonoscopy catch” you pointed out is another example of good intentions gone wrong.

    Forcing someone to obtain an additional polypectomy on another date just clogs the system even more. It’s maximum inefficiency. Preventing a colon cancer is a tiny fraction of the cost of colon cancer treatment, and if polyps could all be removed, colon cancer could be almost eradicated.

    Not only would that save Medicare money, it would save a lot of discomfort, hardship, and loss of life. Whatever happened to “first do no harm”?

    Many thanks,
    Keith

    Reply
  • Judith April 18, 2012, 1:02 AM

    Great article. It seems that no one in government really wants people to tackle obesity. There still seems to be more money to be made in treating the diseases it causes than preventing them.

    Reply

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