According to the Centers for Medicare and Medicaid Services, Medicare is expanding coverage for bariatric surgery. From the press release:
CMS reviewed new data and analyses which demonstrate that surgeons with more experience have similar outcomes for patients of all ages. After reviewing the evidence and considering recommendations of professional societies and other experts in the field, the Agency determined that of the various bariatric surgeries currently available, the evidence indicates that only three types of bariatric surgeries benefit Medicare beneficiaries. Prior to today’s decision, CMS’ only nationally-covered bariatric surgery procedure was gastric bypass surgery. Effective today, the list of nationally-covered procedures now includes open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and open and laparoscopic biliopancreatic diversion with duodenal switch. Until other evidence is available, all other bariatric surgical procedures will be nationally non-covered.
Where Medicare leads, private insurers are sure to follow. As expected, opinions about Medicare’s decision are mixed. Quoted in the Washington Post is Morgan Downey of the American Obesity Association: “This is very positive for millions of Americans…The health system in general has largely ignored paying for weight-loss interventions up to this point. This is going to help them reconsider that.”
Paul Ernsberger of the Case Western Reserve School of Medicine says, “The decision to continue coverage is ill-advised and will expose many people, especially the elderly, to high risk. There may be some benefits, but there are alternative safe and effective treatments for every obesity-related condition.”
The America Health Care Association has yet to issue an opinion on the matter.
