On December 3rd, an FDA Advisory Panel ruled in favor of indicating the LapBand procedure for patients with a BMI of 35 and greater, and for patients with a BMI of 30-35 with a significant medical comorbidity. This is a significant step in allowing patients access to surgical weight loss who were excluded previously due to BMI limitations. Keep in mind this is only an Advisory Panel decision, and the FDA will make a final ruling in the next few months. In general, the FDA will follow the recommendations they receive from such panels.
How does this impact us? Well, assuming the FDA makes its final decision in favor, some insurance companies may adjust their coverage criteria to match the FDA guidelines. This would probably increase the number of LapBand procedures being performed in the US.
I am in favor of the current ruling because there are plenty of patients (who I have had to turn away) who would benefit form surgical weight loss and fall within the BMI 30-40 class.
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Join us at one of our support groups near you! If you have any questions, please call our office or contact us.
| Maui |
Kona, Big Island |
| Date: 8/23 then 3rd Tuesday at 6:00pm
Location:
Maui Medical Group
2180 Main St.
Wailuku, 96793
Annex Building
|
Date: 8/24, then 4th Tuesday at 6:00pm
Location:
Aloha Center
73-4080
Huilikoa Drive
Kailua-Kona
|
| Hilo, Big Island |
Kauai |
| Dates: 8/23, then 4th Tuesday at 6:00pm
Location:
Living Waters Assembly of God
89 Maikai St.
Hilo, HI
|
Date: 8/23, then 4th Tuesday at 6:00pm
Location:
New Beginning Christian Center
3-4251 Kuhio Hwy
|
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The CMS, Centers for Medicare and Medicaid Services, recently announced a decision to review the current literature on the vertical sleeve gastrectomy. CMS determines coverage criteria for surgical weight loss procedures. This is an optimistic step towards possible sleeve coverage by Medicare. A preliminary decision should be released in March 2012, with a final policy decision in mid 2012. Medicare currently only recognizes the Bypass, Band and Switch for surgical weight loss operations performed at Centers of Excellence, COEs.
If Medicare decides to recognize the Sleeve as another option with similar criteria to the current procedures, this could create a wave of private insurers following suit. I personally look forward to seeing UHA and HMA recognize the sleeve, and especially for HMSA to remove their 60 BMI barrier to this operation.
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Posted on July 6, 2010 in Latest News, Sleeves
For all you guys wondering what is going on with the Sleeve Gastrectomy in terms of insurance coverage and new research, here’s the scoop:
Insurance coverage: United Healthcare and Aetna (large mainland insurance companies) now cover the Sleeve Gastrectomy under standard NIH criteria. Medicare and local insurances still are reluctant to follow suit, but my guess is that they will do the same in the next year or two.
Basic Science: We have always thought of the Sleeve Gastrectomy as a restrictive procedure, where weight loss is acheived through limiting the amount of food intake. But this category is probably too simplistic. Ghrelin, a hormone produced in the stomach that signals hunger and fullness, is significantly reduced after this procedure. Also, people with diabetes see immediate improvement after this surgery which is most likely due to rapid transit of food to the ileum, initiating hormones that alter glucose metabolism.
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I have had plenty of Band patients express concern for a Band Erosion after they searched the Internet for answers to some of the quirky sensations they may be having. I want to clarify what a Band Erosion is. Basically, for some reason or variety of reasons, the silicone band around the top part of your stomach erodes into the wall of the stomach. We are not always sure what causes an erosion. It could be how the surgeon did the surgery, or the patient’s eating behavior, or their particular biology. For whatever reason, know that an erosion is RARE. Only 1-2% of patients will ever experience an erosion. If it happens, patients can present in a variety of ways. However, the hallmark is a lack of restriction despite successive Band adjustments (it could also be a leak in the system!). Sometimes people can have abdominal pain, fevers, or even Port-site infections. The doctor can diagnose an erosion with an Upper GI Swallow, but the best test is an EGD. If there is indeed an erosion, then an operation is in order for Band removal.
So remember: an erosion is rare, a significant loss of restriction is the hallmark, and an EGD is the way to diagnose it.
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