Weight Loss Counseling and Maximizing Reimbursement

With more than 70 percent of Americans overweight or obese, we are in the throes of a serious population health challenge. It has been well established that obesity can contribute to many serious health conditions, including type-2 diabetes, cardiovascular disease, stroke, certain cancers, osteoarthritis, sleep apnea, and more. We see this with our patients every day.

There is a high fiscal cost as well. According to the 2013 American Heart Association (AHA) and American College of Cardiology (ACC) issued Guideline for the Management of Overweight and Obesity in Adults, compared to normal weight patients, obese patients incur 46 percent higher inpatient costs, 27 percent more physician visits and outpatient costs, and 80 percent higher prescription drug spending. The cost of obesity care in the United States is enormous: As of 2008, these healthcare costs came in at about $147 billion.

In addition to chronic disease, excess weight impacts health in many other ways. Sometimes surgery will have to be postponed if the patient is obese, and additional weight can increase the likelihood of complications-especially for procedures such as joint replacement surgeries. Also, individuals who are overweight are more likely to have workplace injuries.  And recently, a leading expert from the American Cancer Society announced that obesity is catching up to smoking as a risk factor for cancer.

All these sobering facts remind us that interventions are badly needed.

In 2011, The Affordable Care Act (ACA) included provisions to provide preventative care services. Under these provisions, health plans would be required to cover the U.S. Preventive Services Task Force (USPSTF) recommendations, which include obesity counseling. USPSTF guidelines state that all adults be screened for obesity, and physicians should initiate a conversation about weight loss if the patient has a BMI over 30.

As critical as it is, having the conversation about weight loss can be difficult for some physicians, even for those who have been in practice for many years. Broaching the topic of weight with patients might seem like more of a personal affront than discussions about other medical conditions, such as high blood pressure, glaucoma, or other health issues that may be out of their immediate control. In fact, a 2016 Nielsen survey sponsored by the Council of Accountable Physician Practices (CAPP) found that while 52 percent of physicians report that they advise their patients to start a weight loss program, only 5 percent of those patients polled say they heard this advice.

Weight loss counseling should be incorporated into a physician's practice for several reasons. First and foremost, physicians enter medicine with the primary goal to help people, and excess weight adversely impacts overall health. Second, pay for performance measures make screening for body mass index and weight management counseling a standard for reimbursement and these actions must be documented in the patient's medical records. Third, physicians make a difference. Studies show that when physicians talk to patients about weight, patients are more likely to make the behavioral changes necessary to be successful.

Many different types of providers, from family practitioners to OBGYNs can offer weight loss counseling to their patients. According to CMS guidelines, behavioral therapy for obesity should include screening and measurement of BMI, dietary assessment and Intensive behavioral counseling, and high-intensity interventions and resources to promote sustained weight loss. These interventions could include weight management protocols to promote permanent lifestyle change and behavior modification.

CMS guidelines state that obese patients qualify for up to six months of covered obesity counseling. After six months of regular visits, a reassessment determining weight loss must be performed and documented. At this juncture, patients must have achieved a weight loss of at least 6.6 pounds to qualify for an additional six months of visits. If they have not reached that benchmark, a reassessment of willingness and readiness is appropriate.

Additionally, records should include a comprehensive description of the intervention and measures taken. Medicare suggests documenting the 5-A approach as recommended by the USPSTF (Assess, Advise, Agree, Assist, and Arrange). Obesity screening and counseling are time-based codes and documentation of services should also include the amount of time spent with the patient.

Physicians can have the weight loss conversation and not only maximize reimbursement, but they can also augment revenue by making medically designed and developed weight loss protocols available right in their practice, instead of referring patients elsewhere for these services. Many patients would be happy to pay out of pocket for a viable weight management solution, especially if suggested by a trusted provider.

Reimbursement for obesity counseling gives physicians some "skin in the game" and can be an incentive to help solve a serious public health crisis. Proactive weight loss counseling and interventions is a way to help keep patients and the practice healthy-all while making a meaningful impact in the fight against obesity.

Dr. Ann K Kuenker, D.O. is a family practitioner in private practice in Traverse City, Michigan.  She has offered a medically designed and developed weight loss protocol to her patients since 2009. Dr. Kuenker sits on the Ideal Protein Medical Advisory Board.