Home E-Weekly January 19, 2010

Bariatric Outcomes Improved with Medicare Coverage

Published: January 18, 2010

Bariatric surgical outcomes improved for Medicare beneficiaries after CMS began covering 3 types of bariatric procedures to treat morbid obesity in 2006, according to a study published in the January issue of Archives of Surgery.

Researchers report seeing an uptick in minimally invasive techniques, a reduction in the duration of hospital stays and a decline in overall complication rates after CMS issued its national coverage determination (NCD) for bariatric surgery in February 2006. The NCD expanded Medicare coverage to include laparoscopic and Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and laparoscopic and open biliopancreatic diversion with duodenal switch at centers doing more than 125 procedures a year and certified by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery.

To assess the impact of CMS's decision, researchers led by Ninh T. Nguyen, MD, of the University of California, Irvine Medical Center, analyzed the outcomes of 3,196 bariatric procedures performed on Medicare beneficiaries before the NCD and 3,068 performed after. They report that the volume of gastric banding doubled and the proportion of laparoscopic gastric bypass grew from 60% to 77% after the NCD. In addition, patients' average hospital stays shortened from 3.5 to 3.1 days and complication rates fell from 12.2% to 10%. There was not a significant difference in in-hospital mortality rates between the 2 groups.

The authors attribute the improvements in surgical outcomes after the NCD to the increase in gastric bypass procedures being performed laparoscopically and the movement of care to high-volume centers. They also note that while the NCD did not impede access to care for Medicare beneficiaries, the number of facilities providing care to morbidly obese patients fell from 60 to 45 after the NCD.

Irene Tsikitas

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