Treat and Reduce Obesity Act of 2019 Essay

The health policy and proposed bill I selected is the Treat and Reduce Obesity Act of 2019. This bill was introduced into the house in March of 2019. This bill would expand Medicare coverage of intensive behavioral therapy for obesity. It would allow coverage for therapy by physician assistants and nurse practitioners. This therapy is currently only covered if being provided by a primary care practitioner (Treat and Reduce Obesity Act of 2019, 2019). It specifically exciting for me considering I am going to school for PMHNP. Treat and Reduce Obesity Act of 2019 Essay

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Obesity is a huge problem in the United States and has been steadily increasing. As one of the leading causes of preventable death in the U.S., there is plenty of evidence that this bill and policy needs to be supported. People that are obese have a decreased quality of life and many other health conditions. One study estimated the medical costs of obesity to be $342.2 billion (America’s Health Rankings, 2019). I believe this is significant enough to support more behavioral therapy for patients.

As people reach for diets and surgery to decrease obesity, a main piece of the puzzle is also missing. There have been numerous studies showing that cognitive-behavioral therapy (CBT) has helped treat obesity. One study looked at how telephone-based CBT would affect female patients one year after bariatric surgery. It was noted that CBT can improve eating psychopathology and psychological distress before and after weight loss surgery. The results also demonstrated that it also may improve binge eating, emotional eating, anxiety, and depression (Sockalingam et al., 2019). I personally believe CBT has many benefits and giving more options for Medicare patients would hopefully decrease obesity and there is an extensive evidence base to support. Treat and Reduce Obesity Act of 2019 Essay

References

America’s Health Rankings. (2019). Obesity in the United States.

https://www.americashealthrankings.org/explore/annual/measure/Obesity/state/ALL

Sockalingam, S., Leung, S. E., Hawa, R., Wnuk, S., Parikh, S. V., Jackson, T., & Cassin, S. E. (2019). Telephone-based cognitive

behavioural therapy for female patients 1-year post-bariatric surgery: A pilot study. Obesity Research & Clinical Practice, 13(5),

499–504. https://doi.org/10.1016/j.orcp.2019.07.003

Treat and Reduce Obesity Act of 2019, H.R. 1530, 116th Cong. (2019). https://www.congress.gov/bill/116th-congress/house-

bill/1530?q=%7B%22search%22%3A%5B%22obesity%22%5D%7D&s=6&r=1

Mandy Sikorski

RE: Discussion – Week 7COLLAPSE

The policy that I have chosen for this week’s discussion is S.3380, the Patient Safety Improvement Act of 2020. This bill requires that the Department of Health and Human Services (HHS) review and act upon health care-associated infections, antimicrobial stewardship, and patient safety (S.3380- Patient Safety Improvement Act of 2020, 2020). Patient safety has been an ongoing issue through time. In 2005, there was a Patient Safety and Quality Improvement Act of 2005 statute and rule that created a voluntary system that would review patient safety and quality of care issues (Patient Safety and Quality Improvement Act of 2005 Statute and Rule, 2017). This act also made it possible for HHS to fine people or organizations for any violations of patient safety confidentiality (Patient Safety and Quality Improvement Act of 2005 Statute and Rule, 2017). Treat and Reduce Obesity Act of 2019 Essay

S.3380 is designed to not only assess patient safety, but also reviews health care-associated infections and antimicrobial stewardship, which are two leading causes to becoming ill within the hospital setting. This is a reoccurring problem that we have faced in healthcare and action must be taken to help slow down these infections and resistance of antibiotics. From the perspective of patient safety, S.3380 makes it mandatory that patient safety topics are part of becoming licensed and reporting patient safety concerns (S.3380- Patient Safety Improvement Act of 2020, 2020).

