2014 Providence Registered Nurses (PRN) Election Biographical Information

Three years ago, the Obama administration offered hope to millions of overweight seniors when it announced Medicare would offer free weight-loss counseling.

Officials estimated that about 30 percent of seniors are obese and therefore eligible for counseling services, which studies have shown improve the odds of significant weight loss.

But less than 1 percent of Medicare’s 50 million beneficiaries have used the benefit so far. Experts blame the government’s failure to promote the program, rules that limit where and when patients can go for counseling as well as the low fees for providers.

Since November 2011, about 120,000 seniors have participated, including about 50,000 last year, according to federal data.

“It’s very disappointing,” said Dr. Scott Kahan, an obesity medicine specialist at George Washington University.

“It’s a huge lost opportunity,” said Bonnie Modugno, a registered dietician in Santa Monica, Calif., who advises doctors how to provide weight loss counseling.

By  comparison, about 250,000 seniors last year used Medicare’s tobacco cessation counseling benefit, which started in 2005 and offers greater flexibility about how providers can offer it. Nationally, 9 percent of seniors smoke, while 30 percent are obese.

Obesity and smoking are the two leading causes of preventable death in the United States. Obesity, which is defined as being 35 pounds or more overweight or having a body mass index above 30, increases the risk of many diseases, including diabetes, heart disease and cancer.

Still, physicians typically offer little more than lip service to helping patients lose weight.

“Doctors get little or no training in weight loss in medical school or residency training, and many doctors tend to view obesity as a matter of appearance and self-control, instead of health,” said Kahan, director of the Strategies to Overcome and Prevent Obesity Alliance, a coalition working to combat obesity.

In Medicare, many of the most knowledgeable providers are not even eligible to participate. For instance, Kahan, a board-certified doctor in preventive medicine, obesity medicine and clinical nutrition, is excluded. That’s because only primary care providers and nurse practitioners or physician assistants working in doctors’ offices, can be reimbursed under the regulations.

Medicare officials say they did that so weight loss counseling could be coordinated with the rest of a patient’s health care. Yet, critics say, the policy cuts out providers with deeper expertise in weight loss, most notably,  registered dieticians, diabetes nurse educators, psychologists and obesity medicine specialists. Bills have been introduced in Congress to expand the list of those eligible to participate, but they have gone nowhere.

Another challenge is the requirement that counseling be provided during a separate appointment, rather than when the patient comes in for other services.

That’s a problem for Dr. Reid Blackwelder, board chairman of the American Academy of Family Physicians, who has many obese seniors in his practice in Kingsport, Tenn. But he’s yet to offer obesity counseling because of the burden of bringing patients in for a separate visit. “That is not how family doctors work,” he said. “It’s not the best use of my time.”

Another deterrent is that Medicare pays doctors about $26 for a 15-minute counseling session. Many primary care doctors can earn three or four times that delivering other services.

“Doctors have too many other competing priorities, and Medicare beneficiaries have so many other medical problems that obesity tracks down to last on the priority list,” said Dr. Robert Kushner, clinical director of the Northwestern Comprehensive Center on Obesity in Chicago.

Originally, Medicare coverage for weight-loss counseling was promising to many obesity providers especially since few insurers, public or private, pay for it.

Under Medicare rules, beneficiaries are eligible for one, 15-minute, face-to-face counseling visit per week for one month, then every other week for an additional five months.  Patients who lose at least 6.6 pounds during the first six months are eligible for once-a-month visits for an additional six months.

The federal government has done little to publicize the benefit. A spokeswoman for the Centers for Medicare & Medicaid Services said there has been no publicity except for a mention in the Medicare handbook mailed to seniors’ homes.

While many doctors shy away from discussing obesity issues, regular counseling sessions done in a physician’s office do increase the likelihood of weight loss, according to a 2011 study in the New England Journal of Medicine.

Another study published in the journal Obesity, which was cited by the government when it launched the new benefit, found counseling along with dietary and exercise changes can produce average weight loss of 7 to 8 pounds over one to three years and the change improved blood sugar levels and mobility and reduces the incidence of diabetes.

It worked for Randall Roberts, an 86-year-old retired banker in Valparaiso, Fla., who said he lost 32 pounds after starting counseling at his physician’s office in 2012. He’s now down to 187 pounds and credits his physician’s constant encouragement to change his eating and exercise habits.

