Primary care provider uptake of intensive behavioral therapy for obesity in Medicare patients, 2013-2019

Abstract

Background: The delivery of Intensive Behavioral Therapy (IBT) for obesity by primary care providers (PCPs) has been covered by Medicare to support elderly individuals with obesity (BMI > 30 kg/m2) in managing their weight since 2011 for individual therapy and 2015 for group therapy. We conducted a cohort study of PCPs in an attempt to understand patterns of uptake of IBT for obesity services among PCPs serving the Medicare population across the U.S.

Methods: We used the Centers for Medicare and Medicaid Services Provider Utilization and Payment Data from 2013 to 2019 to identify all PCPs who served more than 10 Medicare beneficiaries in each of the seven-year period to form a longitudinal panel. The procedure codes G0447 and G0473 were used to identify PCPs who provided IBT; and the characteristics of these providers were compared by the IBT-uptake status.

Results: Of the 537,754 eligible PCPs who served Medicare patients in any of the seven years, only 1.2% were found to be IBT service providers in at least one year from 2013 through 2019 (246 always users, 1,358 early adopters, and 4,563 late adopters). IBT providers shared a few common characteristics: they were more likely to be male, internal medicine providers, saw a higher number of Medicare beneficiaries, and practiced in the South and Northeast regions. Having higher proportion of patients with hyperlipidemia was associated with higher likelihood of a provider being an IBT-user.

Conclusions: Very few PCPs continuously billed IBT services for Medicare patients with obesity. Further investigation is needed to mitigate barriers to the uptake of IBT services among PCPs.

Fig 1. Intensive behavioral therapy (IBT) for obesity services utilization patterns (2013–2019).

The number of claims for intensive behavioral therapy (IBT) for obesity services (solid line) and the number of beneficiaries who received the IBT services (dash line) documented in 2013 to 2019 Medicare Fee-for-Service Provider Utilization and Payment Data for Physicians and Other Suppliers.

Fig 2. Choropleth maps for intensive behavioral therapy (IBT) utilization by Medicare beneficiaries and primary care providers.

The number of Intensive behavioral therapy (IBT) beneficiaries per 1,000 Medicare population with Obesity (left panel) and the number of providers per 1,000 eligible primary care providers (right panel) who provided IBT services to more than 10 Medicare beneficiaries across the United States in 2013 and 2019.