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AMA Opens Door to Addressing Obesity in Primary Care



Any regular reader of these pages by now must be well aware of the complexity of obesity and its management.

Not only is obesity often the “root cause” of other chronic conditions, but the paths to obesity are multiple and the management strategies are anything but straightforward (though effective when implemented correctly).

Furthermore, as I have always proposed, long-term management of obesity belongs in primary care.

It is therefore only fitting that since April 1 2009, the Alberta Medical Association has introduced a new health service (billing) code for family physicians who deal with complex obese patients (click here for fact sheet).

According to this code (03.04J), family doctors are allowed to bill an extra $206.70 annually per patient for the extra time taken to develop and monitor a complex care plan that includes specific interventions and goals, especially with the involvement of allied health team members. The care plan should be specific and must be signed by both doctor and patient (click here for template).

The code can be claimed for any obese patient who presents with hypertension, diabetes, COPD, asthma, heart failure, or ischemic heart disease.

Importantly, this code does not prevent the doctor from also claiming the usual codes (and complex modifiers) for these conditions.

For patients with obesity and complications (= Edmonton Obesity Stage 2 or greater), this code will hopefully provide reimbursement for time spent on discussing the contributors, barriers and interventions for weight management (and not just optimization of the comorbidity).

Will doctors know how to appropriately address obesity? Most probably don’t, but at least now there is a clear financial incentive for them to learn how to begin managing this important health issue.

Recently the Canadian Medical Association recognized the Canadian Obesity Network as its key partner in rolling out obesity prevention and management strategies (CMA Looks to CON for Obesity Solutions, Aug 29, 2008). Clearly, now is the time for the Network to partner with the Alberta Medical Association to ensure that complex patients struggling with obesity-related chronic disease receive evidence-based advise and support from their family physicians and their care teams to manage their weight.

AMS
Edmonton, Alberta

3 Comments

  1. I would sure like the primary care providers look at the many sub-acute conditions that contribute to obesity rather than wait until weight has gone up and then just “treat” the obesity and ignore the sub-acute problems.

    Depression, sub-acute infections, thyroid levels that, while within “normal range” are not optimal, cough-variant asthma, sleep apnea, and many more un- and under-diagnosed conditions are NOT addressed until they become, as my husband and I put it, “sick enough that even a doctor can tell.”

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  2. Not only is obesity often the “root cause” of other chronic conditions

    The scientific evidence is far more suggestive of obesity as a side-effect than a root cause, for all except the odd thing like osteoarthritis.

    According to this code (03.04J), family doctors are allowed to bill an extra $206.70 annually per patient for the extra time taken to develop and monitor a complex care plan that includes specific interventions and goals, especially with the involvement of allied health team members. The care plan should be specific and must be signed by both doctor and patient

    When I look at that, I have great difficulty in interpreting that as anything other than a doctor being bribed more money to subject me to more harrassment (trying to push useless healthcare measures on me) because of my appearance and what they think my lifestyle is like based on my appearance.

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