Article:Medicare: Not enough data on obesity surgery

Agencies considering changing policy on payments

Friday, November 5, 2004 Posted: 10:59 AM EST (1559 GMT)

BALTIMORE, Maryland (Reuters) -- Obesity surgery has helped many patients lose weight and improve their health, a panel of experts told U.S. regulators Thursday, but they added there was not enough data on how well it has worked for elderly patients covered by Medicare.

The Centers for Medicare and Medicaid Services (CMS) is considering whether the government's health insurance plan for the elderly and disabled should change its payment policy for the surgery, which shrinks the stomach by removing part of it or implanting a removable band.

"I didn't see any data whatsoever that these very same results could be applied" to Medicare patients, said Barbara McNeil, panel vice chairwoman and head of health-care policy at Harvard Medical School.

Regulations limit CMS coverage to defined diseases, but earlier this year the agency deleted language that said obesity was not a disease. The panelists' advice is not binding but will help CMS officials decide if changes are needed.

The agency already covers weight loss surgery to alleviate serious obesity-related conditions like diabetes, but coverage varies among regions. Most Medicare patients who get coverage for the surgery are younger, disabled patients, according to the American Obesity Association.

Private health insurers, which often eye Medicare coverage decisions when formulating their own, have been growing more skeptical of such surgeries, some experts have said.

The panelists examined data on several types of surgeries, including gastric bypass, which removes part of the stomach and connects the remaining portion to the small intestine to bypass much of the digestive system.

Another procedure, called gastric banding, uses a type a adjustable fluid-filled band to squeeze off a part of the stomach.

A number of companies make devices or parts used in the surgery, including Inamed Corp., International Ltd. and Synovis Life Technologies Inc.. Johnson & Johnson also makes stomach bands used in Europe.

Doctors and advocates called on the panel to recommend that CMS cover all obesity surgeries, including the adjustable band, as well as psychiatric and nutrition counseling.

Picking a specific treatment "is a decision best left to the patient and to the surgeon," said Dr. Henry Buchwald, a non-voting panelist and surgery professor at the University of Minnesota in Minneapolis.

Some surgeons complained that Medicare denied coverage for some severe bypass cases and called on officials to establish a clearer policy.

Weight problems are a growing health issue in the United States, where nearly two-thirds of adults are overweight or obese, according to the National Institutes of Health.

Obesity is defined as having a body mass index (BMI) - a weight-for-height ratio - of more than 30. For an average woman, that usually means being 30 pounds overweight and, for an average man, 35 to 40 pounds.