Answering questions

There's more than pride involved in the effort that Saint Mary's and the Reno-based Western Bariatric Institute are putting into spreading the word about a national designation they recently attained.

The designation goes a long way toward answering some of the questions raised by health insurers as they decide whether to pay the tab for gastric-bypass surgery.

Saint Mary's and Western Bariatric Institute have been designed as a "Bariatric Surgery Center of Excellence" by the American Society for Bariatric Surgery. The designation is based on favorable outcomes of the surgery.

The designation comes at a time when health plans nationwide are thinking carefully about whether they'll pay the cost of the surgery, says Susan Pisano, vice president of communications for America's Health Insurance Plans, an industry group based in Washington, D.C.

While most mainstream health plans cover bariatric surgery, Pisano says insurance companies want assurance that the surgery is handled by experienced physicians in a facility that has expertise with treatment of obesity.

Equally important, Pisano said health insurance companies want to know that the surgery isn't a first resort for treatment of obesity, but instead is undertaken only after weight-loss counseling, diet and exercise have been tried.

The reason for their concern? The surgery isn't inexpensive, and the number of patients who've undergone gastric-bypass procedures nationwide has grown seven-fold in the past decade.

At Saint Mary's, the procedure typically costs about $20,000.

Dennis Shuman, the physician who serves as medical director of Saint Mary's health plans division, says plan administrators believe the cost of bariatric surgery may help offset later medical expenses.

Commonly, he says, the morbidly obese will suffer from diabetes, arthritis, heart disease and other ailments unless they undertake bariatric surgery or other steps to reduce their weight.

With the surgery, Shuman says, "Within a very short period of time, we see a rollback in these co-morbidities."

Equally beneficial is the resumption of a happy social life to morbidly obese patients, says Victoria Simmons, who oversees health management for Saint Mary's Health Plans.

Western Bariatric Institute and Saint Mary's team on fewer than 100 bariatric surgery cases a year.

The surgery, Shuman says, comes only after patients have undergone long counseling sessions that cover psychological as well as physical issues.

And medical staffers keep in touch with them long after the surgery, he says.

Simmons, meanwhile, notes that bariatic surgery centers need to address the special needs of their patients.

Wheelchairs and surgical tables, for instance, need to be large enough for obese patients, and staff members often undertake training to ensure they're sensitive to their patients' special needs.


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