Louis Rocco ate too much bread for decades, but didn’t realize that it was dangerous for his diabetes until he met a registered dietitian in August.
"I’m Italian, so I enjoy eating a lot of bread,’’ he said. But after he spoke to his dietitian and had a session at his local grocery store in Philadelphia, Rocco, 90, noticed a great health difference.
"Several changes in my diet, and eating less bread helped me bring down my sugar readings,’’ he said. "If only I knew about this in the past’’.
Around 15 million Medicare enrollees with chronic kidney disease or diabetes are qualified for the benefit, but only 100,000 recipients were paid to get counseling in 2017 by the federal health insurance program, and the latest billing data is available. But it does not include the 20 million enrollees in private Medicare Advantage plans.
Experts for health say that most people don’t know about the benefit so it is a lost opportunity for beneficiaries to improve their health, and also for the program to save money by preventing diseases from costly complications.
In the past 20 years the prevalence of diabetes has risen markedly, and as people get older the condition is more common.
The Medicare benefits
About 100,000 registered dietitians exist nationwide which is more than people need, said Krista Yoder Latortue executive director of Family Food in Philadelphia, which has employed around 50 dietitians including the one who met with Rocco. According to Medicare data, around 3,500 dietitians billed the program for nutritional counseling in 2017.
Not all doctors know about the Medicare benefit, which represents a problem because they should refer patients to a dietitian.
The benefit was approved by the congress in 2002, after studies found older patients who consulted a nutritionist got their health improved.
Starting from 2011 the counseling has been available without any extra costs to Medicare which has been covered by health provisions of the Affordable Care Act.
The first three hours of dietary counseling are been covered by Medicare in the very first year, where the following years Medicare is covering only two hours.
If a physician believes an additional nutritional therapy is necessary, the doctor can appeal to Medicare for it.
It’s important to talk to a dietitian
Larry Lipman, 70, of Falls Church, Va., said that he couldn’t believe when he learned this year he had diabetes, because he was thin and an active cyclist.
He went to his doctor and accepted going to see a dietitian with his wife, who is the one doing the cooking.
“It was an amazing experience and I enjoyed talking about the food I eat with the dietitian,’’ said Lipman, a retired journalist. "I also learned that I need to keep my carbohydrates down by avoiding rice,’’ he said. "I’m more cautious about what I eat now, and I try to avoid ice cream and Doritos.’’
Doctors who don’t advise patients to talk with dieticians are also responsible for their health.
“Doctors find it easier to prescribe a medicine to patients rather than giving them an advice to talk to a registered dietitian,’’ said Dr. Holly Kramer, a Chicago nephrologist and president of the National Kidney Foundation.
“I don’t understand why are we not using dietitians in our clinics for all these patients, obesity and diabetes are growing rapidly, and we are spending our money for things that mediate from the disease process such as dialysis, arthritis and amputations,’’ she said.
Getting nutritional counseling
Jennifer Weis, who is a registered dietitian in Philadelphia, says that Medicare covers only a limited amount of hours which is not enough in order to change the behavior in older people.
“Even though these limited hours are better than nothing, I’m not fully satisfied,’’ she said.
Doctors may not know all the options Medicare provides, since "It is difficult to keep up with covered and not covered benefits,’’ said Dr. Michael Munger, chairman of the American Academy of Family Physicians who practice in Overland Park, Kan. He said that doctors are not familiar with dietitians in their community because they don’t practice with a large health system.
To make things easier, Munger refers to his diabetes patients to a nurse practitioner in his office for nutritional information and counseling. His Medicare patients face a copayment for the service because the nurse nutritionist is not registered, and therefore not covered under the Medicare benefit.
Nutritional counseling is a Medicare benefit which is underused, even though it prevents health complications, there are also other underused benefits.
Less than 5 percent of Medicare beneficiaries are using 10 to 12 hours of diabetes self-management training benefit, which covers individual and group sessions that provide tips for, monitoring blood sugar, being active, eating healthily, taking drugs and reducing risks.
“It is a huge problem that the public trusts nutritional advice which is not fully correct,’’ said Yoder Latortue in Philadelphia. He also added “Everyone eats different foods and everyone has different opinions.’’
“The federal Centers for Medicare and Medicaid Services sends out notices to health providers once a year but more information is needed,’’ said Lauri Wright, a Jacksonville, Fla., registered dietitian and spokeswoman for the Academy of Nutrition and Dietetics.
A CMS spokeswoman said that around 10,600 registered dietitians have enrolled to treat Medicare Patients. She said that health providers were advised by the agency about the benefit and promoting it to enrollees on its website and annual handbook that they send to beneficiaries.
"People ignore it, because only two diseases are covered by Medicare and the rest aren’t,’’ said Wright.
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