As many of you know, the ASMBS had their Annual Convention in Las Vegas last week and now the journals are starting to pour out a ton of information from that meeting.  I’ve been slacking of late, but I’m going to start putting in the things that they’ve churned out from the meeting as it directly relates to the WLS community.  Maybe not nutrition-wise, but still.

And yet more for the “duh” files..

From Medscape:

Patients Denied Coverage for Bariatric Surgery at High Risk for Obesity-Related Comorbidities

Nancy A. Melville

July 2, 2010 (Las Vegas, Nevada) — Obese patients who are denied insurance coverage for bariatric surgery frequently go on to develop new obesity-related comorbidities in the years after the denial as a result of chronically high body mass indices, according to a study presented here at the American Society for Metabolic and Bariatric Surgery 27th Annual Meeting.

Previous studies have shown a host of health benefits resulting from the weight loss that occurs after bariatric surgery, yet as many as one third of candidates commonly are denied insurance coverage, said Ayman Al Harakeh, MD, a coauthor on the study and surgeon with the Gundersen Lutheran Health System in La Crosse, Wisconsin.

“It can be shown beyond a doubt that bariatric surgery can resolve and improve many obesity-related comorbidities, yet some patients who are severely obese and who are strong candidates are still not able to get approval for the surgery,” he said. “Our results show that 30% of candidates do not get the surgery due to insurance problems, including denials or unattainable prerequisites.”

The researchers evaluated the medical records and presence of comorbidities among patients evaluated for laparoscopic gastric bypass surgery. The group included 587 patients who had laparoscopic gastric bypass surgery and 189 who were medically eligible for the surgery based on National Institutes of Health criteria but who were denied insurance coverage between 2001 and 2007.

At the initial evaluation, the rates of comorbidities among the denial group and surgery cohort were, respectively: diabetes, 20% and 24%; hypertension, 51% and 43%; obstructive sleep apnea, 20% and 22%; lipid disorders, 34% and 24%; and gastroesophageal reflux disease, 62% and 49%.

A 3-year follow-up showed that patients who received the surgery had an average decline in body mass index of 30.5%, and less than 1% developed new obesity-related conditions. Patients in the denial group, however, showed no declines in body mass indexes, and a large number developed new obesity-related conditions.

In the surgery-denied vs surgery-performed groups, respectively:

  • 41.9% vs 0.9% developed hypertension,
  • 34.2% vs 0.4% developed obstructive sleep apnea,
  • 19.4% vs 0.6% developed gastroesophageal reflux disease,
  • 11.2% vs 3% developed lipid disorders, and
  • 9.2% vs 0.3% developed diabetes.

“These results show that patients, in our opinion, who are denied coverage by insurance companies are [highly likely to] develop new obesity-related comorbidities in the near future,” Dr. Al Harakeh said.

He noted that insurance companies have the upper hand in decisions on coverage, and when they deny coverage, patients often do not receive adequate follow-up care.

“Insurance companies can refuse coverage for just about anything. They just don’t often don’t want patients to get the surgery based on the high economic impact on their monetary fund for the year,” Dr. Al Harakeh said.

“We know that many patients are not getting appropriate care, and may not even have a primary care provider…and it’s clear we need to be more attentive and careful in working with this subpopulation of patients.”

John Morton, MD, MPH, FACS, associate professor of medicine and director of bariatric surgery and surgical quality at Stanford University School of Medicine, California, and a discussant for the paper, said the findings offer important evidence of the negative effect on obese patients who are denied coverage for bariatric surgery.

“There is a clear and present danger of adversities to obese patients,” he said. “[Failure to receive] intervention is a recipe for continued progression of comorbidities for these patients, and we can see that bariatric surgery is a powerful tertiary prevention of comorbidity.”

Dr. Harakeh and Dr. Morton have disclosed no relevant financial relationships.

American Society for Metabolic and Bariatric Surgery (ASMBS) 27th Annual Meeting: Abstract PL-103. Presented June 24, 2010.

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