Attached are two papers. Please respond to each paper with substantial detail that provokes further discussion.
1
Running head: OP-ED
Increasing Access to Obesity Benefits for Medicare Patients
Op-Ed
Samantha Florio, BSN, RN
NRS 705 Summer Session 2023
Dr. Catherine Paradiso
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OP-ED
Increasing Access to Obesity Benefits for Medicare Patients
Weight loss behavioral therapy and coverage for medical weight loss options should not
be limited to only primary care physicians for Medicare patients. Increasing who can refer and
provide behavioral therapy and increasing medical weight loss options can lead to an
improvement in health and quality of life for the aging population.
Anyone that has had a body mass index (BMI) of 25 or above has been told by a
physician to “lose weight” to promote health or improve a health condition. What options have
been provided to patients that are overweight or obese? Medicare guidelines cover counseling
provided by a primary care physician only. Health care bill S. 596, entitled “Treat and Reduce
Obesity Act of 2021,” was introduced to Congress in March of 2021. It has been referred to the
Committee on Finance. The purpose of this bill is to improve access and coverage for Medicare
patients for behavioral therapy for weight loss promotion and improve coverage for medical
weight loss therapies such as medications.
Current Medicare guidelines cover obesity behavioral counseling if provided by a
primary care physician in an office setting. The patient must have a BMI of 30 or above, which
would put them in the obesity range. A Medicare patient can only be provided with Medical
Nutrition Therapy if a patient has diabetes, kidney disease, or has received a kidney transplant in
the 36 months, (MEDICARE, 2023). The problem with this logic is patients who are obese are
already at a greater risk for developing diseases such as diabetes. Only allowing access to
behavioral therapy or medical nutrition therapy until after being diagnosed with diabetes is
losing the opportunity utilizing weight loss as a prevention tool instead of a treatment tool.
According to the American Association of Clinical Endocrinologists (AACE) and the American
College of Endocrinology (ACE) guidelines, a 5 to 15% reduction in body weight in individuals
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OP-ED
with a BMI of 25 or above can be significant for preventing or delaying the onset of type 2
diabetes, (Amaro & Kaplan, 2022). Reduction in weight in individuals who are obese or
overweight can also prevent other comorbidities. Examples include a decreased risk in joint
replacement surgeries in patients with osteoarthritis, improved asthma and sleep apnea control,
and an improvement in cardiovascular health, (Amaro & Kaplan, 2022).
The current Medicare benefits also only allow for Intensive Behavioral Therapy for
obesity to be provided by a primary care physician in 15-minute session every 6 months, (Gill et
al., 2017). Unfortunately, a 15-minute session dedicated to weight loss behavioral therapy is
always feasible for a busy primary care physician to provide. The current benefit also does not
include reimbursement opportunities for other healthcare professionals such as nurse
practitioners, physician assistants, registered dieticians, or registered nurses. Increasing access to
who can provide weight loss behavioral therapy can increase the impact it has on quality of life
and overall health for the Medicare population.
As of 2023, 40% of the Medicare population have obesity, (Ward et al., 2023). A large
amount of the Medicare population that have obesity and suffer with comorbidities are of the
minority population including Black and Hispanic beneficiaries, (Ward et al., 2023). As the
aging population continues to increase, the need for weight loss therapies will continue to
increase. Obesity is associated with comorbidities and increased health care costs. The available
advancements in weight loss therapies, behavioral and medical, can help cut down on health care
costs related to obesity. Medicare coverage of weight loss therapies can save the Medicare
program $175 billion to $245 billion over the course of ten years, (Ward et al., 2023).
There are many health benefits associated with weight loss in obese patients but there can
be risks involved. There have been clinical trials that have indicated older adults that participate
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OP-ED
in weight loss lose fat-free mass which can lead to sarcopenia which is a loss in muscle mass and
quality of muscle mass which in return can lead to a higher mortality risk, (Gill et al., 2017).
