It’s politics as usual, but at a cost: the health of the American public. Action Alert!
The Academy of Nutrition and Dietetics (AND, formerly the American Dietetic Association) has collaborated on a Medicare bill that will ensure that Registered Dietitians receive Medicare reimbursement for weight loss counseling. This bill excludes most other nutrition professionals, including many nutritionists and health coaches, limiting consumers’ options.
HR 2415, the Treat and Reduce Obesity Act of 2013, would allow Registered Dietitians (that is, dietitians who go through the AND’s credentialing program), Certified Diabetes Educators, and instructors trained and certified by the National Diabetes Prevention Lifestyle Coach Training Program (funded by the Centers for Disease Control and Prevention) to perform intensive behavioral therapy, communicate nutrition plans to an individual’s primary care physician or practitioner, and be reimbursed for these services by Medicare. It would also provide Medicare coverage on new prescription drugs for obesity management (note that Medicare does not currently provide coverage for weight loss drugs—see our article on that subject in this issue).
The AND is primarily responsible for creating this legislation. An AND spokesperson said, “For nearly two years, the Academy has been working on developing legislation to expand coverage for registered dietitian nutritionists to provide intensive behavioral counseling for obesity outside of the primary care setting.” This, unfortunately, is a ruse: yes the bill expands coverage for RDs, but in whose best interest is this? Only the RDs. It’s certainly not in the best interest of consumers, who now will have even fewer options.
Registered Dietitians (RDs) are allowed to perform services and receive reimbursement on their own merits, while other nutrition professionals, even those with higher educational credentials and twice as many clinical hours to their credit, are excluded unless they have gone through one of the other two listed programs. In other words, the bill would create a distinction that does not currently exist in federal law (the Social Security Act, which controls Medicare, provides equal treatment for RDs and other qualified nutrition professionals).
Medical Nutrition Therapy (MNT) services for people with diabetes are covered under Medicare part B. Currently, federal rules state that RDs or qualified nutrition professionals may provide services so long as they meet certain education and experience requirements and have been certified by a national nutrition organization. If other qualified nutrition professionals can provide MNT services under Medicare, why in the world should they be edged out of reimbursement for obesity management services?
More importantly, it is difficult to believe that the AND is qualified to address our obesity crisis, considering their widely known conflicts of interest: AND receives funding from junk food companies like Coca-Cola, Hershey, Council, Mars, and PepsiCo—the very agents of the obesity epidemic. Furthermore, they conduct continuing education courses sponsored by Coke in which RDs are told that sugar, artificial colors, and nonnutritive sweeteners are perfectly fine for children, and concerns to the contrary are merely “urban myths”!
RDs are credentialed by the Commission on Dietetic Registration, a private organization. “Registered Dietitian” is not a government-based credential, so there is no reason it should be awarded preferential treatment over other credentialing organizations—particularly when it excludes those who possess Masters and PhDs in nutrition from accredited colleges and universities, as well as professionals qualified by other worthy nutrition credentialing organizations.
The bill’s introduction trails an announcement by the American Medical Association that they’ve decided to classify obesity as a disease (see our article in this issue)—and it’s clear that the AND is attempting to cash in on it. Whether you think obesity should be classified as a disease or not, we can all agree that it’s a worsening epidemic in the US. We should be increasing coverage and reimbursement for nutrition professionals who offer nutrition counseling for obesity, not restricting access! More than 104 million Americans are obese; obesity-related conditions include heart disease, strokes, type 2 diabetes, and certain types of cancer. Obesity and related conditions are the leading cause of preventable death. It’s expensive, too. In 2008, medical costs associated with obesity were $147 billion; annual medical costs for individuals were $1,429 higher for obese people than for people of normal weight.
Access to a variety of nutrition professionals is vital to consumers: it allows them to choose a practitioner who aligns with their natural health lifestyle and values. With obesity as widespread and as costly as it is, why should only one organization’s nutrition professionals be given the exclusive right to counsel patients on ways to treat it?
Action Alert! Please write your representative and ask him or her to amend the bill to expand Medicare reimbursement to all qualified nutrition professionals!
Let the consumer choose who they want for health care.
This is another nail in the coffin of America greed. Men can get Viagra with insurance but those who work females or has insurance has to pay $50.00 for BCP. Double standards.
Ah, yes, no surprise here. The ADA is only showing its ugly allopathic side, no different than its medical and dental brethren. Somewhere amidst all this administrative chaos, they’ve manage to throw the baby out with the bath water water; worried more about the process than the patient.
But don’t tell any of them that.
No one group should have a monopoly on nutrition education and this group has the easiest standards to get a license while many other alternative, holistic, and integrated groups have more requirements to get licensed by other outstanding professional organizations of nutrition provides (range across the health care spectrum and may include MDs, PHDs, Etc.)
We are a democracy and no one group should have sole control of the message especially a group that has sponsers food products / drinks that undermine good nutrition and health plus the ingestion of food additives, coloring and sugar are highly detrimental to good health.
