Medicare Announcement 3 Types of Surgeries

Medicare Backs Obesity Surgery U.S. to Pay for Three Types of Stomach-Shrinking Operations By Rob Stein Washington Post Staff Writer Wednesday, February 22, 2006; A08 Medicare endorsed three types of stomach-shrinking surgery yesterday, saying the controversial procedures can offer Americans safe and effective ways to treat obesity. The announcement was seen as a boost for the popular operations, known as bariatric surgery, which had come under a cloud in recent years because of concerns about their safety. "In the right hands, bariatric surgery can benefit patients," said Steve Phurrough of the Centers for Medicare and Medicaid Services, which sets policy for the federal health program. Under the new rules, Medicare will pay for the surgery for obese patients who are suffering from other health problems related to their weight, as long as they undergo the procedure at centers that have been certified as well qualified by the American College of Surgeons or the American Society of Bariatric Surgery. Although some insurers do not cover it, the number of people undergoing the procedures, which cost $25,000 to $40,000, has increased rapidly, jumping from about 16,000 operations in 1992 to an estimated 170,000 in 2005. The decision was hailed by proponents of the surgery, who see it as providing one of the only effective options for Americans struggling with obesity. "This is very positive for millions of Americans," said Morgan Downey of the American Obesity Association. The decision could also open the door for Medicare to cover other treatments for obesity, such as nutritional counseling, physician-supervised weight-loss programs and perhaps weight-loss drugs, Downey said. "We've been waiting to see how they responded to the surgical side. This will give us a cue as to where to go next," Downey said. "I think we'll start seeing Medicare start looking at other interventions." Because private health insurers often follow Medicare's lead, several experts predicted the decision would have broader implications. "The health system in general has largely ignored paying for weight-loss interventions up to this point. This is going to help them reconsider that," Downey said. But critics denounced the decision, saying the procedures are dangerous. "The decision to continue coverage is ill-advised and will expose many people, especially the elderly, to high risk," said Paul Ernsberger of the Case Western Reserve School of Medicine. "There may be some benefits, but there are alternative safe and effective treatments for every obesity-related condition." With one-third of Americans obese, public health experts have become increasingly concerned about the long-term impact on the nation's health. Despite numerous efforts to get Americans to eat better and exercise more, many people find it impossible to lose significant amounts of weight and keep it off, especially those who are extremely overweight. Surgeons perform several variations, but all involve sharply restricting the size of the stomach. The procedures can enable people to lose hundreds of pounds, alleviating disabilities and preventing, even sometimes reversing, serious health problems such as diabetes and high blood pressure. But the rapid increase in the surgeries has raised alarm about their safety, especially when performed by inexperienced surgeons at centers that offer limited follow-up care. Patients are prone to life-threatening complications, including bleeding, blood clots, leakages and infections. Even those with no serious complications can experience unpleasant side effects, including nausea, vomiting and diarrhea. As a result, they require intensive counseling and monitoring. The concerns have led a number of large insurers to refuse to cover the procedures. In October, two large new studies concluded that the surgery is much riskier than had been thought, with patients facing a far greater chance of being hospitalized and dying after the procedures. The following month, the Centers for Medicare and Medicaid Services recommended the program only pay for the operations for the disabled, saying they were too risky for the elderly. But after further analysis indicated that the procedures could be safe for the elderly as long as they are performed by experienced surgeons, the agency decided to approve coverage for them as well, Phurrough said. The coverage will be limited to three of the most commonly performed procedures: Roux-en-Y gastric bypass, gastric banding and biliopancreatic diversion with a duodenal switch, Phurrough said. Best of luck and health. Gary Viscio www.obesitylawyers.com

That is wonderful news for so many people who are on Medicare. I'll have to share this with others on the board Donna 338/154

I using that in my Tricare appeal too, now at the secretary of defense, health ,level, I hope to have them fold too. Need a DS because of a service condition, sometimes u gotta go to the top.

I began this process last week when I attended Tampa General "A Center of Excellence" which Medicare required. At that meeting I was told I would have to be on a weight program under a Doctor for 18 months and these first meeting would not even count because I must attend them with in 12 months of my surgery. When I returned home I began looking up the requirements of Medicare on the internet. I was not able to find the 18 months any where it did stat the 6 to 12 months seem to be reasonable but not necessary. So I called Medicare and after an hour and being transferred to 5 different people to get the requirements. I was told they would send them to me in 10 to 12 days. I asked the woman how long of a weight study did I have to have and she said 4 weeks. No sure what the requirements are can anyone help me with these requirements. I have an appointment with Lee Memorial Hosp in Fort Myers where I live that my Dr. recommended. an said they did things for him in the past. I talked to them today and found that they have a nutritionist working for them but not a Dr. Will this be ok. It will cost me $270 for the program. I am to start Friday ??? Should I start this?? As you can see I AM NEW AT THIS AND FLOUNDERING,PLEASE HELP AND SEND ME ANY INFORMATION YOU MY HAVE ABOUT THE REQUIRMENT MEDICARE IS REQUIRING. THANKS MARTHA