Although weight loss behavior therapy can create better health outcomes it does not take into
account of social determinants of health that can also greatly affect patient outcomes. Weight
loss behavioral therapy includes dietary changes and physical activity level and medical
management. Dietary changes can be costly, especially with the current inflation the United
States population is struggling with. The prices of groceries have greatly increased. An increase
in physical activity promotion does not always consider where people live and their safety.
It would be detrimental to the health of Medicare patients for Congress to approve health
care bill S. 596: Treat and Reduce Obesity Act of 2021. The growing prevalence of obesity in the
aging population creates a unique opportunity to provide weight loss behavioral therapy and
medical weight loss management to decrease prevalence of comorbidities associated with
obesity, prevent, or delay diseases, and improve quality of life.
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OP-ED
References
Amaro, A., & Kaplan, M. (2022). Managed care considerations of weight management
interventions for Obesity. The American Journal of Managed Care, 28(Suppl 15).
https://doi.org/10.37765/ajmc.2022.89294
Gill, L. E., Bartels, S. J., & Batsis, J. A. (2015, June 6). Weight management in older adults current obesity reports. SpringerLink. https://link.springer.com/article/10.1007/s13679015-0161-z.
Medicare. (2023). Obesity Behavioral Therapy. https://www.medicare.gov/
Ward, A. S., Tysinger, B., Nguyen, P., Goldman, D., & Lakdawalla, D. (2023, April 18).
Benefits of Medicare Coverage for Weight Loss Drugs. USC Schaeffer.
https://medicalxpress.com/news/2023-04-white-paper-medicare-coverage-weight.pdf
1
Running head: OP-ED
Taking Measures to Stop the Fentanyl Overdose Crisis
Op-Ed
Joanna Collazo, BSN, RN
NRS 705 Summer Session 2023
Dr. Catherine Paradiso
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OP-ED
Taking Measures to Stop the Fentanyl Overdose Crisis
Imagine being on the receiving end of a phone call informing you the devastating news
that your loved one has become victim of a fentanyl overdose. As daunting as this experience
may sound, unfortunately the reality is, every day there is a family that learns that their loved one
has fallen victim to America’s deadliest drug epidemic. Fentanyl is a synthetic opioid that is
found to be one hundred times more potent than morphine and fifty times more potent than
heroin (United States Drug Enforcement Administration, n.d.). It was approved by the FDA in
2011 for analgesic and anesthetic purposes. However, not only has fentanyl been manufactured
for pharmaceutical purposes, it is also being mass-produced illicitly finding its way through
illegal drug markets and into the hands of vulnerable people.
The potency of fentanyl has proven to be deadly where over one hundred and fifty deaths
are accounted for each day due to fentanyl related overdoses (CDC, n.d.). According to statistics
from the Centers for Disease Control and Prevention (CDC), fentanyl has become one of the
leading sources of death for adults in America ages 18-49. The roots of the opioid epidemic
began many years ago where it traces back to when doctors over prescribed these medications.
As overprescribing reached its climax, by 2017 the Trump administration declared a public
health emergency (Haffajee & Frank, 2018). Yet, as the number of opioid prescriptions dropped,
the overdose death rate continued to surge (Dasgupta, Beletsky & Ciccarone, 2018). To fill the
void in the absence of prescribed opioids, cartels have built a massive illicit pharmaceutical
production of narcotics, smuggling it across the U.S. border, killing thousands of Americans
each day. As mortality rates continue to rise, it poses a threat to society’s health and public
safety.
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OP-ED
So, what do we do to help address this crisis? Fortunately, Congress woman Ann McLane
Kuster with twenty other co-sponsors, introduced the healthcare bill H.R.3375 known as “STOP
fentanyl overdose ACT of 2023” to congress on 5/16/2023. This bill proposes to act towards
addressing the fentanyl substance abuse problem by expanding testing, improving surveillance,
increasing accessibility to the reversal medication Narcan, establishing programs to offer medical
treatment and education, and supporting law enforcement in the detection and handling of
fentanyl. Casting support for bill H.R.3375 can help address the multifaceted nature of this crisis.
