Medicare Will Pay for Three Types of Bariatric Surgery
Medicare officials on Tuesday announced the program will cover three types of bariatric surgery for obese beneficiaries who meet certain qualifications, the Washington Post reports.
Three of the most commonly performed bariatric procedures -- Roux-en-Y gastric bypass, gastric banding and biliopancreatic diversion with a duodenal switch -- will be covered as long as beneficiaries obtain the services at centers that have been certified as well qualified by the American College of Surgeons or the American Society for Bariatric Surgery, the Post reports (Stein, Washington Post, 2/22). To qualify for the surgeries, beneficiaries must have a body mass index of more than 35 and one or more weight-related health problems, including diabetes, heart disease or sleep apnea, according to CMS.
In addition, beneficiaries must have tried other treatments unsuccessfully, USA Today reports.
CMS officials said they do not know how the new coverage will affect costs, though they believe the costs will be significantly less than what Medicare spends on coronary bypass or heart defibrillators, according to USA Today (Appleby, USA Today, 2/22).
The obesity surgeries can cost from $25,000 to $40,000, the Post reports (Washington Post, 2/22).
CMS spokesperson Steve Phurrough said, "We don't think there will be a huge rush of patients or surgeons wanting to do this in the older population."
CMS previously had proposed excluding coverage for the procedures for the elderly but expanding it for the disabled, citing safety concerns. After reviewing new data, CMS determined that experienced surgeons had similar outcomes for all patients, including the elderly, the AP/Long Island Newsday reports (Freking, AP/Long Island Newsday, 2/21).
Although Medicare previously paid for some bariatric surgeries in elderly patients, coverage varied by region. Surgeons that perform the surgeries, companies that make related devices and advocates had pushed Medicare to cover the procedures (Wall Street Journal, 2/22).
Steve Phurrough, spokesperson for CMS, said, "In the right hands, bariatric surgery can benefit patients." Morgan Downey, spokesperson for the American Obesity Association, said, "This is very positive for millions of Americans," adding, "We've been waiting to see how [CMS] responded to the surgical side. This will give us a cue to where to go next. I think we'll start seeing Medicare start looking at other interventions."
Downey said the new Medicare rules could influence private insurance coverage, adding, "The health system in general has largely ignored paying for weight-loss interventions up to this point. This is going to help them reconsider that."
Paul Ernsberger of the Case Western Reserve School of Medicine said, "The decision to continue coverage is ill-advised and will expose many people, especially the elderly, to high risk," adding, "There may be some benefits, but there are alternative safe and effective treatments for every obesity-related condition" (Washington Post, 2/22).