Millions of people with diabetes or chronic kidney disease are eligible for Medicare’s nutrition counseling benefit, but relatively few make use of it, according to a new report by Kaiser Health News. Physician unfamiliarity may be partly to blame.

In 2017, Medicare paid for about 100,000 recipients to get the dietary counseling. Yet 15 million Medicare enrollees with diabetes or chronic kidney disease are eligible for the benefit, the news outlet has found. (The data does not include enrollees in private Medicare Advantage plans.)

Meanwhile, there appear to be plenty of registered dietitians standing by. About 10,600 are enrolled to treat Medicare patients, yet only 3,500 dietitians billed the program for nutritional counseling in 2017. 

Since doctors must refer patients to a dietitian, the problem may in part be due to physician unfamiliarity with the benefit, KHN stated.

Nutrition counseling has been available without out-of-pocket costs to Medicare beneficiaries since 2011. Medicare pays for three hours of counseling in the first year of use, and two hours in subsequent years. A doctor can also appeal to Medicare for continued counseling when medically necessary.

This disuse of counseling is a lost opportunity for older adults and Medicare alike, health experts told KHN.

“I don’t understand how we have this burgeoning obesity and diabetes epidemic and we are not using dietitians in our clinics for all these patients, yet we are paying for all these things that mediate from the disease process such as arthritis, dialysis and amputations,” said Holly Kramer, M.D., a nephrologist and president of the National Kidney Foundation.

Even when utilized, the hours covered by the benefit may not be enough to motivate older adults to change their habits, Jennifer Weis, a registered dietitian in Philadelphia, told KHN. “It’s better than nothing, but in my mind is not sufficient,” she said.