Nutrition Therapy to Fall Under Medicare Umbrella

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January 1, 2002

Nutrition Therapy to Fall Under Medicare Umbrella

By ROBERT PEAR

ASHINGTON, 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.

, 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. 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.

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, f Coresh, an epidemiologist at s 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.

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