Citation: Dimick JB, Nicholas LH, Ryan AM, Thumma JR, Birkmeyer JD. Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence. JAMA. 2013;309(8):792-799. doi:10.1001/jama.2013.755.

ASMBS Response Letter

Article Abstract:

Importance  Starting in 2006, the Centers for Medicare & Medicaid Services (CMS) has restricted coverage of bariatric surgery to hospitals designated as centers of excellence (COE) by 2 major professional organizations.

Objective  To evaluate whether the implementation of the COE component of the national coverage decision was associated with improved bariatric surgery outcomes in Medicare patients.

Design, Setting, and Patients  Retrospective, longitudinal study using 2004-2009 hospital discharge data from 12 states (n = 321 464 patients) of changes in outcomes in Medicare patients undergoing bariatric surgery (n = 6723 before and n = 15 854 after implementation of the policy). A difference-in-differences analytic approach was used to evaluate whether the national coverage decision was associated with improved outcomes in Medicare patients above and beyond existing time trends in non-Medicare patients (n = 95 558 before and n = 155 117 after implementation of the policy).

Main Outcome Measures  Risk-adjusted rates of any complication, serious complications, and reoperation.

Results  Bariatric surgery outcomes improved during the study period in both Medicare and non-Medicare patients; however, this change was already under way prior to the CMS coverage decision. After accounting for patient factors, changes in procedure type, and preexisting time trends toward improved outcomes, there were no statistically significant improvements in outcomes after (vs before) implementation of the CMS national coverage decision for any complication (8.0% after vs 7.0% before; relative risk [RR], 1.14 [95% CI, 0.95-1.33]), serious complications (3.3% vs 3.6%, respectively; RR, 0.92 [95% CI, 0.62-1.22]), and reoperation (1.0% vs 1.1%; RR, 0.90 [95% CI, 0.64-1.17]). In a direct assessment comparing outcomes at hospitals designated as COEs (n = 179) vs hospitals without the COE designation (n = 519), no significant differences were found for any complication (5.5% vs 6.0%, respectively; RR, 0.98 [95% CI, 0.90-1.06]), serious complications (2.2% vs 2.5%; RR, 0.92 [95% CI, 0.84-1.00]), and reoperation (0.83% vs 0.96%; RR, 1.00 [95% CI, 0.86-1.17]).

Conclusions and Relevance  Among Medicare patients undergoing bariatric surgery, there was no significant difference in the rates of complications and reoperation before vs after the CMS policy of restricting coverage to COEs. Combined with prior studies showing no association of COE designation and outcomes, these results suggest that Medicare should reconsider this policy.

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Article: Impact of Bariatric Surgery on Health Care Costs of Obese PersonsA 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data

Citation: Weiner JP, Goodwin SM, Chang H, et al. Impact of Bariatric Surgery on Health Care Costs of Obese Persons: A 6-Year Follow-up of Surgical and Comparison Cohorts Using Health Plan Data. JAMA Surg. 2013;():1-8. doi:10.1001/jamasurg.2013.1504.

ASMBS Response Letter

Article Abstract:

Importance  Bariatric surgery is a well-documented treatment for obesity, but there are uncertainties about the degree to which such surgery is associated with health care cost reductions that are sustained over time.

Objective  To provide a comprehensive, multiyear analysis of health care costs by type of procedure within a large cohort of privately insured persons who underwent bariatric surgery compared with a matched nonsurgical cohort.

Design  Longitudinal analysis of 2002-2008 claims data comparing a bariatric surgery cohort with a matched nonsurgical cohort.

Setting  Seven BlueCross BlueShield health insurance plans with a total enrollment of more than 18 million persons.

Participants  A total of 29 820 plan members who underwent bariatric surgery between January 1, 2002, and December 31, 2008, and a 1:1 matched comparison group of persons not undergoing surgery but with diagnoses closely associated with obesity.

Main Outcome Measures  Standardized costs (overall and by type of care) and adjusted ratios of the surgical group’s costs relative to those of the comparison group.

