Challenges with the Medicare Obesity Benefit: Practical Concerns &amp; Proposed Solutions

Batsis, John A.; Huyck, Karen L.; Bartels, Stephen J.

doi:10.1007/s11606-014-3031-6

Cited by 37 publications

(38 citation statements)

References 37 publications

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“…However, its utility in clinical practice for obesity alone should be used with great caution informed by our study findings. Two major initiatives rely on BMI in an older adult population, including the Physician Quality reporting measures 22 , and the Medicare Obesity Benefit 23 . Our data proves the limitations of using this measure, but also demonstrate that the majority of older people in the United States population that have obesity based on body composition, may otherwise be classified as not having obesity based on a BMI<30kg/m 25 .…”

Section: Discussionmentioning

confidence: 99%

“…While DEXA may be widely available for measurement of body composition, in the United States, it is not a reimbursable procedure for this indication and hence the need to consider alternative anthropometrics. Physical function and quality of life are important patient-specific outcomes in older adults and targeted outcomes of primary care obesity interventions in this population should alter the focus from weight or BMI to such measures as advocated by others 23, 25 .…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004

et al. 2015

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Background Body composition changes with aging lead to increased adiposity and decreased muscle mass, making the diagnosis of obesity challenging. Conventional anthropometry, including body mass index (BMI), while easy to use clinically may misrepresent adiposity. We determined the diagnostic accuracy of BMI using dual energy x-ray absorptiometry (DEXA) in assessing the degree of obesity in older adults. Methods The National Health and Nutrition Examination Surveys 1999–2004 were used to identify adults aged ≥60years with DEXA measures. They were categorized (yes/no) as having elevated body fat by gender (men≥25%; females ≥35%) and by body mass index (BMI) ≥25 and ≥30kg/m2. The diagnostic performance of BMI was assessed. Metabolic characteristics were compared in discordant cases of BMI/body fat. Weighting and analyses were performed per NHANES guidelines. Results We identified 4,984 subjects (men:2,453; female:2,531). Mean BMI and % body fat was 28.0kg/m2 and 30.8% in men, and 28.5kg/m2 and 42.1% in females. A BMI ≥30kg/m2 had a low sensitivity and moderately high specificity (men:32.9% and 80.8%, concordance index 0.66; females:38.5% and 78.5%, concordance 0.69) correctly classifying 41.0 and 45.1% of obese subjects. A BMI ≥25kg/m2 had a moderately high sensitivity and specificity (men:80.7% and 99.6%, concordance 0.81;females:76.9% and 98.8%, concordance 0.84) correctly classifying 80.8 and 78.5% of obese subjects. In subjects with BMI<30kg/m2 body fat was considered elevated in 67.1% and 61.5% of males and females, respectively. For a BMI≥30kg/m2, sensitivity drops from 40.3 to 14.5% and 44.5 to 23.4%, while specificity remains elevated (>98%),in males and females, respectively in those 60–69.9years to subjects aged ≥80years. Correct classification of obesity using a cutoff of 30kg/m2 drops from 48.1 to 23.9% and 49.0 to 19.6%, in males and females in these two age groups. Conclusions Traditional measures poorly identify obesity in the elderly. In older adults, BMI may be a suboptimal marker for adiposity.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004

et al. 2015

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“…The benefit currently covers physicians, associate providers and clinical nurse specialists but is not extended to others integrally involved in behavior change, for example, exercise physiologists, behavioral psychologists, or dieticians. The very slow uptake in practices implementing the MOB is likely due to practice management issues, insufficient reimbursement, the high frequency of visits, and an infrastructure that cannot support this benefit [22]. Our group identified only 46,821 Medicare beneficiaries (0.17%) who availed themselves of the benefit in 2013, accounting for 101,290 claims (mean claims/beneficiary 2.16) [23].…”

Section: Medicare Obesity Benefitmentioning

confidence: 99%

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

2017

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BackgroundThe growing prevalence of obesity is paralleling a rise in the older adult population creating an increased risk of functional impairment, nursing home placement and early mortality. The Centers for Medicare and Medicaid recognized the importance of treating obesity and instituted a benefit in primary care settings to encourage intensive behavioral therapy in beneficiaries by primary care clinicians. This benefit covers frequent, brief, clinic visits designed to address older adult obesity.DiscussionWe describe the challenges in the implementation and delivery into real-world settings. The challenges in rural settings that have the fastest growing elderly population, high obesity rates, but also workforce shortages and lack of specialized services are emphasized. The use of Telemedicine has successfully been implemented in other specialties and could be a useful modality in delivering much needed intensive behavioral therapy, particularly in distant, under-resourced environments. This review outlines some of the challenges with the current benefit and proposed solutions in overcoming rural primary care barriers to implementation, including changes in staffing models.ConclusionsRecommendations to extend the benefit’s coverage to be more inclusive of non-physician team members is needed but also for improvement in reimbursement for telemedicine services for older adults with obesity.

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“…Waist-hip ratio also accurately predicts disability outcomes in men [24]. These anthropometric measures are as inexpensive and easy to perform in practice therefore, they may be used practically to provide additional risk stratification among overweight and obese individuals [25 • ]. Densitometry can also be used to estimate body composition by measuring total body density.…”

Section: Identifying Obesity In Clinical Practice and The Limits Of Bmentioning

confidence: 99%

Weight Management in Older Adults

2015

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As the number of older adults increases rapidly, the national epidemic of obesity is also affecting our aging population. This is particularly concerning given the numerous health risks and increased costs associated with this condition. Weight management is extremely important for older adults given the risks associated with abdominal adiposity, which is a typical fat redistribution during aging, and the prevalence of comorbid conditions in this age group. However, approaches to weight loss must be considered critically given the dangers of sarcopenia (a condition that occurs when muscle mass and quality is lost), the increase risk of hip fracture with weight loss, and the association between reduced mortality and increased BMI in older adults. This overview highlights the challenges and implications of measuring adiposity in older adults, the dangers and benefits of weight loss in this population, and provides an overview of the new Medicare Obesity Benefit. In addition we provide a summary of outcomes from successful weight loss interventions for older adults and discuss implications for advancing clinical practice.

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Challenges with the Medicare Obesity Benefit: Practical Concerns & Proposed Solutions

Cited by 37 publications

References 37 publications

Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004

Diagnostic accuracy of body mass index to identify obesity in older adults: NHANES 1999–2004

Telemedicine and primary care obesity management in rural areas – innovative approach for older adults?

Weight Management in Older Adults

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