May 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
- Register Today for the ASMBS 39th Annual Meeting!
- Let Your Voice Be Heard! Vote for your EC Leadership
ASMBS Integrated Health Presidential Message
- ASMBS 2023 Annual Meeting Theme: Enhancing Outcomes Through Combined Therapy
- IHEC Elections are Open! Vote Today!!
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!.
Discounted hotel room rates END on Friday, May 19, 2023. Please register for the annual meeting before you book your hotel room!
Why should I take BE-SAFE?
BE-SAFE! Stands for Bariatric Endoscopy – Skill Acquisition Focused Evaluation
Take BE-SAFE because it documents your skill set and your ability to offer these endoscopic procedures to patients in need.
BE-SAFE runs through different scenarios which assess your judgment and ability to use different tools in the endoscopic armamentarium to address complications following bariatric procedures. These endoscopic approaches can facilitate minimally invasive care in this high-risk patient group.
The next BE-SAFE! hands-on skills verification will be offered at the 2023 ASMBS Annual Meeting in Las Vegas, NV on Monday, June 26th, 2023, from 1:30 – 3:30 PM and 3:30 – 5:00 PM. Space is limited. Register Today!
Upcoming Webinars
- May 5 | The FELLOW Project: How to Manage Gallbladders and Hernias Before, During, and After Bariatric Surgery
- May 9 | Bariatric Malpractice
- May 25 | The Bariatric Happy Hour!
- May 30 | START Program Open House 2
3. Committee Updates
Clinical Issues Committee “ASMBS Bariatric Emergencies for the General Surgeon Statement” published in SOARD can be found in our ASMBS Resources.
Maria S. Altieri, M.D., Ann Rogers, M.D., Cheguevara Afaneh, M.D., Fady Moustarah, M.D., Brandon T. Grover, M.D., Zhamak Khorgami, M.D., Dan Eisenberg, M.D.
General & Foregut Surgery Committee “Gastroparesis: an evidence-based review for the bariatric and foregut surgeon” published in SOARD can be found in our ASMBS Resources.
The ASMBS Pediatric Committee is looking for Toolkit resources.
Our goal is to develop a repository of helpful files that can be shared between programs. This is particularly timely with new 2022 ASMBS/IFSO Guidelines and updated AAP Clinical Guidelines for obesity management. In order to help children’s wellness programs strengthen a surgical component and to assist established adult bariatric and metabolic surgery programs expand their scope of care, we are asking you to share the materials that you use in your programs. All of the materials will be reviewed to remove any identifiable information about your facility or physicians if the material is proprietary.
The ASMBS Pediatric Committee will work to organize these files by program type so that 3 sets of reference documents for each subject matter (children’s hospital, pediatric program within adult hospital, adult program caring for children) is available for easy access from the ASMBS Toolkits site.
If you are interested in contributing, please send materials to: pediatric.surgery@asmbs.org
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!
Foundation News
Congratulations to the 2023 LEAD Award Honorees
5. Advocacy & Access to Care
Oregon Medicaid
Draft coverage guidance for Oregon Medicaid has been posted on their website and will be finalized on May 18, 2023. We are seeing an expansion of coverage for:
- BMI 35 plus with or without comorbidities
- Expansion with BMI 30-35 with type 2 diabetes
- Procedural expansion for SADIS and OAGB are up for coverage
This is a major expansion and big win in the bariatrics space.
Mr. Greg Showell, Oregon’s IH STAR, and Dr. Derek Rogalsky, Oregon’s MD STAR, have been instrumental in the success of this coverage and communicating it back to the committee. Dr. Rogalsky commented:
“I’ve worked very hard to get these draft guidelines to the point that they are. These guidelines will not go into effect until voted on by the Health Evidence Review Committee on 5/18/23. If anyone is interested in signing up to testify in support of these draft guidelines, it would be much appreciated. In order to speak you need to sign up ahead of time.”
What: A public meeting of the Health Evidence Review Commission
When: May 18, 1:30-4:30 p.m.
Where: Join our Cloud HD Video Meeting
For more information about the meeting, visit the committee’s website. The meeting agenda and materials will be available one week before the meeting.
