Dyan Hes, MD
American Board of Obesity Medicine board members are passionate about the field of obesity medicine. It is why they devote countless hours leading the organization, writing exam items, and lending their voices as thought leaders throughout the medical community. Periodically, we ask board members to share their views on an important topic within the field of obesity medicine.
Below, Dr. Dyan Hes, a pediatrician and ABOM board member, turns her focus to the value of making obesity medicine a part of a general practice. Hes is the medical director of Gramercy Pediatrics and a Clinical Assistant Professor of Pediatrics at Weill Cornell Medical College:

Many doctors think that they must choose between primary care and specialty medicine. This was not an option for me. I love primary care and did not want to give it up completely. I was driven to come up with my own model to blend my passion for obesity medicine with my primary care pediatrics practice. When I started incorporating obesity medicine in a pediatric setting, people thought that it could not be done. However, by devoting about forty percent of my time to seeing children with weight issues, I found a way to make this unique situation work.

Due to the nature of obesity, obesity medicine physicians have to see their weight management patients often. In my practice, most obesity medicine patients are school aged and cannot have recurrent visits during the school day. For this reason, I see most of my weight management patients in the late afternoon or early evening hours. This leaves me the rest of the day to practice the primary care that I love.

Providing obesity medicine care is quite time consuming, but very rewarding. For each obesity medicine patient I treat, I could probably see three general patients. However, I bill the insurance companies for these visits based on time and level of care. I am an in-network provider for most major commercial health care plans. For each new obesity medicine patient I treat, I bill a level five consult and send a detailed report back to their primary care physician. This visit usually lasts 45 minutes to one hour. For follow up visits I usually see the patient for 30 minutes. I bill this between a level three and a level four visit based on time and severity of the child’s healthcare status. With each visit I send a consult note to the primary care doctor.

I am unique in that I provide weight management care on my own. I do not use a nutritionist or mental health worker in my office. I find that with motivational interviewing and lifestyle counseling, I have been able to successfully treat the majority of my patients. I think a nutritionist and mental health worker are necessary when the doctor is too busy to provide this care by him or herself.

In regards to billing, I cannot recall a time that any of my bills have been rejected. Occasionally, I have been audited by insurance companies because I have a greater number of level four and level five visits for my patients who are obese. After providing the insurance companies with my medical progress notes, I am always reimbursed because I keep excellent documentation regarding the complicated co-morbidities of these patients. Billing can be tricky for providers who participate in Medicaid plans. Medicaid reimbursement differs state by state. Some states do not reimburse for obesity medicine and that is when physicians have to rely on billing for the co-morbidities that they are treating and not the “obesity” code as the primary diagnosis.

I am truly happy with this balance that I have created. I find practicing pediatric obesity medicine very rewarding and I believe that the physicians in my community enjoy having me as a resource for these difficult patients and their families.

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