I am Desperate....no co-morbids

Co-morbidities

Nine of 27 of our acceptable articles had data on co-morbidities; however, none had co-morbidity data on persons over the age of 65. Of the seven TAs we reviewed, none had co-morbidity data on persons over age 65 and four of seven had data on co-morbidities in the general population.

Regarding the prevalence of co-morbidities in the population eligible for bariatric surgery, Pope demonstrated that the percentage of persons that had obesity surgery and had at least one major pre-operative co-morbidity was estimated to be 20.8% in 1990 and 31.4% in 1997. Yet in Gonzalez’ cohort study, for persons 50 years old or older, 47 of 52 (90%) had co-morbidities such as: degenerative joint disease (60%), diabetes and gastroesophageal reflux disease (GERD) (40%), and hypertension (56%). Approximately 90% of each type improved post-operatively with the exception of hypertension, where 56% improved. In a study by Residori, 57% of patients had at least one metabolic complication, with 30% having diabetes, 38% dyslipidemia, and 38% hypertension.²⁹ Approximately one-third of the diabetes cases and one-half of the dyslipidemia and hypertension cases were previously undiagnosed. Dindo calculated, after adjustment for BMI and age, that the occurrence of dyslipidemia was higher in Caucasians than Hispanics or African Americans, while hypertension rates were about the same

Medical therapy prior to surgery

One bariatric surgery group wrote that it favored bariatric surgery for those over age 65 and standardized facility criteria, but believed that a medical treatment weight loss trial for 6 to 12 months was not necessary. They commented that the decision of when to perform surgery was best left to the surgeon and the patient.

Generally, a common comment introduced pertained to the subjective nature of the medical treatment requirement prior to surgery. Some stated that there were no data to support such a requirement and others stated that the requirement only prolonged the time to needed surgery.

The standard of care for any surgical procedure is that medical management options are exhaustively considered and exercised by both patient and physician prior to surgery. This standard applies to the treatment of co-morbid conditions related to obesity. We will not impose a specific time period, but expect all surgeons to be part of a comprehensive program for the treatment of co-morbid conditions related to obesity and to have applied principles of good medical care prior to surgery.

https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewd ecisionmemo.asp&id=160&

CMS has determined that covered bariatric surgery procedures are reasonable and necessary only when performed at facilities that are: (1) certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center (program standards and requirements in effect on February 15, 2006); or (2) certified by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (BSCOE) (program standards and requirements in effect on February 15, 2006).

Centers for Medicare & Medicaid
https://www.cms.hhs.gov/mcd/viewdecisionmemo.asp?from2=viewdecisionmemo.asp&id=160&


Edited to say that I posted this question on another thread and want to apologize to you Amy. You are right and Medicare and Medicaid are 2 different programs. I didn't know since I've never had either. I guess this Decision Memo is for Medicare beneficiaries and coverage for Medicaid beneficiaries may vary state to state. I'm glad I now know so I can post this reply to only Medicare beneficiaries from now on.