Education about weight management for providers

Learning about providing weight management

  • Access CU eLearning modules on obesity management
    Get updated on evidence-based weight loss and maintenance treatments and overcome common patient communications issues around addressing weight as a health concern.  Examples of patient scenarios and treatment, including in-visit scripting.

    Earn up to 2 CME credits for completion.
    Register at https://CUeLearning.org
    Your registration code is: PATHWEIGH
    You will then be directed to a “My Account” page where you can access the eLearning module.
    If you have questions about the eLearning module, you may contact Support@cuelearning.org.
  • UpToDate - is available in Epic and contains comprehensive information on weight management
    UpToDate contains individual chapters on dietary therapy, physical activity, behavior modification, anti-obesity medications, and more.  Below are two examples of chapters:
    “Obesity in Adults: Prevalence, screening, and evaluation” - guidelines on obesity screening and evaluation
    “Obesity in Adults: Overview of management” – approach to therapy, dietary and exercise, and behavior modification
  • Access the clinician and staff PATHWEIGH Training
    Learn how to use the PATHWEIGH workflow and disappearing help text available in Epic. Find directions on using the e-consult service in Epic to request consultation on patients with complex presentations.
    PATHWEIGH introduction video
  • Access eConsults for weight management
    • What is an eConsult?   
      • eConsults enable primary care providers to consult remotely and conveniently with specialists through a patient’s electronic health medical record.
    • How to place an eConsult?
      • PCP Attestation: Patient has consented to this Virtual Consultation understanding that there may be an associated co-pay bill.
      • In Epic, during a clinic visit or within an order note, place order for “Referral to Endocrinology.”
      • Within referral click on eConsult button.
      • Provide reason for consult – “Obesity and weight management consult.”
      • Provide patient specific information and consult question.
      • Submit consult.

Conducting weight management

    Visit flow: 

    1. The diagnosis of overweight or obesity is added to the problem list in the Epic EMR for patients with a BMI≥25 kg/m2 or ≥30 kg/m2, respectively, recognizing these as bonified disease states.
    2. Pre-populated information from the questionnaires completed by the patients before the visit guide the clinician-patient discussion, flagging weight management strategies based on guidelines from the Obesity Society.
    3. Specifically, clinicians should consider a discussion of
      1. lifestyle change for patients with BMI≥25 kg/m2,
      2. anti-obesity medication at BMI≥30 kg/m2 (or BMI≥27 kg/m2 with weight-related comorbidities) and
      3. bariatric surgery for BMI≥40 kg/m2 (or BMI≥35 kg/m2 with weight-related comorbidities).
    4. Patients especially with mental health issues, binge-eating disorder, or past trauma associated with weight may be referred to in-practice or local behavioral health support. Other patients with challenges in making and sustaining behavior changes may also be referred.
    5. Use of the flowsheets is entirely optional for clinicians. While the clinician can use them ahead of the visit (automatically sent to patients through their health portal), the clinician or the patient can also spontaneously decide to prioritize weight management within an already-scheduled visit.
    6. Use of disappearing help text is also optional as providers can use all, some or none of the text prompts. PATHWEIGH Epic Tools Video
    7. The process strongly encourages regular follow-up (usually at 4- to 6-week intervals and more often initially). Clinicians may schedule more frequent visits, and selecting the * opens up the option to select another follow-up time period. Many clinicians like to see patients again in 1-2 weeks after the initial visit.
    8. E-consults are available through endocrinology PATHWEIGH eConsult Order

    Links to coupons and prior authorization strategies for anti-obesity meds

    1. GoodRx app or website can be used to find commonly used medications at a lower cost to the patient – phentermine, topiramate, naltrexone, bupropion.
    2. Wegovy (Semaglutide) – often requires the trial of ≥ 1 weight loss medication in addition to lifestyle changes (diet and exercise).  Documentation of past trials and attempted lifestyle changes will support the approval of Wegovy.
    3. Coupons and Copay Cards:
      1. Qsymia (Phentermine and topiramate extended-release) - https://qsymiaengage.com
      2. Contrave (Bupropion and naltrexone) - https://contrave.com/enrollment/
      3. Plenity - https://www.myplenity.com

    Getting Paid

    1. Weight-Prioritized visits can be billed using an E&M code
    2. Nurse (RN) weight visits
    3. For Medicare beneficiaries with obesity, who are competent and alert at the time that counseling is provided and whose counseling is furnished by a qualified primary care physician or other primary care practitioner and in a primary care setting, CMS covers
      1. One face-to-face visit every week for the first month;
      2. One face-to-face visit every other week for months 2-6;
      3. One face-to-face visit every month for months 7-12, if the beneficiary meets the 3kg (6.6 lbs) weight loss requirement as discussed below.

    At the six-month visit, a reassessment of obesity and a determination of the amount of weight loss must be performed. To be eligible for additional face-to-face visits occurring once a month for an additional six months, beneficiaries must have achieved a reduction in weight of at least 3kg (6.6 lbs) over the course of the first six months of intensive therapy. This determination must be documented in the physician office records for applicable beneficiaries consistent with usual practice. For beneficiaries who do not achieve a weight loss of at least 3kg (6.6 lbs) during the first six months of intensive therapy, a reassessment of both their readiness to change and their BMI level is appropriate after an additional six-month period.

    Websites:tinyurl.com/yp5uf2n8

    https://www.medicare.gov/coverage/obesity-behavioral-therapy

     

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