Prescribe Fit and Healthcare Providers - Part 2

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In part 1 we started looking at a company called Prescribe Fit that is focused on getting referrals from orthopedics office of higher-weight patients with musculoskeletal (MSK) issues. We looked at the scientific basis they are using as well as their promises around efficacy. Today, we’ll look at what they have available for providers.

The first thing I noticed is that they have trademarked the term “orthob*sity” (which they’ve labeled a “crisis”) defining it as “a trend where overw*ight individuals are increasingly presenting to orthopedic practices.”

This, for me, is an overarching issue of the weight loss industry in general. When people are rushing to profit from weight loss, even if it’s a matter of well-intentioned paradigm entrenchment, they tend to miss the realities that could lead to higher-weight people actually developing health issues. Let’s take the example of higher-weight people presenting more often at orthopedic practices as a hypothetical:

 We know that experiences of weight stigma can lead to higher-weight people disengaging from healthcare, so when they experience a little bit of joint pain they may avoid going to the doctor because they assume that the doctor will just tell them to lose weight (which, as we can see, isn’t, like, out of the question.) So instead of something that could have been solved by a simple intervention by their Primary Care Provider, they wait and end up with something more serious that requires an ortho. (And I want to be absolutely clear, the blame here lies in the weight stigma and myopic weight focus that higher-weight people experience in healthcare, not in higher-weight people’s response to it.)

Or, when they present with acute MSK issues (the same ones that thin people present with) they may be told to lose weight, while thinner people get actual evidence-based healthcare options. Then the higher-weight people go out and exercise on an acute injury, turning into a chronic one, which will also be blamed on their weight. Finally, there’s the fact that the durable medical equipment (DME) (like braces, for example) that is often used to aid in recovery from MSK injuries often doesn’t fit, or doesn’t properly fit, higher weight bodies and/or a facility fails to stock/obtain properly sized equipment for their higher-weight patients, preferring to tell them to become thin patients so that they fit the DME, rather than making sure they have DME that fits them.

Once again, we get a vicious cycle wherein the healthcare system allows higher-weight people to receive unequal, subpar care. Then the issues created by that care are blamed on higher-weight people’s bodies and the weight loss industry creates and trademarks terms to pathologize them and sell “weight loss solutions” that have absolutely no evidence of long-term success. Hypothetically.

Back to Prescribe Fit which has a system for healthcare providers. There are seven steps to “Put your patient on the fast track to health™” (They’ve trademarked “fast track to health”)

The physician is only involved in Step 1- physician “refers”, Step 6 - physician “monitors” and Step 7 - physician “bills” For this step they offer the precise billing codes to use.

They get more specific in the “Practice FAQs” section:

Physicians can collect approximately $210.89 per patient per month in insurance reimbursement for the following RPM CPT codes:

$19.65 one-time for CPT 99453: Initial setup visit to issue device & educate patient.

$46.83 every 30 days for CPT 99454: Provide one or more devices to the patient & collect data.

$48.14 monthly for CPT 99457: Initial 20-minutes of monitoring/communication time spent per patient.

$38.64 for CPT 99458 x3: Additional 20-minute increments of monitoring/communication time spent per patient.

Additional reimbursement for RTM Musculoskeletal (MSK) System Monitoring CPT Codes 98975, 98977, 98980, and 98981 coming soon!”

“All we need from you is an automated weekly list of patients with upcoming appointments who meet target patient population criteria. Prescribe FIT works on your behalf to fully enroll patients and coach and monitor them throughout the program. The practice bills the patient’s insurance for reimbursement as normal.”

“Our audit-ready billing reports offer simple identification of CPT codes to bill. These reports are auto-generated based on the logic from the current AMA Codebook. Reports are in PDF format to export anytime.”

I spoke to doctors who treat orthopedic conditions and, acknowledging that they are not lawyers, they did share some concerns:

First, they noted that, in their medical opinion, weight itself is rarely the cause of pain, suggesting that this program does not actually address the root cause. From a legality perspective, there was concern that the website stresses the "minimal commitment" of the ortho practice, but provides monetary compensation. One felt that it would be akin to "a situation where I prescribe PT for a patient, they do the PT with the therapist themselves, I review the PT notes and then I GET PAID for that PT's work" expressing concern that this might violate Stark Law (https://oig.hhs.gov/compliance/physician-education/fraud-abuse-laws/) Further, there was concern around what would happen in the event of a poor outcome or negligence on the part of Prescribe Fit or any of its agents. Again, this doesn't necessarily mean that Prescribe Fit is doing anything wrong, but may be helpful in terms of questions to ask. 

Since neither of the people who asked me to write about this mentioned that their provided disclosed that they would be profiting from this referral, I have some further questions. Now, I’m not a lawyer, nor am I giving a legal opinion, just asking some questions.

Some of the doctors I spoke with mentioned the Anti-Kickback Statute (AKS). From my reading, this appears to only apply to Medicare and Medicaid and it reads, in part

“The AKS is a criminal law that prohibits the knowing and willful payment of "remuneration" to induce or reward patient referrals or the generation of business involving any item or service payable by the Federal health care programs (e.g., drugs, supplies, or health care services for Medicare or Medicaid patients)…In some industries, it is acceptable to reward those who refer business to you. However, in the Federal health care programs, paying for referrals is a crime. The statute covers the payers of kickbacks-those who offer or pay remuneration- as well as the recipients of kickbacks-those who solicit or receive remuneration. Each party's intent is a key element of their liability under the AKS.” (emphasis theirs)

Then I found an article from 2022 from law firm Lewis Brisbois called “DOJ Expands Reach by Prosecuting kickbacks involving private insurance payors” that said

“Healthcare companies may need to be mindful that the federal government has started investigating and prosecuting referral-based arrangements for private insurance claims under the Travel Act and the Eliminating Kickbacks in Recovery Act (EKRA). While the Anti-Kickback Statute (AKS) has historically been the basis for enforcement actions in the healthcare industry for alleged kickbacks where only federal funds are involved, healthcare companies ought to reassess their referral-based arrangements for private insurance claims under this new trend.”

I reached out to the firm for clarification but I haven’t yet heard back.

Again, I’m not saying that this company or the doctors who are referring patients to them are doing anything wrong- there may be a reason that this is not considered a paid referral and it may be considered a completely ethical business practice. Knowing you, my readers, as I do, I assumed that the next question would be “is this legal” so I wanted to do some work around that for you in advance.

I will say that personally, as a patient, I would not be happy if my doctor prescribed this to me and didn’t disclose that they were profiting from it and/or Prescribe Fit’s lack of long term success data.

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More research and resources:
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’s Belly of the Beast: The Politics of Anti-Fatness as Anti-Blackness for more on this.