|
January 1,
2002
The New
York Times
Nutrition Therapy to Fall Under Medicare Umbrella
By ROBERT PEAR
WASHINGTON, Dec. 31 — Starting on Tuesday, Medicare will recognize
and pay for two services badly needed but little used by the elderly,
nutrition therapy and pain management.
The nutrition benefits will be available to more than seven million
people who have diabetes or kidney disease, helping them choose the
kinds of foods that can control or treat their illnesses. Based on the
experiences of this group, the secretary of health and human services is
supposed to advise Congress whether similar benefits should be made
available to other people on Medicare, providing ways to reduce high
blood pressure or to lower cholesterol, for example.
Cindy Moore, director of nutrition therapy at the Cleveland Clinic
Foundation and a spokeswoman for the American Dietetic Association,
said: "There is enormous potential for medical nutrition therapy to
save taxpayers dollars and improve the quality of life for patients.
Diet has a major role in the management of diabetes and can help reduce
the risk of getting many other chronic diseases of aging like heart
disease, osteoporosis and cancer."
Doctors said Medicare's decision to recognize pain management as a
specialty would help many patients with cancer, sickle cell disease and
other conditions that cause chronic pain.
Medicare's coverage decisions often influence private insurers.
Dietitians and doctors who specialize in pain medicine said they hoped
private insurers would follow the example set by Medicare in recognizing
the value of their services.
For years, dietitians have sought Medicare coverage of nutrition
counseling and therapy. Congress, as part of a law passed in December
2000, agreed to provide the benefits after receiving a report from the
National Academy of Sciences that said such coverage was likely to save
money for Medicare and benefit patients.
Nutrition therapy is supposed to mesh with other types of care that a
patient receives. The patient must have a referral from a treating
physician — the primary care doctor or specialist coordinating the
patient's care. The government will then pay for a registered dietitian
or other nutrition professional to assess the patient's needs, provide
counseling and develop a treatment plan to improve the patient's diet.
The Department of Health and Human Services estimates that Medicare
will spend $270 million on nutrition therapy benefits in the first five
years. It has not estimated the savings that might result from a
reduction in hospital admissions, surgery and other costs.
Ms. Moore said a dietitian might charge $100 to $130 for 45 minutes
to an hour of counseling. A visit to a doctor could cost three to five
times as much, and a surgical procedure would cost far more.
In recent years, Medicare has slowly expanded to encompass a small
but growing number of preventive health care services. Nutrition therapy
illustrates that trend.
On Tuesday, the government will also establish a reimbursement code
allowing doctors to identify themselves as specialists in pain
management. This is a major accomplishment for the field of pain
medicine and will make it easier for doctors to bill Medicare for these
services.
Kimberly A. Kutska, a spokeswoman for the American Academy of Pain
Medicine, said the new billing code would help patients and doctors.
"Often," Ms. Kutska said, "specialists in pain
medicine don't get properly reimbursed for the procedures because they
don't have their own specialty code."
Many expert studies have concluded that patients are not being
adequately treated for chronic pain. The Medicare reimbursement code
will encourage doctors to provide such treatment to patients with
cancer, arthritis, sickle cell anemia, AIDS and other diseases that
cause severe pain.
Dr. Albert L. Ray, president of the American Academy of Pain
Medicine, said, "With the new code, it will be far easier for
patients to identify and locate doctors who specialize in pain
medicine."
Such doctors may now be listed as neurologists, neurosurgeons,
anesthesiologists, psychiatrists or specialists in rehabilitation
medicine.
Medicare provides health insurance for 40 million people who are
elderly or disabled. About 6.3 million people ages 65 or older — more
than 18 percent of the elderly — have diabetes and could qualify for
nutrition therapy, according to government data.
In addition, Josef Coresh, an epidemiologist at Johns Hopkins
University, said that eight million people had lost at least half of
their kidney function and that six million of them were 65 or older.
Those with advanced kidney disease may have priority in receiving
nutrition therapy. About 330,000 elderly people have lost at least
three-fourths of their kidney function and are likely to have the most
severe nutritional deficiencies, Dr. Coresh said.
"People with kidney disease become nauseous, lose their
appetite, have a higher risk of malnutrition and have poorer metabolism
of the food they do eat," he said. "So they should be able to
benefit from nutrition therapy."
Another change in Medicare that takes effect on Tuesday will limit
the ability of beneficiaries to move into and out of health maintenance
organizations. They have been able to drop out of H.M.O.'s or switch to
other health plans once a month. But in the coming year, they will be
able to make only one change, in the first six months of the year. In
the annual open enrollment period in November, they will be able to make
a new choice for 2003.
Organizations representing Medicare beneficiaries and H.M.O.'s have
lobbied Congress to repeal the law that locks patients into health
plans, but Congress has not taken action.
|
