Possibly more changes on the horizon for weight loss surgery are in the making.
These changes will have an effect on the entire landscape of bariatric surgery in the U.S. First, a little history....
When bariatric surgery first started (weight loss surgery) there were few regulations and a multitude of procedures that were tried. All procedures were done through a large incision and most of the patients are high risk due to their weight and many other additional medical problems brought on by the weight, i.e., diabetes, high blood pressure, heart disease, sleep apnea, etc. This combination led to a high complication rate and high mortality. What has changed in the past several decades to make these procedures much safer is the innovation of laparoscopy. This allows us to do the procedure with tiny incisions, fewer wound problems, much less pain, and shorter hospital stays. Other changes that have happened are the standards that were set for bariatric centers. These standards were fairly rigid and the procedures done were made more standard. What we have learned is the bariatric patient needs a higher level of pre-operative evaluation and post-operative care than the average patient. Because of this, the American Society for Bariatric Surgery was formed and guidelines were created to improve safety and "centers of excellence" were created. Centers of excellence were formed based on criteria set for pre and post op care, and a minimum number of cases done in a year.
After gaining experience and analyzing a ton of data, it was discovered that the center of excellence really does not change outcomes. What this means is you can have a procedure done at a center of excellence or a non-accredited center and have just as good an outcome. The net effect of the center of excellence has been to limit access for medicare and medicaid patients with no real benefit.
After joining forces, the American College of Surgeons and the American Society for Bariatric Surgery are trying to change (in my opinion for the better) the center of excellence guidelines. Here is what the proposed changes will look like:
1. Three divisions will be set up, the first being band centers, where only lap bands will be performed.
The Gastric Band on the stomach.
The second division will be "low acuity" centers of excellence. These are smaller facilities "like INTEGRIS Grove hospital" that have qualified surgeons but limited ancillary services. These centers will be able to do staple procedures on "lighter" individuals with few other medical problems. In other words, healthier, lighter patients will be able to have their procedure done on a more local basis and not have to travel to big centers.
Sleeve gastrectomy Gastric bypass
In these lower acuity centers, the work up is the same and all of the patients are tracked by a National Data base.
The third division is the high acuity center. This is where heavier and more complicated patients will have to go, usually in the larger regional hospitals.
This is the proposal that was sent to the CMS (Medicare). However, they have different ideas about the whole thing. CMS, looking at the data, thinks that possibly communities would be better served if the whole center of excellence thing was just eliminated. They do have a substantial amount of data that shows there is no improvement in outcomes. Now the Politics come in. What politics? Well, current centers of excellence don't want any change and centers that want to gain this distinction can't because the number of cases that must be performed, under the current rules, cannot be reached. The number of people needing the surgery continues to grow and many cannot get to a current center of excellence for care. My feeling is that if you have a qualified surgeon and a program in place....what difference does it make. People that need the surgery should not have to travel hundreds of miles, and according to the data, it makes no difference. Hopefully, a reasonable compromise will prevail....and soon. Many programs, ours included, are sitting on go, waiting for some sort of direction. In the mean time, we are limited to private pay patients and private insurance patients currently. We are looking for some type of decision in 2014 and are hoping for good things.
Of course the changes will mostly only effect Medicare and Medicaid patients but some private insurance as well.
So that is what's on the horizon...better access. We hope to be a low acuity center in the very near future as Dr Miller is fellowship trained, certainly qualified, and ready to go!
Our cash prices are pretty good too (see below) and you don't need to travel to Mexico either!!
So come see us today!! Cosmetic consultations are always complimentary!! The spring laser liposuction special is going on so act now to reserve your time! 918-786-7780 or 1-866-weight0. And don't forget our low prices on breast augmentation either!!!
Keep an eye out for the news reports on the sleeve gastrectomy!!!