Why is use of the Medicare Intensive Behavioral Therapy for Obesity Benefit so low? Finding what works to promote wider dissemination.

肥胖是我们这个时代最普遍、最具挑战性的公共卫生问题之一。2011年11月， 医疗保险和医疗补助服务中心(CMS)批准使用一种新的医疗保健共同 用于提供密集行为的初级保健付费的程序编码系统(HCPCS)代码 针对肥胖患者的治疗(IBT)。尽管肥胖症在医疗保险中普遍存在 人口中，这一福利的使用大大低于预期，这表明 对这一利益的利用不足。本探索性研究将追求以下目标：1)开发一种彻底的 了解与使用和不使用Medicare IBT治疗肥胖症有关的最紧迫问题 在初级保健中受益，以及2)研究在成功实施的实践中使用的战略 根据IBT针对肥胖的医疗保险提供的服务受益并描述：a)这些服务的特点 做法及其环境背景，b)促进执行进程的关键要素 成功的实践干预，c)患者使用IBT治疗肥胖症，包括继续接受 符合减重要求的福利后的服务，以及d)提供服务的成本 报销金额。为了实现目标1，我们将查询Medicare提供者使用和支付 数据：三个州的医生和其他供应商数据库：科罗拉多州、密歇根州和北卡罗来纳州 确定联邦医疗保险为肥胖患者提供IBT服务所支付的所有提供者及其实践 在2012至2014年间的一年内提供给10名或更多受益人。我们将确定初级保健服务的做法 这些提供商并对所有实践(多达100个)进行半结构化电话采访 总计)。然后，我们将根据邮政编码、业务规模(&gt；5)确定未使用IBT优势的操作规范 提供者)，以及家庭或内科医学实践使用的好处，并与此进行类似的采访 一群人。面谈将评估福利的实践特点、使用原因、不使用和停止使用， 涉及的流程和人员，以及任何已知的患者结果。为了实现目标2，我们将有目的地 从AIM 1中选择符合我们的IBT肥胖实施成功标准的36个实践，收集在- 深度信息，以了解其实施情况、患者结果和成本。数据收集将包括 现场访谈和观察，以及EMR数据提取。归一化过程理论将被用于 了解对实施至关重要的因素。这些方法还将用于获取信息以 估计提供IBT服务的实践成本，并评估其在当前和 替代报销金额。我们的发现具有直接的政策含义，通知传播 有效执行战略的可持续性，可从继续交付的实践中学习 肥胖症服务的IBT。这项研究将通过确定使用该领域的好处、使用理由 和停止使用，并确定在初级保健中有效实施IBT的潜在战略。

Obesity is one of the most prevalent and challenging public health issues of our time. In November 2011, the Centers for Medicare and Medicaid Services (CMS) approved the use of a new Healthcare Common Procedure Coding System (HCPCS) code for payment in primary care for providing Intensive Behavioral Therapy (IBT) treatment for obese patients. Despite the widespread prevalence of obesity in the Medicare population, use of this benefit has been substantially lower than expected suggesting significant underutilization of this benefit. This exploratory study will pursue the following aims: 1) To develop a thorough understanding of the most pressing issues related to the use and non-use of the Medicare IBT for obesity benefit in primary care, and 2) To study the strategies used in practices that have successfully implemented services in accordance with the IBT for obesity Medicare benefit and describe: a) characteristics of these practices and their environmental context, b) key elements of the implementation process that facilitate successful in-practice intervention, c) patients use of the IBT for obesity benefit, including continuing receipt of services after meeting the weight loss requirement of the benefit, and d) cost to provide the service relative to the reimbursement amount. To accomplish aim 1, we will query the Medicare Provider Utilization and Payment Data: Physician and Other Supplier database for three states: Colorado, Michigan, and North Carolina and identify all providers and their practices that have been paid by Medicare for delivering IBT for obesity services to 10 or more beneficiaries in a year between 2012 and 2014. We will identify the primary care practices of these providers and conduct semi-structured telephone interviews with the universe of practices (up to 100 total). We will then identify practices that are not using the IBT benefit, matched on zip code, practice size (>5 providers), and family or internal medicine to practices using the benefit and conduct similar interviews with this group. Interviews will assess practice characteristics, reasons for use, non-use and stopping use of the benefit, processes and personnel involved, and any known patient results. To accomplish aim 2, we will purposefully select 36 practices from aim 1 that meet our criteria for IBT for obesity implementation success to collect in- depth information to understand their implementation, patient outcomes and costs. Data gathering will include on-site interviews and observations, and EMR data extraction. Normalization process theory will be used to understand factors important to implementation. These methods will also be used to obtain information to estimate the cost to the practice of providing IBT services and assess its sustainability under current and alternative reimbursement amounts. Our findings have direct policy implications informing the dissemination and sustainability of effective implementation strategies that can be learned from practices continuing to deliver IBT for obesity services. This study will add to the field by determining the use of this benefit, reasons for use and discontinuation of use, and identify potential strategies for effective implementation of IBT in primary care.