A proposed rule on how the CMS would cover bariatric and gastric banding surgeries is getting mixed reviews from doctors who are credentialed to perform those procedures.
Bariatric surgeons chided the CMS' proposal for doing little to expand the patient base eligible for the procedures, even while they laud the federal agency for tackling what has become a highly polarized debate--whether or not the procedures should be covered in the first place.
Neil Hutcher, president of the American Society for Bariatric Surgery, said it will ask the CMS to remove certain age restrictions in the proposal. As written, the rule requires the presence of a co-morbidity, like diabetes or heart disease, as the basis for the CMS' coverage, and would restrict the procedure to seniors ages 65 and under, according to a CMS spokesman. The rule does not cover certain variations on the procedure, and the CMS is undecided if it should include volume requirements.
But the battle is less about financial impact than it is about a perceived discrimination against those who are overweight, Hutcher said. Obesity, he said, is the "last politically correct discrimination." And as such, Medicare policies in the past--and private payers in the present--have balked at paying for such surgeries. More than 60% of the U.S.' population is classified as overweight or obese, according to a Nov. 23 CMS news release. Hutcher added that obesity has surpassed tobacco as the No. 1 cause of disease and that overall obesity-related illnesses cost employers more than $100 billion annually.
"We shouldn't have to defend it on cost issues," Hutcher said. "We treat lung cancer for smokers and broken necks for motorcyclists, after all."
Another expert said the CMS' proposed rule could have a large effect. David Flum, associate professor of surgery at the University of Washington and head of the Surgical Outcomes Research Center, said the proposed rule "has huge implications." Just by taking up payment plans for the procedures, the CMS "establishes legitimacy for bariatric (surgery) and gastric banding," which could lead to better overall acceptance, he said.
The proposal would establish national coverage for Medicare beneficiaries under age 65 for open and laparoscopic Roux-en-Y gastric bypass surgery and laparoscopic banding, a less invasive procedure where a band is wrapped around the stomach to give the effect of "being full." The CMS is expected to issue a final rule after a 30-day comment period, which began Nov. 24.