Conquering obesity is very difficult especially in our current environment and many professionals are needed to coordinate and work as a team. i.e., diabetic nutrition support people range from nutritions, dietitanx, social workers, mds, nds, dos, etc. So why limit this to one group that focus on political will and have all the power and money.
There isn’t such a thing as dietitian nutritionists. Clinical nutritionists know far more than dietitians because we not only need to know about diets, but we also need to know nutritional therapies.
Ze’ev Ben-Dror, C.C.N.
Anti-Aging Agora
member, Life Extension Foundation
member, British Longevity Society
Clinical nutritionist know far more than dietitians based on??? Such an ignorant statement. You think all dietitians know are about diets? Nutrition therapy is the foundation of what dietitians know and do. Typical anti dietitian talk… On the otherside of the coin I also depise dietitians that think thtey are the only qualified experts in the field. IMO depending on the specialty nutrition experts vary regardless of credential.
I do agree with some points of this article, but remember that there are many dietitians out there that are disgusted with some of the actions that the AND have been making. Remember not all dietitians = AND members and not all dietitians are created equally.. I cancelled my membership almost 10 years ago and during my career so far I’ve met my fair share of idiotic and ‘why did you waste your time being a dietitian again?’ type dietitians if you catch my drift…
Could you define “all qualified nutrition professionals” for me? Who does this include?
I once attended a 4-hour nutrition training when I was fresh out of college, and received a certificate stating that I was a “nutritionist.” Would I have been allowed to accept Medicare for my clients? How do you flesh out who is and isn’t “qualified?”
Thanks for your thoughts,
Em
Consumers should be allowed to decide who they go to for health and nutrition counseling, and insurance should cover whomever that ends up being. AND is being greedy, and is the last place a person should go for sound nutritional advice. Look at their sponsors: Coke, Pepsi, Hershey, Mars, etc. That tells where their loyalties are, not with their clients health.
In reply to someone asking about “insurance reimbursement issues” the law as proposed is not limited to who gets to work with insurance reimbursement. We should be able to choose whoever we want, including a bush doctor, if we want, to set up services and exchange for nutritional information.
THe new bill is not limiting choices more. Right now only MD’s Nurse Practionars and Physicians assistnats can bill for intensive obesity treamtment and it can only be provided in the primary care setting, so a docotr who is a specailst can not bill under those codes for this service, so by opeing it up to RD’s it is expanding not limiting more. if the other professionals want to be able to bill medicare then their respective organizations should push for that. But why say taht AND is doing something wring. They are trying to get consumers at least one more option they they already have.
I don’t consider dieticians to be nutritional experts. Case in point: hospital food. You get charged an arm and leg when in the hospital and yet the quality of food is usually awful and not just taste-wise. Proper nutrition should be considered as a healing tool as much as the medical treatments. I have known some people who have had to have someone sneak vitamins to them while in the hospital. You have to be careful because the nurses might take them away!
I appreciate your comment about hospital food – it should be a source of nourishment especially among sick people. The idea that Registered Dietitians (note spelling) are responsible for the quality of food in hospitals is preposterous. You can blame greedy foodservice companies like Aramark and Sodexo for that. Don’t even get me started on the people with ESRD, CAD, CHF etc who order take out in the hospital I work in.
Did you even read the bills? It allows a wide range of qualified providers AND EVEN TALKS ABOUT OTHER NUTRITION PROFESSIONALS. Are you confused or intentionally misleading?
The process of becoming a “Registered Dietitian” is extremely challenging and therefore merely accomplishing it deserves merit. As a Registered Dietitian, I do not choose to subscribe to the ADA/AND whatever they call themselves because I think it is a joke that they (my credentialing agency) is in fact funded by Coca Cola…however… not EVERYONE who is a Registered Dietitian supports this..
There are extensive education requirements and experience behind receiving this credential and the internship process is a living NIGHTMARE.. I personally admit there are many nutrition professionals without an RD who are much more knowledgable than I am and I enjoy learning from them…However…the number of quacks out there who call themselves “nutritionists” is certainly something to consider before allowing such loose terms on reimbursement for “non qualified nutrition professionals” by whomever defines it. RD’s can barely get reimbursement as it is…
In short, don’t hate the player…hate the game. I hated it the whole time I played it–but I played–and I won.
There has to be some kind of guideline for separation….just because you have a Maters or a PhD doesn’t mean you can do you a better job,. I have met many on both sides who are complete idiots…
It is such a ridiculous process but because I made it through and can now define my own beliefs and go my own way…I think theres something to be said about conquering the game and then making your own rules. Market yourself and be true to that. That’s what its all about.
If you are that legit…and you don’t need the credentials…people will pay.
..Diabetics think Boost Glucose Control is good for them…and they are paying for it. It is crap.
Its all about marketing.
Best of luck to you.
Masters*