Medicare to Pay for More Weight-Reduction Surgery

Medicare on Tuesday approved three types of stomach-shrinking surgery for obese patients who also have other serious health problems such as diabetes, hypertension and heart disease.

The move could open the way for increased coverage of the surgeries by private insurance companies, which have differed greatly in their policies.

Neil Hutcher, president of the American Society for Bariatric Surgery and a surgeon in Richmond, Va., applauded the decision, saying it will allow more people to undergo the procedures, which have proved to be among the most effective ways to reduce weight.

“The average person cannot afford to self-pay for bariatric surgical procedures,” Hutcher said, estimating that the surgeries cost about $25,000 on average.

“I’m especially enthusiastic because in the past, private insurers would follow the lead of the government when it came to determination of coverage,” he said.

The three procedures endorsed by Medicare are biliopancreatic diversion with duodenal switch, Roux-en-Y gastric bypass and laparoscopic gastric banding.

The first two procedures are improvements on traditional gastric bypass surgery, which involves taking the lower part of the stomach and connecting it directly to the large intestine, thus bypassing the small intestine. The bypass reduces the amount of food that is digested.

Gastric banding involves placing a kind of collar around the stomach, shrinking its capacity.

All the surgeries can produce dramatic, permanent weight loss of 100 pounds or more, accompanied by a reduction in the risk of diabetes, heart disease and other illnesses.

The Centers for Medicare and Medicaid Services, which oversees healthcare for Americans over 65 and the disabled, has for decades paid for gastric bypass surgery for obese patients with other serious health problems.

Medicare had no national standard for the other types of obesity surgery.

Over the last few years, concerns have been raised about the safety of the various obesity procedures, known collectively as bariatric surgery. Some recent studies have seen increased risks of dying from heart attack, stroke, infection and malnutrition.

“We went through a long period of time where the surgeries were such that the risk was just too high,” said Dr. Steve Phurrough, director of coverage and analysis for the Centers for Medicare and Medicaid Services.

Medicare was particularly concerned about the effect of the surgeries on older patients, who make up the bulk of the more than 40 million people enrolled in the program.

“We weren’t going to make a national decision until the evidence had gotten better,” Phurrough said.

That recently happened. Phurrough cited a study showing that patients over 65 who underwent bariatric surgeries did as well as younger patients if the surgeons were highly experienced and performed the surgeries routinely.

Medicare decided it would pay for the surgery, but only at hospitals considered “centers for excellence” by the American College of Surgeons and the American Society for Bariatric Surgery.

Phurrough expects the number of surgeries will increase now. Annually for the last few years, Medicare has paid for bariatric surgery for about 300 people over age 65 and for 3,000 disabled people under 65.