Why do so few surgeons perform the DS?
Why, if the DS is so superior (and yes, yes it IS), isn't it more available?
1) By the time the DS procedure was developed and perfected, from 1988 to the mid 90s, the RNY was entrenched. Thousands of general surgeons had taken weekend courses and hung out their shingles, offering RNY-mill operations -- doing 4-6 surgeries/day, with little or no follow up. A money-making machine. The insurance companies got in on the act as desperate people demanded that bariatric surgery be covered, and drove the reimbursement rate down by leveraging the thousands of RNY surgeons against each other. If the surgeons wanted to get a steady stream of patients sent to them by the insurance companies, they had to contract with the insurance companies and their ****ty reimbursement rates.
2) The DS is a FAR more difficult surgery to learn. The duodenal anastomosis is a very tricky procedure -- the tissue of the duodenum is difficult to stitch. It cannot be learned in a weekend -- it requires being proctored by a VERY experienced surgeon. And most of the RNY hacks don't want to take time off from their high-throughput lucrative RNY mill practices to learn a new procedure when they've got plenty of RNY fish to fillet.
Also, there isn't to my knowledge a DS surgeon who does more than 2 DSs per day, and many spend lots of hours providing follow on care for their patients, because they CARE about them, and are providing not only follow on care but also collecting statistics to publish and provide scientific evidence of the superiority of the procedure for future patients to use to fight their insurance companies. These honorable practices have resulted in NUMEROUS insurance companies changing their policies over the last several years -- some of which policy changes I am proud to say I have had some small part in -- including BC of CA, Cigna, Aetna and Medicare.
Because of this economic disincentive, not many of the DS surgeons contract with insurance companies. They don't have to, in order to get their FULL fee, to which they are entitled. If they accepted the paltry rate of reimbursement the insurance companies offer for the DS (i.e., what they are willing to pay for the RNY), they would not be in business very long. In fact, many of the DS surgeons who DO contract with insurance companies have instituted mandatory non-insurance-reimbursable "program fees" amounting to several thousand of dollars that the patients have to come up with before surgery, just to make the surgery marginally profitable to the surgeon. This is a practice I find despicable, even if I understand why they do it.
3)
Insurance companies are in business to make money for their executive management and shareholders. Their managers are paid and retained on their ability to spend less in any given immediate time period than they collect in premiums. They have data showing that the average insured person changes insurance companies (through job move, job loss, or choice) about once every three years. The longer the insurance company puts off having to pay any amount of money, the more money they make in THAT time period. And the higher the chance that the sick person will LEAVE before they have to pay a claim. They don't CARE what is more cost effective in the long run -- they care about what is the cheapest in the current quarter. Period. They don't CARE about making you healthy -- they are hoping you change insurers or DIE before they have to pay a big claim in THIS quarter. Period.
Read more: http://weightlosssurgery.proboards.com/index.cgi?action=disp lay&board=dsdata&thread=2045&page=1#29877#ixzz1lrvjBYKM
1) By the time the DS procedure was developed and perfected, from 1988 to the mid 90s, the RNY was entrenched. Thousands of general surgeons had taken weekend courses and hung out their shingles, offering RNY-mill operations -- doing 4-6 surgeries/day, with little or no follow up. A money-making machine. The insurance companies got in on the act as desperate people demanded that bariatric surgery be covered, and drove the reimbursement rate down by leveraging the thousands of RNY surgeons against each other. If the surgeons wanted to get a steady stream of patients sent to them by the insurance companies, they had to contract with the insurance companies and their ****ty reimbursement rates.
2) The DS is a FAR more difficult surgery to learn. The duodenal anastomosis is a very tricky procedure -- the tissue of the duodenum is difficult to stitch. It cannot be learned in a weekend -- it requires being proctored by a VERY experienced surgeon. And most of the RNY hacks don't want to take time off from their high-throughput lucrative RNY mill practices to learn a new procedure when they've got plenty of RNY fish to fillet.
Also, there isn't to my knowledge a DS surgeon who does more than 2 DSs per day, and many spend lots of hours providing follow on care for their patients, because they CARE about them, and are providing not only follow on care but also collecting statistics to publish and provide scientific evidence of the superiority of the procedure for future patients to use to fight their insurance companies. These honorable practices have resulted in NUMEROUS insurance companies changing their policies over the last several years -- some of which policy changes I am proud to say I have had some small part in -- including BC of CA, Cigna, Aetna and Medicare.