Results  Total costs were greater in the bariatric surgery group during the second and third years following surgery but were similar in the later years. However, the bariatric group’s prescription and office visit costs were lower and their inpatient costs were higher. Those undergoing laparoscopic surgery had lower costs in the first few years after surgery, but these differences did not persist.

Conclusions and Relevance  Bariatric surgery does not reduce overall health care costs in the long term. Also, there is no evidence that any one type of surgery is more likely to reduce long-term health care costs. To assess the value of bariatric surgery, future studies should focus on the potential benefit of improved health and well-being of persons undergoing the procedure rather than on cost savings.

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GAINESVILLE, FL — May 15, 2013 – On the heels of New Jersey Governor Chris Christie’s revelation that he had weight loss surgery, a U.S. Congressman from New York announced that he too had a weight loss operation. The Buffalo News reported this week, “multiple indignities and a major health scare prompted Rep. Tom Reed to undergo gastric bypass surgery in February. His new lifestyle has left him 70 pounds lighter and diabetes-free.”

“Two highly visible figures in American politics revealed they had weight loss surgery this week showing no American is immune from the disease of obesity,” said Jaime Ponce, MD, president of the American Society for Metabolic and Bariatric Surgery (ASMBS).  “We hope the attention they receive sparks a conversation on what we as individuals and as a country can do to create an environment that promotes both the prevention and treatment of obesity and related diseases.”

Many health insurance companies and employers specifically exclude the treatment of obesity and severe obesity. When the Affordable Care Act goes into effect next year, it is believed that only five state health exchanges will cover weight loss programs and only 23 will cover weight loss surgery.

“Metabolic and bariatric surgery has been shown to be the most effective and long lasting treatment for morbid obesity, resulting in significant weight loss. It is also the most successful and durable treatment for many obesity-related diseases, including Type 2 diabetes,” said Ninh T. Nguyen, MD, president-elect of the ASMBS and Chief of the Division of Gastrointestinal Surgery at University of California, Irvine. “Studies have demonstrated the safety of bariatric surgery with the risk of death being equivalent to hip replacement surgery  and the overall likelihood of major complications at about 4 percent.”

Obesity is one of the greatest public health and economic threats facing the United States. The Centers for Disease Control and Prevention (CDC) reports more than 72 million Americans have obesity and, according to the ASMBS, about 24 million have morbid obesity. Obese individuals with a BMI greater than 30 have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals, as well as an increased risk of developing more than 30 obesity-related diseases and conditions including Type 2 diabetes, heart disease and certain cancers. ,  The federal government estimated that in 2008, annual obesity-related health spending reached $147 billion,  double what it was a decade ago. Spending on obesity related issues is projected to rise to $344 billion each year by 2018.

“Both Governor Christie and Congressman Reed indicated their decisions were to improve their long term health specifically for the sake of their families. It’s the new American dream- to redeem your health through weight loss. But it doesn’t have to be a dream, it can be a reality, if we work together at federal, state, local and individual levels to address an epidemic that hurts Americans from all walks of life,” said John Morton, MD, MPH, ASMBS Secretary-Treasurer and Chief of Bariatric and Minimally Invasive Surgery at Stanford University.

About the ASMBS
The ASMBS is the largest organization for bariatric and metabolic surgeons and integrated health professionals in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information, visit www.asmbs.org.

CONTACT: Amber Hamilton, (212) 266-0062

Previously, ASMBS has suggested using the CPT code 43280 (Laparoscopic Fundoplasty) as this code includes laparoscopic repair of the diaphragmatic crura in addition to the fundoplasty.  ASMBS has suggested the addition of with reduced work modifier (-52) when billing repair of sliding type hiatal hernias when performed in conjunction with laparoscopic adjustable gastric bands or laparoscopic sleeve gastrectomy.  The ASMBS felt this fairly represented the usual dissection of the diaphragmatic crura and their reapproximation.  The reduced work modifier was appended to represent that a gastric fundoplication was not being performed as described in the CPT handbook.

