Weight management: With obesity on the rise, physician reimbursement for weight management is becoming a growing issue.
When a physician spends time talking to an obese patient about the importance of keeping one's weight at a healthy level, it's a question mark whether the doctor will get paid for that service.
Physician reimbursement of patient weight management counseling and treatment varies from insurer to insurer, even though data show that obesity, if untreated, leads to higher health care costs.
An article in the March/April issue of Health Affairs reported that obesity is linked to a 36% increase in inpatient and outpatient health care costs and a 77% increase in prescription drug costs.
Despite the link between obesity and chronic health problems such as diabetes and high blood pressure, few insurers say they will pay for separate office visits just for patients to talk with their physicians about weight management.
"Very few insurance companies pay for obesity and, if they do, they have very limited coverage," said Craig A. Keebler, MD, an ob-gyn, board certified with the American Society of Bariatric Medicine. Dr. Keebler runs Bellevue Premier Health, a weight m
anagement clinic, in Bellevue, Wash.
Obesity causes a 36% increase in inpatient and outpatient costs.
It costs patients about $120 to $220 a month for treatment at the clinic, including exams and counseling, he said.
But increased coverage of obesity counseling and treatment is something insurers are looking at, especially in wake of the U.S. surgeon general's report on obesity and a clarification of Internal Revenue Service rules allowing patients to get tax deduc
tions for the costs of weight management programs.
CIGNA Healthcare's policy is that discussion of a patient's weight is "part of a normal office visit. There wouldn't be a separate code for [weight] counseling in the office," said Janet Maurer, MD, the plan's corporate medical director.
Some of CIGNA's products cover up to three nutrition counseling visits with a dietitian, Dr. Maurer said. In addition, patients participating in CIGNA's disease management programs receive counseling on weight management and nutrition.
And if many patients demanded more coverage of obesity treatment, the company would consider it, she said. "We are always listening to what the members want."
Humana Inc. is also studying coverage of weight management treatments, a company spokeswoman said.
Obesity is linked to a 77% increase in medication costs.
Anthem Blue Cross Blue Shield offers members discounts to weight management programs and gym memberships. In addition, weight management counseling is part of -- or should be part of -- regular preventive physicals, said Robert Scalettar, MD, Anthem's
corporate medical director.
But reducing the rate of obesity in the United States is much more complex that simply providing more insurance coverage for weight loss programs, he said.
"There are a lot of unknowns in this," Dr. Scalettar said. "How can obesity be prevented, what are the most effective treatment strategies and how do we get people to modify their behavior and eating activities?
"We need to focus time and energy in a broader swath than what's covered and what's not," he added.
David Allen, MD, medical director for Aetna in Kentucky and Indiana, said the rising incidence of obesity is causing insurers to "take a renewed look at the magnitude of obesity as a precursor to health problems and costs."
But managed care doesn't give doctors much time to counsel patients on weight management, he acknowledged. "There's been an emphasis on expedited encounters with physician," he said.
Dr. Keebler agreed that it's difficult for physicians to squeeze in weight management counseling during a brief office visit. "You cannot counsel people in eight minutes," he said. "So much of obesity treatment includes coaching, counseling and reviewi
ng records."
For Aetna plans that include weight management benefits, the insurer covers counseling and treatment for patients with a body mass index of at least 30, or a BMI of at least 27 with hypertension, diabetes or coronary heart disease.
But Dr. Allen predicted that insurers soon would offer new types of coverage in which patients can spend more time with their physician on weight management and wellness counseling by paying higher co-payments or premiums.
Insurers also may decide to cover group weight management counseling, Dr. Allen said.
"There should be a new form of reimbursement for group counseling [for weight management]," Dr. Allen said. "It is important. Many doctors, in fact, have created weight management groups."
One of the physicians who has done so is Shelley C. Giebel, MD, an ob-gyn in Temple, Texas. After noticing that about half of her patients were obese, Dr. Giebel signed on with Health Management Resources, a physician-directed weight management program
based in Boston. Dr. Giebel's weight management patients attend a group meeting with her once a week. At the sessions they discuss how to exercise more and make nutritious food choices. They also have to phone her once a week and keep a food diary.
Dr. Giebel does not accept insurance payments, although her staff will file claims for patients who want to try to get reimbursed.
But Dr. Giebel thinks that insurance coverage of weight counseling won't help more people lose weight. In fact, she thinks that patients are more committed to a weight loss program when they are paying for it themselves.
"If patients are paying $80 a month to attend these classes, they are going to come," Dr Giebel said. "If the insurance company is covering it, the pull is not there."
But Dr. Keebler disagreed. "It absolutely should be covered. Not covering weight management is like not covering prenatal care. Preventive care makes a lot of sense, and it is the right approach."
Even if insurers cover more weight management treatment, talking to patients about their weight isn't easy, he said. Doctors are often afraid of offending overweight patients or think that the patients won't listen.
"But the most important thing is to bring attention to the problem for the patient," he said.
By Julie A. Jacob
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Copyright 2002 American Medical Association. All rights reserved.
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