June 2023 Edition
1. Presidential Messages
Teresa LaMasters, MD FACS FASMBS DABOM and Nate Sann, MSN FNP-BC deliver the monthly Presidential Video Message. Hear about the current state of the Society and upcoming events.
ASMBS Presidential Message
ASMBS Integrated Health Presidential Message
2. Education & Events
Enhancing Outcomes Through Combined Therapies
June 25 – 29, 2023
There’s so much fun in the cards for The ASMBS 39th Annual Meeting!.
Hotel rooms are still being offered at a discounted rate. Please register for the annual meeting before you book your hotel room!
INTEGRATED HEALTH EXPO
Enjoy this complimentar networking & engagement opportunity! Attendees can enter into a drawing for valuable give-aways!
The Integrated Health Expo offers IH professionals at the ASMBS 2023 Annual Meeting access to an exclusive area where they can enjoy lunch and network with Exhibitors and ASMBS IH Committees.
Enjoy a dedicated lunch break to spend with this target audience in a more intimate setting. Network with the exhibitors listed below, as well as IH Leadership, CBN Committee & Membership Committee representatives!
IH Expo Exhibitors
- Bariatric Advantage
- BariatricPal
- Baritrax360
- Endo Pharmaceuticals
- Health Economic Advisors, Inc.
- Medtronic
- NewTri Health
- Northgate Technologies Inc
- UNJURY Protein
Upcoming Webinars
- June 22 | The Bariatric Happy Hour!
3. Committee Updates
The Certified Bariatric Nurses (CBN) Committee releases the Spring 2023 CBN Newsletter
Download the Spring 2023 CBN Newsletter
4. Membership News
ASMBS Membership Matters
The #ASMBSisME social media campaign is back! Our unique backgrounds are what bring value to this organization and we all have different reasons why we enjoy our membership.
Be sure you’re following ASMBS on Facebook , Instagram , Twitter , and LinkedIn to join the conversation. We want to know why you joined ASMBS and what you enjoy about your membership.
Share your story and invite a friend or colleague to join today!
5. Advocacy & Access to Care
Aetna
(22.5 million covered lives) has made progressive changes.
Highlights:
- Expanded criteria to include low BMI for Asians (37.5 without comorbidities or 32.5 with co-morbidities)
- Updated criteria to remove requirement for screening for diabetes, cardiac clearance by a cardiologist for persons w/history of cardiac disease, and optimized glycemic control
- Revised criteria for adolescents with BMI exceeding 40 to remove severe co-morbidities. Removed criteria for BMI exceeding 50 with less-serious co-morbidities
Gaps that remain:
- BMI 35+ without comorbidities
- BMI 30-35 with type 2 diabetes
- OAGB
BCBS Michigan/Blue Care Network (4.6 million covered lives) has revised their policy (effective 7/1/23) and expanded coverage for BMI 30-35 with Type 2 diabetes.
Premera Blue Cross (2.2 million covered lives) has revised their policy and expanded coverage for BMI 30-35 with Type 2 diabetes
- Criteria specifies individual has inadequate glycemic control (i.e. HbA1c***level is ≥7) despite lifestyle changes and use of antidiabetic medications
Capital Blue Cross
Capital Blue Cross Medical Policy-Pennsylvania: Please see the attached Capital Blue Cross policy that has changes to its bariatric surgery section.
BCBS Tennessee
We have seen on the Blue Cross Blue Shield of TN website that they will now be following many of the new ASMBS/IFSO guidelines. Please let us know at accesstocare@asmbs.org if you hear of any other insurance wins with our new 2022 ASMBS/IFSO Guidelines!
Oregon Health Authority
The Health Evidence Review Commission of the Oregon Health Authority voted on May 18th to approve new coverage guidelines for bariatric surgery in Oregon.
Guidelines are adults BMI of 35 or more, BMI of 30-34.9 with type 2 diabetes and a1c of 8 or more despite two oral medications, and coverage for adolescents 13 years of age or older who meet AAP guidelines. They also eliminated the 6 months waiting period and the mandatory nicotine and drug testing 6 months apart. This will represent a major positive shift in access for the Oregon Medicaid population.
The next big push needs to be to lobby state law makers about funding for surgery because most hospitals have low capitated payment structures for OHP patients which discourages providing this service which is upfront expensive but long term good for population health.
Dr. Derek Rogalsky, Oregon’s Access to Care STAR, commented “I am currently trying to get in touch with my local state representative to champion this issue.”
Geisinger (615k covered lives) revised their bariatric policy and significantly expanded coverage to include:
- BMI 35+ with & without comorbidities
- BMI 30-35 with comorbidities
- Added coverage for SADI-S
- Uncontrolled GERD added to the list of comorbidities
CMS recently published Change Request 13210 that establishes a new HCPCS code, C9784, to describe endoscopic sleeve gastroplasty procedures. The new code will become effective July 1, 2023.
