Companies want Medicare to cover obesity surgery
Several device makers and a group representing surgeons have asked the U.S. government to pay for weight loss surgery for elderly and disabled people who are morbidly obese, health officials said on Tuesday.
The companies, which include Inamed Corp., Tyco International Ltd.‘s US Surgical, and Johnson & Johnson unit Ethicon Endo-Surgery Inc., make stomach bands and other devices used in several types of weight-reducing procedures.
The Centers for Medicare and Medicare Services (CMS) said it will consider the request and is seeking public comment on the surgery, which shrinks the stomach by removing part of it or implanting a removable band.
Weight loss surgery is already covered to alleviate serious obesity-related conditions like diabetes, but payment varies among regions. Most beneficiaries who get coverage for the surgery are younger, disabled patients, according to the American Obesity Association.
The companies and the American Society for Bariatric Surgery asked CMS to extend coverage to include Obesity itself. Their request comes as more Americans are putting on extra pounds, with nearly two-thirds of adults considered overweight or obese by the National Institutes of Health.
Medicare, the nation’s health insurance program for the elderly and disabled, covers 43 million Americans.
“We believe this expansion, based upon sound data, will improve the health, extend the duration and enhance the quality of life of Medicare beneficiaries,” the doctors’ group wrote.
Private health insurers, which often consider Medicare’s coverage decisions, have been growing more skeptical of such surgeries, some experts have said. Advocates and some doctors have said surgery is the only option for some people and usually works when paired with diet and exercise changes.
In November, a Medicare advisory panel concluded there was not enough data to show how well it worked for older patients.
Inamed Vice President for Global Corporate and Government Affairs Dan Cohen said the company is working to provide data for older patients, but that it was difficult because many severely obese people die early.
Spokespeople for the other companies, which also includes privately held Transneuronix Corp, could not immediately be reached for comment.
Revision date: June 11, 2011
Last revised: by Jorge P. Ribeiro, MD