But both men said the move was positive on the whole. Eckel called it "a step in the right direction" that would "make me more capable as a clinician to deal with the [obesity] epidemic," and said he expected that the AHA would be very pleased with the decision.
Gail Wilensky, currently a senior fellow at Project HOPE and formerly a top adviser to Pres. Bill Clinton, said it would be "important and useful to set up a mechanism to evaluate the program in three to five years," modifying or killing it according to the results.
To qualify under the new benefit, counseling must be consistent with the "five A's" listed in a U.S. Preventive Services Task Force recommendation, according to CMS's decision memo:
Assess: Ask about/assess behavioral health risk(s) and factors affecting choice of behavior change goals/methods.
Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.
Agree: Collaboratively select appropriate treatment goals and methods based on the patient's interest in and willingness to change the behavior.
Assist: Using behavior change techniques (self-help and/or counseling), aid the patient in achieving agreed-upon goals by acquiring the skills, confidence, and social/environmental supports for behavior change, supplemented with adjunctive medical treatments when appropriate.
Arrange: Schedule follow-up contacts (in person or by telephone) to provide ongoing assistance/support and to adjust the treatment plan as needed, including referral to more intensive or specialized treatment.
The agency had published the proposal to cover obesity screening and counseling under Medicare in early September, with a 90-day comment period to follow.
It based the decision on a review of studies and other evidence indicating that such counseling is effective in helping obese patients to lose significant weight, which in turn reduces risk of cardiovascular events and other adverse outcomes.