title: Best practices in policy and access (coding and reimbursement) for weight loss surgery.
abstract: To update evidence-based best practice guidelines for coding and reimbursement and establish policy and access standards for weight loss surgery (WLS). Systematic search of English-language literature on WLS and health-care policy, access, insurance reimbursement, coding, private payers, public policy, and mandated benefits published between April 2004 and May 2007 in MEDLINE, EMBASE, and the Cochrane Library. Use of key words to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence-based models. We identified 51 publications in our literature search; the 20 most relevant were examined in detail. These included reviews, cost-benefit analyses, and trend and cost studies from administrative databases. Literature on policy issues surrounding WLS are very sparse and largely focused on economic analyses. Reports on policy initiatives in the public and private arenas are primarily limited to narrative reviews of nonsurgical efforts to fight obesity. A substantial body of work shows that WLS improves or reverses most obesity-related comorbidities. Mounting evidence also indicates that WLS confers a significant survival advantage for those who undergo it. WLS is a viable and cost-effective treatment for an increasingly common disease, and policy decisions are more frequently being linked to incentives for national health-care goals. However, access to WLS often varies by payer and region. Currently, there are no uniform criteria for determining patient appropriateness for surgery.
authors.affiliation: Tufts Medical Center, Boston, Massachusetts, USA. Sshikora@tuftsmedicalcenter.org
authors.forename: Scott A
authors.initials: SA
authors.lastname: Shikora
authors.forename: Rayford S
authors.initials: RS
authors.lastname: Kruger
authors.forename: George L
authors.initials: GL
authors.lastname: Blackburn
authors.forename: John A
authors.initials: JA
authors.lastname: Fallon
authors.forename: Alan M
authors.initials: AM
authors.lastname: Harvey
authors.forename: Elvira Q
authors.initials: EQ
authors.lastname: Johnson
authors.forename: Lee
authors.initials: L
authors.lastname: Kaplan
authors.forename: Edward C
authors.initials: EC
authors.lastname: Mun
authors.forename: Stancel
authors.initials: S
authors.lastname: Riley
authors.forename: Malcolm K
authors.initials: MK
authors.lastname: Robinson
authors.forename: James E
authors.initials: JE
authors.lastname: Sabin
authors.forename: Roger L
authors.initials: RL
authors.lastname: Snow
authors.forename: Robert
authors.initials: R
authors.lastname: Lonigro
authors.forename: Lee J
authors.initials: LJ
authors.lastname: Steingisser
authors.forename: David B
authors.initials: DB
authors.lastname: Lautz
mesh_terms: D050110:Bariatric Surgery / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D003362:Cost-Benefit Analysis / Q000191:economics / Q000592:standards; D019317:Evidence-Based Medicine / Q000592:standards; D006291:Health Policy; D006297:Health Services Accessibility / Q000592:standards*; D006801:Humans; D008507:Medically Underserved Area; D009765:Obesity / Q000453:epidemiology / Q000601:surgery; D009767:Obesity, Morbid / Q000453:epidemiology / Q000601:surgery; D010353:Patient Education as Topic; D015995:Prevalence; D012051:Reimbursement Mechanisms / Q000592:standards*; D015203:Reproducibility of Results