The question then becomes is there alternate way to code for diaphragmatic crural repair/reapproximation in conjunction with bariatric surgery that is more appropriate?  CPT does not have a specific code for Laparoscopic Diaphragmatic Crural Repair/Reapproximation.  Below are some CPT codes the coder might be tempted to use instead of the CPT 43280.  The codes are followed by some advice and reasoning on their use:

Possible coding options:

• 39599 unlisted, diaphragm (RVU not listed)
• 43281 – Lap paraesophageal hernia (RVU 45.68)
• 43282 – w mesh (RVU 51.36)
• 43289 – Unlisted Lap procedure esophagus
• 43332- paraesophageal hernia via laparotomy ( rvu 34.41)
• 43333 – w mesh ( rvu 37.41)
• 43334 – paraesophageal hernia via thoracotomy (RVU 37.65)
• 43335 – w mesh (40.54)
• 43336 – paraesophageal hernia via thoracoabdominal (RVU 44.49)
• 43337 – w mesh (RVU 48.7)
• 43499 – Unlisted procedure esophagus

Unlisted Procedure or Service Codes

It is recognized that there may be services or procedures performed by physicians or other qualified health care professional that are not found in the CPT code set.  Therefore, a number of specific code numbers have been designated for reporting unlisted procedures.  When an unlisted procedure number is used, the service or procedure should be described (see specific section guidelines). Each of these unlisted procedural code numbers (with appropriate accompanying topical entry) relates to a specific section of the book and is presented in the guidelines of that section.  In some cases alternative coding and procedural nomenclature as contained in other code sets may allow appropriate reporting of a more specific code.  CPT references to use an unlisted procedure code do not preclude the reporting of an appropriate code that may be found in other code sets.

For example: A service or procedure may be provided that is not listed in the CPT codebook.  When reporting such a service, the appropriate “Unlisted Procedure” code may be used to indicate the service, identifying it by “Special Report” as discussed in the section below.

Special Report

A service that is rarely provided, unusual, variable, or new may require a special report.  Pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.

If the surgeon chooses to report and bill via the unlisted code.  The operative report should contain an adequate definition or description of the nature, extent, and need for the procedure, and the time, effort, and equipment necessary to provide the service.  Unfortunately, unlisted codes are notoriously difficult to receive payment on.  Which makes this alternative less attractive.

Modifier 22

The surgeon could use theModifier -22: increased procedural services – appended to the primary surgery procedure.   Below are the guidelines for the use of the 22 modifier.  Based on these guidelines, there are several reasons the 22 modifier is probably not appropriate for most surgeons:

1. The use of the code should be infrequent (generally less than 10% of cases).  Many surgeons have reported performing diaphragmatic crural reapproximation/repair in 50-100% of adjustable gastric band cases and up to 100% of sleeve gastrectomy cases.  By definition this is not infrequent
2. The amount of work is “more extensive than normal” Generally speaking crural reapproximation requires a few extra minutes to procedures that are coded at an RVU value that represents 90-105 minutes of OR time.  If the dissection and repair leads to OR times significantly greater than this, the 22 modifier would be appropriate.  At that point, if the hiatal hernia was substantial enough it might be better coded with CPT 43281

AMA Guidelines

Modifier 22 is appropriate in reporting substantially increased procedural work than is typically required, such as;

• Trauma extensive enough to complicate the particular procedure and that cannot be billed with additional procedure codes
• Significant scarring requiring extra time and work
• Extra work resulting from morbid obesity or other unusual anatomic anomalies
• Increased time resulting from extra work by the physician
• Additional work and time involved in managing a patient’s co-morbid conditions throughout the procedure
• When work associated with bundled procedures is more extensive than normal.

CMS Guidelines

CMS requires the following information when the claim is submitted:

• A concise statement about how the services differed from the usual
• An operative report submitted with the claim.

