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

To add to the confusion and hair pulling .. I went in for the first step with my Dr .. the seminar and turning in paperwork to set up the first apt and was informed that the Drs are now not sure if it is only the centers or the Drs themselves that must have the accreditadation. I am waiting to find out if I can now be taken as a patient or try another Dr !!! Laura

Laura; I was told by my surgeon that both the his practice and the hospital have to be approved. Ron

What kind of pre- approval are you talking about? As far as medicare goes, they must be on the cms minumum standard list i called Medicare and there is NO Pre-approval .. Drs and hospitals must submit their bills AFTER surgery and if they filed theirclaims correctly, then they will be paid, i called and double checked again yesterday..and was told the same exact thing no pre-approval.. is this the kind of pre=approval u r talking about? the CMS centers for Medicare and Mediciad? finding a surgeon and a hospital that accepts medicare and are on the list .. and also are willing to take new patients ....seems to be the real problem at least for me.Iam now going to Centennial for the seminar march 25 I was told they will accept medicare both hospital and surgeons Bertha

Doctors and hospitals have had notice about this. They have had time to apply for certification. This ruling is to protect patients from having surgery done by doctors who don't really have the training in what is required beyond the actual surgery. There have been too many people who have had serious complications because they had no or inadequate follow up care. WLS is not like other surgeries where you see the surgeon, have the surgery, go in for 1 or 2 post-op visits and never see the surgeon again. We need lifelong support from doctors, nurses and nutritionists who are knowledgable about our long term needs and what problems can occur several years after surgery. There are many hospitals and doctors all over the country who applied for and earned the certification. Instead of pressuring for a weakening of the rules, we need to be pressuring the doctors and hospitals to earn the certification.

Susan; While I agree with most of your position on this matter, I disagree with the idea that The Surgeons and Hospitals were given ample time to comply. My surgeons office has been waiting months on the SRC for approval. Now the load that the SRC has will make it many more months before some hospitals and surgeons can be approved. Medicare made these requirements take effect immediately with no reguard to those of us that have come so far in our pre-op preparations. All my pre-op tests and consults were complete and I had a surgery date. At least a 30 day grace period would have been an more appropriate cosideration. The big gripe that most of us have, is not the instituting of these new requirements, quite the contrary. These new requirements will help insure quality treatment for future Medicare WLS patients in the long term, but now it will be a great long time before many of us will be able to have the surgery we need. Also because of the co-mobities, some of us may not live that long. Another problem is that there are only 117 Centers of Excellance in the USA and those are only located in 31 states and very few of those approved accept Medicare. I'm not asking for a weakening of the rules I'm just asking for a little consideration in the implimentation of the rules. Ron Martin

please tell me ..what is this "new ruling"?? I went to Baptist hospital for a seminar yesterday march 15,2006 after calling ahead and being told the surgeons and hospital accept medicare .. after the seminar i was told to call back in 30 days that there were basic guidelines that had to be met and they could npt accept medicare at this time i put in a call to Vanderbilt today and wating for them to call back i called medicare again todayand was told if medicare claim is filed properly AFTER surgery there is no reason why they will not pay (as long as Dr says it is medically necessary) they do not Preapprove any info you can give me would help thank you.. Bertha B

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