Payment system thwarts efforts to treat obesity: many physicians try to get counseling reimbursed by coding for related comorbidities such as diabetes.(Practice Trends)

With the obesity epidemic growing, physicians are facing a payment system that hasn't caught up.

Although coverage varies by payer, most Medicare carriers do not pay for office visits coded only for obesity and the same is true for most private payers, physicians told this newspaper.

"The payment mechanism is certainly lagging behind," said Sandra Hassink, M.D., a member of the American Academy of Pediatrics' national task force on obesity and director of the weight management program at the Alfred I. duPont Hospital for Children in Wilmington, Del.

As a result, many physicians find ways to get counseling paid for by coding for related comorbidities such as diabetes or heart disease, said Donna E. Sweet, M.D., chair of the board of regents of the American College of Physicians and professor of internal medicine at the University of Kansas in Wichita.

But that's far from a perfect solution, she said. If physicians could code for obesity as the primary diagnosis they could spend less time trying to work around the payment system, she said. And they could perform early interventions to keep obesity and overweight from leading to diabetes and heart disease, she said.

Payment for obesity counseling and interventions is part of a larger problem with the episode-driven payment approach, she said. "So much of this revolves around fixing our payment system," Dr. Sweet said.

But there isn't complete agreement about whether third-party payment for obesity treatment would help patients, said G. Michael Steelman, M.D., a bariatric physician in Oklahoma City and president of the American Society of Bariatric Physicians. Many members of his group are split on this issue, he said.