A Survey of Primary Care Practices on Their Use of the Intensive Behavioral Therapy for Obese Medicare Patients

Abstract

OBJECTIVE:To fill the gap in knowledge on systematic differences between primary care practices (PCP) that do or do not provide intensive behavioral therapy (IBT) for obese Medicare patients. METHODS: A mixed modality survey (paper and online) of primary care practices obtained from a random sample of Medicare databases and a convenience sample of practice-based research network practices. KEY RESULTS: A total of 287 practices responded to the survey, including 140 (7.4% response rate) from the random sample and 147 (response rate not estimable) from the convenience sample. We found differences between the IBT-using and non-using practices in practice ownership, patient populations, and participation in Accountable Care Organizations. The non-IBT-using practices, though not billing for IBT, did offer some other assistance with obesity for their patients. Among those who had billed for IBT, but stopped billing, the most commonly cited reason was billing difficulties. Many providers experienced denied claims due to billing complexities. CONCLUSIONS: Although the Centers for Medicare and Medicaid Services established payment codes for PCPs to deliver IBT for obesity in 2011, very few providers submitted fee-for-service claims for these services after almost 10 years. A survey completed by both a random and convenience sample of practices using and not using IBT for obesity payment codes revealed that billing for these services was problematic, and many providers that began using the codes discontinued using them over the past 7 years.

Primary care provider uptake of intensive behavioral therapy for obesity in Medicare patients, 2013–2019

“…This relationship between the patient composition and provider IBT-uptake was consistent with the need for obesity management in patients with high lipids. These patterns were consistent with practicelevel characteristics associated with IBT uptake (e.g., larger practices are more likely to use IBT) [18], geographic distribution of the Medicare population with obesity (e.g., prevalence of beneficiaries with obesity is highest in the South) [19], and the complexity of obesity management (e.g., some PCPs such as nurse practitioners need more formal training for treating obesity) [20].…”

The Joys and Challenges of Delivering Obesity Care: a Qualitative Study of US Primary Care Practices

“…Survey methods and results are available elsewhere 24 . The core qualitative analysis team included a practicing physician, clinical psychologist, and health services researcher.…”

“…Therefore, we contacted leaders of practice-based research networks, using the same approach to introduce the study and request participation, resulting in a higher response to our requests. Details of this recruitment process are found elsewhere 24 . However, given the qualitative nature of this study and focus on practices providing obesity management, we were not trying to be representative of US practices (i.e., this was a convenience sample).…”

An Assessment of Weight Loss Management in Health System Primary Care Practices

“…[2][3][4][5][6] There are many evidence-based treatments available for patients with obesity, including medications, diet and nutrition counseling, behavior change support, and surgery; however, these treatments are often not implemented in primary care. [7][8][9][10] Although clinicians note the high importance of treating patients' obesity as a standard of care, 11 barriers include insufficient clinician training/familiarity with obesity treatment; challenges with access for/prioritization of obesity treatment; lack of workable structures, workflows, and resources; and low/no reimbursement for direct provision of obesity care without other comorbidities. [12][13][14][15] Patients also face many barriers including stigma, lack of motivation, ability to successfully lose weight, and cost and lack of access to services.…”