CMS Coverage of Vertical Sleeve

Currently, Medicare does not cover the Vertical Sleeve Gastrectomy (‘the sleeve’). However this lesser-known weight loss procedure is gaining traction with physicians in the US who see it as a strong choice for patients considering bariatric surgery. Although several major insurance providers do cover the sleeve, it has not yet been added to the list of procedures that Medicare covers. Since insurance providers often look to Medicare to see which procedures are covered, before making their own coverage decisions, having the sleeve become an approved Medicare procedure may cause a ripple effect in coverage throughout the country.

Medicare is actively considering adding the sleeve to its covered procedures. They are in a period of accepting public comments on the proposal. Comments are specifically sought in regard to “whether there is adequate evidence, including clinical trials, for evaluating health outcomes of laparoscopic sleeve gastrectomy for the indications listed in the current Bariatric Surgery for the Treatment of Morbid Obesity National Coverage Determination”. You can view the details and share comments with CMS here.

Dr. Mona Misra, a bariatric surgeon in Beverly Hills, spoke to us in depth about the sleeve procedure. She said:

“With the continually rising incidence of obesity and its directly-associated illnesses, the need for the perfect bariatric procedure has never been more critical. We have been fortunate, as physicians and surgeons to have developed a therapy that can and will continue to provide effective weight loss, reduction in comorbid conditions, and most importantly improved quality and length of life. Despite the generally overwhelming success experienced by our patients as a whole, some fail to achieve their intended goals with our traditional surgical options. Most concerning though, despite the evidence of the vastly superior outcomes of surgical therapies over diet and exercise alone, only about 1% are choosing to access this life improving therapy.

The recently developed laparoscopic sleeve gastrectomy (sleeve) is proving to be a very effective and safe option with excellent results as an additional therapeutic option for our patients. Recently published studies show 60-70% early excess weight loss, and maintenance of excellent weight loss at intermediate term follow-up. These results are comparable to the traditionally accepted options of Laparoscopic Gastric Bypass (bypass) and Laparoscopic Adjustable Gastric Banding (band) and as such, in properly selected patients, should provide similar health benefits to our patients.

The bypass is generally thought of as the most robust traditional procedure, but has higher early complication rates, and potentially higher malnutrition rates compared to the sleeve and the gastric band in the long-term. The band is considered to be extremely safe and effective, but some feel it is associated with slower rates of weight loss, the need for extensive, intense life-long follow-up and support, and a greater overall risk of failure, especially in less mobile or higher weight patients.

In comparison to the traditional procedures, the SG is proving to provide a balanced combination of the positive aspects of both procedures. It has a weight loss trajectory more similar to the RNY than the LAGB. It also does not carry the inherent failure risks and required “repair re-operations” found with the use of an implantable device. Though there is a staple line, there is the benefit of no anastomosis (a connection which can have complications of leaks or ulcers), less risk of dumping syndrome, no loss of easy access to all portions of the gastrointestinal tract, or the malabsorption of essential nutrients.

I believe it is important to cover the sleeve gastrectomy procedure as it will allow patients desperately needing a safe, durable treatment option access to a “better fit” procedure to permanently address their obesity and its many associated illnesses. Unfortunately, the options available to our patients today are many times perceived as “too radical” as in the case of the gastric bypass, or “not enough” in the case of the gastric band, so many patients just choose to do nothing.

I have seen significant successes in my own practice with the sleeve. Many of these patients would not have pursued this life-saving therapy is not for their access to the option of the sleeve gastrectomy.”

You can learn more about the sleeve procedure here.

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