The development of this bill is to amend already existing federal laws in order to make state laws stronger in order to help assist in combating patient safety, health care-associated infections, and antimicrobial stewardship (Patient Safety Improvement Act of 2020, 2020). I believe that there is a sufficient evidence base to support this act as health care-associated infections have continued to grow just as antibiotic resistance has. By this act assisting with antimicrobial stewardship and helping health care providers with this, we can decrease the infection rate while also reducing the resistance of antibiotics used in infections (Antimicrobial Stewardship, n.d.). There can never be too much safety when it comes to our patients, this is one of the first things that we think of when interacting with them. By making it mandatory to have education on patient safety in order to obtain licensure, this is something small that can go a long way. Treat and Reduce Obesity Act of 2019 Essay

The nation is paying the price for overlooking the importance of food and nutrition. We are an increasingly overweight and obese nation, with two-thirds of the adult population carrying excess weight. Obesity is an astronomically expensive problem for our nation ($210 billion per year). The Treat and Reduce Obesity Act offers clinically- and cost-effective solutions to the obesity epidemic.

Clinically Effective

The bill removes unnecessary barriers to (1) allow a variety of qualified practitioners, such as RDNs, to effectively treat obesity through IBT and authorize coverage for FDA-approved weight loss medications that complement IBT.
Research shows that after two years, patients who received IBT from a RDN are twice as likely to achieve clinically significant weight loss, experience greater average weight loss, and exercise more than patients who did not receive IBT.
The expert consensus is that RDNs are the best practitioners to carry out IBT, as stated by the IOM, U.S. Preventive Services Task Force and most physicians. Treat and Reduce Obesity Act of 2019 Essay
Cost Effective

Supporting RDNs to provide IBT is cost effective.
RDNs’ services cost 25-percent less per 2 pounds of weight loss.
RDNs’ payment fee is 85 percent of primary care providers’ fees.
RDNs can help minimize costs for nutrition services, like IBT, while delivering the best results.
The bill provides coordinated, interdisciplinary care that increases efficiency and efficacy, which improves health care quality and reduces costs.
Download the Academy’s Treat and Reduce Obesity Act 2019 issue brief and leave behind for information about the re-introduction of the legislation in 2019.

With our aging population, growing life expectancies, and incidence of obesity in the United States (US), initiatives to effectively address obesity in older adults are critical. This policy brief summarizes the issues that have led to the introduction of The Treat and Reduce Obesity Act (TROA) of 2019 and addresses reasons to support it. Treat and Reduce Obesity Act of 2019 Essay

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The Medicare population has grown steadily since the program’s inception in 1966, with 44 million beneficiaries presently enrolled.1 Enrollment is expected to rise to 79 million by 2030.1 Life expectancy rates in the US are record high, with people born in 2005 projected to have an average life expectancy of 78 years.2 These findings reflect a continuing trend of increasing life expectancy that began in 1955, when the average American lived to be 70 years old.2 From 2007 to 2010, more than one-third of adults aged 65 years or over had obesity, which corresponds to approximately 13 million older adults with obesity.3 The US Centers for Disease Control and Prevention (CDC) estimate that about 41 percent of adults aged 60 years or over had obesity between 2015 and 2016, representing more than 27 million people.4 By 2050, the number of older American adults (i.e., people aged 65 years or over) is expected to more than double, rising from 40.2 million to 88.5 million. Treat and Reduce Obesity Act of 2019 Essay

Obesity and Aging
Both aging and obesity contribute to increased healthcare use.3 Obesity accounts for 21 percent of national healthcare spending, which is roughly $210 billion/year.5 Treatment costs associated with obesity in patients on Medicare or Medicaid are estimated at $61.8 billion annually; eradicating obesity could result in 8.5 percent in savings in Medicare spending.5 An increase in the proportion of older adults with obesity might compound healthcare spending. As Americans live longer and the age distribution shifts so that there are more older adults, the number of older adults with obesity could grow, even without an increase in obesity prevalence.3

According to the National Institutes of Health (NIH), obesity and overweight are the second-leading cause of preventable death nationally, with an estimated 300,000 deaths annually attributed to the epidemic.4 Obesity increases the risk for chronic diseases, including high blood pressure, heart disease, certain cancers, arthritis, mental illness, sleep apnea, and diabetes.4 More than half of Medicare beneficiaries are treated for five or more chronic conditions yearly.4 The rate of obesity among Medicare beneficiaries doubled from 1987 to 2002 and nearly doubled again by 2016, with Medicare spending on individuals with obesity during that time rising proportionately to reach $50 billion in 2014.4 Men and women with obesity aged 65 years or older have decreased life expectancy.4 The direct and indirect cost of obesity was greater than $427.8 billion in 2014 and continues to increase.4 Medicare spends $2,018 more per patient annually treating beneficiaries with obesity compared to those of healthy weight. Treat and Reduce Obesity Act of 2019 Essay