Correct Coding Initiative Guideline

“Routine use of the modifier 22 is inappropriate as this practice would suggest cases routinely have unusual circumstances.  When an unusual or extensive service is provided, it is more appropriate to utilize the 22 modifier than to report a separate code that does not accurately describe the service provided.”  Local Part B contractors may also have authoritative written guidelines for using modifier 22.

Occasionally a provider may perform two procedures that should not be reported together based on an NCCI edit.  If the edit allows use of NCCI associated modifiers to bypass it and the clinical circumstances justify use of one of these modifiers, both services may be reported with the NCCI-associated modifier.  However, if the NCCI edit does not allow use of NCCI-associated modifiers to bypass it and the procedure qualifies as an unusual procedural service, the physician may report the column one HCPCS/CPS code of the NCCI edit with modifier 22.  The Carrier (A/B MAC processing practitioner service claims) may then evaluate the unusual procedural service to determine whether additional payment is justified.

Documentations Requirements

• The surgeon’s documentation should be thorough.  If it does not support the substantial additional work and the reason for the additional work, carriers will not automatically increase the fee.
• Documentation should be submitted with the claim because modifier 22 claims may spur an automatic manual review
• Additional work must be substantial.  Many coding specialist say unless 25% more work was performed, modifier 22 should not be appended.  For CMS and many other third-party payers, if the physician’s operative time is increased by 50% or more, modifier 22 should be appended.  A second diagnosis code may be warranted to account for the unusual circumstances.
• Any additional fees should be charged up front to payers, which are unlikely to raise fees on their own just because modifier 22 is appended.
• When claims are submitted with modifier 22 appended to the procedure, the payer requires submission of documentation to validate any additional fee charged for the services.
• Use diagnosis codes to support the complexity and in the case of morbid obesity that requires additional work, the diagnosis for BMI (body mass index) must be reported with 278.01.
• You should also include

1. Time: Time is quantifiable, making it easier for a payer to convert into additional reimbursement.  For example, statements such as “50 percent more time than usual was required to take down adhesions because the patient’s obesity, making the total procedure 90 minutes instead of 30 minutes” can be very effective. Use of special equipment
2. Technique:  Clearly indicate when there has been a change in technique during the procedure and, more important, why there was a change in technique – for example, “Adhesions prohibited a successful laparoscopic procedure, hence its conversion to an open one. Or that the adhesions had to be taken down in order for the surgeon to accomplish his/her intended procedure.

While documentation supporting the use of modifier 22 can and should be found anywhere in the operative note.  Best practice is to include a separate statement with supporting information detailing the additional time and/or complexity of the case.  The Guidelines to the CPT surgery chapter have been updated to include instructions for a “Special Report” to describe the information that should be included in operative and procedural reports that will have increased (modifier 22).  CPT now specifies that “pertinent information should include an adequate definition or description of the nature, extent, and need for the procedure, and the time, effort and equipment necessary to provide the service.

Medicare and the American College of Surgeons have recommended that providers intending to submit a claim with modifier 22 “prepare a written statement of what made the service unusual.  [Noridian] recommends placing a separate paragraph right in the operative note, preferably at the conclusion of the report, with a heading “unusual Procedure” [that] briefly describes, in  one or two paragraphs, the difficult nature of the service(s) that justify why the service was unusual and the increased work that was necessary for that patient.  Use simple medical explanations and terminology—it must be clear to a non-surgeon.  Include the typical average circumstances vs. this patient’s circumstances.  Compare normal time to complete a typical procedure and the actual time to complete the procedure (making clear why the additional time was required).”  Although describe briefly, the information should be sufficiently detailed that the additional time and/or complexity is clearly demonstrated.

Modifier 22 Validation Letter

ABC Insurance
1234 Street Ave
Anytown, USA 12345

Date

RE: Increased Procedural Services

Patient:
Member ID
DOB:
DOS:

Dear Medical Director:

Attached is a copy of the operative report and claim for the above-mentioned patient.  This procedure was more technically demanding and time consuming than described by the CPT code 43775/43770, laparoscopic sleeve gastrectomy/laparoscopic gastric banding.

