Prepared by Christopher Gallagher, ASMBS Washington Representative
OMA Hosts OCAN Fall Advocacy Day
On September 27, 2018, more than 60 obesity advocates descended on Capitol Hill as part of the Obesity Care Advocacy Network’s (OCAN) Fall Advocacy Day. The Obesity Medicine Association (OMA) served as the host organization for the Day on the Hill as OMA provided the majority of advocates who were already in Washington, DC for the association’s Overcoming Obesity 2018 Conference.
In total, OCAN advocates visited 55 Senate and a dozen House offices — urging legislators to support the Treat and Reduce Obesity Act (TROA) and take action to promote National Obesity Care Week during the week of October 7th-13th, 2018. Senate and House members from 39 states across the country were called on to elevate the dialogue regarding those affected by obesity and address critical coverage gaps in treatment such as those under the Medicare program that prohibit Medicare beneficiary access to FDA-approved obesity drugs and the full array of qualified healthcare professionals regarding intensive behavioral therapy.
Please take a few minutes to let your legislators know of your support for TROA and National Obesity Care Week by visiting the Obesity Action Coalition’s (OAC) Action Center where you will be able to send a letter to both your Senators and local Representative from your state’s congressional delegation.
USPSTF Final Recommendations Regarding Obesity Counseling
On September 7, 2018, the United States Preventive Services Task Force (USPSTF) issued final recommendations, entitled, “Weight Loss to Prevent Obesity-Related Morbidity and Mortality in Adults: Behavioral Interventions.” The September 7th USPSTF guidelines recommend that clinicians offer or refer adults with a body mass index (BMI) of 30 or higher (calculated as weight in kilograms divided by height in meters squared) to intensive, multicomponent behavioral interventions.
On March 19th, the Obesity Care Advocacy Network (OCAN) submitted formal comments in response to the Task Force’s draft recommendations, which cited the critical need for a multidisciplinary treatment approach to obesity following diagnosis. OCAN urged the Task Force to amend its formal recommendation statement to: “The USPSTF recommends that clinicians offer or refer adults with obesity for evidence-based treatments including: intensive multi-component behavioral interventions, obesity pharmacotherapy, and surgery.”
Additionally, OCAN raised concerns over the Task Force’s assessment regarding obesity pharmacotherapy as well as the lack of consideration of bariatric surgery as a treatment option. Finally, OCAN groups urged the USPSTF to universally accept the use of people first language throughout its scientific documents and statements.
Unfortunately, the final recommendations continue to ignore these two proven treatment avenues and illustrate the Task Force’s continuing failure to recognize that obesity is a complex and chronic disease. For example, the USPSTF stated that “data were lacking about the maintenance of improvement after discontinuation of pharmacotherapy. As a result, the USPSTF encourages clinicians to promote behavioral interventions as the primary focus of effective interventions for weight loss in adults.” The Task Force would never make such a statement regarding an individual’s ability to maintain normal blood pressure following discontinuation of anti-hypertensive medications.
OCAN Urges Delay on Key Medicare Payment Changes
On September 10, 2018, OCAN submitted formal comments in response to proposed regulations issued by the Centers for Medicare & Medicaid Services (CMS) regarding “Medicare Program; Revisions to Payment Policies under the Physician Fee Schedule and Other Revisions to Part B for CY 2019; Medicare Shared Savings Program Requirements; Quality Payment Program; and Medicaid Promoting Interoperability Program.”
Under the proposed rule, payment for new patient office visits levels two through five (CPT codes 99202-99205) would be blended into a single $135 payment. Payment for established patient office visits level two through five (CPT codes 99212-99215) would be blended into a single $93 payment. While these proposed changes might appropriately promote the use of short visits focused on a single, straightforward problem, they could discourage longer visits that address the multiple medical needs of complex patients, such as those affected by obesity.
OCAN expressed strong concerns over these proposed restructuring and payment reductions for key evaluation and management (E&M) reimbursement codes and urged CMS to delay implementation of these changes until at least 2020 so they can be thoroughly vetted to ensure they do not undermine patient access to care or patient safety for those with chronic and complex disease states.
On a separate issue, OCAN expressed support for CMS’ intent to create Merit-based Incentive Payment System (MIPS) public health priority sets across the four performance categories (quality, improvement activities, promoting interoperability, and cost). While thankful that the agency has identified opioids, diabetes, blood pressure and general health (healthy habits) as the first set of public health priority sets to develop, OCAN questioned the omission of obesity in this initial set given the prevalence of this disease among Medicare beneficiaries and Americans in general.
Addressing this point, OCAN highlighted that “more than two out of every three adults in the United States have obesity or overweight and are poised to develop a wide range of weight-related chronic diseases that disables our population and fuels our nation’s health costs.” CMS has stated that “obesity is directly or indirectly associated with many chronic diseases including cardiovascular disease, musculoskeletal conditions and diabetes.” Given these facts, one could argue that inclusion of obesity in the initial set of public health priorities should be obvious for CMS – especially given that obesity could be considered the underlying disease contributing to diabetes, high blood pressure, poor general health and even possible opioid addiction associated with the musculoskeletal effects of obesity.