Posts Tagged ‘Obama’

Stealth Provision Expands Obesity Coverage for Millions

July 21st, 2010

 

On July 19, 2010, The Department of Health and Human Services issued ‘interim final regulations’ requiring  insurers in the group and individual markets  to include preventive services without any cost sharing as part of the the health care reform law signed by President Obama earlier this year. Preventive services include an important, sleeper provision regarding obesity. Here’s how it works.

The law defines “preventive services” as those with an A or B grade recommendation from the U.S. Preventive Services Task Force (USPSTF). The USPSTF has B grade recommendations for intensive behavioral counseling for adults with obesity and for screening and counseling for children. U.S. Preventive Services Task Force Recommendations

Coverage without cost sharing goes into effect on September 23, 2010. Interestingly, the regulations do not provide any limitations on the frequency, intensity or duration of such coverage. This represents a significant new benefit coverage  affecting millions of Americans. Most of the USPSTF recommendations cover screening tests but counseling is covered for tobacco cessation, sexually transmitted infections, dietary counseling for persons with hyperlipidemia and related cardiovascular risk factors, and promote breast-feeding.

I call this a stealth provision because Congress assumed the USPSTF recommendations were screening tests and probably would have rejected this kind of coverage as a listed benefit.

The regulation background information discusses the low level of obesity counseling presently and the benefits to be expected from broader coverage.

Comments can be received for 60 days from July 14, 2010. The proposed regulation can be accessed at Federal Register Contents, Monday, July 19, 2010

Time for Obesity in Health Care Reform

September 27th, 2009

January 30, 2009 :: By Morgan Downey

These are exciting times for health care reformers. We seem to have a President who is truly committed to reform of the health care system with the political strength to get his program enacted, at least a good part of it. What is the President’s program and how does or can, obesity be part of it?

First, some parts have already been enacted in the American Recovery and Reinvestment Act (ARRA), aka the Stimulus Bill. Millions of federal dollars are starting to flow into (a) expanded Health Care Information Technology, (b) comparative-effectiveness research and (c) expanded research at the National Institutes of Health. In addition, President Obama and several of his key aides, such as Melody Barnes, Director of Domestic Policy Council, and Peter Orszag, director of Office of Management and Budget have both addressed obesity and its important role in reducing health care costs and increasing the nation’s health.

Second, a major component to be worked on this summer is providing health insurance to millions of Americans without health insurance.

How might these plans affect obesity?

Healthcare Information Technology (HIT) may provide some interesting opportunities. In a few places, extensive clinical databases are already in use which track patients receiving bariatric surgery. The Surgical Review Corporation, for one, has 100,000 surgical patients which are being tracked for long-term outcomes. The Geisinger Medical Center in central Pennsylvania also has extensive database on patients in surgical and medical treatment. Such clinical registries can provide a vast improvement in understanding obesity and its co-morbidities as well as tracking long-term improvements. Doing this in real time with real-world patients can add tremendous information to clinical trials, which, by their nature, have more restrictive populations and end-points. Last year, the National Committee on Quality Assurance (NCQA) expanded the widely used HEDIS system which measures quality in managed care plans to capture Body Mass Index (BMI) for adults and children. The Administration’s emphasis on electronic medical records (EMR) in primary care practice, by requiring capture of BMIs, along with other clinical indicators, such as blood pressure, cholesterol levels and lipids, can provide a tremendous database for researchers and has the potential to greatly improve patient care. But there is a third level as well. Private entities, such as Google and Microsoft, are developing Personal Health Records (PHR) for individuals to track their own information, which might include nutritional and exercise patterns. One can almost envision a system whereby food and exercise diaries, clinical indicators, pharmaceutical and surgical information is available for patients, health care professionals and researchers.

Of course, such systems take a lot of effort. Common terminology must be agreed to. Data has to be able to be verified. Systems have to interface and patient privacy has to be protected. Who owns this information is a critical issue.

Comparative effectiveness research has already received a great deal of funding under ARRA. The Institute of Medicine has a panel recommending research priorities and, given the discussion at a public meeting on March 20, 2009, there is good reason to anticipate that obesity will be one of the priorities. But the question should not be just what is the best way to lose weight. The research should look at weight loss by various interventions against standard treatments for a number of the co-morbid conditions associated with obesity. And, while there is good data on the efficacy of weight loss for resolution of type 2 diabetes and cardiovascular disease, less is know about its efficacy in mobility problems, such as knee and hip replacements, asthma or breast cancer.

Finally, the Obama Administration has an enormous opportunity in the coverage of the uninsured to make a real change for persons with obesity. First, the Administration should oppose using overweight or obesity as a pre-existing exclusion. While we do not know what percent of the uninsured population is overweight or obese, it is unlikely that the rate is any lower than the national averages. To exclude 30-60% of the uninsured population because of their weight would be poor policy indeed. Next, the Administration should provide a full range of interventions from counseling on nutrition and physical activity to pharmaceutical and surgical interventions. Not only would this directly address the source of many of the uninsured population’s health care problems, it could break the logjam of resistance to coverage of obesity prevention and treatment. While these two steps will be costly, we have seen the rising rates of health care costs and obesity go hand-in-hand. Economists today see obesity as a major contributor to chronic illness and its costs. Finally, coverage should be tied into electronic records which can track long term outcomes.

In the April 15, 2009 issue of the Journal of the American Medical Association, Johathan Q. Purnell and David R. Flum estimate that gastric bypass surgery could save 14, 310 diabetes-related deaths over five years. The evidence on the power of weight loss to prevent and improve chronic disease is there, if not yet perfect. The Administration has an opportunity to make a major leap forward in addressing obesity. It should not miss this chance.