Medicare to Cover Heart Disease Counseling - Texas Journal of Chiropractic

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Medicare to Cover Heart Disease Counseling

Published 12/03/2011 - 11:20 a.m. CDT

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Medpagetoday.com REPORTS HERE that "the Centers for Medicare and Medicaid Services (CMS) announced it will begin paying for one office visit per year for Medicare patients that is aimed at preventing cardiovascular disease."

"Medicare will now pay for an "intensive behavioral therapy" session in a primary care physician's office, where the doctor encourages aspirin use for primary prevention of cardiovascular disease for men ages 45 to 79 and women ages 55 to 79, and screens for high blood pressure in adults. The behavioral therapy also should include intensive behavioral counseling on the importance of a healthy diet for adults with hyperlipidemia, hypertension, and other risk factors for cardiovascular and diet-related chronic disease."

"The decision states that the visit should be consistent with the "five A's" concept for behavioral counseling advocated by the U.S. Preventive Services Task Force:

Assess: Ask about behavioral health risk(s) and factors affecting choice of behavior change goals.

Advise: Give clear, specific, and personalized behavior change advice, including information about personal health harms and benefits.

Agree: Collaboratively select appropriate treatment goals based on the patient's interest in and willingness to change the behavior.

Assist: Using behavior change techniques, aid the patient in achieving agreed-upon goals, supplemented with adjunctive medical treatments when appropriate.

Arrange: Schedule follow-up with the patient to provide ongoing support and to adjust the treatment plan as needed."

"The covered office visit must occur in a primary care setting, which CMS defines as 'one in which there is provision of integrated, accessible healthcare services by clinicians who are accountable for addressing a large majority of personal healthcare needs, developing a sustained partnership with patients, and practicing in the context of family and community.'"
"Cardiovascular disease counseling won't be reimbursed by Medicare if it is performed in hospitals, ambulatory surgical centers, diagnostic testing facilities, rehabilitation facilities, or hospices."

"CMS recently proposed paying for obesity counseling as well, although that decision hasn't been finalized."

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