Vital Signs Blog

Insurance coverage, provider preference affect who gets bariatric surgery, report finds

Wide variations in whether Medicare patients undergo bariatric surgery to treat obesity suggest that insurance coverage and provider preference are heavily influencing who has access to the procedure, a new report indicates. What the report didn't find, however, was a correlation between the bariatric surgery rate and the rate of diabetes and obesity in the community.

Patients in Muskegon, Mich., for example, are 27 times more likely to undergo bariatric surgery (PDF) than those in San Francisco, according to the report from the Dartmouth Atlas Project, a series that is looking at variations in care for surgical procedures.

The strict insurance criteria for the procedure makes it unlikely that the procedure is being overused, said Dr. Justin Dimick, one of the authors of the report who heads the division of minimally invasive surgery at the University of Michigan. It is more likely that there are patients who would qualify for the procedure who aren't getting it.

“The coverage for bariatric surgery is very different for different regions,” he said on a media call Tuesday. Medicare, for instance, left it up to individual carriers whether to cover sleeve gastrectomy, the more common bariatric surgery approach that shrinks the stomach by stapling it rather than through use of a gastric band device. “There's just a lot more variability driven by insurance coverage,” he said.

In addition, while gastric bands have fallen out of favor due to lower efficacy and higher complication rates, there are some providers who continue to use that method exclusively. “If you're a patient choosing a provider, you want to make sure you're getting all options,” Dimick said.

About 10 million people meet the current criteria for bariatric surgery. If just 10% of them underwent the surgery, the cost would amount to more than $15 billion, Dimick said. Fewer than 150,000 procedures were performed in 2010.

The national average for bariatric procedures is 32.8 surgeries per 100,000 Medicare beneficiaries. But in San Francisco, as few as 4 beneficiaries per 100,000 get the procedure while as many as 110.9 per 100,000 do in Muskegon.

“We think bariatric surgery is a great place to start thinking about shared decisionmaking,” Dimick said.

The report is the first in a series of six from the Dartmouth Atlas of Healthcare that its examining variations in surgical care. Other reports will focus on cerebral aneurysms, peripheral artery disease, spinal stenosis, organ transplants and prostate cancer.

Follow Beth Kutscher on Twitter: @MHbkutscher


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