We seek a Bariatric Surgeon to join the Metabolic Institute, a comprehensive weight management, diabetes and associated metabolic disease management service line that affords patients broad access to a multidisciplinary clinical team of bariatric/laparoscopic surgeons, non-surgical weight management physicians, endocrinologists, physician extenders and nurses, certified diabetes educators, clinical psychologists/behaviorists, dietitians and exercise physiologists.

The Opportunity:
• Hospital employed position offering outstanding compensation including generous incentives
• State of the art operating rooms, seasoned office staff, well-appointed offices
• Strong collegial support: Join a “CT Top Doc”! (Connecticut Magazine, 2012)
• Comprehensive benefits include 7 weeks paid time off, malpractice, LTD/LTC/Life, $4500 in CME reimbursement, 403b, and high quality, low cost medical and dental.

The Community:
• An attractive and affordable lifestyle
• Located less than 2 hours from New York City and Boston
• World class sports, dining, theatre, shopping and so much more
• Commute from the shore line –or-
• Convenient commute from many desirable towns including West Hartford- a Kiplinger “Top 10 Best City to Raise a Family” and “America’s coolest suburb” according to Travel and Leisure magazine.
• Some of the finest public and private schools in the nation

Interested candidates can contact Patricia Lowicki at 860-224-5576, or email plowicki@thocc.org. For more information please see our web site at www.thocc.org.

Posted: 5/14/12
Expires: 8/14/12

Temple University Hospital and Jeanes Hospital are designated as a Bariatric Surgery Center of Excellence® by the American Society for Metabolic and Bariatric Surgery. This designation recognizes programs with a demonstrated track record of success. Temple received five stars in HealthGrades’ 2010/2011 Hospital Quality Ratings for Bariatric Surgery. We have also been awarded the Blue Distinction Center for Bariatric Surgery® by Independence Blue Cross, the Institute of Quality for Bariatric Surgery by Aetna, and a Center of Excellence by Philadelphia magazine.

Selwyn O. Rogers, Jr., MD, MPH, FACS, has been named Professor and Chair of the Department of Surgery at Temple University School of Medicine, and Surgeon-in-Chief of Temple University Health System, effective July 16, 2012. Currently, Rogers serves as Associate Professor of Surgery at Harvard Medical School and Chief of the Division of Trauma, Burn and Surgical Critical Care at Harvard-affiliate Brigham and Women’s Hospital, in Boston, Massachusetts.

Interested candidates should submit a current curriculum vitae and complete contact information to the address below. Personal statements summarizing teaching experience, clinical and research interests, leadership experience and contributions to diversity are encouraged.

Michael Lester, Director, Physician/Faculty Recruitment & Retention, Temple University School of Medicine, 3420 N. Broad Street, MRB 101, Philadelphia, PA 19140, Email: michael.lester@tuhs.temple.edu, Ph: 215-707-5666, Fax: 215-707-9452.

The University is especially interested in qualified candidates who can contribute through their research, teaching, and/or service to the diversity and excellence of the academic community. Temple University School of Medicine is an Affirmative Action/Equal Opportunity Employer and strongly encourages applications from women and minorities.

Posted: 5/14/12
Expires: 6/15/12

St. Luke’s-Roosevelt, with two locations on Manhattan’s West Side, is an academic affiliate of Columbia University College of Physicians and Surgeons. Widely respected for our high quality care, we are also known for reaching out to the diverse communities we serve – communities where many of our employees live. Our exceptional staff enjoys the family feel that comes from working with friends and neighbors, while benefiting from the tremendous support, stability and resources needed to help them grow and advance. Currently, we are looking for more people like them to join our exceptional team.

We are seeking an experienced Nurse Practitioner (NP) to join our multidisciplinary team in the Institute for Bariatric and Minimally Invasive Surgery – an active clinical program that has performed more than 600 bariatric surgery procedures in 2011. You will perform examinations, evaluations, assessments and interpretation of clinical data for patients requiring bariatric surgical intervention. You will also support continuity of patient treatment, patient flow and protocols within the Bariatric Surgery Program – an American College of Surgeons-designated “Center of Excellence.”

