ASMBS Access to Care Committee

Published in February Issue             

The Access to Care Committee (ATCC) of the ASMBS aims to help maintain an environment where patients can obtain appropriate, safe and effective surgical care for the treatment of metabolic and obesity-related disease. The ATCC assists in identifying areas where patients who suffer from obesity are systematically and unfairly denied treatment or have discriminatory burdens placed on their treatment pathway. The ultimate goal of the ATCC is widespread, unfettered and universal acceptance of bariatric surgery as a treatment modality for this disease.

The ATCC has the largest membership of any committee in the ASMBS. Its members understand that their mission is to promote an atmosphere of acceptance for patients who struggle with obesity, identify and counteract social and economic barriers to their care, and assist in educating skeptical policymakers on the benefits of metabolic surgical treatments.

The ATCC has a long history of advocacy and played an active role in changing
long-standing discriminatory policies that denied millions of patients an opportunity to utilize metabolic and bariatric surgery. Through the leadership of past chairmen and co-chairmen like Drs. John Morton, Wayne English and Brandon Williams, the ATCC played a vital role in the addition of the gastric sleeve for Medicare patients. A strategic campaign was initiated to educate and advocate for acceptance of the gastric sleeve as an approved, stand-alone, non-experimental bariatric procedure. Through persistent pressure exerted by the leadership and committee members, all 14 of the regional Medicare Administrative Contractors (MAC) issued local coverage decisions that allowed
sleeve gastrectomies.

The ATCC has participated in several other major advocacy efforts around the country. In addition to the Medicare campaign, the ATCC and its partners that are actively serving in the military played a dynamic role to successfully lobby Tricare to allow for sleeve coverage for its members. In 2014, the ATCC and the State Chapters Committee spearheaded the “No State Left Behind Campaign,” which sought to advocate on behalf of the millions of citizens who were denied bariatric coverage through their state health insurance exchanges under the Affordable Care Act. Though their efforts, many of which continue today, several former “No” states, such as Colorado and Washington, have given their citizens the ability to pursue bariatric surgical options.

Although the ATCC has tirelessly advocated for patients who suffer from obesity and its related comorbidities, several serious challenges remain. For example, several states, including South Carolina and Pennsylvania, prohibit their employees from obtaining bariatric surgical coverage despite the overwhelming evidence of the macro-economic benefits of coverage on state employee health plans. In addition, many insurance entities continue to employ unnecessary, burdensome and overtly discriminatory practices such as mandatory 6- and 12-month medical weight-loss holds as a way to delay and deny surgical coverage to patients. Another area of concern is the continued practice by insurance providers of mandating excessive regulatory hurdles in the pathway to treatment, such as restrictive comorbidity requirements or excessive documentation requests. The ATCC continues to advocate for patient rights in these arenas.

Since the tasks assigned to the ATCC are extensive and its work impacts the surgical practice of the majority of the ASMBS membership, a well-defined organizational structure is necessary to mitigate these assignments. Current committee chairman Dr. John Scott and his co-chairmen Drs. Teresa LaMasters and Joe Northup, with guidance from Dr. Morton and the Executive Council, assist in organizational efforts and directing resources to areas where the greatest impact can be administered.

Each state is assigned a state access to care representative (STAR) that works on behalf of the state chapter to identify access to care issues and to communicate advocacy activities back to the state membership. As a complement to the STAR structure, regional superSTARS have been assigned to coordinate multi-state efforts and serve as bellwethers for access-related issues in their territories. In addition to physician advocates, the ATCC works closely with industry-sponsored lobbyists and advocacy experts, the patient-led advocacy group Obesity Action Coalition, and Chris Gallagher, a Washington-based legislative expert from Potomac Currents. Together, more than 70 advocacy-minded individuals assist in the national effort and give their time and effort on behalf of the ATCC.

The ObesityPAC fully supports the mission of the ATCC and plays an ever-important role in advancing the legislative agenda necessary to promote its cause. The easiest way for the ASMBS membership to become patient advocates is to support and participate in the ObesityPAC. The website is https://asmbs.org/obesitypac/donation and the password is: obesity. We encourage all ASMBS members to share in this endeavor.

The ATCC also promotes local and regional advocacy efforts though its “Access to Care” toolkit on the ASMBS website. This resource is an extensive database of example letters, legislative and governmental contacts, Powerpoint slides and a bibliography of compelling articles that promote bariatric surgery as a lasting, comorbidity-reducing, life-extending, economically beneficial weapon against obesity and its related disease.

Challenges remain in this ever-changing health care environment. A new administration yields new opportunities to be a beacon for patient-centered care. Our patients struggle to find their voices in light of the blatant discrimination they face on a daily basis. Perseverance is required for those that care for this vulnerable population. Every bariatric surgeon can be an advocate for his or her patients, as extensive local and regional challenges remain. One does not have to be an ATCC member to participate in the process, but only needs to be passionate, engaged, vocal and active. Together, with our patients, we can end discriminatory practices and enshrine our surgeries into the pantheon of universally accepted treatments for obesity-related disease.