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| CMS to Expand Weight-loss Surgery Coverage
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In a departure from the restrictive bariatric coverage CMS proposed in late November, Medicare will now cover the three most popular types of weight-loss surgery for its beneficiaries, including those over 65 years of age. Coverage for seniors, who have experienced high complication rates in some settings, will be provided if the procedures are done in high-volume centers that achieve low mortality rates.
"Medicare did say [its November proposal] was a preliminary finding and gave us an opportunity to submit data," says Neil Hutcher, MD, president of the American Society for Bariatric Surgery. "Multiple people went back to their databases and weeded out data for those over 65 ... to show that if [bariatric surgery] is done in a high-volume institution, it could be done with the same safety as for other populations."
CMS, says Dr. Hutcher, "accepted the fact that, if surgery were done at the appropriate institutions with the appropriate surgeons, it could be done safely, and that the benefits far exceed the risks."
The highlights of the final decision memorandum:
Medicare will pay for the surgery for obese elderly (including those older than 65) or disabled patients who have tried but failed with other weight-loss options, have at least one weight-related medical problem and have a high body mass index. Medicare officials had earlier proposed coverage only for disabled patients, citing possible risks for the elderly.
Medicare will only pay for the surgery if patients 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.
The coverage will be limited to three of the most commonly performed types of stomach-shrinking surgery procedures: open and laparoscopic Roux-en-Y gastric bypass, open and laparoscopic biliopancreatic diversion with a duodenal switch and laparoscopic gastric banding. Previously, Medicare patients could only receive gastric bypass surgery.
"Bariatric surgery is not the first option for obesity treatment, but when performed by expert surgeons it is an important option for some of our beneficiaries," says CMS Administrator Mark B. McClellan, MD, PhD. "While we want to see more evidence on the benefits and risks of this procedure, some centers have demonstrated high success rates and we want to ensure access to the most up-to-date treatment alternatives for our beneficiaries."
Dr. Hutcher says this bodes well for the future of bariatric surgery, which has rapidly gained acceptance as a cure for obesity since CMS declared obesity a disease in November 2004.
"Historically, whenever there's been a Medicare determination, the private sector has followed suit, and we see no reason to change history," says Dr. Hutcher. "It's the most rehabilitative treatment in modern medicine today. If the industry looked past the short-term cost and looked at bariatric surgery as an investment over the life the of patient, [insurers] would be demanding it, instead of us demanding that they let us do it."
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| ASC Administrator Talks Transparency with President Bush
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At a panel discussion that included President George W. Bush and other federal officials, Jerry W. Henderson, RN, MBA, CNOR, CASC, executive director of the SurgiCenter of Baltimore in Owings Mills, Md., made the case for why a growing number of Americans are choosing ambulatory surgery centers for their outpatient procedures.
"Under the current Medicare system, it is nearly impossible for patients to make even the most basic comparisons," says Ms. Henderson. "And of course, for the patient, cost is only one of a whole host of benefits that include convenience, comfort and customer service."
The White House, which invited Ms. Henderson to the Feb. 16 meeting at the Department of Health and Human Services to address transparency in health care, has asked HHS to oversee the creation of a voluntary program that would publicize the prices healthcare providers charge for their services. Ms. Henderson says such transparency would be key to providing better patient care while saving patients and taxpayer money.
"Surgeries that were once lengthy and complex procedures requiring hospitalization are now safe, less costly outpatient procedures," says Ms. Henderson. "But a lack of information, as well as restrictions on insurance coverage, often keep patients from knowing their options. They can't make decisions that are truly informed about quality or cost, and reimbursement regulations often keep them from following their doctor's advice."
At the meeting, Mr. Bush noted, "When somebody else pays the bills, rarely do you ask the cost of something. I mean, it seems kind of convenient, doesn't it? You pay your premium, you pay your co-pay, you pay your deductible and somebody pays the bills for you."
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| Study: Chewing Gum Assists Colon Surgery Recovery
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Chewing gum after colon surgery appears to speed the return of bowel functions and shorten patients' hospital stays, according to a study in February's Archives of Surgery.
The study of 34 patients was conducted at Santa Barbara Cottage Hospital in Santa Barbara, Calif. Half the group chewed sugarless gum three times a day beginning the day after their surgeries.
Gum chewers left the hospital in 4.3 days, as compared to 6.8 days for the control group in the study. Patients who chewed gum also passed gas faster (65.4 hours post surgery, compared to 80.2 hours) and had their first bowel movement sooner (63.2 hours versus 89.4 hours).
While abdominal surgeries frequently lead to post-operative ileus, longer hospital stays, increased risks of infection and respiratory difficulties, the chewing of gum may stimulate the same nerves that eating does, researchers say, releasing hormones that activate the gastrointestinal tract.
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| News and Notes |
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PRESERVATIVE-FREE EYE DROPS are cause for caution, particularly when they're dispensed from multiple-use containers, according to a study published in February's British Journal of Ophthalmology. Researchers at the Tennent Institute of Ophthalmology in Glasgow, Scotland, found they were more likely to become contaminated with microorganisms than preservative-containing eyedrops. "The prescription of these drops to patients with compromised ocular surface defenses needs to be considered with caution," the researchers write. For the study, 95 bottles of 10 different drops were collected from patients after several days' use. While none of the 53 bottles of preservative eyedrops were found to be contaminated, eight of the 42 preservative-free bottles were. Hydroxypropylmethylcellulose was the most frequently contaminated, followed by prednisolone and acetylcysteine. Staphylococcus aureus was the most commonly found contaminant. Also present were coagulase negative staphylococcus, Bacillus spp, Serattia spp, Klebsiella oxytoca, Enterobacter cloacae, and alpha streptococcus.
ANESTHESIOLOGIST ASSISTANTS ARE NOW LICENSED to work in Washington, D.C., surgical facilities. AAs are also licensed to work in nine other states and allowed to practice in six more if facilities or physician anesthesiologists specifically request them. The licensing has been a long time in coming: in 2002, the D.C. Board of Medicine issued AA guidelines; the district's council passed a law creating licensure in 2004; the council wrote the licensure regulations last year; and licensing was finally approved on Tuesday. "We have had a shortage of anesthesia providers for a while," says Frederick Finelli, MD, president of the medical staff of Washington Hospital Center and chairman of the D.C. Board of Medicine. "AAs are helping to alleviate that shortage." Seven AAs now work in the capital.
LOCAL ANESTHESIA FOR PATIENTS UNDERGOING THYROIDECTOMY is rivaling general anesthesia, say researchers. Thyroidectomies performed under local with monitored anesthesia care offer quicker procedures and shorter patient recovery times than general, while maintaining equally good outcomes, says Samuel K. Snyder, MD, of the Scott & White Clinic in Tempe, Ariz., in February's Archives of Surgery. Researchers conducted a prospective study of 58 consecutive thyroidectomies performed at the Scott & White Memorial Hospital during 2000 and 2001. Half the patients received general anesthesia and half local anesthesia with monitored anesthesia care. Patients in the local anesthesia group spent an average of 13 fewer minutes in the operating room than the general group, say the researchers. More significantly, however, the local procedure "virtually eliminated" the need for patients to spend time in PACU. While the general patients spent an average of 80 minutes there, the local patients spent only four. |
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