Increasing Bariatric Procedures

Published in July 2014 Issue             

When people ask me what I hope to accomplish during my presidency
I say simply I want to help increase the number of bariatric and metabolic procedures. I say this unabashedly because when you have a treatment that is being utilized by less than 1 percent of the affected population, you know with certainty many people are being unnecessarily denied, delayed or deterred from the care they need. This must change and this month’s action by Blue Cross and Blue Shield of North Carolina (BCBSNC) offered more hope that change is on the way.

The insurer agreed to revise its coverage policy and remove the six-month medical weight loss requirement prior to surgery. It also made its revision surgery and duodenal switch coverage less restrictive (Everybody Wins: Model Collaboration Leads to Policy Change, Greater Patient Access in North Carolina).

This took some effort from the ASMBS Carolinas State Chapter, led by Dr. Ranjan Sudan, but the effort proved well worth it, as now more patients in North Carolina will face fewer restrictions when seeking surgical treatment
for obesity.

Removal of any barrier to evidence-based treatment is a win, but it will take many victories to ensure appropriate patient access to metabolic and bariatric surgery. Some insurers and employers do not cover surgery at all. Others place too many hurdles in front of patients. Currently, only 22 of 50 states list bariatric surgery as a covered benefit within the Affordable Care Act (ACA), and only five states provide coverage for weight loss programs.

We are working very hard to change this, and each victory, like the one in North Carolina, gives us leverage for the next one. As the BCBSNC senior medical director put it, “The evidence is the same, and there is more convergence than divergence among payers.”

We need this convergence now for the sake of our patients. A mountain of evidence shows bariatric surgery to be the most effective treatment for severe obesity and its safety profile has never been better. Policy has to catch up to scientific and medical consensus and barriers to care need to fall. Too many people are being hurt by outdated policies and notions of what surgery used to be. Updates to coverage policy are required and they are required now. We call on insurers and employers in every state to take a fresh look at the evidence. They will like what they see.