6 Trends in Bariatric Surgery From Dr. Kent Sasse of Surgery Center of Reno

Here are six trends driving the growth of bariatric surgery according to from Kent Sasse, MD, owner of the Surgery Center of Reno (Nev.) and principle in the Western Bariatric Institute in Reno.

1. Epidemic of weight gain and obesity shows no sign of letting up. Dr. Sasse says obesity has overtaken other diseases to become the number one health problem in America. "And that is the number one drive of demand," Dr. Sasse says. "Weight loss surgery has been very effective. No one had much confidence that diets and other things really worked, but weight loss surgery has had good data behind it. These operations have now have been around for nearly 30 years and allowed a lot of data to accrue and the long-term data are very striking in their success. It takes time, but word has gotten out and slowly people are learning how overweight people live longer lives after weight loss surgery with a higher quality of life. We have also seen that weight loss surgery is a very effective treatment of other conditions, such as sleep apnea, heart disease and diabetes."

2. Growing move to outpatient settings has intensified in last three years. Dr. Sasse says the surgery has become less and less invasive. "Now there are several very effective weight loss operations done with laparoscopy and minimally invasive techniques that lend themselves to an outpatient environment," he says. "The same factors that are pushing so many other surgeries in orthopedics, spine and OB/GYN are driving weight loss surgery as well. It's more economical and offers better customer service.

"People feel a more personal touch and less like they're in large, impersonal medical institutions," Dr. Sasse says. "Unique to bariatric surgery patients is the strong desire for privacy, to have a more private experience. And that can be accomplished easier in a smaller outpatient center."

3. Expansion of eligibility for weight loss surgery. Under current National Institutes of Health criteria, the number of patients with a body mass index (BMI) of over 40 means there are about 20 million Americans eligible for weight loss surgery, Dr. Sasse says.

"However, research has shown more and more people who will be eligible for the surgery and considered appropriate candidates," he says. "Even moderately overweight people can benefit from the procedures with improved health and lowered risk of diabetes even when their weight isn't what we normally think of as obese."

He says that would open this medical application to 50 million Americans, more than doubling the current number of eligible patients for the procedure. Dr. Sasse notes that some 200,000 weight loss surgeries are performed annually in the United States.

4. Competition between leading device companies. "We're at the very beginning of a very large marketing and public relations effort by two competing medical device manufacturers, both of which make outpatient laparoscopic gastric band devices — Ethicon Endosurgery, a division of Johnson & Johnson, and Allergan," he says, saying the devices they manufacture cost around $3,000. "We're starting to see gastric banding commercials on TV and I think guess this will culturally change the perception of weight loss surgery as it becomes increasingly common in the coming years."

5. Quality movement. "We are moving towards quality measures and reported outcomes in bariatric surgery," Dr. Sasse says. "Increasingly, hospitals and health plans are interested in individual surgical data and soon that be available to consumers. At the same time we're seeing greater transparency going on with the creation of the Centers of Excellence, accreditation efforts by the American Society for Metabolic and Bariatric Surgery and a parallel process from the American College of Surgeons."

He says the entities will offer accreditation for center of excellence status to surgery centers meeting their rigorous criteria for volume and quality.

6. Better Medicare coverage. Dr. Sasse says that Medicare beneficiaries comprised only 10 percent of the 200,000 patients receiving bariatric surgery in 2008.

"But as Baby Boomer age, there will be a growing number of Medicare beneficiaries who would stand to benefit from bariatric surgery," he says. "We will see more pressure on Medicare to make the reimbursement more attractive to bariatric surgeons and centers."

While Medicare does cover the procedure, Dr. Sasse says its reimbursement level is below what it generally costs to deliver a good cost bariatric surgery program.

"Our center does not just do surgery and walk away," he says. "There is a comprehensive course that includes a dietary program, support groups and pre- and post-meetings with dieticians and physicians. It's a long-term program with a lot of materials and classes we generate and after-hours work on the part of our staff. It's not feasible to put on that kind of program and services for the rate Medicare now pays, between $1,100–$1,600 for the surgical component."

He says the roughly $17,000 his center charges includes surgery, anesthesia and many other services.

"Right now there are very few bariatric surgical programs that accept Medicare," Dr. Sasse says. "At one point ours was the only bariatric surgery center west of the Mississippi that accepted Medicare. It's increasingly difficult to find practitioners of many medical specialties who will accept Medicare. And that's real concern just starting to become recognized."

Dr. Sasse is owner with 30 other physicians of the Surgery Center of Reno (www.surgerycenterofreno.com) and a principle in the nationally recognized medical practice weight loss center, the Western Bariatric Institute in Reno. Dr. Sasse is a nationally recognized expert in bariatric surgery, founder of the International Metabolic Institute and the author of "Outpatient Weight Loss Surgery."

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