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WEIGHING RISKS AND BENEFITS; Weight-Loss Surgery: Medicare May End Coverage for Elderly

Posted on: Thursday, 8 December 2005, 18:00 CST

By Sue Reinert; SUE REINERT

The Patriot Ledger

A new Medicare proposal would end coverage of weight loss surgery for patients over 65 because it's too risky and there is no proven benefit for the elderly, officials say.

The federal program, which pays medical bills for 35.6 million elders and 6.5 million younger disabled people, announced the proposed change the day before Thanksgiving.

The procedure, which involves drastically reducing the size of the stomach, costs about $13,000, said Roseanne Pawelec, a spokeswoman at the Centers for Medicaid and Medicare Services in Boston.

Officials said recent research found that patients over 65 who had the surgery had almost three times the risk of dying compared to younger patients. With no studies on benefit to the elderly and findings that "the surgical risk is significantly higher we believe that it is inappropriate to perform this surgery in this population," a Medicare memorandum said.

Medicare now covers gastric bypass surgery, the most popular weight loss operation, for patients of any age if it is deemed necessary to treat a medical condition.

The Nov. 23 proposal also rejected most of a request from the professional organization of weight loss surgeons to expand coverage. Officials at the American Society for Bariatric Surgery could not be reached yesterday.

Medicare officials have not adopted the change and have asked for comment. The government might pay for the stomach-stapling operation if older patients were enrolled in a research study, the proposal said.

Last year, Medicare covered about 2,000 weight loss surgeries nationwide for patients over 65 and 6,000 for younger people, Pawelec said. With more and more extremely obese patients turning to the surgery, its risks have come under scrutiny Massachusetts hospitals reported doing 25 of the gastric bypass operations on patients over 65 in 2003, according to the Agency for Healthcare Research Quality. The number dropped to 16 in the year that ended Sept. 30, Pawelec said.

Officials at several hospitals that do the procedure said yesterday they were unaware of the proposed change.

Dr. Lee Kaplan, director of the Weight Center at Massachusetts General Hospital, said many elderly candidates for the operation "have strong need for the surgery."

There's no evidence of benefit because researchers have never studied it specifically in the over-65 population, Kaplan said.

Hospitals with well trained surgeons, adequate services and other "best practices" recommended by experts can reduce risks of the surgery, Kaplan said.

"Therefore I disagree with the Medicare proposal," he said. Most Massachusetts General weight loss surgery patients are under 65, but "in selected individuals where the benefits outweigh the risks we do the surgery," Kaplan said.

An expert panel in Massachusetts recommended last year that the state require hospitals and surgeons doing gastric bypass operations to perform a minimum number of procedures. At the time, 14 of the 24 hospitals offering the operation met the standard.

A spokeswoman could not say whether the state has adopted any requirements. The Medicare proposal would require hospitals and surgeons to be credentialed but did not include specific standards.

The Massachusetts report did not discuss surgeries for elderly patients.

Former Commissioner of Health Christine Ferguson, who had the surgery herself, convened the panel after six patients died since 1998.

Among them was Mark Gratta, 43, of Hingham, a well-known contractor. He died Jan. 22, 2003, of a massive infection after surgery to reduce the size of his stomach.

His family is suing the surgeon and Boston Medical Center, contending that five surgical sponges left in his body caused the infection.

The doctor has acknowledged leaving the sponges but denied that they caused the infection.

Sue Reinert may be reached at sreinert@ledger.com.

Source: Patriot Ledger, The; Quincy, Mass.

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