As a Registered Dietitian dedicated to improving the health of Americans, I would like to call your attention to the recent decision memorandum by the Centers for Medicare and Medicaid Services (CMS) regarding Intensive Behavioral Therapy for Obesity (CAG-00423N). In the decision, CMS determined that this potentially lifesaving preventive service could only be furnished by primary care providers in the primary care setting. As a result, CMS has eliminated the most qualified providers, notably Registered Dietitians (RDs), along with clinical psychologists and other specialists who have been able to produce the best results for patients. The decision prevents this group from directly billing for services and from providing services outside of primary care, and limits access for older patients to qualified professionals that would help manage chronic disease. In this regard, CMS’ decision goes against the U.S. Preventive Services Task Force's recommendations upon which it is based.
I am very concerned that our nation’s Medicare beneficiaries are not able to receive high-quality, comprehensive and cost-effective nutrition counseling for obesity by Registered Dietitians. The Institute of Medicine has previously reported Registered Dietitians to be "the single identifiable group of health-care professionals with standardized education, clinical training, continuing education and national credentialing requirements necessary to be directly reimbursed as a provider of nutrition therapy." Under CMS' decision, primary care providers with significantly less training on obesity counseling are being asked to produce quality outcomes in the treatment of this costly and disabling condition. This is despite a recent survey of primary-care physicians in which 78 percent said they had no prior training on weight-related issues. Of those, 72 percent said no one in their office had weight-loss training.
Registered Dietitians, on the other hand, are cost-effective physician extenders who provide services collaboratively and demonstrate a return on investment that results in cost savings in the delivery of our nation's health care. RDs are a crucial partner to physicians as they coordinate each Medicare beneficiary's care.
While CMS indicates that the decision does not preclude the primary care providers from referring eligible beneficiaries to other practitioners for intensive, multi-component counseling, payment does not follow. Ultimately, therefore, people identified with a serious chronic medical condition—obesity—continue to be denied access to the very health-care professionals who are most qualified to provide the service defined in the decision memo and in the most cost-effective manner.
As a constituent, I am asking you to take the following action:
- Contact your CMS liaison and indicate your opposition to this decision.
- Support efforts to expand coverage and reimbursement of nutrition services by Registered Dietitians as a component of quality health care delivery.
In addition, I will be asking you to sign on to a forthcoming letter from fellow members of Congress to CMS that asks the agency to reinterpret statutes used in determining this coverage and to reconsider its rule. I will follow up with you when the letter is ready for signature. For more information regarding the letter, contact Jeanne Blankenship, MS RD at firstname.lastname@example.org or at 202/775-8277 ext. 6004.
Please contact me if you have questions on how to make changes that will allow for cost-effective and high-quality care for our older and disabled Americans who are struggling to manage obesity.