Medicare change tied to safer weight loss surgery

After Medicare changed its rules regarding coverage for weight loss surgeries in 2006, the cost for the procedures went down while safety measures increased, according to a new study.

Researchers found that the benefits were primarily due to a rules change that allowed Medicare to pay for a newer, less invasive procedure called laparoscopic adjustable banding.

Prior to the 2006 changes, Medicare, the federally-funded health insurance for older or disabled people, only reimbursed doctors for performing gastric bypass surgeries.

"This is one of the more recent natural experiments by Medicare to try and change the health care system for the better," said Dr. David Flum, the study's lead author and a professor at the University of Washington. "The message is, it worked."

Laparoscopic gastric banding helps people lose weight by squeezing off a portion of the stomach into a small pouch that can handle only limited amounts of food.

Gastric bypass also makes the stomach smaller, while detouring food around part of the small intestine.

Obesity Surgery: Laparoscopic Adjustable Banding (LAP-BAND® System) Weight Loss Surgery

Laparoscopic adjustable gastric banding is a new minimally invasive surgical treatment for weight loss that requires no stomach stapling or intestinal re-routing. The LAP-BAND® is adjusted in the physician's office for the needs of each patient. This procedure enables patients to recover more quickly with less pain and less risk of wound complications than traditional weight loss surgery.

Ashley H. Vernon, MD, Associate Surgeon at BWH, performed the procedure, assisted by David B. Lautz, MD, Director of Bariatric Surgery. Malcolm K. Robinson, MD, Director of the BWH Program for Weight Management, narrated the webcast, which included an overview of pre- and post-surgical considerations, patient candidacy, and risks and benefits of laparoscopic adjustable banding.

Flum and his team gathered data from the Centers for Medicare and Medicaid Services (CMS) on people with Medicare insurance who underwent weight loss surgery between 2004 and 2008.

Throughout the study period, more than 47,000 people had weight loss surgery.

Before the 2006 rules changes, no one in this group received laparoscopic banding. After the changes, that procedure made up more than a third of the weight loss surgeries.

As "lap banding" was introduced, the number of people who died after surgery fell by more than half.

Fifteen out of every 1,000 people who had weight loss surgery before Medicare changed its rules died within 90 days of the procedure. After the rules change, seven out of every 1,000 people died after the surgery.