BMI Screening and Follow-up for People with Serious Mental Illness
The percentage of patients 18 years and older with a serious mental illness who received a screening for body mass index and follow-up for those people who were identified as obese (a body mass index greater than or equal to 30 kg/m2).
Note: The proposed health plan measure is adapted from an existing provider-level measure for the general population (Preventive Care & Screening: Body Mass Index: Screening and Follow-Up NQF #0421). It is currently stewarded by CMS and used in the Physician Quality Reporting System.
ACP does not support NQF measure #2601: “BMI Screening and Follow-up for People with Serious Mental Illness.” The urgency posed by the obesity epidemic underscores the need for evidence-based and clinically meaningful performance measures. However, this is a “check the box measure” and the numerator specifies interventions that do not necessarily lead to meaningful improvements in clinical outcomes. For example, documenting a referral to a nutritionist may not be an effective intervention for weight loss management. Furthermore, it is unclear why the specifications limit pharmacotherapy options to Orlistat. Developers should consider revising the specifications to include additional medications that are equally as effective in treating patients who are diagnosed with obesity. Additionally, developers should update the measure specifications to align with current United States Preventive Services Task Force (USPSTF) recommendations on obesity screening and include waist circumference as a screening tool. Furthermore, as currently specified, implementation may pressure clinicians to spend a disproportionate amount of time focusing on the patient’s weight, when other conditions should take precedence. Finally, there is no evidence on appropriate screening intervals. We advocate for annual versus biennial screening.