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ASMBS Update Fall 2011

ASMBS Update Fall 2011. Robin Blackstone, MD, FACS, FASMBS President, ASMBS. ASMBS Focus 2011/2012 Building a Bridge to the future. ASMBS Focus 2011/2012 Building a Bridge to the future. Current Coverage Landscape. Federal: Covered by Medicare

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ASMBS Update Fall 2011

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  1. ASMBS Update Fall 2011 Robin Blackstone, MD, FACS, FASMBS President, ASMBS

  2. ASMBS Focus 2011/2012 Building a Bridge to the future

  3. ASMBS Focus 2011/2012Building a Bridge to the future

  4. Current Coverage Landscape • Federal: Covered by Medicare • States: covered as a standard benefit in 43/50 State employees and 47/50 State Medicaid Plans • Employer Coverage: • 40% of plans <500 employees • Small employers coverage is growing at 8% per year • This is the group targeted by EHB • 76% of plans with 20,000 or more employees • Mandated Coverage: • New Hampshire, Indiana, Maryland • Georgia and Virginia – employers have to be offered the ability to buy coverage • State Rule regarding medical necessity and HMO regulation also require coverage: Michigan, New York, California

  5. Bariatric Surgery Coverage by Number of Employees Mercer National Survey of Employer-sponsored Health Plans Rapid Response Team of the Access Committee

  6. Figure 3. Annual rate of bariatric surgery per 100,000 adults, 1990 to 2008. Data from 1990 to 1997 was derived from Pope and colleagues7; data from 1998 to 2002 was derived from Nguyen and colleagues Inpatient sample 2008 124,000 in-patient cases

  7. Figure 2. Number of bariatric surgeons with membership in the American Society for Metabolic and Bariatric Surgery (ASMBS), 1998 to 2008.

  8. Need to prepare surgeons to participate in endoscopic therapies and new devices and procedures Endoscopic Therapies and FDA: Read the report on the ASMBS website

  9. ASMBS Position Statements have clout – Clinical Issues CommitteeStacy Brethaur, Chair • HCSC: BCBS of Illinois, Texas, New Mexico and Oklahoma • ASMBS Position Statement on Preoperative weight loss mailed to all medical directors in the United States • Decision to Change Medical Policy for this requirement (last week) • Will not have an immediate effect on the Self Funded employer plans but eventually medical policy should align it • Data has a profound impact on medical policy

  10. Patients should have access to obesity treatment through the essential health benefit Recent all for Public Comment to HHS: Blackstone at HHS in Washington DC Every major city surgeons and patients partnered to testify (Obesity Action Coalition) We have a presence on the hill every month visiting key people

  11. ASMBS is the source of credible information on metabolic treatment of obesity • KeavinRevis, Chair, Communication Committee • New and improved website • Keith Kim, Chair Public Education Committee • Drive patients to our website for information and linkages to

  12. Summary – Access to Care • Continue effort to expand coverage to employers with 10-499 employees through essential health benefit and expanded coverage among employers – John Morton, Chair Access to Care Committee • Prepare surgeons to participate in new technologies and procedures (Endoscopic training, central system for new procedures and technologies to be studied and approved through ASMBS) – Marc Bessler, EC; Bipan Chand, Chair Emerging Technology, Ninh Nguyen Sec/Treasurer • Continue to put out high impact position statements Stacy Brethaur, Chair Clinical Issues Committee • Continue to partner with Obesity Action Coalition, The Obesity Society and other colleagues to promote treatment across the continuum of care

  13. Bariatric Surgery 2011 Bridge to the future

  14. EPIGENETICS: Rapidly growing research field that investigates heritable alterations in gene expression caused by mechanisms other than changes in DNA sequence. http://nihroadmap.nih.gov/EPIGENOMICS/images/epigeneticmechanisms.jpg 2005

  15. Bariatric Surgery 2011 Bridge to the future

  16. Mechanism of Action • Mechanical • Calorie Restriction • Malabsorption • Physiologic • Hormones from intestinal track • Hormones from Fat Cells • Neuromodulation through changes in signaling of vagus nerve Weight Dependent effects only – Adjustable Gastric Band Weight Dependent and Weight Independent effects – Sleeve, Gastric Bypass and Switch

  17. Key Theme of the ASMBS Annual Meeting in San Diego June 2012 The Biology of Obesity and Mechanism of Action of Surgery

  18. Bariatric Surgery 2011 Bridge to the future

  19. COE was Established for a Reason • To improve quality and patient safety • It has contributed to a decrease in mortality (0.4 to 0.1%) • Established a culture of outcomes reporting in community hospitals/surgeons • Primary quality discriminator was facility volume of >125 cases • Very low volume programs dropped out of the market • Original 10 standards were interpreted by BSRC and “details” added over time – making it more “prescriptive” and more expensive for facilities to provide • Support from CMS in 2006 and other payers

  20. ASMBS BSCOE ProgramProgram Participants Hospitals Fully Approved 458 Provisionally Approved 143 Provisional in Process 83(52 new added through August 2011)Total Participants 684 Surgeons Fully Approved 849 Provisionally Approved 260 Provisional in Process 147(83 new added through August 2011) Total Participants 1,256 As reported by personal communication with Gary Pratt

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