Are Expanded Obesity Treatment Avenues Coming for Medicare Beneficiaries?

| June 1, 2015

by Christopher Gallagher

Christopher Gallagher is Washington Coordinator, Obesity Care Continuum.

Bariatric Times. 2015;12(6):11.

May was a very good month for advocacy efforts to expand coverage for obesity treatment avenues for Medicare Beneficiaries. Two major events occurred on Capitol Hill during May 2015—one on the House side and the other across the Hill in the United States Senate.

On the House side, Representatives Paulsen (R-MN) and Kind (D-WI) took to the floor on May 18, 2015, to reintroduce the Treat and Reduce Obesity Act (TROA) of 2015 (HR 2404). This legislation would provide the Centers for Medicare and Medicaid Services (CMS) with the authority to expand the Medicare benefit for intensive behavioral counseling by allowing additional types of healthcare providers to offer these services. It would also allow the agency to expand Medicare Part D to provide coverage of FDA-approved prescription drugs for chronic weight management.

Joining Representatives Paulsen and Kind in co-sponsoring the bipartisan legislation in the House of Representatives are 41 of their colleagues from 20 different states across the country. The strong support for TROA is not surprising given that more than 120 members of Congress cosponsored the legislation during the previous 113th Congress. On June 4, 2015 Senators Carper (D-DE); Cassidy (R-LA); Coons (D-DE), Grassley (R-IA) Heinrich (D-NM); and Murkowski (R-AK) added their support for this effort by introducing the senate companion bill to HR 2404.

While the legislation never made it past the committee level during the last Congress, many obesity advocates see a tremendous opportunity for TROA’s passage this time around, especially after Senate Finance Committee Chairman Orrin Hatch (R-Utah) and Ranking Member Ron Wyden (D-Ore.) announced the formation of a bipartisan working group in an effort to begin exploring solutions that will improve outcomes for Medicare patients requiring chronic care.

Hatch and Wyden announced the initiative following the Finance Committee hearing on May 15 on the issue and have appointed committee members Johnny Isakson (R-Ga.) and Mark Warner (D-Va.) to lead the effort, which will include seeking input from healthcare stakeholders. In a letter to stakeholders on May 22, 2015, the working group leaders highlighted three main bipartisan goals they would like every stakeholder group to focus on during the 30-day comment period:
1.    The proposed policy increase care coordination among individual providers across care settings who are treating patients living with chronic disease
2.    The proposed policy streamlines Medicare’s current payment systems to incentivize the appropriate level of care for patients living with chronic disease
3.    The proposed policy facilitates the delivery of high-quality care, improves care transitions, produces stronger patient outcomes, increases program efficiency and contributes to an overall effort that will reduce the growth in Medicare spending.

In addition, the working group laid out several issue areas they plan to consider as part of their efforts, including the effective use, coordination, and cost of prescription drugs as well as options for empowering Medicare patients to play a greater role in managing their health and meaningfully engaging with health care providers.[1]
It is clear that the TROA will once again have strong bipartisan support as likely 150 Members of Congress should be supporting the bill by Labor Day (September 7, 2015). It’s also likely that there will be an enhanced congressional focus on addressing chronic disease management as evidenced by this new Senate Finance Committee working group. However, the key question that will need to be answered by this new working group is whether they will view obesity as a chronic disease worthy of recognition and treatment. While this may seem intuitive to obesity advocates, others still haven’t reached that stage.

For example, when policymakers at CMS proposed new Medicare payments for non face-to-face chronic care management services beginning in 2015, obesity was left out of the discussion because it was not on Medicare’s list of chronic conditions eligible for this new enhanced payment, which are listed in the Medicare Chronic Conditions Chartbook.[2]

The Chartbook highlights the prevalence of chronic conditions among Medicare beneficiaries and the impact of chronic conditions on Medicare service utilization and spending. The obesity community argued that the Chartbook should include obesity, especially given that 13 of the15 conditions listed (high blood pressure, high cholesterol, ischemic heart disease, arthritis, diabetes, heart failure, chronic kidney disease, depression, COPD, atrial fibrillation, certain cancers, asthma, and stroke) are commonly associated with obesity and/or are exacerbated by obesity.[3]

In making this argument, the Obesity Care Continuum highlighted how obesity clearly met the criteria CMS outlined in the proposed rule as the rational for selecting the 15 conditions eligible for the chronic care management payments. Specifically the following: 1) obesity is highly prevalent among the Medicare population; 2) obesity is chronic (i.e., typically lasts for more than 12 months); 3) obesity poses increased risk for death, acute exacerbation/decompensation, or functional decline; 4) obesity results in increased use of healthcare services; and 5) successful care management of obesity can improve outcomes/reduce costs.

Sadly though, CMS sidestepped this issue when the agency issued its final regulations surrounding chronic care management. Our hope is that the Senate Finance Committee working group will step up on this issue and make strong recommendations regarding the need to treat obesity seriously. Let’s make sure that Medicare beneficiaries have access to all evidence-based treatment avenues for this complex and chronic disease.

About the Obesity Care Continuum. The leading obesity advocate groups founded the OCC in 2010 to better influence the healthcare reform debate and its impact on those affected by overweight and obesity. Currently, the OCC is composed of the Obesity Action Coalition (OAC), the Obesity Society (TOS), the Academy of Nutrition and Dietetics (AND), the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American Society of Bariatric Physicians (ASBP). With a combined membership of more than 125,000 patient and healthcare professional advocates, the OCC covers the full scope of care from nutrition, exercise and weight management through pharmacotherapy to device and surgery.

References
1.    The United States Senate Committee on Finance. Hatch, Wyden Launch Working Group to Seek Input and Explore Chronic Care Solutions. May 22, 2015. http://www.finance.senate.gov/newsroom/chairman/release/?id=9f9f2d3e-401e-409b-a53a-22bbe3f56f2c. Accessed June 4, 2015.
2.    Centers for Medicare and Medicaid Services. Chronic Conditions Among Medicare Beneficiaries. Chartbook: 2012 Edition. http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/Chronic-Conditions/Downloads/2012Chartbook.pdf. Accessed June 4, 2015.
3.    The Obesity Care Continuum. Re: Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule, Clinical Fee Schedule & Other Revisions to Part B for CY 2014. http://www.obesityaction.org/wp-content/uploads/090613-OCC-Final-Comments-on-proposed-2014-MPFS-.pdf. Accessed June 4, 2015.
funding: No funding was provided.

Disclosures: Christopher Gallagher is a paid consultant for federal advocacy services for The Obesity Society, Obesity Action Coalition, American Society for Metabolic and Bariatric Surgery, and American Society of Bariatric Physicians.

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