Primary Care Provider Uptake of Intensive Behavioral Therapy for Obesity in Medicare Patients, 2012-2017

Background: The delivery of Intensive Behavioral Therapy for obesity (IBT) by primary care providers (PCPs) has been covered by Medicare to support elderly obese individuals (BMI > 30 kg/m2) in managing their weight since 2011 for individual therapy and 2015 for group therapy. We sought to understand patterns of uptake of IBT for obesity services among PCPs serving the Medicare population across the U.S. Methods: We used the Centers for Medicare and Medicaid Services Provider Utilization and Payment Data from 2012 to 2017 to extract all PCPs who served more than 10 Medicare beneficiaries in each of the six-year period for form a longitudinal study. The procedure codes G0447 and/or G0473 were used to identify PCPs who provided IBT and their characteristics were compared by the IBT-using status. Results: Of the 452,127 eligible PCPs who served Medicare patients in all six years, only 0.9% were found to be IBT utilizers in at least one year from 2012 through 2017 (147 always users, 988 early adopters, and 3,062 late adopters). IBT utilizing providers shared a few common characteristics: they were more likely to be male, internal medicine and family practice providers, saw a higher number of unique Medicare beneficiaries, and practiced in the South and Northeast regions. The proportions of patients with hypertension, diabetes or hyperlipidemia were similar between IBT and non-IBT providers. Conclusions: Very few primary care providers continuously bill IBT services for Medicare patients. Further investigation is needed to identify barriers to the uptake of IBT services among PCPs. Trial registration: not applicable.