Stop Hidden Medicare Discrimination to Save Dollars and Lives

Contributor: Jessica Setnick, MS, RD, CEDRD – Founder of the International Federation of Eating Disorder Dietitians

This week for the first time, a dollar amount was assigned to the economic burden of inadequate treatment of eating disorders in the US. That cost is in the billions.

A significant portion of the cost is accounted for by emergency department visits and repeat hospital stays, costs that could largely be prevented with simple outpatient care. So why do individuals with eating disorders, successfully treated in the hospital, relapse to the point of needing the ER? Here’s my theory.

Patients in the hospital for any reason are screened by Registered Dietitian Nutritionists and, when indicated, receive Medical Nutrition Therapy (MNT). This benefits the patient and also saves the system money since nutrition is the foundation for almost everything else.

Reversing malnutrition and dysfunctional eating makes medications work better, shortens surgery recovery time and hospital stays, improves immunity and pregnancy outcomes, reduces readmission rates, decreases NICU time, and on and on and on.

In the short term, the value of MNT is clear and obvious. But chronic, ongoing conditions – diabetes, kidney failure, eating disorders – need ongoing care, long past a stay in the hospital.

MNT improvements need to be maintained, whether at a medical office, clinic, or virtually from home. It’s available for people with diabetes or kidney failure even after they leave the hospital.

But it’s not covered outside of the hospital for your friends or family with eating disorders. And that’s why eating disorder recovery, firmly established in the hospital but unable to find sure footing at home, begins to fall apart.

Jenna Line, disabled by anorexia nervosa and reliant on Medicare, had been discharged from hospital treatment with strict instructions for follow-up care. The hospital could only do so much; she was told. The rest of her treatment would be in outpatient clinics.

She was given three days’ worth of her prescriptions and two upcoming appointment dates – one with her doctor, the other with her therapist. But something – someone – was missing. “What about my dietitian?” she asked. “Who is going to help with my eating?”

“That’s not covered,” was the response repeated over and over by everyone she asked. Not covered? That didn’t make sense.

Even in the hospital, she had had difficulty completing meals. And that was when every bite had been put on her plate, every plate had been put on her tray, and every tray had been carefully planned – all overseen by the program’s dietitian.

In Jenna’s group and private meetings, the dietitian had taught her that eating was not the cause of her pain, it was the reverse. Malnutrition was what made eating hurt and eating every meal, every day was the only way to heal.

It had taken everything she had, putting that much effort into every single meal, then coping with the anguish that eating always caused. How on earth was she ever going to do it on her own?

Jenna’s experience is far from unique. The information she received – though shocking – was correct. Medical care and mental health counseling for eating disorder treatment are both covered by Medicare and Social Security Disability Insurance (SSDI) during a hospital stay and afterward. MNT, however, is only covered during the hospital stay.

No one ever made this decision. It’s a glitch caused by the separate systems for medical and mental health care. Medical Nutrition Therapy for eating disorders is a medical procedure for a mental health condition.

So, Jenna and thousands of Americans like her find themselves on the receiving end of the startling bad news that nutrition therapy for eating disorders is simply not covered. Not by Medicare, not by TRICARE, and not by private insurance using Medicare as a guide.

Medical Nutrition Therapy is cost-effective, with great ROI. Doing without it is costly in terms of both health and economics. Hospital readmissions and emergency department visits are expensive and not effective long-term. No matter how well you’re treated, you simply can’t live there.

If this feels like someone else’s problem, I hope it always is. But the odds are not in your favor. Eating disorders are shockingly common, and they don’t discriminate. They can affect anyone, of any age, and we don’t know when or why.

If you ever lose your appetite when you’re stressed, didn’t have enough to eat as a child, eat for comfort, or obsess about your weight, you are at risk. So are your children, your parents, your neighbors, your friends. Eating disorders don’t discriminate. Why does Medicare?

The good news? Medical Nutrition Therapy is essential, and you can improve its access. Support the Nutrition CARE Act (H.R. 3711/S. 2907) led by a bipartisan group of lawmakers including Rep. Judy Chu (D-CA-27), Rep. Jackie Walorski (R-IN-02), Sen. Lisa Murkowski (R-AK) and Sen. Maggie Hassan (D-NH).

Nutrition CARE provides Medicare coverage for Medical Nutrition Therapy for individuals with eating disorders outside of the hospital so they can continue to recover at home. This straightforward solution will fix the glitch and ensure that comprehensive eating disorder treatment is there for all of us if we ever need it.

Jessica Setnick, MS, RD, CEDRD, is a leader in the field of nutrition counseling for eating disorder treatment. A Certified Eating Disorder Dietitian and CEDRD Supervisor, Jessica’s publications include The Eating Disorder Clinical Pocket Guide, A Dietitian’s Guide to Professional Speaking, and three Eating Disorders Boot Camp training workshops. Jessica manages IFEDD, the International Federation of Eating Disorder Dietitians, and EatingDisorderJobs.com, and is a tireless advocate for eliminating bias and insurance discrimination in our field.

The opinions and views of our guest contributors are shared to provide a broad perspective on eating disorders. These are not necessarily the views of Eating Disorder Hope, but an effort to offer a discussion of various issues by different concerned individuals.

We at Eating Disorder Hope understand that eating disorders result from a combination of environmental and genetic factors. If you or a loved one are suffering from an eating disorder, please know that there is hope for you, and seek immediate professional help.

Published June 29, 2020, on EatingDisorderHope.com
Reviewed & Approved on June 29, 2020, by Jacquelyn Ekern MS, LPC

Eating Disorder Hope Staff

The EatingDisorderHope.com editorial team comprises experienced writers, editors, and medical reviewers specializing in eating disorders, treatment, and mental and behavioral health.