Obesity Medicine Practice Models
Obesity is a complex chronic medical condition that is directly related to over 230 other disease states. Obesity medicine aims to address the root cause that is driving these medical conditions, rather than putting bandaids on the complications of obesity. Excess adiposity affects nearly every organ system, and thus, regardless of the field of medicine you work in, you are probably treating complications of obesity. You may even experience limitations in the treatment you can offer your patients because of an elevated BMI, such as joint replacements, hernia repairs, and other necessary treatment options. Adding science-based, compassionate, comprehensive obesity management to your practice can be incredibly rewarding for you as a provider and for your patients. To truly provide the best care, we must address root causes and treat the patient holistically.
The first step is to become educated on obesity. My recommendation for this is joining the Obesity Medicine Association (OMA), the clinical leader in obesity medicine. Physicians can become board certified in obesity medicine through the American Board of Obesity Medicine, and PAs and NPs can obtain the Certificate of Advanced Education in Obesity Management through OMA.
Once you have received adequate education and are ready to start an obesity program, you will want to consider how you want to incorporate obesity medicine into your practice. There are several options for practice models for an obesity program or clinic. Here, we discuss a few options, however, there may be other models that are best suited for your needs and goals. Finding which model is best suited for your clinic is a highly personal, individualized decision. All models can include insurance, cash, or a combination of insurance and cash reimbursement. Models include small private practice, large groups, and hospital or university-based programs. Examples of practice models include:
Incorporating Obesity Medicine into Current Practice: Obesity management becomes part of the current practice, while continuing to treat other medical conditions simultaneously. These types of practices are typically insurance based, with the usual billing and coding practices. If following this model, keep in mind that obesity management requires more frequent follow-ups than typically seen with other chronic conditions. Ensure that this can fit into your current scheduling. If you are planning to use standard 30-minute new patient appointments and 15-minute follow up appointments, it is recommended that you have a plan in place to sufficiently address lifestyle factors. This does not necessarily need to be done by the provider and can be delegated to a staff member, completed electronically or remotely, or can be referred out. Consider using local resources, such as commercial weight loss programs, local dietitians, exercise physiologists/ trainer/ physical therapists, psychologists, and health coaches to provide lifestyle counseling, while you focus primarily of the medical management.
Adding a Separate Obesity Management Clinic to an Existing Practice: This can be done in primary care, but also in any specialty practice, for example GI, orthopedics, cardiology, urology, OB/GYN, etc. Having a separate clinic allows for differences in scheduling, staffing, and resources. It allows for one or more providers and staff to be dedicated completely to obesity, or work on both sides of the clinic. This allows for flexibility and growth, especially with a new program. I recommend having separate accounts and credit card processors for each program, so that you can determine revenue from each program separately. Again, this model can be cash, insurance based, or a combination. The role of the obesity medicine provider can be filled by a physician, PA, or NP with adequate training in comprehensive obesity management. PAs and FNPs are uniquely positioned to take on the role of the obesity management provider in a specialty setting, since they are trained as generalists and have the taxonomy codes to code for preventative visits.
Separate Obesity Medicine Practice: This may be an option if you choose to dedicate yourself 100% to obesity medicine. This can be cash-based, insurance-based, or a mixed-model. These models can vary greatly by size of clinic and staff. Some obesity specialists choose to manage nutrition, physical activity, emotional well-being, and sleep themselves, since the specialized training of an obesity medicine provider covers these topics thoroughly. If providing all the services yourself, staff and overhead can be minimized, but patient volume is also limited. This can be mitigated by offering Shared Medical Appointments (SMAs) or hiring additional staff, including dietitians, exercise physiologists, health coaches, mental health specialists, or additional providers. Some services may not be covered by insurance and may require cash reimbursement. I recommend keeping overhead as low as possible during the initial stages and expanding services, staff, and space as the program grows. Keep this in mind as you negotiate your rental agreement and consider the amount of space you will need. Also consider that services like telemedicine can allow you to increase your number of providers and patients without necessarily needing a larger space.
Partnering with Metabolic and Bariatric Surgery: It has become increasingly common for metabolic and bariatric surgery clinics or centers to include a non-surgical, medical obesity management program as an adjunct to the surgical program. This may be a great opportunity for medical obesity providers to join a surgical clinic or group. There are numerous benefits to this approach, including:
1. The medical team can optimize the patient’s health prior to surgery and assist with the medical weight management that is typically required by most insurances for 3-6 months prior to surgery. This also reduces surgical risk and length of hospital stay.
2. The medical team can manage the bariatric surgery patients long-term since these patients will always require long-term follow up. This frees the surgical team to perform pre-op and post-op visits, and to perform more surgeries.
3. It allows for cost-sharing of office space and staff. On days when surgeons are in the OR, the office space and staff can be used for medical management.
4. It provides alternative treatment for patients who do not qualify for surgery, who are not good surgical candidates, who do not have insurance coverage for surgery, who do not want to have surgery, or those who have had surgery and need additional treatment to keep their obesity controlled.
5. It keeps the patients within your program rather than losing the patient if, for example, their insurance does not cover surgery. Insurance plans and coverage constantly change, and the patient may be a candidate for surgery in the future.
6. Offering comprehensive obesity treatment elevates the practice and may differentiate it from the competition. It gives the practice the capability to offer a full spectrum of treatment options, allowing for true individualization of care.
7. Obesity is a chronic medical condition without a cure. Patients may need a range of tools depending on where they are in their disease state. This model allows for improved coordination of care.
8. It allows additional accreditation through MBSAQIP to be a Comprehensive Center with Obesity Medicine Qualifications (https://www.facs.org/-/media/files/quality-programs/bariatric/2019_mbsaqip_standards_manual.ashx). For tracking outcomes, go to: facs.org/quality-programs/mbsaqip/resources and you will find an excel spreadsheet to track your data.
For more resources on getting an obesity program started, visit www.GainingHealth.com. On the website, you will find the newly released book Developing an Obesity Management Program; The Healthcare Provider’s Roadmap, as well as customizable obesity medicine forms and templates that you can use to build your program! Subscribe to Gaining Health to receive updates on newly released materials, including patient education materials that will be released later this spring or early summer.
About the author: Karli Burridge is a nationally recognized expert in obesity medicine. She is a PA and Fellow of the Obesity Medicine Association. She is a co-author of the Obesity Algorithm® and serves on the Board of Trustees for the Illinois Obesity Society. She has developed numerous obesity programs in a variety of clinic settings. She has received multiple awards for her work in expanding the field of obesity medicine and in furthering obesity education for health care providers.
Karli is the founder of Gaining Health, which she developed to provide resources to health care providers who want to incorporate obesity medicine into their medical practice.