The surgery was more complex because: (List facts)

1.  The patient was morbidly obesity with a BMI of 41, creating more difficulty in accomplishing the procedure.
2.  The hiatal hernia had to be repaired.  Unlike gastric bypass, not repairing the hiatal hernia could cause increased post-operative symptomology.

I estimate that the above makes this case approximately 40% more difficult than that described by CPT code 43775/43770.  Therefore, I am asking for a 40% increase in the usual reimbursement for the Laparoscopic Sleeve Gastrectomy/Laparoscopic Gastric Banding performed.

Because of the unusual circumstances, we request review by a surgeon specializing in this procedure.

If you have any questions, do not hesitate to contact me at (555) 432-1018

Sincerely,

Bariatric Surgeon, MD
Enclosed: Operative Report

Use of CPT 42381:  Laparoscopic paraesophageal hernia repair, including fundoplasty, when performed.

The description of this code includes “ The physician reduces the herniated stomach into the abdomen and dissects the hernia sac and gastroesophageal fat pad using a combination of sharp and blunt dissection”.  While significant paraesophageal hernias do occur in bariatric surgery, they represent a small minority (up to perhaps 8-10%).  When true paraesophageal hernias occur, 43281 can be billed with all bariatric procedures in the current CCI edit.

Examples:

For the patients with, a “dimple”, a “palpable weakness”, a positive balloon test, prophylactic repair, and any solely anterior repair, it has been the opinion of the ASMBS that these were best billed as CPT 43280.  As such, can no longer be billed together with any primary bariatric procedure.

For patients who have a significant portion of the actual stomach above the diaphragm with an identifiable hernia sac that requires dissection (likely circumferential around the esophagus) this extra work can be billed as CPT 43281.  However the reduced work modifier should be appended to represent that the fundoplasty was not performed.

Use of Codes 43332-7:  Use of the codes for laparoscopic cruraplasty in conjunction with bariatric surgery would be inappropriate unless performed through one of these open techniques.  The codes are high valued to represent the difficulty and morbidity of these open approaches.  It is also inappropriate, to select an open code for a laparoscopic procedure, when a better laparoscopic code exists solely because a CCI edit prevents billing of the laparoscopic code.

Matthew Brengman, Chair, ASMBS Insurance Committee

I am proud to report a successful first lobbying effort in DC April 11^th.  Our group consisted of myself, Mike Bono MD, president, Lou Dimarco, DO, our treasurer, his business manager Allen Swalina, Ann Rogers, MD, our access to care representative, and guided by Chris Gallagher of Potomac Currents.  We were able to meet with the offices and staff of Senator Casey and Toomey, and Congressmen Doyle, Pitts, Gerlach, and Barletta, and Congresswoman Schwartz (who just put her candidacy for Governor).  Our specific issues of concern to Pennsylvania discussed included:

1. Pennsylvania Employee Benefits Trust Fund (PEBTF) – insurance for our 85,000 state employees does not support bariatric surgery for about a decade – if you include family coverage, approximately 200,000 people
2. Essential Health Benefits for small businesses

Overall, the staff and Legislators were very interested, educated, and asked pertinent questions.  Congressman Barletta has agreed to spearhead a sign on letter to HHS Secretary Kathleen Sebelius — requesting that HHS respond to the specific question raised by obesity advocates in their attached joint comment letter on the proposed regulations governing state exchange plans and the essential health benefits package.

Our next step will be at the state level, focusing on our state insurance commissioner, and again, PEBTF.  We also are coordinating a longer visit with Senator Casey.   I would recommend and challenge all states to take advantage of a DC lobbying effort – the more aware, the more access and appreciation.  We will keep you abreast of our future efforts.

