FIGHT MEDICARE'S RULING ABOUT HOSPITALS!!

According to the news and the PA at the surgeon's office where I *had* an appointment for next week, on February 21st the announcement was made that "Medicare would cover some procedures only at hospitals considered "centers for excellence" by the American College of Surgeons and the American Society for Bariatric Surgery." Hospitals were given no time to apply for certification from either organization. We ALL need to contact our federal congressmen and senators about this. The more he11 we raise, the more likely it is the rule will be reversed or revised. Here are some things to point out in your communication (preferably by phone): 1. There was no notice given for this ruling. Hospitals should have had time to apply for certification. 2. Obesity is a life-threatening disease and this ruling has dramatically reduced the facilities available to perform bariatric surgery for months to come. 3. Waivers ARE available and you should urge your politicians to push for a waiver for your particular hospital. Here's the list of US Senators. Just find yours and slam them with emails & phone calls: http://www.senate.gov/general/contact_information/senators_cfm.cfm Here's the list of Congressmen. Ditto above: http://www.congress.org/congressorg/issuesaction/alertlist/?issue=30

Thank you so much for the information. I have been through the entire program at University Hospital in Syracuse, NY and getting ready for the surgery. I found out about this medicare ruling at support group and am totally sick about it. Not only do I have to fight my secondary insurance but also struggle to get the surgery here in the city I live through my primary which is medicare- the bariatric program here in syracuse is excellent and have terrific outcomes. Again thank you for the information and if you know where the nearest center of excellence is to syracuse, please advise. I plan on persuing this with our political leaders. Tina

Check out the ASBS (American Society for Bariatric Surgery) site and this link.... http://www.asbs.org/html/about/coe.html I am not sure what is closest to you? I also do not know if my local hospital Albany Medical Center's program is a COE? You can call them to find out: 262-8674/262-5623 or in Schenectady Ellis Hospital's: http://www.ellishospital.org/bariatrics.cfm Phone: 518.243.1313 (neither are on the list but I do not know how UP TO DATE the list is.... Can email or call the ASBS also! American Society for Bariatric Surgery Phone: 352-331-4900 Email: [email protected] OR: For questions regarding ASBS Centers of Excellence applications please call the Surgical Review Corporation at 866.790.4772. Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

Lisa: I understand this will affect many people.The bariatric community has been aware that this trend/issue for almost 2 years. (When I saw my surgeon last in the Fall of 2004 we spoke of it and in the Spring of 2004 the ASBS starting the process to initiate the COE). Many programs have been PROACTIVE in keeping with the bariatric/insurance industries...It is not an easy process and it is all expensive and time consuming, BUT it is not all aboout $$$ it is also about statistics, data on OUTCOMES. MANY programs/hospitals do not have this data (or would not qualify as their outcomes are not satisfactory!). Centers of Excellence (*albeit not perfect) will not only affect Medicare patients the predictions are eventually ALL insurers. With this not being a NEW concept, many programs are on board. IMHO It is not all a BAD thing per se, these centers of excellence are meant to PROTECT the patient from many (and I mean MANY) ill equipt, fly-by-night programs that can/are hurting more people than they are helping. (We are a vulnerable population who want to be healthy so bad we will do just about anything!). They are setting standards for programs and follow up as many surgeons are operating and never seeing pts again, have no nutrition or exercise or psych or support follow up. We are in the midst of an obesity epidemic...surgery can potentially be VERY lucrative, many programs do not committ fully to the patients and are seeking the CA$H only......It costs to have a top notch program.... Take a look at this link to WHY THE ASBS COE were formed. http://www.surgicalreview.org/centers.html Here is the process http://www.surgicalreview.org/registration.aspx I agree for those programs/facilities/surgeons who were not proactive, a 'grace' period to apply and process in a reasonable time frame for a COE provisional status should be fought for. Then ultimately it is up to the Bariatric surgeons/centers to follow through. I know a few programs who have shut down due to this as well as Malpractice carrier issues and fees in NY also. I wish everyone well with the process. Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"

Hi, everyone. Thanks for your responses. I'd like to clarify a couple of things: First, I was mistaken in thinking that this ruling just popped out of somebody's head. There *was* a comment period on the proposed ruling and so forth; apparently the hospitals knew this might be coming. So if you were in-process for WLS when this ruling came out, I urge you to contact your hospital and your surgeon and tell them that waivers are available. Ask them if they've applied for a waiver. Urge them to do it if they haven't and stay on them until they do. Second, I believe the new rules are *good*, not bad. My objection is only that the ruling didn't give facilities time to get certified, thus leaving so many of us hanging. I received a response from one of you saying that the comment period ended in December of 2005 and that the ruling went into effect in February of 2006. That's not NEARLY enough time for all the WLS facilities to get certified. Who knows how long it takes to get from application to approval? We're talking bureaucracy here, people. Nothing moves quickly. Third, here's concrete proof that this ruling didn't allow enough time to get certified: in the whole USA there are now only 117 facilities certified to perform WLS. Whole areas of the country don't have a certified facility. See which hospitals *are* certified here: http://www.cms.hhs.gov/MedicareApprovedFacilitie/BSF/list.asp#TopOfPage (thanks for the link, those who posted it) One of you pointed out that Medicare recipients should have been notified of the proposed rule; I agree wholeheartedly. Another response pointed out that the hospitals were hoping the rule wouldn't pass, which is why they didn't apply for certification. I disagree. There are just too many hospitals that aren't on the certified list - there can't be that many with their heads in the sand. Someone else suggested that hospitals didn't apply for the certification because it costs them money to get certified. THAT, I believe. I still urge you to contact your lawmakers. I paid to have this issue listed in the Soapbox at congress.org; I'm now asking everyone to PLEASE visit and voice your opinion: http://www.congress.org/congressorg/issues/alert/?alertid=8541136&content_dir=ua_congressorg Thanks, everyone. Lisa Owens