Job Requirements:
•Graduate of an accredited Nurse Practitioner Program
•Master’s Degree in Nursing
•At least two years of nursing experience in surgery, neurosurgery, and/or surgical critical care
•New York State RN and NP certificates, as well as DEA certificate
•Work Monday to Friday (9AM to 5PM)

When you join us, you’ll be rewarded with a competitive salary, comprehensive benefits, and an environment that welcomes your input and expertise.

Continuum Health Partners is committed to diversity and equal opportunity.

For consideration and to apply, please visit wehealny-employment.com and search for Job Number 40241.

Posted: 5/14/12
Expires: 6/15/12

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.

The ASMBS is also providing a discounted registration to the 2012 Annual Conference.

“The American Surgical Association was founded in 1880 and is the nation’s oldest and most prestigious surgical organization. Its members include the nation’s most prominent surgeons from the country’s leading academic medical institutions, many of whom are Chairs of the Departments of Surgery at these institutions. Membership also includes leading surgeons from around the world, making it much more than an American association.” {ASA website}

Director

Division of Advocacy and Health Policy

American College of Surgeons

20 F St, NW Suite 1000

Washington, DC 20001

Email:  cshalgian@facs.org

Phone:  202-672-1504

April 27, 2012

Louis Jacques, MD

Director, Coverage and Analysis Group

Centers for Medicaid and Medicare Services

[submitted electronically]

Re: Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2)

Dear Dr. Jacques:

The American College of Surgeons (ACS) is a scientific and educational association of surgeons, founded in 1913, to improve the quality of care for the surgical patient by setting high standards for surgical education and practice.  On behalf of the more than 78,000 members of the ACS, we appreciate the opportunity to support the American Society of Metabolic and Bariatric Surgery’s (ASMBS) comments dated April 5, 2012, on the proposed coverage decision for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

Specifically, the ACS echoes the concerns of the ASMBS with the Centers for Medicare and Medicaid Services’ (CMS) proposal to consider laparoscopic vertical sleeve gastrectomy a non-covered service. We believe that laparoscopic vertical sleeve gastrectomy is a reasonable and necessary procedure for the treatment of morbid obesity in the Medicare population.

The ACS asks that CMS review the new literature evidence submitted in the aforementioned ASMBS letter including Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes;Obesity, Type 2 Diabetes Mellitus, and Other Comorbidities: A Prospective Cohort Study of Laparoscopic Sleeve Gastrectomy vs. Medical Treatment; and SLEEVEPASS: A randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in the treatment of morbid obesity: preliminary results. We believe that these studies provide evidence that laparoscopic vertical sleeve gastrectomy is safe and effective in a randomized trial basis with both medical therapy and covered bariatric surgeries as controls.

Also as stated in the ASMBS letter, the ACS recommends that CMS give additional consideration to the appropriateness of laparoscopic vertical sleeve gastrectomy to the entire Medicare population based on previously submitted evidence.  We believe that this should include Medicare beneficiaries whose age is <65 who are disabled, have End-Stage Renal Disease, or are dually eligible for both Medicare and Medicaid (“dual eligible”).

Given the new evidence submitted by the ASMBS, the ACS recommends that CMS reevaluate its proposal to consider laparoscopic vertical sleeve gastrectomy a non-covered service. We believe that laparoscopic vertical sleeve gastrectomy is a reasonable and necessary procedure for the treatment of morbid obesity in the Medicare population and should be a covered service for Medicare beneficiaries.

Use the sidebar on the right to log into the site and access this content.

