Three paragraphs in the latest version of the Senate's health reform bill could lead to an enormous increase in the cost of medical diagnostic equipment for physician's offices, clinics, and hospitals, in part to accommodate the obese or morbidly obese.
Within two years, the Architectural and Transportation Barriers Compliance Board would set standards to assure that people with "accessibility needs" can be treated "in physician's offices, clinics, emergency rooms, hospitals, and other medical settings," according to Section 510 of Title IV of the Patient Protection and Affordable Care Act.
The medical diagnostic equipment standards "shall apply to equipment that includes examination tables, examination chairs (including chairs used for eye examinations or procedures, and dental examinations or procedures), weight scales, mammography equipment, x-ray machines, and other radiological equipment commonly used for diagnostic purposes by health professionals," the provision reads.
The new rule would set "minimum technical criteria for medical diagnostic equipment used in (or in conjunction with) physician's offices, clinics, emergency rooms, hospitals, and other medical settings.
Experts agree that one major application for such a rule is any care setting for the growing number of morbidly obese in the U.S., a group the Centers for Disease Control and Prevention estimates at 5.9% of U.S. adults. For these very overweight people, standard-sized exam tables, blood pressure monitors or scales may not work.
"The standards shall ensure that such equipment is accessible to, and usable by, individuals with accessibility needs, and shall allow independent entry to, use of, and exit from the equipment by such individuals to the maximum extent possible," according to the bill.
Accommodating morbidly obese patients is a challenge for many physician practices and the lack of certain types of equipment can mean patients don't get the proper care, says Tracy Martinez, a nurse with the Scripps Wittgrove Bariatric Center in La Jolla, CA, and who is a member of the American Society for Metabolic & Bariatric Surgery.
For example, she says, many clinicians resort to "estimating" their patients weight because the office scales can't accommodate them, or blood pressure monitors aren't big enough to fit around a patient's arm. The doctors or nurses then may miss that "a patient may have gained 42 pounds since the last visit, or that the patient has high blood pressure," she says.
But, if such requirements pass, some providers may have trouble trying to adapt.