Doctor James Goto

OAC, ACP, and Doctors Take on Medical Care for Obesity

Doctors who want to provide medical care for obesity — before it leads to a litany of chronic diseases — face a medical system that is stacked against them. Payers will rarely pay for medical care relating solely to obesity. So those who want to be paid for their work more often address the complications of obesity — work that’s abundant and reimbursable. But most significantly, doctors feel ill-prepared for the unique demands of obesity medicine. It requires special skills, time, and patience to address this complex condition. The Obesity Action Coalition (OAC) and the American College of Physicians (ACP) have joined forces to address this problem with a new DVD and guidebook that physicians can use with their patients.

“When you delve into the literature, there are dozens of effective clinical treatments for patients, but getting the treatment reimbursed is a real challenge,” says Scott Kahan, Director of the National Center for Weight and Wellness in Washington, DC. “My staff recently examined a sample of insurance claims for patients with obesity and found that the reimbursement rate was only about 10%. Many of these are claims that would be routinely paid in a general internal medicine clinic.”

Primary care physicians like Andre Pasternak of Reno, NV, see patients with obesity and excess weight every day, and even though he tries, he observes that “a lot of times [your efforts] don’t take.”

“It’s frustrating, because we have very good surgeons in town who will do gastric bypass and get paid really well for it,” says Pasternak. “But if we want to spend 20 or 30 minutes with a patient discussing their dietary habits and exercise … a lot of times it doesn’t get reimbursed.”

Addressing obesity is “challenging in terms of the time required to do it right and the lack of coverage” by most insurers, says Yul David Ejnes, a Cranston, RI, internist and past chair of the Board of Regents of the American College of Physicians. Despite his best efforts, “sometimes it becomes clear that one approach isn’t going to work, no matter how hard you try,” Ejnes says. Recognizing that this is part of the process, he uses the opportunity to better understand a patient’s needs. “My approach is to get them back on the wagon. You learn from the failure.”

“The adult problem is harder to cure, because it’s been more long-standing in each person,” says Joseph J. Colella, MD, a bariatric surgeon at the University of Pittsburgh Medical Center. Colella advises physicians to avoid rote advice to eat less and move more in  their first discussions about healthy weight goals.

“People who are struggling with their weight have heard [that advice] ad nauseam,” he says. “The minute they hear it from another person, they zone out and stop listening.”

Lyle Bohlman, a physician in Memphis, treats seniors with obesity and Medicare is now reimbursing him for his efforts. “So, my counseling session would include helping people understand that reducing calorie intake is just a part of it, exercise is absolutely essential to losing weight,” Bohlman says. “I view it like a prescription, and I actually write it on a prescription pad.” According to Bohlman, Medicare-eligible patients present special challenges. “In older people, they have a fixed habit pattern that is a little more difficult to deal with probably than younger people. But I try to tap into the positives about that — you have more time that you can exercise, you’re not working 40, 50 hours a week like you used to.”

Click here to read more about the OAC/ACP resources for physicians treating obesity, click here to read more about the challenges physicians face in treating obesity in American Medical News and click here to read more from wknofm.org.

Doctor James Goto, Medical Director of the Manzanar Relocation Center, Manzanar, CA, 1942, image by Dorothea Lange from the National Archives / Wikimedia

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