First, there is a significant gap in the access of medical treatment. With almost three
million Americans suffering from an opioid abuse disorder, four out of five people do not receive
any form of medical treatment (Madras et al., 2020). Increasing access to medical treatment and
establishing programs that offer education on prevention can help reduce adverse health
outcomes and mortality rates since there are effective treatments out there that exist.
Additionally, providing resources to address mental health issues among users who abuse
opioids and other illicit drugs can reduce barriers to medical treatment since “among the millions
of people with opioid use disorder, 27% have a serious mental illness, 64% have any mental
illness” (National Institutes of Health, n.d.). Therefore, more must be done to treat those who are
addicted.
Secondly, Narcan—a lifesaving opioid antagonist—is not always available where and
when its needed. Although providers are allowed to prescribe Narcan to patients at risk for
overdose, the process of “prescribing and dispensing has been unable to meet the needs of the
growing opioid crisis” (White, 2018). Not every person who is at risk of an opioid overdose is
linked to a provider that can help them gain access to this life saving medication. With the bills
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OP-ED
proposal to increase education and access by expanding who can receive and distribute Narcan,
its utilization can improve.
Third, and most importantly, more action must be done to support law enforcement in
their fight to stop fentanyl overdoses. Law enforcement plays an instrumental part in cracking
down on the illicit use of fentanyl. Hence, it is imperative for law enforcement to receive the
resources and training they need to not only learn how to detect and handle fentanyl, but to also
target the drug cartels that mass produce fentanyl and smuggle it into the country. According to
data from the U.S. Customs and Border Protection (CBP), majority of fentanyl confiscations take
place along the southern border. In the year 2022 alone, over fourteen thousand pounds of
fentanyl was seized at the Mexican border (CBP, n.d.). Increasing surveillance especially at our
borders can help prevent the illegal entry of fentanyl.
As the number of fentanyl overdoses continue to take America by storm, we must take
action to end the overwhelming number of deaths associated with this crisis. No one should ever
receive the unbearable life changing call that someone they love has died from an overdose. Its
time to take the steps needed to solve this terrible crisis. With supporting “STOP fentanyl
overdose ACT of 2023” we can become one step closer to addressing this epidemic and saving
lives.
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OP-ED
References
Centers for Disease Control and Prevention. (n.d.). Fentanyl Facts. United States Department of
Health & Human Services. https://www.cdc.gov/stopoverdose/fentanyl/index.html
Dasgupta, N., Beletsky, L., & Ciccarone, D. (2018). Opioid crisis: No easy fix to its social and
economic determinants. American journal of public health, 108(2), 182–186.
https://doi.org/10.2105/AJPH.2017.304187
Haffajee, R. L., & Frank, R. G. (2018). Making the opioid public health emergency
effective. JAMA psychiatry, 75(8), 767–768.
https://doi.org/10.1001/jamapsychiatry.2018.0611
Madras, B. K., N. J. Ahmad, J. Wen, J. Sharfstein, and the Prevention, Treatment, and Recovery
Working Group of the Action Collaborative on Countering the U.S. Opioid
Epidemic. (2020). Improving access to evidence-based medical treatment for opioid use
disorder: Strategies to address key barriers within the treatment system. National Academy
of Medicine Perspectives. Discussion Paper, Washington,
DC. https://doi.org/10.31478/202004b
National Institutes of Health. (n.d.). Optimizing care for people with opioid use disorder and
mental health conditions. U.S. Department of Health and Human Services.
https://heal.nih.gov/research/new-strategies/optimizing-care
United States Customs and Border Protection. (n.d.). Drug Seizure Statistics. U.S. Department of
Homeland Security. https://www.cbp.gov/newsroom/stats/drug-seizure-statistics
United States Drug Enforcement Administration. (n.d.). Fentanyl. United States Department of
Justice. https://www.dea.gov/factsheets/fentanyl
White N. D. (2018). Increasing naloxone access and use to prevent opioid overdose death and
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OP-ED
disability. American journal of lifestyle medicine, 13(1), 33–35.
https://doi.org/10.1177/1559827618803874
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