Barriers to Effective Obesity Treatment
One of the barriers to effective obesity treatment is that US Centers for Medicare & Medicaid Services (CMS) limits coverage for intensive behavioral therapy (IBT) only to services that are provided by a primary care provider in the primary care setting.4,7 IBT consists of measurement of body mass index (BMI), nutritional assessments, and intensive behavioral counselling that promote sustained weight loss through high-intensity diet and exercise interventions. In 2012, the US Preventive Services Task Force (USPSTF) recommended screening all adults for obesity and either referring or offering patients with a BMI of 30kg/m2 or higher to intensive, multicomponent behavioral interventions.4 USPSTF’s evidence report concluded that these interventions are an effective component in obesity management, which can result in an average weight loss of 4 to 7kg and improve glucose intolerance, blood pressure, and other physiologic risk factors for cardiovascular disease.4,6,7 This narrow coverage decision prevents healthcare providers, such as dietitians, who are best suited to effectively provide IBT from doing so.4,7 Furthermore, Medicare’s decision is contradictory to the USPSTF evidence report, which highlighted that primary care providers have limited time, training, and skills to conduct the high-intensity interventions that have been shown to be the most effective to produce the greatest results.4,7 Additionally, when Congress enacted the Medicare prescription drug program, there were no widely accepted FDA-approved obesity drugs.4,7 There have been significant medical advances in the development of obesity medications over the past few years.7 That fact combined with our current and growing obesity epidemic illustrate that the Part D statute is both out of date and out of touch with the current scientific evidence surrounding these new pharmacotherapies.4,7 The efficacy of IBT for obesity and the potential benefit of adding pharmacotherapy have been demonstrated in the literature. Treat and Reduce Obesity Act of 2019 Essay

What is the Solution?
The Treat and Reduce Obesity Act of 2019 (S 595/HR 1530) aims to effectively treat and reduce obesity in older Americans.4,6,7 This bill addresses the barriers to effective obesity treatment by enhancing Medicare beneficiary access to healthcare providers who are best suited to provide this therapy, including specialized nurse practitioners, physician assistants, clinical nurse specialists, dietitians, obesity medicine specialists, endocrinologists, bariatric surgeons, and psychologists or psychiatrists and permitting Medicare Part D to cover FDA-approved obesity drugs.4,6,7

Reasons to Support TROA
Weight management is important for older adults due to the risks associated with typical fat redistribution during aging and the prevalence of comorbid conditions in this age group.9 The number of older adults is projected to increase substantially, and addressing obesity is essential for the health of this rapidly growing population.9 Obesity in older adults impacts not only morbidity and mortality, but also impacts quality of life and the risk of institutionalization.10 Weight loss interventions can effectively lead to improved physical function. With the emergence of newer medications effective in weight management, older adults are increasingly asking about the possibility of taking such medications. Treat and Reduce Obesity Act of 2019 Essay

Patients who received IBT from a dietitian for at least two years are twice as likely to achieve clinically significant weight loss, experience greater average weight loss, and exercise more than patients who did not receive IBT.11 The expert consensus is that dietitians are the best suited to carry out IBT, as stated by the National Academies of Science, Engineering, and Medicine (formerly the Institute of Medicine), USPSTF and a majority of physicians.11 Supporting dietitians to provide IBT is also cost-effective because their services cost 25-percent less per two pounds of weight loss. Additionally, their payment fee is 85 percent of fees charged by primary care providers. Dietitians can help minimize costs for nutrition services such as IBT, while delivering the best results. TROA enforces coordinated, interdisciplinary care that increases efficiency and efficacy, which improves healthcare quality and reduces costs.Treat and Reduce Obesity Act of 2019 Essay