Medicare policy to shake up weight-loss field
July 18, 2004
By:Gina Kolata and Denise Grady
The new policy announced by the federal government last week that enables Medicare to consider paying for obesity treatments may transform the weight-loss field by providing, for the first time, reliable data on methods for losing weight.
Health and Human Services Secretary Tommy Thompson announced Thursday that Medicare was abandoning a long-held policy that said obesity was not a disease.
That opens the way for the government to pay for a whole range of possible treatments, from surgery and diets to psychotherapy.
But the government also said that to be eligible for coverage, treatments must be proved effective. And to determine whether an obesity treatment works, Medicare said it could end up paying for large studies of the treatment's effectiveness.
"I could see us using that here," said Mark McClellan, administrator of the federal Centers for Medicare and Medicaid Services.
That, obesity experts said, could finally put hard data behind a notoriously fuzzy field and perhaps help millions of overweight Americans decide what to do.
The new Medicare policy appeared not as a positive statement but rather as a deletion in its Medicare Coverage Issues Manual. Gone was the phrase "obesity itself cannot be considered an illness," and gone was the implication that coverage would be denied for any treatments intended to treat obesity alone. Until now, Medicare has paid for weight-loss surgery, for example, only if it was intended to treat a condition such as diabetes that arose from obesity.
McClellan said he was expecting a deluge of requests that Medicare pay for treatments such as surgery, diets, behavioral therapy and exercise therapy. The agency does not pay for drug treatments.
An estimated 18 percent of the Medicare population meets the official definition of obese: a body mass index above 30, as would occur, for example, in a woman who was 5 feet 5 inches and weighed more than 180 pounds or a 6-foot man weighing more than 221 pounds. With weight-loss surgery costing $30,000 to $40,000 if there are no complications, the cost to Medicare of obesity treatments could be astronomical.
But that depends on whether the agency decides that obesity treatments are effective. And that, in turn, depends on what constitutes effectiveness.
"We do need to get input" on those questions, McClellan said in a telephone interview. Medicare is convening an advisory committee this fall "to help us think through these issues," he said.
Obesity researchers said it would not be easy.
One question is how to define success. Obese people want to look thinner. But academic obesity programs, said Gary Foster, clinical director of the weight and eating disorder program at the University of Pennsylvania, define success as losing 5 to 10 percent of your weight. That, he says, is the amount of weight loss needed to improve blood pressure, blood glucose levels and cholesterol levels. People may still be fat, but healthier.
Others, like Jules Hirsch, an obesity researcher at Rockefeller University in New York, say there is another definition of success: getting rid of the weight problem for good.
"At the end of the treatment, are they now like all kinds of other people who never had the problem of obesity?" Hirsch said. "By that definition, there has been nothing that works."
Commercial programs are considering what the Medicare change might mean for them.
Stuart Trager, medical director for Atkins Nutritionals, said, "We will pursue having the Atkins nutritional approach become a therapeutic option that is reimbursable."
Chris Corcoran, a spokeswoman for Weight Watchers, said she did not know if the company would seek coverage for its services, but she said some people could already get at least partial reimbursement through flexible-spending accounts and other types of employee benefit programs.
Many insurers take their cues from Medicare's policies. Scott Smith, vice president and chief medical officer for a large managed care company, First Health Group, said the Medicare decision was almost certain to affect practices in the insurance industry. "I can't believe it won't," Smith said.
Source:www.azcentral.com
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