On March 29, 2012, the Centers for Medicaid and Medicare Services proposed coverage for laparoscopic sleeve gastrectomy (LSG) only as part of a randomized control trial

The ASMBS Access to Care Response Team led by Robin Blackstone, President and John Morton, Chair, Access to Care responded to CMS the ASMBS CMS Response Letter regarding SG, vigorously defending the rightful coverage of LSG for CMS beneficiaries. In the letter, ASMBS provided ample evidence not previously reviewed by CMS including the NEJM STAMPEDE trial and two other prospective, controlled trials regarding LSG. Furthermore, CMS focused exclusively on Medicare beneficiaries whose age is >65 ignoring other Medicare beneficiaries such as patients who are disabled, have End-Stage Renal Disease or beneficiaries who are dual eligible for both Medicare and Medicaid. Even for >65 y/o patients, ASMBS provided three studies and bariatric surgery registry data indicating the safe and effective use of LSG in this population. Finally, ASMBS indicated that a RCT is redundant, cost-ineffective and in conflict with CMS published standards of scientific integrity and relevance.

In an unprecedented display of unity and focus, the following groups were active supporters of the ASMBS CMS Response Letter: American College of Surgeons, American Society of Bariatric Physicians, Michigan Bariatric Surgery Collaborative, Obesity Action Coalition, SAGES, and The Obesity Society. Our membership, particularly the Access to Care and State Chapters Committee, also rallied to the cause along with patients sent in over 350 comments, which doubled the previous comments from the initial proposal for LSG coverage in October 2011.

CMS will complete its National Coverage Analysis for LSG by June 27, 2012 and ASMBS will continue to advocate that Medicare beneficiaries should receive the same level of LSG coverage as over 100 million other Americans enjoy.