Are Medicare and Medicaid Patients Required to Weigh-In?

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I hear from a lot of people who are on Medicare and Medicaid that they have been told that they are required to weigh in at their appointments or the services won’t be covered. 

This is a misconception. Medicare and Medicaid's Merit-based Incentive Payment System (MIPS) (Content note – link contains anti-fat language), does require physicians to document a discussion, treatment plan, and follow-up for each patient with a BMI over 24.9  at least once per "performance period" (though it is not considered a “High Priority Measure.)

This is part of a doctor's "quality score," which is closely tied to the reimbursement they receive. Basically, doctors can get a lower quality score and then be paid less for the services they did provide if they don't push weight loss.

This is problematic on any number of levels (not the least of which is that it is encouraging doctors to give advice that is not ethical, evidence-based, or likely to work, and may well end up harming their patients. 

Regardless, your doctor receiving less compensation does not waive your right to informed consent/refusal. So even if it means your doctor gets paid less, they still have an ethical obligation to allow you to refuse routine weigh-in. 

But there’s good news, in researching this, I found that if a patient opts out of weigh-in, that patient is removed from both the numerator and the denominator for the doctor’s MIPS calculation. I wanted to double-check this, so I reached out to Kelley Aurand, DO, family physician and Informaticist who said:

“Basically, if the patient declines weight or there is an underlying medical reason not to weigh, then the patient can be excluded from the denominator.”

Dr Aurand also provided a link to an explainer document. While I do want to point out that it is deeply rooted in the weight loss paradigm, it may be something you can share with your healthcare provider (in particular, check out the “denominator exceptions” section.)  https://ecqi.healthit.gov/ecqm/ep/2022/cms069v10

Aurand does point out that there may be some tricky technical issues for your provider to navigate: 

“One would need to document this [weigh-in denial/medical reason for not weighing in] discretely in the electronic health record (EHR) so it can be automatically excluded from the reporting tools that are used for MIPS. I doubt most EHRs have this built in. We use one of the major EHRs and I'm not aware of a mechanism to document this information so the patient would be removed from the measure.” 

Still, you get to center your needs and experiences as a patient and, just like lowered compensation, technical difficulties faced by your provider do not negate your right to informed consent/refusal of the weigh-in as a Medicare/Medicaid patient. 

If you’re looking for options to decline the weigh-in, I have a piece about that here.

Shelby Gordon and I also cover this in our video workshop: Navigating Weight Stigma at the Doctor’s Office (there is a pay-what-you-can-afford option so that money isn’t a barrier.)

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More Research

For a full bank of research, check out https://haeshealthsheets.com/resources/

*Note on language: I use “fat” as a neutral descriptor as used by the fat activist community, I use “ob*se” and “overw*ight” to acknowledge that these are terms that were created to medicalize and pathologize fat bodies, with roots in racism and specifically anti-Blackness. Please read Sabrina Strings: Fearing the Black Body – the Racial Origins of Fat Phobia and Da’Shaun Harrison: Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.