“I did not have stamina to go on long walks but he encouraged me to get back on my treadmill,” he said.

Roberts said food helped him cope after his wife passed away a few years ago. Today, he’s learned to cut out fast food, eat salads without fattening ranch dressing and look to nuts for snacks.

Dr. Thomas McKnight, Roberts’ family physician in Niceville, Fla., said he and his staff have provided weight loss counseling to about 30 Medicare patients in the past three years —those who they deem motivated to change.

He said doctors won’t get rich providing the benefit but “when you break it down, the $26 is not as bad a hit as it may seem.” He stresses to patients that weight loss is a gradual process done through small steps, such as limiting portion size and eliminating sodas.

Harry Herrlinger, 74, a retired marketing manager in Santa Rosa Beach, Fla., who calls himself “a former fat guy,” said McKnight taught him the importance of keeping a diary of everything he eats and of exercising.

He has lost 35 pounds in the past year and his diabetes is now under better control, along with his cholesterol. “I’m glad to see Medicare step up and offer this because the country is really obese and the cheeseburger generation is marching in.”

This article was produced by Kaiser Health News with support from The SCAN Foundation.

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.

After several years of modest increases, American spending on medications is projected to shoot up by 12 percent this year, pushing the nation’s drug bill to between $375 billion and $385 billion, according to a report by the IMS Institute for Healthcare Informatics.

Several factors are driving the spending spike, including the introduction of expensive new hepatitis C drugs and fewer drug patent expirations than in previous years, the report found. Such expirations typically lead to savings as cheaper generics replace brand-name drugs.

The 11.7 percent rise is a dramatic departure from the more modest average increases of 3.6 percent in annual drug spending during the past five years.

The report anticipates the pace of spending increases will slow to 7 to 9 percent in 2015, as the impact of the new hepatitis C drugs declines, less expensive biosimilar products become available and several brand-name drugs — such as cancer drug Gleevac and the antipsychotic Abilify — are replaced by generics.

“We expect this bubble of innovation around hepatitis C will pass, so we won’t see such a contribution to growth in outer years,” said Murray Aitken, executive director of IMS Health. “We think the spike in growth will moderate next year, and further moderate in 2016.”

Drug costs are projected to increase between 3 percent and 5 percent in 2016, he said.
The new hepatitis C drug Sovaldi, made by Gilead Sciences and approved in December 2013, costs $1,000 a pill, with a 12-week course of treatment running about $84,000. Another hepatitis C drug — Harvoni — approved by the FDA in October, costs $1,125 a pill, or $94,500 for a 12-week course of treatment.

An estimated 3 to 4 million Americans have hepatitis C and are potentially eligible for treatment. Hepatitis drug treatments accounted for $8 billion of the approximately $40 billion in projected increased drug spending this year.

“The hepatitis C drugs are Exhibit A when you look at escalating drug costs,” said Brian Henry, a spokesman for Express Scripts, the country’s largest pharmacy benefits manager. “You never had a drug that costs that much that can treat so many people.”
The price of Sovaldi “caught payers by surprise,” he said.

Innovative new therapies, especially in the area of cancer, have also pushed up costs. The Affordable Care Act, which expanded access to health care and medications, may also have played a role, along with a new emphasis on preventive care and adherence to medications, Aitken said.

Holly Campbell, director of communications for the drug industry trade group, PhRMA, said the cost of developing drugs has skyrocketed, pointing to a report this week by the Tufts Center for the Study of Drug Development that estimated the price of bringing a drug to market at $2.6 billion. The process can take a decade, the report said.

“These most recent findings underscore the ongoing challenges our industry faces,” Campbell said.

An AARP report noted the increase in prices of brand-name drugs. The report found that the prices of 227 brand name prescription drugs used by many older Americans increased by 12.9 percent on average last year, well above the 1.5 percent rate of inflation, bringing the average cost of a brand-name drug used regularly to $3,000.

“We have started to hear from members who have to decide between taking a drug they need and paying their electric bill,” said Leigh Purvis, director of health service research at the AARP Public Policy Institute and a co-author of the report.

But, she added, the impact goes beyond seniors. “This is a concern not just for our members but for everyone.”

Kaiser Health News (KHN) is a national health policy news service. It is an editorially independent program of the Henry J. Kaiser Family Foundation.