Michael D. Bono, MD, FACS, FASMBS 
President, PA Chapter American Society for Metabolic and Bariatric Surgery

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CONTACT:
Amber Hamilton
(212) 266-0062

 NJ GOVERNOR CHRIS CHRISTIE SPARKS NATIONAL CONVERSATION ON OBESITY 

American Society for Metabolic and Bariatric Surgery (ASMBS) Comments on What’s Missing from the Conversation

GAINESVILLE, FL — May 10, 2013 — The revelation earlier this week that New Jersey Governor Chris Christie had weight loss surgery made headlines throughout the world. Much was made of why he had it, which procedure he had, how quickly he would lose the weight and what it would mean for his political future. All valid areas of exploration and speculation.

One critical question, however, was left unasked and unanswered. What does it mean for the millions of Americans who suffer with the same disease of obesity, but do not have access to the same care Governor Christie received? More than 35 percent of adults in the United States are considered obese[i] and it is estimated 24 million have severe obesity. What happens to them?

Many health insurance policies specifically exclude the treatment of obesity and severe obesity. When the Affordable Care Act goes into effect next year, it is believed that only five state health exchanges will cover weight loss programs and only 22 will cover weight loss surgery.

“Society as a whole has to change its thinking about obesity and begin to remove the policy, social, medical, discriminatory, economic and perceptual barriers that deny people appropriate treatment and support across the spectrum of obesity,” said Jaime Ponce, MD, president of the ASMBS. “Governor Christie made an important personal decision to take control over his obesity. Now it’s time for our health care system to make that same option for treatment available to all people who suffer from the disease of obesity.”

Governor Christie said when he turned 50 in September he was “confronted” by his own “mortality” and for the sake of his wife and children he “needed to take a more significant step to try to get my weight under control so that I could have a really active next half of my life.”

Individuals with obesity have a 50 to 100 percent increased risk of premature death compared to healthy weight individuals.[ii] The disease of obesity has been linked to more than 30 other diseases including type 2 diabetes, heart disease and certain cancers.

“We cannot operate our way out of the obesity crisis. We must work together to prevent the obesity epidemic from continuing to grow. At the same time, we need to provide solutions to help those already affected with safe and proven treatments, and treat them with respect and dignity. America’s future is depending on it,” said John Morton, MD, ASMBS Secretary-Treasurer, Access Chair and Associate Professor of Surgery at Stanford University.

About the ASMBS

The ASMBS is the largest organization for bariatric and metabolic surgeons and integrated health professionals in the world. It is a non-profit organization that works to advance the art and science of bariatric surgery and is committed to educating medical professionals and the lay public about bariatric surgery as an option for the treatment of morbid obesity, as well as the associated risks and benefits. It encourages its members to investigate and discover new advances in bariatric surgery, while maintaining a steady exchange of experiences and ideas that may lead to improved surgical outcomes for morbidly obese patients. For more information, visit www.asmbs.org.

References
[1] http://www.cdc.gov/nchs/data/databriefs/db82.pdf
[2] http://www.surgeongeneral.gov/library/calls/obesity/fact_consequences.html

He / she is responsible for verifying patients insurance coverage, obtaining authorization and computing patient insurance benefits for a busy multi surgeon practice.

Works closely with hospital’s admitting department, medical records and the clinic’s medical staff.

Assist with analysis of referral source, payor mix, and provider reimbursements.

Participates in performance improvement and CQI activities. Provides weekly insurance updates regarding status of patients.

Maintain insurance logs.

Assist with patient registration, and clinic charges.

Has current knowledge in Medicare, HMOs and PPOs policies and guidelines.

Stays informed about changes in Medicare, HMOs, and PPOs.

