Bariatric Times

MAY 2017

A peer-reviewed, evidence-based journal that promotes clinical development and metabolic insights in total bariatric patient care for the healthcare professional

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14 Brief Report Bariatric Times • May 2017 8 90,000 South Carolinians with fee- for-service Medicaid benefits. Covered surgery is limited to members who demonstrate medical necessity based on InterQual ® c riteria and receive prior authorization. It is our hope that this decision helps turn the tide of obesity in South Carolina, which, as of September 2016, ranks 13th in t he United States for obesity prevalence. 9 MUCH WORK REMAINING In 2015, the National Conference o f Insurance Legislators called for all treatments of obesity to be covered, including surgery. We are still far from that vision. Across the country, coverage and a ccess to bariatric surgery vary wildly. South Carolina's decision leaves Montana and Mississippi as the last holdouts to offer no bariatric surgery coverage for their M edicaid recipients. State employees are in the same position in nine states that exclude coverage for bariatric surgery or are conducting limited pilots. To test the economic feasibility of bariatric surgery, the state granted access to the procedure to just 100 of its more than 400,000 state employees. South Carolina has yet to extend that benefit to the rest of its workforce. We are encouraged to see bariatric surgeons, medical device industry advocates, medical societies, national associations, and the Obesity Action Coalition, standing shoulder to shoulder with patients to seek ways to prevent obesity and change the outcomes for this rampant disease. We call on every bariatric surgeon in America to advocate for these patients and for an end to treatment disparity. We invite other clinical and industry stakeholders to collaborate with us to raise awareness and expand access at every point of entry— Medicaid, Medicare, employers, commercial insurers and government – so that more patients can receive the treatment they need to live healthier, more fulfilling lives. REFERENCES 1. Cawley J, Meyerhoefer C. The medical care costs of obesity: an instrumental variables approach. Working paper 16467. National Bureau of Economic Research website. 7. Published October 2010. Accessed April 8, 2016. 2. Tice JA, Karliner L, Walsh J, Petersen AJ, Feldman MD. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–893. 3. Brethauer SA, Hammel JP, Schauer PR. Systematic review of sleeve gastrectomy as staging and primary bariatric procedure. Surg Obes Relat Dis. 2009;5(4):469–475. 4. Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg. 2000;232(4):515-529. 5. DeMaria EJ, Sugerman HJ, Kellum JM, et al. Results of 281 consecutive total laparoscopic Roux-en-Y gastric bypasses to treat morbid obesity. Ann Surg. 2002;235(5):640–645; discussion 645–647. 6. Schauer PR, Kashyup SR, Wolski K, et al. Bariatric surgery versus intensive medical therapy in obese patients with diabetes. N Engl J Med. 2012;366(17):1567–1576. 7. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta- analysis. JAMA. 2004;292(14):1724–1737. 8. Johnson B, Latham B, Cull D, et al. Bariatric surgery is associated with a reduction in major macrovascular and microvascular complications in moderately to severely obese patients with type 2 diabetes mellitus. J Am Coll Surg. 2013;216(4):545–558. 9. Trust for America's Health and the Robert Wood Johnson Foundation. The State of Obesity: Better Policies for a Healthier America. 2016. Accessed September 9, 2016.) FUNDING: No funding was provided. DISCLOSURES: Natalie Heidrich is Director of Health Economics and Market Access for Ethicon, Cincinnati, Ohio. AUTHOR AFFILIATION: John D. Scott, MD, is Associate Professor of Surgery with the University of South Carolina School of Medicine Greenville, Greenville, South Carolina; Metabolic and Bariatric Surgery Director for the Bariatric Surgical Program of Greenville Health System; Assistant Program Director for Greenville Health System General Surgery Residency Program and Minimally Invasive Surgery Fellowship Program; and Director of Research for Greenville Health System's Department of Surgery. Dr. Scott also serves as Co-chair of the Access to Care Committee for the American Society for Bariatric and Metabolic Surgery. Natalie Heidrich is Director of Health Economics and Market Access for Ethicon, Cincinnati, Ohio. ADDRESS FOR CORRESPONDENCE: John D. Scott, MD; E-mail: C a l l f o r Case Reports! D o y o u ha v e a n uni que c a s e t o s ha r e ? B a r i a t r i c T i m e s i s s e e k i ng s ubm i s s i o ns ! Case reports are short presentations of unique cases that stimulate research and the exchange of information and illustrate the signs and symptoms, diagnosis, and treatment of a disorder. Specifications: • At least 15 current references are recommended • Illustrative material is preferred • Must include abstract • Recommended length 1,000 to 3,000 words, not including references. ALSO ACCEPTING VIDEO CLIPS WITH SUBMISSIONS. If accepted, your video clip could be included in the Bariatric Times digital edition with your case report. To submit a case report, contact: Angela Saba, Managing Editor, Matrix Medical Communications E-mail:, Phone: (484) 266-0702; Toll-free: (866) 325-9907; Fax: (484) 266-0726 YOUR VIDEO HERE

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