CMS Proposes Some New Medicare Coverage for Bariatric Surgery
CMS officials on Wednesday proposed expanding coverage of bariatric surgery for beneficiaries ages 64 and younger and eliminating coverage of the procedure for beneficiaries ages 65 and older, CQ HealthBeat reports (CQ HealthBeat, 11/23). Currently, Medicare covers bariatric surgery if the procedure is needed for treatment of conditions other than obesity.
The proposed changes would expand coverage for beneficiaries with disabilities who are younger than age 65 to include bariatric surgery for treatment of obesity itself (AP/Wall Street Journal, 11/25).
According to a CMS spokesperson, the proposed changes would cover open and laparoscopic gastric bypass surgery and laparoscopic adjustable gastric banding in very obese patients under age 65, regardless if the beneficiary has other chronic conditions (CQ HealthBeat, 11/23).
CMS Administrator Mark McClellan said, "While the best proven treatment is a nutritious diet and regular exercise ... some beneficiaries may significantly reduce their health risks through surgery."
In 2004, Medicare covered bariatric surgeries for about 8,000 beneficiaries, about 75% of whom were disabled beneficiaries under age 65. The average cost to Medicare was about $13,000 per procedure, an agency official said (AP/Wall Street Journal, 11/25).
CMS is seeking public comment on the proposal (CQ HealthBeat, 11/23).
In related news, the Richmond Times-Dispatch on Monday examined how hospitals are improving bariatric care. To evaluate bariatric surgery programs, the American College of Surgeons and the American Society for Bariatric Surgery each have created accreditation programs.
Neil Hutcher, director of bariatric surgical services at St. Mary's Hospital and president of ASBS, said more than 500 hospitals have applied for designation as a "Bariatric Center of Excellence," a certification granted by ASBS's Surgical Review Corporation.
To receive the designation, hospitals must complete at least 125 surgeries annually and individual surgeons must perform at least 125 procedures during their careers and at least 50 annually. SRC inspectors also evaluate the hospital's bariatric surgery team, the level of follow-up care, rates of death and complications, and other quality criteria (Smith, Richmond Times-Dispatch, 11/28).