Consensus and Collaboration
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1 Consensus and Collaboration John Morton, MD, MPH, FACS, FASMBS Chief, Bariatric & Minimally Invasive Surgery Stanford School of Medicine Past-President, American Society of Metabolic and Bariatric Surgery, Chair, Committee on Metabolic and Bariatric Surgery, American College of Surgeons
2 Overview Summit Deliverables Challenges ACCESS UTILIZATION ACCEPTANCE Opportunities HOSPITAL COLLABORATION DIGITAL
3 Age-adjusted Prevalence of Obesity and Diagnosed Diabetes Among US Adults Obesity (BMI 30 kg/m 2 ) No Data <14.0% 14.0% 17.9% 18.0% 21.9% 22.0% 25.9% > 26.0% Diabetes No Data <4.5% 4.5% 5.9% 6.0% 7.4% 7.5% 8.9% >9.0% CDC s Division of Diabetes Translation. United States Surveillance System available at
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7 Obesity Summit Deliverables Educational Initiative- ABOM and Obesity Medicine Education Collaborative Advocacy- Obesity Care Collaborative Position Statements American Hip and Knee Society National Lipid Association American College of Obstetrics and Gynecology American College of Occupational and Environmental Medicine American Hernia Society American Society for Clinical Oncology
8 Advocacy Acceptance of Disease Assessment of Intervention Access to Care Accuracy of Progress Advance the Cause (Stewards of Care)
9
10 Sleeve Gastrectomy Coverage by Medicare June 2012 (as of June 27, 2012) AK WA MT ND MN ME OR CA NV ID UT AZ WY CO NM SD NE KS OK WI IA IL MO AR MS MI IN KY TN AL OH GA NY PA WV VA NC SC NJ DE MD RI CT NH VT MA TX LA HI FL States with CONFIRMED Sleeve Coverage from their MAC States with DRAFT Sleeve Coverage from their MAC States with NO Sleeve Coverage Note: The Center for Medicare and Medicaid Services decided on June 27, 2012 to defer Medicare s coverage decision making for Sleeve Gastrectomy to the regional Medicare Administrative Contractors (MACs).
11 AK Sleeve Gastrectomy Coverage by Medicare Administrative Contractors (MACs) (as of February 18, 2014) WA MT ND MN ME OR CA NV ID UT AZ WY CO NM SD NE KS OK WI IA IL MO AR MS MI IN KY TN AL OH GA NY PA WV VA NC SC NJ DE MD RI CT NH VT MA DC TX LA HI FL States with CONFIRMED Sleeve Coverage from their MACs Coverage current as of 2/18/14; coverage may have changed since this printing
12 Collaborative Position Statements American Hip and Knee Society National Lipid Association American College of Obstetrics and Gynecology American College of Occupational and Environmental Medicine American Hernia Society American Society for Clinical Oncology
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14 COMPENSATED HEART FAILURE
15 ULTIMATE PRE-HAB SWIFT TRIAL- Mutual Meetings
16 Employers Joint session- New Orleans 2018
17 Diffusion
18 Challenges
19 ASMBS /NORC Survey 83% of Americans report that obesity is a very serious health problem Obesity and cancer tie as the top 2 most often cited serious health problems Four in 10 Americans who meet the BMI criteria for obesity have not talked with a doctor or health professional about their weight
20 Long-Term Follow Up Churn Rate National Migration Payor Demands Increase Confidence for Patients Optimize Care for Providers
21 1-5 with 1 low confidence and 5 high confidence Benefit Outweighs Harm Short Term 3.69 Mid-Term 3.15
22 What s Next EMR Patient Reported Outcomes Biometric Scale Telemedicine
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24 OPPORTUNITIES
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26 OBESITY INSTITUTE WHITE PAPERS TEACH-INS SUMMITS WEB SITE LEARNING ACADEMY ADVOCACY
27 EXTENDING CONFIDENCE
28 BARIATRIC SURGERY: AMERICAN SURGICAL SUCCESS STORY 4.5 Bariatric Surgery In-hospital Mortality by Year (N = 105,287) Deaths per 1, Year Nguyen et al. SOARD 2012
29 Does hospital accreditation impact bariatric surgery safety? John Morton 1, MD, MPH, FACS, FASMBS Trit Garg 1, BA Ninh T. Nguyen 2, MD, FACS, FASMBS 1 Stanford University 2 University of California, Irvine 134 th Annual Meeting of the American Surgical Association
30 In-Patient Outcomes Morton, Ann Surg 2014 Unaccredited Accredited P value Total charges (mean), $ Any complication, % 51,189 42,212 < Mortality, % FTR, % Abbreviations: FTR, failure to rescue
31
32 MBSAQIP Accreditation Required Blue Cross Centers of Distinction Aetna Institutes of Quality United/Optum Centers of Excellence Cigna Bariatric Centers of Excellence
33 SAR Summary Data for Cases in CY day Mortality Snapshot All Cases Number of Sites Total Cases Death Cases Mortality Rate (%) Mean Site Mortality Rate (%) Day Morbidity LSG: Leak,0.22% ; SSI, 0.32% LRNYGB: Leak,0.32% ; SSI, 1.35%
34 Any Readmission By Quarter DROP 128 HOSPITALS Readmission Rates by Quarter LSG Quarter Cases Rate % Change P Readmission Rate All LSG Pre Pre Quarter
35 MEDICAL WEIGHT LOSS MBSAQIP STANDARDS
36 MBSAQIP STANDARDS
37
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