Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD
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-morbidit...
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| description | 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/m
2
and 30 kg/m
2
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. |
| doi_str_mv | 10.1007/s00464-023-10212-9 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2842452079</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2842452079</sourcerecordid><originalsourceid>FETCH-LOGICAL-c326t-9711b27e05b085a9af2132d17739721a0cf27316d55ce678b8a6a1716acaf5a93</originalsourceid><addsrcrecordid>eNp9kctKxDAUhoMoOl5ewIUE3LiJJidt0i7FOwiCl3U4bdOZykxTk9bL25s6o4ILIZCEfOfL4fyE7At-LDjXJ4HzRCWMg2SCgwCWr5GJSCQwAJGtkwnPJWeg82SLbIfwzCOfi3STbEkdD0rxCXl_GPzUupba9876xralpW9NP6NNGwaP47VAHx98oL2jrq4j1U7pFEPvm5IWHx2GQDGu6HhtqtHACgy2oi4asW-ivHaedtjP3NxNY9HVxf35LtmocR7s3mrfIU-XF49n1-z27urm7PSWlRJUz3ItRAHa8rTgWYo51iAkVEJrmWsQyMsatBSqStPSKp0VGSoUWigssY683CFHS2_n3ctgQ28WTSjtfI6tdUMwkCWQpMD1iB7-QZ_d4NvYXaRUlug0BxkpWFKldyF4W5vONwv0H0ZwM-ZilrmYmIv5ysWM6oOVeigWtvop-Q4iAnIJhG6cr_W_f_-j_QS6LpiX</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2868475923</pqid></control><display><type>article</type><title>Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD</title><source>MEDLINE</source><source>SpringerNature Journals</source><creator>Ibele, Anna R. ; Nau, Peter N. ; Galvani, Carlos ; Roth, J. Scott ; Goldberg, Ross F. ; Kurian, Marina S. ; Khaitan, Leena ; Gould, Jon ; Pandya, Yagnik K.</creator><creatorcontrib>Ibele, Anna R. ; Nau, Peter N. ; Galvani, Carlos ; Roth, J. Scott ; Goldberg, Ross F. ; Kurian, Marina S. ; Khaitan, Leena ; Gould, Jon ; Pandya, Yagnik K. ; SAGES Foregut Taskforce ; the SAGES Foregut Taskforce</creatorcontrib><description>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/m
2
and 30 kg/m
2
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.</description><identifier>ISSN: 0930-2794</identifier><identifier>EISSN: 1432-2218</identifier><identifier>DOI: 10.1007/s00464-023-10212-9</identifier><identifier>PMID: 37491660</identifier><language>eng</language><publisher>New York: Springer US</publisher><subject>Abdominal Surgery ; Gastric Bypass - methods ; Gastroenterology ; Gastroesophageal reflux ; Gastroesophageal Reflux - complications ; Gastroesophageal Reflux - surgery ; Gastrointestinal surgery ; Gynecology ; Hepatology ; Humans ; Insurance ; Insurance coverage ; Insurance policies ; Medicine ; Medicine & Public Health ; Obesity ; Obesity, Morbid - complications ; Obesity, Morbid - surgery ; Proctology ; Retrospective Studies ; Surgeons ; Surgery ; Treatment Outcome</subject><ispartof>Surgical endoscopy, 2023-10, Vol.37 (10), p.7642-7648</ispartof><rights>The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2023. Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.</rights><rights>2023. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c326t-9711b27e05b085a9af2132d17739721a0cf27316d55ce678b8a6a1716acaf5a93</cites><orcidid>0000-0002-8850-3141</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00464-023-10212-9$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00464-023-10212-9$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/37491660$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Ibele, Anna R.</creatorcontrib><creatorcontrib>Nau, Peter N.</creatorcontrib><creatorcontrib>Galvani, Carlos</creatorcontrib><creatorcontrib>Roth, J. Scott</creatorcontrib><creatorcontrib>Goldberg, Ross F.</creatorcontrib><creatorcontrib>Kurian, Marina S.</creatorcontrib><creatorcontrib>Khaitan, Leena</creatorcontrib><creatorcontrib>Gould, Jon</creatorcontrib><creatorcontrib>Pandya, Yagnik K.</creatorcontrib><creatorcontrib>SAGES Foregut Taskforce</creatorcontrib><creatorcontrib>the SAGES Foregut Taskforce</creatorcontrib><title>Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD</title><title>Surgical endoscopy</title><addtitle>Surg Endosc</addtitle><addtitle>Surg Endosc</addtitle><description>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/m
2
and 30 kg/m
2
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.