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Medicare Now Covers Obesity Counseling

Older couple eating togetherObese people on Medicare  now have the opportunity to have regular weight loss counseling paid for when offered by a primary care provider.  Since this is considered prevention, there is no co-pay.

On November 29, the Centers for Medicare and Medicaid Services announced that there was enough evidence that intensive behavioral counseling was reasonable and necessary to prevent disease or disability and that Medicare beneficiaries were entitled to coverage as a preventive service.

This is particularly good news for people trying to prevent colon or rectal cancer since studies have consistently found a link between body mass index (fatness) and colorectal cancer, including the World  Cancer Research Foundation which included BMI and colorectal cancer in their 2007 comprehensive analysis reported in  Food, Nutrition, Physical Activity and the Prevention of Cancer.

This year the WCRF updated their analysis for colorectal cancer looking at new studies published since 2007 as part of the Continuous Update Project.  They wrote,

The CUP Panel agreed that the recent evidence was consistent with the conclusion of the Second Expert Report; the evidence that greater body fatness is a cause of colorectal cancer is convincing.

With the latest CMS coverage decision, Medicare patients with a BMI of 30 or over  can get:

  • One face-to-face visit every week for the first month
  • One face-to-face visit every other week for months 2-6
  • One face-to-face visit every month for months 7-12, if the individual has lost at least 6.6 pounds.

The benefit is limited to counseling delivered in primary care settings by primary care doctors or primary care nurse practitioners, clinical nurse specialists, or physician assistants.

Benefits are also provided for screening to determine BMI and nutritional assessment.

CMS defines intensive behavioral counseling as providing the 5-As:

  • Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
  • Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
  • Agree: Collaboratively select appropriate treatment goals and methods based on the patient’s interest in and willingness to change the behavior.
  • Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
  • Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.

CMS estimates that 1 in 3 people receiving Medicare are obese.

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

Body Mass Index (BMI) is calculated using weight and height. It doesn’t measure “fatness” directly but correlates well to overall amount of body fat. You can use this CDC calculator to find out your own BMI.

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