Laparoscopic Greater Curve Plication is a bariatric procedure developed in Iran and South America.   The intent of the operation is to produce early and persistent satiety with small low calorie meals to effect significant weight loss.  The conceptual basis for the operation is gastric volume reduction by inverting the stomach into itself and suturing it in this position.  Published series from outside the United States report mobilization of the greater curve of the stomach, including the short gastric arteries, and then inversion/imbrication of the greater curve from the GE Junction to within several centimeters of the pylorus.   Generally two or three layers of sutures are used to perform the procedure.  Endoscopic guidance is generally used during the procedure to help guide the degree of restriction.   One US trial compared anterior gastric plication alone without mobilization of the greater curve  to full greater curve plication.  While anterior plication was presumed to be safer, weight loss was superior and more durable in the greater curve group.

Coding for Gastric Plication:  The standard accepted bariatric procedures have ICD-9-CM and CPT procedure codes intended for use with these operations and accepted by payers.  Gastric Plication has not been through this lengthy process.  As billing is much easier with a standard accepted code, surgeons and coders are tempted to look at existing codes and see if they apply.

ICD-9-CM Vol.3 procedures codes: 

44.68 Laparoscopic gastroplasty

Banding

Silastic vertical banding

Vertical banded gastroplasty (VBG)

Code also any synchronous laparoscopic gastroenterostomy (44.38)

44.69 Other

Inversion of gastric diverticulum

Repair of stomach NOS

As can be seen the title for ICD-9-CM vol. 3 44.68 appears to apply.  However under the detail, there is clarification on its use and procedures to be used with.  This code is intended for use in non-adjustable gastric banding (adjustable banding has its own unique code), and VBG and its variants.  These procedures are clearly different conceptually and involve very different surgical techniques.  Even 44.69 doesn’t really apply even as an “other” code once the details are examined

CPT:

These codes are procedure specific and generally include a description of the procedure in the code itself.  Gastric Plication has not been through the CPT process for code development and valuation.  Should the procedure become widely performed and establish a base of literature supporting its use, this process can be initiated.  If Gastric Plication was already part of another procedure, use of the applicable code with a reduced work modifier (as is recommended for hiatal hernia repair in conjunction with some bariatric procedures) might be appropriate.  However such a procedure does not currently exist.  Therefore the unlisted code 43659 is the only appropriate CPT code for this procedure.

As is standard for billing 43659 with insurers the practice would need to include a cover letter suggesting a comparable procedure for charge purposes and the operative note.  At this point, many insurers specifically exclude gastric plication as investigational, so this is unlikely to result in insurance payment.

For any bariatric surgery insurance questions please email Insurance@asmbs.org

Matthew L. Brengman, MD, FASMBS
Chair,  Insurance Committee

Last year, national threats to bariatric surgery coverage took many off guard.  Since we will now be called upon to fight for our profession on a state by state basis, it is vital to have a local, unifying body through which to advocate.  Thus, the State and Local Chapters Committee is more determined than ever to ensure there is an ASMBS chapter in every US state.

Dr. Lloyd Stegemann, Chairman of the ASMBS State Chapters Committee, and Joe Nadglowski, President/CEO of the Obesity Action Coalition, are continuing their joint efforts of holding educational symposiums in desiring states.  The aim is to help organize an ASMBS chapter in each state, ultimately providing bariatric professionals with a centralized means for advocating on behalf of their patients and facilities.  This State Chapter Symposium has been given in Alabama, Louisiana, Kansas, Iowa, and Indiana and has led to preliminary chapter formation in all of those states!  Upcoming symposiums will be held for Maine, North Dakota, South Dakota, Wyoming, Montana, Colorado, and Minnesota in the coming months.

*If your state does not have a chapter and you would like to help organize one, contact Nooriel Nolan at Nooriel@asmbs.org, or 352.331.4900, to arrange for the symposium to come to your state.

If you are attending the ASMBS2012 Annual Meeting in San Diego, consider going to your state’s chapter meeting.  State Chapters will meet on Wednesday evening, June 20 from 6:00pm -7:00pm.  Each chapter will have its own room so make sure you look in the program book to find where your state is gathering.

Join us in strengthening state chapters!   They can really make a difference!

State and Local Chapters Committee