# of Gastric Bypass Surgeries Soars as Coverage Shrinks

Wednesday, December 21st, 2005
This post was written by Melanie Matthews

As obesity rates continue to rise across America, so are the number of gastric bypass procedures.

According to a new article at Forbes.com , researchers at the University of California at Irvine found through an analysis of the Nationwide Inpatient Sample from the
Healthcare Cost and Utilization Project (HCUP) at the Agency for Healthcare Research and Quality, the number of gastric bypasses and other bariatric surgeries conducted in the United States more than quadrupled between 1998 to 2002, from 12,775 procedures to 70,256.

And experts at the American Society for Bariatric Surgey estimate that this number may have doubled again since then, to more than 140,000 bariatric procedures performed in 2004.

But there’s a misbalance in the industry about the cost-effectiveness of the surgery. BlueCross BlueShield of Florida, which serves more than 6 million people in Florida and is one of the largest health insurers in the state, stopped covering obesity surgery on January 1, 2005.

Also in Florida, Cigna, United Healthcare and Humana dropped obesity surgery from standard coverage in 2004 or earlier. The companies do tailor certain policies to include the coverage when employers want to offer the benefit.

The Centers for Medicare and Medicaid Services, meanwhile, has proposed national coverage for Medicare beneficiaries under age 65 for open and laparoscopic Roux-en-Y gastric bypass and laparoscopic adjustable gastric banding under certain clinical circumstances and when performed in a facility meeting evidence-based standards for bariatric surgery; but is seeking comment on coverage for Medicare beneficiaries aged 65 and over.

With the ever-increasing number of gastric bypass surgeries, what should the coverage be? Our report, “Disease Management & Obesity: Healthcare Impacts and Initiatives,” looks at the approach that MediCorp Health System has taken for its weight management/obesity management programs. MediCorp is a not-for-profit regional system of 28 healthcare facilities and wellness services in the Fredericksburg, Va., area.

MediCorp believes that for an obesity weight management program to succeed it must take a very strong behavioral approach with patients, covering the following areas: dietary; pharmacological; mental well-being; physical activity; and surgical intervention when applicable and only when all other venues have failed or a person’s life is at risk.

Is self-management a first step in the possible 140,000 bariatric procedures performed in 2004? I wonder?

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