The agendas for these meetings have been updated to include a draft coverage guidance on Bariatric Procedures, referred at the April 20, 2023 meeting of the Evidence-based Guidelines Subcommittee and include:
HERC will consider the following topics:
- Value-based Benefits Subcommittee Report*
- Bariatric procedures (Weight loss surgery for adults and adolescents–added 4/21/2023)
- Subcommittee membership changes
*Topics which remain unresolved at the conclusion of the morning’s VbBS meeting will not be heard by HERC until a later date. Public notice of tabled topics will be announced 28-days prior their next scheduled discussion.
Note: Unscheduled verbal testimony will not be allowed at the meeting. If you think you may want to testify, please complete the survey to sign up at Health Evidence Review Commission Public Testimony Sign Up by Tuesday, 5/16/23, 12:00 pm Pacific. If you decide not to testify, you can always decline later. If you need assistance in signing up for public testimony, please call Daphne Peck at 503-373-1985.
Written public comment (up to 1,000 words per sender for each topic) will be accepted until noon on 5/16/23; submit to HERC.info@oha.oregon.gov.
BCBS Alabama
(2.3 million covered lives) added a seemingly harmless but profound note: “When performed for treatment of GERD in an obese patient without a previous gastric sleeve procedure, Roux-en-Y gastric bypass is still classified as bariatric surgery.” Meaning primary RYGB cannot be done for GERD as the primary indication. One other criteria remains on their policy: “The condition of morbid obesity…must be of at least 3 years (36 months) duration.”
BCBS North Dakota
(~270k covered lives) made changes in sync with Highmark, i.e. added 6-month pre-op weight loss, nuanced definitions of comorbidities, and made banding eligible only when other bariatric procedures are contraindicated.
Horizon BCBS NJ
(2.7 million covered lives) revised its bariatric policy (effective March 14th) and expanded coverage for BMI 30-35 with Type 2 Diabetes.
Barriers that remain:
- 3 months multi-disciplinary preparatory regimen or 6 months of physician supervised nutrition/exercise program (they don’t mention “weight loss” program)
- SADI-S still not covered
- No consideration for low BMI for Asians or those with BMI 35-40 without comorbidities
Nonetheless, a major positive movement by Horizon!
Centene
(5.4 million covered lives) did a massive expansion. Per ASMBS/IFSO 2022 guidelines they expanded coverage to include BMI 35+ with/without comorbidities, 30-35 w T2D, and they added bariatric as a bridge to joint arthroplasty, abdominal hernia repair, and organ transplantation. Comment from Santosh Agarwal, Medtronic: “This is the first policy, I believe, which includes bariatrics as a bridge criteria.
Highmark
(3.2 million covered lives) has tightened criteria at 3 places: (Please note that the West Virginia policy is attached but the same policy applies to Pennsylvania, New York, and Delaware)
- Added 6-month pre-op weight loss.
- Specified criteria for comorbidities – diabetes requires HbA1c of 8%+ on one or more medications; similar details have been added for hyperlipidemia and OSA. They did expand to include 2 new comorbidities – coronary heart disease and pseudotumor cerebri.
- Banding has been moved to a procedure that’s indicated only when the patient is contraindicated to BPD-DS, RYGB, and sleeve.
ICD-10 Meetings
ICD-10 Meetings are in progress, and they are considering creating new sub-categories for obesity codes based on obesity class. No major negative implications. If anything, it will help identify more patients who could be eligible for surgery. See attached PDF on the proposal.
- New code E66.811 Obesity, class 1 (30-35 BMI)
- New code E66.812 Obesity, class 2
- New code E66.813 Obesity, class 3
- New code E66.89 Other obesity not elsewhere classified.
Please start using those codes to coincide with the new 2022 ASMBS/IFSO Guidelines – Dr. Seger, Access to Care Committee Chair.
United Healthcare
(~25 million covered lives) has combined their commercial and individual exchange policies into one policy. They have tightened criteria for revisional surgery which includes technical failure (such as bowel perforation, band migration, band removal, leak, obstruction, staple line failure, reflux). Meaning inadequate weight loss will no longer be accepted as the sole criteria for revisions.
Medicaid Unwind – Impact by State
Unwinding of the Continuous Enrollment Provision for Medicaid Effective May 1, 2023
This chart spells out predications by state that would impact each state disproportionately, depending on state eligibility and economic situation; see: 1) Estimated medicaid coverage loss and 2) Number of individuals transitioning to uninsured.