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.
More
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.
More
With Medicare reviewing its coverage criteria for the Vertical Sleeve Gastrectomy, the American Society for Metabolic and Bariatric Surgery, ASMBS, has decided to update its Position Statement. The ASMBS is the society that represents bariatric surgeons and is also responsible for setting up the Centers of Excellence (COE) Program. Up to now, ASMBS held the position that the Sleeve looked “promising” with early and intermediate follow up data, and that the procedure should be studied more, before a final recommendation for its use would be made. The new statement to be released considers the sleeve as a viable alternative surgery option to the Band and Bypass, and that the SLEEVE CRITERIA FOR COVERAGE SHOULD BE THE SAME AS FOR THE BAND AND BYPASS. This is a great step in the right direction for increasing options for surgical weight loss patients. All of these procedures have their distinct advantages and disadvantages. This should help us match an operation more closely to a patients’ expectations for improved health and weight loss.
More
So what is a Hiatal Hernia and why should I care about it?
Hiatal Hernia is a condition where the opening from your chest to your abdominal cavity is abnormally large. The esophagus passes through this opening, or ‘hiatus”, so the most common problem associated with this condition is where part of the stomach gets pushed up into the chest. Hiatal Hernias are often small and asymptomatic. Less than 10% of the population has one, and usually the only thing they notice is acid reflux symptoms. So if you have strong heart burn and have to watch what you eat, there is a possibility that you have this condition.
It is very important for your weight loss surgeon to fix this defect if it is found during the operation. Recent data suggests that an unrepaired Hiatal Hernia during placement of an adjustable Gastric Band is associated with early Band failure… i.e. slippage, pouch dilation, band intollernce, etc. For Bypass and Sleeve patients, the Hiatal Hernia should be fixed to ensure that the gastric pouch size or sleeve creation are the correct size. Repairing a Hiatal Hernia almost always can be done laparoscopically through the same incisions I create, and usually adds just a little extra time to the original procedure.
More
By Aloha Surgery (i)
08 Mar, 2012
Adjustable Gastric Band, Bariatric Surgery, Dietary, Food Tips, Gastric Bypass, Post Operative Problems, Vertical Sleeve Gastrectomy, Vitamins, Weight Loss Surgery
Aloha Surgery, Biotin, Dr. Steve Fowler, hair loss, iron, supplements, vitamins, zing
Hair Loss after weight loss surgery can be a big issue for some people. Most of my patients would rather not deal with any hair loss, whatsoever! There is a ton of information available about what is the best thing to do to prevent this, but unfortunately a lot of the literature is poor on scientific facts and liberal on anecdotal marketing! Here’s the facts:
- Hair loss is a response to the stress on the body from a surgical procedure and significant weight loss
- Hair loss is temporary, and usually is most prominent at 6 months after surgery
- If hair loss is still present after one year, this is rare and can be associated with a nutritional deficiency
- Supplements may help, but your body needs to go through its normal response to stress
If you want to take something to try and minimize hair loss, be aware that results are not proven with any product out there. We do know that Iron and Zinc and protein stores should be at their normal levels to minimize hair loss. Taking a multivitamin (and iron if you’ve had a Bypass) should be adequate. Biotin has been a popular supplement, but there is no proof of efficacy.
More
