RD Billing

Let's Go RD Community - Get Coverage for Obesity Services!

Treat and Reduce Obesity Act

The Treat and Reduce Obesity Act would allow for qualified health care professionals, typically Registered Dietitians, to bill directly for their Medical Nutrition Therapy and Intensive Behavioral Therapy services.  Increasing access to qualified healthcare professionals helps to reduce the cost of treatment and increase access for obesity treatment provided to Older Americans.  This is a clinically appropriate and cost-effective piece to the puzzle in tring to increase preventive care in our health care system.  I think it is important to ensure that Medicare patients have access to the best possible care at a fraction of the cost.

Medical Nutrition Therapy

The Preventive Services Task Force found that intensive behavioral therapy carried out for obese patients by Registered Dietitians led to clinically significant weight loss, greater weight loss and increase in exercise.  With the obesity epidemic costing our nation $210 billion annually, this is an immensely important issue.  

Go to Grassroots Manager now to write to Congress!

Advocating for our services from the platform of public policy is what will shape the landscape for nutrition services decades from now.  I urge my fellow RDs to log in and help support this bill, as coverage issued by the Centers for Medicare and Medicaid often trickle down to becoming standards of care within the industry.

Alliance for a Healthier Generation

In 2005 the American Heart Association and the Clinton Foundation teamed up to develop an alliance against childhood obesity.  What resulted is a fantastic initiative that systematically looks at our environment and incentivizes preventive services and healthier surroundings.  

Alliance for a Healthier Generation

RD Coverage: The Alliance has worked with the American Academy of Pediatrics and the Academy of Nutrition and Dietetics to offer comprehensive health benefits to children and families for preventive and treatment services surrounding childhood obesity.  Eligible children have access to four visits with an RD for nutrition services.  [Fellow RDs, learn about how to become a provider here!]

Image from Healthier Generation site.

Image from Healthier Generation site.

Big Food, Deep Pockets, and Healthcare

Fast Talk About Fast Food

I was reading an interesting article recently, written by practicing physician Dr. Adams in Baltimore, that discussed many of the main themes of the public health crisis and the role that food marketing and lobbying plays in our national health crisis.  Nothing I haven't heard, read, or discussed before, but I enjoyed this particular article because he was genuinely pissed off.  

And I really don't blame him.  As health care professionals why aren't more of us this upset over the suppressive role that big food plays in government policy and agricultural subsidies, or the convenient role that fast food companies play in sponsoring health oranizations.  To steal a word from him, this "diabesity" crisis only continues to grow, which in turn burdens our health care system and government further.

RD Critique

He is critical of dietitians in this article for touting portion control as a critical means to weight control.  I can respect his frustrations with this but have to say, that is a very broad stroke analysis of what a Registered Dietitian does.  

Media outlets have RDs on television/radio/print media to help get across a wide array of nutrition messages (a common one being portion control - because it works), so yes often times it all seems simpler than it should be.  Where the rubber hits the road is when an RD can develop an ongoing therapeutic relationship with a client/patient and be part of the support system that helps them develop healthy eating patterns.

Nobody develops obesity overnight, so that is where continuity of care and insurance reimbursement are important.  The role of the RD is that of health expert that can help explain physiological concepts and answeres questions on food and digestion, physical activity, exercise, and chronic disease management.  As a dietitian I also see it as my role to be the obejctive eye for the client and help them see their own patterns of food intake.  

So Dr. Adams, fight alongside me to stop the subsidies of big agriculture, and improve CMS and private insurance reimbursement for RD services.

Better Diabetes Prevention in Primary Care

Paradigm Shift in Public Health

As the discussion regarding the cost of healthcare and disease in this country continues to evolve, it is clear to me that Registered Dietitians will continue to play an important role.  While I believe in our role in preventive medicine (naturally!), it is nice to see more and more research provide the hard numbers and support from health institutions willing to place stake in that notion.

One large contributor to health care dollars spent in the US (let alone the impact to businesses from lost productivity) is diabetes care.  The Diabetes Prevention Program has been a coordinated clinical effort to study the impact of lifestyle changes, nutrition counseling, and weight loss in the role of preventing diabetes diagnosis.  The DPP utilized 27 clinical centers accross the country to study over 3000 participants.  Participants were overweight and had prediabetes, two strong predictors of diabetes diagnosis, and were separated into two groups: lifestyle intervention and medicinal intervention (850mg Glucophage BID).  

Nutrition and Lifestyle Intervention

The lifestyle intervention reduced incidence of Type II Diabetes diagnosis by 58% in this high-risk population, while usual intervention reduced incidence by only 14%.  See more about the research at the DPP link above or here!  Results like these beg the question... How do we turn that into common medical practice?

Well for one thing, expansion in Medicare and Medicaid reimbursement for preventive care practices and Medical Nutrition Therapy is helping to lead the way.  Private insurance companies often see the value in reimbursing visits to a Registered Dietitian so their range in reimbursement of RD services is much more liberal than Medicare/Medicaid.  [Reimbursement of services is something I could go on for many more blogs so I'll spare you right now - e-mail me with questions and we can continue the discussion!]

Growing the Role of Nutrition in Primary Care

The Primary Care Physician is the gatekeeper to specialty services and helps to coordinate the totality of your medical care, so find someone you trust with your health and feel free to have a conversation with them.  If you are struggling with certain chronic conditions and feel nutrition counseling can make a difference, ask about your options.  More and more PCPs truly understand the role of the Registered Dietitian in medicine and are making the appropriate referrals.

And to my fellow RDs: document, document document!  Make sure you're recording any and all useful data from beginning to end (BMI, weight, waist circumference, lipid panels, HbA1c, medication use, etc) with your clientele.  The only way we can and will continue to expand coverage for our services is by documenting the impact of nutrition counseling and lifestyle changes!

Response to Centers for Medicaid and Medicare Service

Background Info

For those readers that aren't in the profession, here's a little background information on what's been going on and why it's important in this country's fight against the obesity epidemic:  The Centers for Medicare and Medicaid Service recently announced that it would reimburse specific health professions (MDs, psychiatrists) for billing for Intensive Behavioral Therapy for Obesity in the primary care setting but that it would not reimburse dietitians for this.  The reason that we as a profession are fighting for our rights to bill for this code is because Registered Dietitians are the premiere health care professional trained in counseling for obesity and overweight. 

How it Impacts Healthcare

RDs are the most effective at tailoring a nutrition care plan to each individual and helping them to reduce their weight.  With this memorandum, obese persons with Medicare and Medicaid will have very limited access to dietitians until they have Diabetes (which RDs can currently bill for, along with Chronic Kidney Disease Stage IV and V).  It saddens me that a potentially live-saving preventive service is not going to be able to be offered by myself and other RDs, as we are a group of providers that have been able to produce the best results.  On top of that it is a very needed among those utilizing Medicare and Medicaid.

While I am personally disappointed in this I am and will continue to help in the fight for improved billing for our profession.  Thank you to everyone who aided in signing the White House Petition.  If you're a fellow RD and haven't done so already, please go to the the Grassroots Manager on eatright.org and send your legislators your thoughts on the matter.

And while there's a lot more to delve into on the topic it's too complicated to make into a blog post... feel free to comment and we'll continue the conversation.