Contact:
Agee Bridgette
bridgette.agee@marinahospital.com
(310) 577-5541

Posted 5/10/2013
Expires 8/10/2013

Exciting opportunity to join a multidisciplinary Center of Excellence certified Program that serves the Tri state region of OR, WA, and ID as well as AK. Growing multi campus program. Very competitive reimbursement and benefits package, 401k contributions etc. Call if interested in more details, or email:

ross.mcmahon@swedish.org 
206-215-2090

Posted 5/10/2013
Expires 8/10/2013

Dr. Blackstone provided commentary and perspective on news surrounding NJ Governor Chris Christie’s gastric band surgery, in addition to discussion the prevalence of surgery, the safety of bariatric operations and the differences between banding, gastric bypass and sleeve gastrectomy. Dr. Blackstone also responded to listeners’ comments and questions during the live broadcast.

The online article for the broadcast is below and you can listen to the full broadcast by clicking here.

On Point with Tom Ashbrook - “Weight-Loss Surgeries: Does Success Offset Controversy?”

http://onpoint.wbur.org/2013/05/09/weight-loss-surgeries

Big Chris Christie, New Jersey governor, has had weight-loss surgery. We’ll look at the buzz and controversy around gastric bypass surgery, lap bands and more.

New Jersey governor Chris Christie is a big guy. Between 300 and 350 was the weight most people guessed, while he joked with a doughnut on David Letterman and told critics of his heavy poundage to back off.

But early this year, Chris Christie secretly did what a growing number of heavy Americans are doing these days. The big governor had weight loss surgery. Brought the doctors in to do it. Word is he’s lost forty pounds.

So, is it a good idea ? For him? For the country? To be banding and stapling our stomachs for weight loss?

Up next On Point: Chris Christie, big America, and weight loss surgery.

Guests:

• Dan Goldberg, health reporter for The Newark Star-Ledger. (@DanGoldbergSL)
• Dr. Robin Blackstone, medical director and bariatric surgeon at the Scottsdale Healthcare Bariatric Center and former president of the American Society for Metabolic and Bariatric Surgery. (@rblackstonemd)
• Diana Zuckerman, president of the National Research Center for Women and Families and author of the 2011 New York Times op-ed “Playing With The Band.”
• Marion Nestle, professor in the Department of Nutrition, Food Studies, and Public Health at New York University. Author of “Food Politics” and “What To Eat.” Co-author of “Why Calories Count.” (@marionnestle)
• Mark Ambinder, contributing editor at The Atlantic. He underwent gastric bypass surgery and wrote about his experience in the 2010 Atlantic piece “Beating Obesity.” (@marcambinder)

Puget Sound Surgical Center (PSSC) is a leader in weight loss surgery with locations in both Edmonds and Bellingham. PSSC is an outpatient center offering bariatric procedures both at our center and the hospital and has a well-established bariatric program that is very successful. At this time, PSSC is seeking a Bariatric Nurse Practitioner or Physician Assistant who is willing/interested to relocate to the Pacific Northwest and is looking to join a vibrant bariatric practice that continues to grow.

The successful candidate will provide comprehensive care to bariatric patients and will work closely with the bariatric surgeons and other members of the practice’s comprehensive care program including dietitians, mental health therapists and exercise physiologists.

PSSC offers a competitive compensation package with salary, bonus and benefits.

License, certification and education requirements:

Current advanced practice registered nurse
Current nurse practitioner certification (Family, Adult or Acute)
Current PA certification
Certified Bariatric Nurse
Current ACLS and BLS
Master of Science- Nursing
Minimum 3 years of experience Bariatric Surgery

OR or First Assist experience – Preferred

To learn more about Puget Sound Surgical and Bariatric Center please visit: www.pugetsoundbariatrics.com.

For more info regarding this exciting opportunity please contact Ben Kocaj at 425.778.2220 or bkocaj@pssurgicalcenter.com.

