The Medicare Obesity Decision


A new Medicare ruling means that doctors will be paid for screening for obesity and counseling of those eligible beneficiaries. What does that mean?  It means that they will pay for face-to-face counseling every week for one month, then one counseling appointment every other week for the following five months for people who screen positive for obesity.  CMS will require counseling be given only by physicians, nurse practitioners, clinical nurse specialists or physician assistants.  Now, here is the big question.   Who has the time to fit a patient in that often?   The answer is no one.  The USA Today discusses the debate over this issue and whether doctors even have the training to do counseling for weight loss.  We don’t.  Since our governmental dietary recommendations (low fat, high grain, high carb) may be a mistake  anyway, I am not sure it would even make a difference.  More importantly, I am just amazed at the fact that another new initiative comes down from CMS without a method or plan to carry it out.  Well done, my friends, well done.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  5 comments for “The Medicare Obesity Decision

  1. Halaluani
    December 7, 2011 at 1:17 pm

    It puzzles me how people who are obese are spoken about as if they take no responsibility for their obesity when we live in a country that is unable to agree on what constitutes a healthy diet. If a physician doesn’t know this why would lay people know it? Looking back in history shows us that obesity became epidemic in this country when the “low fat” diet rich in carbohydrates became the standard. We live in a country that thinks that starch is a necessary food group. Is it any wonder we are having an obesity epidemic?

    • Doug Farrago
      December 7, 2011 at 1:30 pm

      Agreed. I think the Paleo diet people might be right.

  2. Kurt
    December 7, 2011 at 9:07 am

    Until the ivory tower bastards realize that they are going to have to affect the patient’s pocketbook before they are going to change any of the health habits in this country, they will keep “blaming” the nation’s health problems on doctors instead of the patients.

    How does one do this? Give discounts on premiums for achieving modest goals plus, in the case of diabetes, covering for a comprehensive education course run by certified educators. If the patient fails it’s their own fault.

    Critera can be relaxed a bit for the aged. Heck, if someone is 90 and made it there with a glyco-hb of 8.0 must be in the lucky group!

    The incentives need to be patient driven and not doctor driven. Give the money/discounts to them for their good habits not to me! Physicians for hundreds of years have preached what one needs to do for good health based on current scientific thinking. A majority of patients continue to ignore that advice. If there was financial incentives, patients would start taking our advice more seriously.
    On the other hand, education programs will need to be a covered benefit to give them the tools to make the needed changes.

    The way things are headed, primary care is doomed and it is reflected with the intentions of the current batch of medical students. The AAFP is a bunch of clueless dolts.

    • December 8, 2011 at 7:13 am

      Well said!!!

  3. December 6, 2011 at 12:18 pm

    That finisher made me laugh. 😀

    On a more serious note, I think this won’t work. Doctors need to sleep, too. It’s very unlikely to find time to fit that counseling. In my opinion, it’s up to the obese individual to find ways to solve his/her problem. They won’t go to counseling unless they’re not in denial anyway. And if they’re past denial and really want to solve it, then, they’ll be able to find ways. I know a lot of people who overcame obesity. Yes, they got help at some point, but those help won’t mean anything unless they’re really willing to work through their problem.

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