Expanded Medicare Coverage Sought for Weight Loss Surgery
GAINESVILLE, Fla., May 25 /PRNewswire/ — The American Society for Bariatric Surgery (ASBS) has submitted an official request to Medicare for a new National Coverage Determination (NCD) for Bariatric Surgery to improve access to weight loss surgery for Medicare recipients.
According to the current Medicare Coverage Manual, Medicare only covers gastric bypass surgery, one form of weight loss surgery, if it is medically appropriate and if the surgery is used to correct an illness “which caused the obesity or was aggravated by the obesity.”
The ASBS is requesting that Medicare cover other methods of weight loss surgery, including laparoscopic procedures, and that coverage be made more uniform throughout the country. Currently, Medicare coverage of weight loss surgery is decided from region to region.
“Weight loss surgery has been shown to be the most effective treatment for people with a BMI of 40 or more (about 100 lbs above ideal body weight) regardless of the medical complications of obesity and for people with a BMI of 35 to 40 if they have one or more complications, such as diabetes or severe joint dysfunction,” said Harvey Sugerman, MD, President, ASBS.
“The current coverage policy has become outdated as new surgical procedures have become available and as evidence mounts as to their safety and effectiveness. We hope Medicare looks favorably upon this request for improved coverage and provides beneficiaries access to this potentially lifesaving surgery wherever they may live in the country,” Dr. Sugerman said.
An NCD is a determination by the Centers for Medicare and Medicaid Services (CMS) that a specific item or service is or is not covered by Medicare. It may also establish certain conditions or limitations on coverage. NCDs are binding on all Medicare contractors and no local coverage policy may be inconsistent with an NCD. Once a request for an NCD is made, CMS is required to make a decision within six months.
In July 2004, the Department of Health and Human Services (HHS) eliminated the Medicare policy statement previously stating that obesity was not a disease. In November, a Medicare Coverage Advisory Committee (MCAC) concluded that there is significant scientific evidence supporting the safety and effectiveness of open and laparoscopic weight loss surgery and its ability to improve a number of life-threatening obesity related conditions including diabetes, high blood pressure and high cholesterol in the general adult population.
In its NCD request, the ASBS recommended that Medicare patients who meet eligibility requirements should be directed only to those hospitals and surgeons with a high degree of expertise and experience in the surgical treatment of morbid obesity.
In addition, the request outlines how weight loss surgery has been shown to decrease mortality when compared to non-surgical treatments, dramatically decrease or eliminate numerous medical complications of obesity, pay for itself through decreased medication costs, physician and hospital visits over time and improve the quality of life for those who suffer from morbid obesity.
The ASBS says a new NCD should provide significant cost savings to Medicare over the long-run.
Approximately 90% of Medicare beneficiaries who currently receive weight loss surgery are under 65 and are categorized as Disabled under the Social Security Act.
“Should bariatric surgery provide removal of disability status through improvement in disabling arthritis, cardiovascular or pulmonary dysfunction, cost savings would be significant for Medicare and the health implications would be enormous,” Dr. Sugerman added.
Morbid obesity continues to be a growing problem in the U.S. affecting between 8 and 12 million people. The number of people who are morbidly obese is growing at double the rate of the rest of the obese population.
As with any surgery, the risks and benefits should be carefully considered by the surgeon, the patient and the patient’s family.
The ASBS is the largest organization for bariatric surgeons in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public alike about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information about the ASBS, visit http://www.asbs.org/.
The American Society for Bariatric Surgery
CONTACT: Rob Deveraturda, +1-212-527-7541, for The American Society forBariatric Surgery
Web site: http://www.asbs.org/