Journal article
Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD
Surgical endoscopy, Vol.37(10), pp.7642-7648
10/2023
DOI: 10.1007/s00464-023-10212-9
PMID: 37491660
Abstract
Introduction
Obesity is an increasingly prevalent public health problem often associated with poorly controlled gastroesophageal reflux disease. Fundoplication has been shown to have limited long-term efficacy in patients with morbid obesity and does not address additional weight-related co-morbidities. Roux-en-Y gastric bypass (RYGB) is the gold standard operation for durable resolution of GERD in patients with obesity, and is also used as a salvage operation for GERD after prior foregut surgery. Surgeons report access to RYGB as surgical treatment for GERD is often limited by RYGB-specific benefit exclusions embedded within insurance policies, but the magnitude and scope of this problem is unknown.
Methods
A 9-item survey evaluating surgeon practice and experience with insurance coverage for RYGB for GERD was developed and piloted by a SAGES Foregut Taskforce working group. This survey was then administered to surgeon members of the SAGES Foregut Taskforce and to surgeons participating in the SAGES Bariatrics and/or Foregut Facebook groups.
Results
187 surgeons completed the survey. 89% reported using the RYGB as an anti-reflux procedure. 44% and 26% used a BMI of 35 kg/m2 and 30 kg/m2 respectively as cutoff for the RYGB. 89% viewed RYGB as the procedure of choice for GERD after bariatric surgery. 69% reported using RYGB to address recurrent reflux secondary to failed fundoplication. 74% of responders experienced trouble with insurance coverage at least half the time RYGB was offered for GERD, and 8% reported they were never able to get approval for RYGB for GERD indications in their patient populations.
Conclusion
For many patients, GERD and obesity are related diseases that are best addressed with RYGB. However, insurance coverage for RYGB for GERD is often limited by policies which run contrary to evidence-based medicine. Advocacy is critical to improve access to appropriate surgical care for GERD in patients with obesity.
Details
- Title: Subtitle
- Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD
- Creators
- Anna R Ibele - University of UtahPeter N Nau - University of IowaCarlos Galvani - Tulane UniversityJ Scott Roth - University of KentuckyRoss F GoldbergMarina S KurianLeena Khaitan - University Hospitals of ClevelandJon Gould - Medical College of WisconsinYagnik K Pandya - MetroWest Medical CenterSAGES Foregut Taskforce
- Resource Type
- Journal article
- Publication Details
- Surgical endoscopy, Vol.37(10), pp.7642-7648
- DOI
- 10.1007/s00464-023-10212-9
- PMID
- 37491660
- eISSN
- 1432-2218
- Language
- English
- Electronic publication date
- 07/25/2023
- Date published
- 10/2023
- Academic Unit
- Surgery
- Record Identifier
- 9984448058202771
Metrics
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