Because of this economic disincentive, not many of the DS surgeons contract with insurance companies. They don't have to, in order to get their FULL fee, to which they are entitled. If they accepted the paltry rate of reimbursement the insurance companies offer for the DS (i.e., what they are willing to pay for the RNY), they would not be in business very long. In fact, many of the DS surgeons who DO contract with insurance companies have instituted mandatory non-insurance-reimbursable "program fees" amounting to several thousand of dollars that the patients have to come up with before surgery, just to make the surgery marginally profitable to the surgeon. This is a practice I find despicable, even if I understand why they do it.
3)
Insurance companies are in business to make money for their executive management and shareholders. Their managers are paid and retained on their ability to spend less in any given immediate time period than they collect in premiums. They have data showing that the average insured person changes insurance companies (through job move, job loss, or choice) about once every three years. The longer the insurance company puts off having to pay any amount of money, the more money they make in THAT time period. And the higher the chance that the sick person will LEAVE before they have to pay a claim. They don't CARE what is more cost effective in the long run -- they care about what is the cheapest in the current quarter. Period. They don't CARE about making you healthy -- they are hoping you change insurers or DIE before they have to pay a big claim in THIS quarter. Period.
Read more: http://weightlosssurgery.proboards.com/index.cgi?action=disp lay&board=dsdata&thread=2045&page=1#29877#ixzz1lrvjBYKM
On February 8, 2012 at 11:51 PM Pacific Time, goodkel wrote:
Why, if the DS is so superior (and yes, yes it IS), isn't it more available? 1) By the time the DS procedure was developed and perfected, from 1988 to the mid 90s, the RNY was entrenched. Thousands of general surgeons had taken weekend courses and hung out their shingles, offering RNY-mill operations -- doing 4-6 surgeries/day, with little or no follow up. A money-making machine. The insurance companies got in on the act as desperate people demanded that bariatric surgery be covered, and drove the reimbursement rate down by leveraging the thousands of RNY surgeons against each other. If the surgeons wanted to get a steady stream of patients sent to them by the insurance companies, they had to contract with the insurance companies and their ****ty reimbursement rates.
2) The DS is a FAR more difficult surgery to learn. The duodenal anastomosis is a very tricky procedure -- the tissue of the duodenum is difficult to stitch. It cannot be learned in a weekend -- it requires being proctored by a VERY experienced surgeon. And most of the RNY hacks don't want to take time off from their high-throughput lucrative RNY mill practices to learn a new procedure when they've got plenty of RNY fish to fillet.
Also, there isn't to my knowledge a DS surgeon who does more than 2 DSs per day, and many spend lots of hours providing follow on care for their patients, because they CARE about them, and are providing not only follow on care but also collecting statistics to publish and provide scientific evidence of the superiority of the procedure for future patients to use to fight their insurance companies. These honorable practices have resulted in NUMEROUS insurance companies changing their policies over the last several years -- some of which policy changes I am proud to say I have had some small part in -- including BC of CA, Cigna, Aetna and Medicare.
Because of this economic disincentive, not many of the DS surgeons contract with insurance companies. They don't have to, in order to get their FULL fee, to which they are entitled. If they accepted the paltry rate of reimbursement the insurance companies offer for the DS (i.e., what they are willing to pay for the RNY), they would not be in business very long. In fact, many of the DS surgeons who DO contract with insurance companies have instituted mandatory non-insurance-reimbursable "program fees" amounting to several thousand of dollars that the patients have to come up with before surgery, just to make the surgery marginally profitable to the surgeon. This is a practice I find despicable, even if I understand why they do it.
3)
Insurance companies are in business to make money for their executive management and shareholders. Their managers are paid and retained on their ability to spend less in any given immediate time period than they collect in premiums. They have data showing that the average insured person changes insurance companies (through job move, job loss, or choice) about once every three years. The longer the insurance company puts off having to pay any amount of money, the more money they make in THAT time period. And the higher the chance that the sick person will LEAVE before they have to pay a claim. They don't CARE what is more cost effective in the long run -- they care about what is the cheapest in the current quarter. Period. They don't CARE about making you healthy -- they are hoping you change insurers or DIE before they have to pay a big claim in THIS quarter. Period.
Read more: http://weightlosssurgery.proboards.com/index.cgi?action=disp lay&board=dsdata&thread=2045&page=1#29877#ixzz1lrvjBYKM
I understand what you're going through. I had the same problems with my lap band. I got completely unfilled this summer & have been trying to get my insurance company to pay for a revision. At first, I was scared of how drastic the DS seemed. I read a lot of medical journals & decided that it was the best choice for me. Unfortunately, a lot of the really helpful DS vets don't post here anymore. I encourage you to do lots of research on the internet to get the best information.
Best wishes to you.
Best wishes to you.
Got a lap band in 2008. Tried hard, but didn't lose much weight & developed swallowing problems. Fought my insurance company for almost a year & finally had a band to DS revision on 5/11/12. Have now lost 125 pounds. Yay!
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