Resolution to Improve Obesity Medicare & Insurance Coverage (PDF

Richmond Academy of Medicine

WHEREAS, in 2010, the Congressional Budget Office released a report that showed obesity rates
among Americans had more than doubled from 13 to 28 percent from 1987 to 2007, and

WHEREAS, since then, obesity rates have grown measurably worse with nearly 70 percent of
Americans affected by excess weight or obesity, and 42 percent of Americans projected
to become affected by obesity by 2030, and

WHEREAS, estimated direct obesity costs are 5.7% of total U.S. Health expenditures and Healthcare
costs related to obesity exceed $400 billion each year, and

WHEREAS, a majority of Americans affected by excess weight or obesity are also at risk for over 230
associated diseases including heart disease, stroke, fatty liver, type 2 diabetes,
dementia, depression, respiratory impairment, certain cancers and marked diminished life
expectancy and deprives individuals on average from 19 years of healthy living making
obesity a healthcare and financial epidemic/burden requiring access to a full range of
safe and effective treatment options, and

WHEREAS, treatments that reduce the weight as little as 5-10% have been shown to improve quality
of life, reduce mortality, significantly improve cardiovascular and other obesity related
diseases, and save $2137/year per individual, and

WHEREAS, in June 2012 the U.S. Preventative Services Task Force (USPSTF) recommended that
clinicians screen all adult patients for obesity and offer or refer patients with body mass
index of 30 kg/m2 or higher to intensive multicomponent behavioral interventions to
promote sustained weight loss for obese adults (grade B recommendation.), and

WHEREAS, in June 2013 the American Medical Association officially declared Obesity as a disease
(Resolution 420) stating the “American Medical Association recognizes Obesity as a
disease state with multiple pathophysiological aspects requiring a range of interventions
to advance obesity treatment and prevention,” and

WHEREAS, in June 2017 the U.S. Preventative Services Task Force (USPSTF) recommended that
clinicians screen for obesity in children and adolescents 6 years and older and offer or
refer them to comprehensive, intensive behavioral interventions to promote
improvements in weight status (recommendation B), and

WHEREAS, several medical associations such as the Obesity Medicine Association and the National
Institutes of Health define Obesity as a chronic, relapsing, multi-factorial, neurobehavioral
disease, wherein an increase in body fat promotes adipose tissue dysfunction and
abnormal fat mass physical forces, resulting in adverse metabolic, biomechanical, and
psychosocial health consequences, and

WHEREAS, since 2011, the Center of Medicare and Medicaid Services (CMS) has determined that
Interventional Behavioral Therapy (IBT) for Obesity, defined as all people who have a
body mass index (BMI) of 30 kg/m2 or greater, is necessary for the prevention or early
detection of illness or disability and is appropriate for individuals entitled to benefits under
Part A or enrolled under part B and is recommended with a grade A or B by the USPSTF,

WHEREAS, CMS offers coverage of screening and Interventional Behavioral Therapy (IBT) to help
eligible patients lose weight but restricts such coverage to the Primary Care Provider in
the primary care setting and excludes other appropriate evidence based treatment
modalities, and

WHEREAS, primary care physicians by CMS includes physicians with designation in Family Medicine,
general Internal Medicine, Obstetrician/Gynecology and Pediatric Medicine, or Nurse
Practitioners, Clinical nurse specialists or physician assistants. PCPs are not trained in
the delivery of IBT, offices are not properly equipped, and restricting care services to
primary care doctors is unusual and represents a biased and stigmatizing practice, and

WHEREAS, CMS states that ER departments, inpatient hospital settings, ambulatory surgical centers,
independent diagnostic testing facilities, skilled nursing facilities, inpatient rehabilitation
facilities and hospice are not considered primary care settings, and

WHEREAS, for Medicare beneficiaries who are diagnosed with Obesity whose counseling is furnished
by a qualified PCP or other PCP in a primary care setting, CMS covers:
• 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 beneficiary achieves a
reduction in weight of at least 3 kg (6.6 lbs) over the course of the first 6 months of
intensive therapy if this goal is not reached, therapy typically ends. The PCP can assess
the patient for another Obesity screening benefit after an additional 6-month period, and

WHEREAS, The Treat and Reduce Obesity Act (TROA) in the 115th Congress (s. 1509) will provide
Medicare beneficiaries and their healthcare providers with meaningful tools to reduce
obesity by improving access to weight-loss counseling and new prescription medications
for chronic weight management, and

WHEREAS, The Treat and Reduce Obesity Act (TROA) will provide Centers for Medicare and
Medicaid Services (CMS) with the authority to expand the Medicare benefit for intensive
behavioral counseling by allowing additional types of health care providers, such as
dieticians, psychologists and specialty physicians (obesity medicine specialists,
endocrinologists, bariatric surgeons, psychiatrists, etc.) as well as community-based
programs to offer counseling, and

WHEREAS, TROA will expand Medicare Part D to provide coverage of FDA-approved prescription
drugs for chronic weight management, and

WHEREAS, while the legislation is focused on improving access to obesity treatments for Medicare
beneficiaries, it is important to remember that often times private and employer based
insurance plans base their coverage on matching Medicare coverage; therefore, this
legislation is important to all Americans, therefore be it

RESOLVED, that the Richmond Academy of Medicine and the Medical Society of Virginia through its
delegation to the AMA support coverage for healthcare costs associated with medical,
surgical, nutritional and behavioral treatment interventions for patients diagnosed with

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