Medicare to Cover Preventive Services for Obesity
Preventive services for obesity now will be included under Medicare and can be provided by primary care physicians or primary care practitioners only (nurse practitioners, clinical nurse specialists, or physician assistants) in primary care settings only.
Under the regulations, announced on Tuesday by the Centers for Medicare and Medicaid Services, physical therapists do not currently fit all the requirements to provide obesity intensive preventive therapies, which include:
- Screening for obesity in adults (BMI measurement; BMI ≥ 30 kg/m2);
- Dietary (nutritional) assessment; and
- Intensive behavioral counseling and behavioral therapy through high-intensity interventions, including diet and exercise.
Additionally, any behavioral intensity therapy should meet the 5-A framework recommended by the US Preventive Services Task Force:
- Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
- Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
- Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior.
- Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
- Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.
Primary care physicians in non-primary care settings are not precluded from conducting an obesity screening, then referring the patient to a primary care setting for further obesity therapy to be conducted by the primary care physician or primary care practitioner.
APTA is gathering the necessary supportive data to demonstrate the value of physical therapy interventions in reducing obesity and to advocate for inclusion of physical therapists in obesity prevention.