</description><subject>Abdominal Surgery</subject><subject>Gastric Bypass - methods</subject><subject>Gastroenterology</subject><subject>Gastroesophageal reflux</subject><subject>Gastroesophageal Reflux - complications</subject><subject>Gastroesophageal Reflux - surgery</subject><subject>Gastrointestinal surgery</subject><subject>Gynecology</subject><subject>Hepatology</subject><subject>Humans</subject><subject>Insurance</subject><subject>Insurance coverage</subject><subject>Insurance policies</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Obesity</subject><subject>Obesity, Morbid - complications</subject><subject>Obesity, Morbid - surgery</subject><subject>Proctology</subject><subject>Retrospective Studies</subject><subject>Surgeons</subject><subject>Surgery</subject><subject>Treatment Outcome</subject><issn>0930-2794</issn><issn>1432-2218</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2023</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kctKxDAUhoMoOl5ewIUE3LiJJidt0i7FOwiCl3U4bdOZykxTk9bL25s6o4ILIZCEfOfL4fyE7At-LDjXJ4HzRCWMg2SCgwCWr5GJSCQwAJGtkwnPJWeg82SLbIfwzCOfi3STbEkdD0rxCXl_GPzUupba9876xralpW9NP6NNGwaP47VAHx98oL2jrq4j1U7pFEPvm5IWHx2GQDGu6HhtqtHACgy2oi4asW-ivHaedtjP3NxNY9HVxf35LtmocR7s3mrfIU-XF49n1-z27urm7PSWlRJUz3ItRAHa8rTgWYo51iAkVEJrmWsQyMsatBSqStPSKp0VGSoUWigssY683CFHS2_n3ctgQ28WTSjtfI6tdUMwkCWQpMD1iB7-QZ_d4NvYXaRUlug0BxkpWFKldyF4W5vONwv0H0ZwM-ZilrmYmIv5ysWM6oOVeigWtvop-Q4iAnIJhG6cr_W_f_-j_QS6LpiX</recordid><startdate>20231001</startdate><enddate>20231001</enddate><creator>Ibele, Anna R.</creator><creator>Nau, Peter N.</creator><creator>Galvani, Carlos</creator><creator>Roth, J. Scott</creator><creator>Goldberg, Ross F.</creator><creator>Kurian, Marina S.</creator><creator>Khaitan, Leena</creator><creator>Gould, Jon</creator><creator>Pandya, Yagnik K.</creator><general>Springer US</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0002-8850-3141</orcidid></search><sort><creationdate>20231001</creationdate><title>Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD</title><author>Ibele, Anna R. ; Nau, Peter N. ; Galvani, Carlos ; Roth, J. Scott ; Goldberg, Ross F. ; Kurian, Marina S. ; Khaitan, Leena ; Gould, Jon ; Pandya, Yagnik K.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c326t-9711b27e05b085a9af2132d17739721a0cf27316d55ce678b8a6a1716acaf5a93</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2023</creationdate><topic>Abdominal Surgery</topic><topic>Gastric Bypass - methods</topic><topic>Gastroenterology</topic><topic>Gastroesophageal reflux</topic><topic>Gastroesophageal Reflux - complications</topic><topic>Gastroesophageal Reflux - surgery</topic><topic>Gastrointestinal surgery</topic><topic>Gynecology</topic><topic>Hepatology</topic><topic>Humans</topic><topic>Insurance</topic><topic>Insurance coverage</topic><topic>Insurance policies</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Obesity</topic><topic>Obesity, Morbid - complications</topic><topic>Obesity, Morbid - surgery</topic><topic>Proctology</topic><topic>Retrospective Studies</topic><topic>Surgeons</topic><topic>Surgery</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Ibele, Anna R.</creatorcontrib><creatorcontrib>Nau, Peter N.</creatorcontrib><creatorcontrib>Galvani, Carlos</creatorcontrib><creatorcontrib>Roth, J. Scott</creatorcontrib><creatorcontrib>Goldberg, Ross F.</creatorcontrib><creatorcontrib>Kurian, Marina S.</creatorcontrib><creatorcontrib>Khaitan, Leena</creatorcontrib><creatorcontrib>Gould, Jon</creatorcontrib><creatorcontrib>Pandya, Yagnik K.</creatorcontrib><creatorcontrib>SAGES Foregut Taskforce</creatorcontrib><creatorcontrib>the SAGES Foregut Taskforce</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><jtitle>Surgical endoscopy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Ibele, Anna R.</au><au>Nau, Peter N.</au><au>Galvani, Carlos</au><au>Roth, J. Scott</au><au>Goldberg, Ross F.</au><au>Kurian, Marina S.</au><au>Khaitan, Leena</au><au>Gould, Jon</au><au>Pandya, Yagnik K.</au><aucorp>SAGES Foregut Taskforce</aucorp><aucorp>the SAGES Foregut Taskforce</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD</atitle><jtitle>Surgical endoscopy</jtitle><stitle>Surg Endosc</stitle><addtitle>Surg Endosc</addtitle><date>2023-10-01</date><risdate>2023</risdate><volume>37</volume><issue>10</issue><spage>7642</spage><epage>7648</epage><pages>7642-7648</pages><issn>0930-2794</issn><eissn>1432-2218</eissn><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/m
2
and 30 kg/m
2
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.</abstract><cop>New York</cop><pub>Springer US</pub><pmid>37491660</pmid><doi>10.1007/s00464-023-10212-9</doi><tpages>7</tpages><orcidid>https://orcid.org/0000-0002-8850-3141</orcidid></addata></record> |
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| source | MEDLINE; SpringerNature Journals |
| subjects | Abdominal Surgery Gastric Bypass - methods Gastroenterology Gastroesophageal reflux Gastroesophageal Reflux - complications Gastroesophageal Reflux - surgery Gastrointestinal surgery Gynecology Hepatology Humans Insurance Insurance coverage Insurance policies Medicine Medicine & Public Health Obesity Obesity, Morbid - complications Obesity, Morbid - surgery Proctology Retrospective Studies Surgeons Surgery Treatment Outcome |
| title | Surgeon experience with insurance barriers to offering gastric bypass as an evidence-based operation for pathologic GERD |
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