March 6, 2006
Dear ASBS Members:
The reaction to Medicare's decision to endorse bariatric surgery as a safe and effective treatment for morbid obesity has been overwhelmingly positive. Surgeons and patients realize that this decision is not only a victory for Medicare patients, but for thousands more patients who have been unnecessarily denied bariatric surgery because of outdated and overly restrictive policies by some private insurers. As the biggest insurer in America, Medicare decisions often cause private insurers to follow suit and we expect they will do that in this case.
The Medicare decision should also be applauded for its mandate that bariatric surgery only be performed at either an ASBS/Surgical Review Corporation (SRC) or American College of Surgeons (ACS) Level 1 designated Center of Excellence. This mandate is based on solid clinical evidence that shows the best patient outcomes and the fewest complications occur in centers with the most experience.
We do understand, however, that the decision comes as many of you are in the process of applying for designation as a center of excellence. Unfortunately, this means that Medicare patients who were scheduled for surgery prior to the Medicare decision at a non-COE will have difficulty obtaining coverage. While the Medicare population for bariatric surgery is small (6 percent of the bariatric procedures performed in 2005), the ASBS feels strongly that these patients should not continue to suffer if they are appropriate candidates.
We strongly encourage all currently designated COEs to accept Medicare patients and we urge provisional COEs to make that referral until they have their own designation. There are now nearly 120 designated ASBS/SRC COEs in the U.S. We expect that number to nearly double within the next few months. It is all our responsibility, our obligation, to put patients first during this transition. In the mean time, the SRC is fully prepared to expeditiously review existing and new applications and conduct site inspections so that qualified programs get their designations as quickly as possible.
A new day is coming in bariatric surgery -- a day that will allow appropriate patients the access they need to this lifesaving surgery based on solid clinical criteria and patient outcomes. That day is not tomorrow because changes in coverage policy at private insurers do not take place overnight. However, this will give bariatric programs the time to meet volume and outcomes requirements for an ASBS/SRC Center of Excellence designation.
It is absolutely vital we work together and build on this tremendous endorsement of bariatric surgery and the strong momentum it creates for greater patient access and the highest quality of care. Ultimately, this will save patient lives, elevate the practice of bariatric surgery and help society deal with the scourge of obesity. Thank you for your role in making this happen.
Sincerely,
Neil Hutcher, MD
President