Posted 5/7/2013
Expires 8/7/2013

Visit Chapter Website

The Louisiana Chapter of the ASMBS was incorporated as a non-profit corporation in May 2012.  The specific purpose of the corporation is to study morbid obesity and advance the art and science of bariatric surgery by:

• the encouragement of its members to pursue investigations both in the clinic and laboratory
• the interchange of ideas, information and experience pertaining to bariatric surgery
• the establishment of guidelines for patient selection and care
• the promotion of guidelines for patient selection and care
• the promotion of improved perioperative and long-term care of patients and the reduction of patient risk
• the fostering of educational programs for physicians, paramedical persons and lay people
• the promotion of outcome studies and quality assurance
• keeping abreast of governmental activities, regulations, laws, proposed regulation and proposed legislation, whether nation, state or local, which affect bariatric surgeons
• making recommendations, providing testimony, and engaging in such lobbying activities as may be deemed appropriate with regard to goernmental activities, regulations, laws, proposed regulations and proposed legisltation, whether national, state or local, which affect bariatric surgeons

Chapter Info | Access | Insurance Coverage | Quality Centers | Support Groups | Updates | Other

Chapter Info

Mission Statement

The Louisiana Chapter of the American Society for Metabolic and Bariatric Surgery (LA-ASMBS) is dedicated to advancing the care of the bariatric patient in the state of Louisiana.

• Through a statewide network of bariatric surgeons and associate members, LA-ASMBS is actively engaged in legislative efforts and advocacy focused on improving quality and access to care for Louisiana residents.
• The LA-ASMBS promotes fellowship among the state’s bariatric providers as well facilitating the active interchange of ideas and best practices through educational events and annual meetings.
• Sponsorship of public events is promoted as a way to increase public awareness of the problem of obesity in the state of Louisiana.
• LA-ASMBS seeks to enroll all practicing bariatric providers in the state of Louisiana and speak with one voice for the bariatric patients of our state

Executive Officers

President: Rachel Moore, MD
Vice Pres: James Parrish, MD
STAR (State Access to Care Rep): Stephanie Barnes, MD
Secretary/Treasurer: George Merriman, MD

Board Members:

Rachel Moore, MD, FACS
James Parrish, MD, FACS
George Merriman, MD, FACS
Andrew Hargroder, MD, FACS
Jim Barnes, MD, FACS
Laura Boyer, RN

Members

Surgeon Members:
Brent Allain, MD
James Barnes, MD
Stephanie Barnes, MD
Drake Bellanger, MD
Todd Belott, MD
Samuel Bledsoe, MD
Uyen Chu, MD
Carson Cunningham, MD
Dennis Eschete, MD
Edward Facundus, MD
Matthew French, MD
Phil Gachassin, MD
Andrew Hargroder, MD
Mark Hausmann, MD
Kenneth Kleinpeter, MD
Tom Lavin, MD
Karl Leblanc, MD
George Merriman, MD
Rachel Moore, MD
James Parrish, MD
Jimmy Redmann, MD
William Richardson, MD
Michael Thomas, MD
David Treen, MD
Clark Warden, MD
James Wooldridge, MD

Associate Members:
Laura Boyer, RN
Charmaine Cuccia, RN, NP
Brooke Doucet, RN
Lee Daugherty
Jennifer Endsley,
Jill Hurley, OT
Lisa Miller, RN, NP
Lauren Naquin,
Alison Nolan, RN
Kim Mulkey, RN
Chris Nelson, RN, NP
Marci Parker, RD
Kate Rountree, RD
Betsy Taylor,  RN
Katherine Wardlaw, RN

Contact Info

To contact the LA Chapter, please access this online form.

Access

Access to Care Tool Kit

Resource for members – Take action in your state with our Access to Care Toolkit.

Insurance Coverage

Top 10 Payers in Louisiana

Quality Centers

American College of Surgeons:

Full approval as an ACS Accredited Bariatric Center is granted once a provisionally approved center has completed a successful site visit. After full approval is conferred, ACS BSCN sends a Certificate of Accreditation and updates the center’s status on its Web site.

More information about the conjoint ASMBS-ACS Quality Program is coming soon.

Support Groups

Local support group information coming soon!

Updates

Learn about the May 2013 state-wide Walk from Obesity.

Other

Other Information on this chapter coming soon.