Natural history and metabolic consequences of morbid obesity for patients denied coverage for bariatric surgery

Harakeh, Ayman B. Al; Burkhamer, Kyle J.; Kallies, Kara J.; Mathiason, Michelle A.; Kothari, Shanu N.

doi:10.1016/j.soard.2010.08.012

Cited by 34 publications

(15 citation statements)

References 27 publications

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“…This delay puts them at risk for the development of further comorbidities and/or worsening of comorbidities they already possess. 15 It should also be noted that there were fewer Medicaid patients in our study compared with Medicare. This may be related to the factors mentioned by Alexander et al in 2008, including decreased payment to physicians and hospitals for the care of Medicaid patients, prejudice against economically deprived individuals, and lower rates of approval for bariatric procedures by Medicaid.…”

Section: Discussionmentioning

confidence: 75%

Health insurance does matter: clinically significant variation in obesity-related diagnoses between insurance types in 83,059 morbidly obese patients

Tyrrell¹,

Blair²,

Slotman³

2018

AOWMC

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Introduction: Clinical management of morbidly obese patients is a growing challenge. In this milieu, any new information adds to the therapeutic acumen for these complex individuals. However, the interaction of insurance status with weight-related medical illnesses is unknown.Objective: To identify variations in the distribution of weight-related medical problems according to health insurance. Methods:Pre-operative data on 83,059 patients from the Surgical Review Corporation's BOLD database who were about to undergo laparoscopic Roux-en-Y gastric bypass was examined in four groups: Medicaid (n=3,305), Medicare (n=8,643), Private insurance (n=60,163), and Self-Pay (n=1,493). Continuous variables were tested by analysis of variance. Distribution of obesity comorbidities was examined using a general linear model with treatment in the model and modified for a binomial distribution.Results: Among the morbidly obese, clinically important weight-related medical problems vary significantly according to the health insurance status of the patients. Morbidly obese Medicare participants have the highest rates of comorbidities and adverse socioeconomic factors. (p<0.001 to<0.0001) The Medicaid group had the highest BMI and asthma rate and was second only to Medicare in almost all of the other categories. (p<0.0001) Private Insurance patients had fewer obesity-related comorbidities than did Medicaid and Medicare, and the lowest unemployment rate. Self-Pay individuals generally had the lowest rates of comorbidities of any of the groups. Conclusion:These results suggest that the index of suspicion for weight-related medical problems should be heightened according to the variation in their incidence reported here when treating obese patients.

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Section: Discussionmentioning

confidence: 75%

Health insurance does matter: clinically significant variation in obesity-related diagnoses between insurance types in 83,059 morbidly obese patients

Tyrrell¹,

Blair²,

Slotman³

2018

AOWMC

View full text Add to dashboard Cite

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“…As they go on to develop new comorbidities, or experience worsening of established co-morbidities, the associated cost of their medical care will almost certainly increase as well. Indeed, in an adult cohort denied WLS, greater comorbidity burden was observed over time despite no significant change in BMI (16).…”

Section: Discussionmentioning

confidence: 94%

“…However, for the other half, the process was more prolonged, delayed by a median of 2 months, and for one patient, over 1.5 years for appeal(s). This experience with accessing insurance benefits for adolescents stands in contrast to the adult experience, wherein 80‐85% of patients are approved initially without need for appeal . Frequent denials were observed despite the fact that these were cases with BMI levels typically greater than 50 kg/m 2 , with major comorbidities related to obesity.…”

Section: Discussionmentioning

confidence: 99%

Access to care for adolescents seeking weight loss surgery

Inge

Boyce

Lee

et al. 2014

Obesity

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Objective: Adolescents seeking weight loss surgery (WLS) frequently encounter obstacles obtaining treatment authorization from insurance carriers. This study identified factors influencing authorization for adolescents with clinical indications for WLS. Methods: A retrospective review was conducted for adolescents with clinical indications for WLS at five adolescent centers. This cohort represented a consecutive series of adolescents with insurance benefits for WLS for whom insurance authorization was sought between 2009 and 2011. Outcomes included number and timing of insurance authorizations for surgery, denials, and appeals. Results: Records from 57 adolescents (74% female; mean age 16 (range: 12-17) years; mean BMI 51.3 kg/m 2 ) were reviewed. Of these, only 47% were approved with the original request. Eighty percent of those denied were approved on appeal, while 11% never obtained authorization for surgery. Age less than 18 years and proposed procedure were the most common reasons for denial.Conclusions: Less than half of adolescents with clinical indications for surgery received approval for the procedure on the first request. The appeal process typically resulted in overturning of denials, so that surgical care could be delivered.

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“…Incidence of comorbidities (type 2 diabetes, hypertension, and dyslipidemia) were estimated from power law modeling of wait-listed patients in the US setting. 24 During the wait for surgery, some patients are expected to drop out of the program; data from a Canadian study on wait-listed patients were used for survival analysis with an exponential model to estimate dropout rate as a function of time following referral. Patients who dropped out were assumed to have no comorbidity resolution.…”

Section: Presurgical Periodmentioning

confidence: 99%

Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada

Davis

Saunders

2020

JAMA Netw Open

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IMPORTANCE Information on the associations between barriers to delivery of bariatric surgery and poor weight trajectory afterward is lacking. Estimates are needed to inform decisions by administrators and clinicians to improve care. OBJECTIVE To estimate the difference in patient-years of treatment for diabetes, hypertension, and dyslipidemia and public-payer cost between the Canadian standard and an improved bariatric surgery care pathway. DESIGN, SETTING, AND PARTICIPANTS Economic evaluation of a decision analytic model comparing the outcomes of the standard care in Canada with an improved bariatric care pathway with earlier sleeve gastrectomy delivery and better postsurgical weight trajectory. The model was informed by published clinical data (101 studies) and meta-analyses (11 studies) between January and May 2019. Participants were a hypothetical 100-patient cohort with demographic characteristics derived from a Canadian study. INTERVENTIONS Reduction of Canadian mean bariatric surgery wait time by 2.5 years following referral and improvement of patient postsurgery weight trajectory to levels observed in other countries. MAIN OUTCOMES AND MEASURES Modeling weight trajectory after sleeve gastrectomy and resolution rates for comorbidities in Canada in comparison with an improved care pathway to estimate differences in patient-years of comorbidity treatment over 10 years following referral and the associated costs. RESULTS For the 100-patient cohort (mean [SD] 88.2% [1.4%] female; mean [SD] age, 43.6 [9.2] years; mean [SD] body mass index, 49.4 [8.2]; and mean [SD] comorbidity prevalence of 50.0% [4.1%], 66.0% [3.9%], and 59.3% [4.0%] for diabetes, hypertension, and dyslipidemia, respectively) over 10 years following referral, the improved vs standard care pathway was associated with median reduction in patient-years of treatment of 324 (95% credibility interval [CrI], 249-396) for diabetes, 245 (95% CrI, 163-356) for hypertension, and 255 (95% CrI, 169-352

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Natural history and metabolic consequences of morbid obesity for patients denied coverage for bariatric surgery

Cited by 34 publications

References 27 publications

Health insurance does matter: clinically significant variation in obesity-related diagnoses between insurance types in 83,059 morbidly obese patients

Health insurance does matter: clinically significant variation in obesity-related diagnoses between insurance types in 83,059 morbidly obese patients

Access to care for adolescents seeking weight loss surgery

Comparison of Comorbidity Treatment and Costs Associated With Bariatric Surgery Among Adults With Obesity in Canada

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