ASMBS News and Update—March 2012

by Robin L. Blackstone, MD, FACS, FASMBS

Dr. Blackstone is President of the American Society for Metabolic and Bariatric Surgery and Medical Director, Scottsdale Healthcare Bariatric Center, Scottsdale, Arizona

We are Aligned and Poised for Great Success

On March 7, 2012 the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) signed a memorandum of agreement creating a unified metabolic and bariatric surgery accreditation and quality improvement program. The creation of this new program marks a turning point for us as a society, and perhaps even more importantly, for patients seeking access to the most effective long-term treatment for obesity.

Together, the ASMBS and ACS will be better positioned to meet the needs of its members and to continuously improve quality and access to care in ways that neither organization can do alone.

Our goal is to decrease morbidity from metabolic surgery by 50 percent over the next five years; to have an inclusive, value-based program that improves patient safety, decreases cost of care, improves access to care, and has 100-percent participation from every surgeon providing metabolic and bariatric surgery as part of their practice whether they practice in the Unites States or abroad. This new paradigm in bariatric quality is strengthened by the long history and effort by the ACS in administering the general surgery National Surgical Quality Improvement Program (NSQIP), trauma, and oncology programs. To view a YouTube video from ACS on quality, visit http://www.youtube.com/watch?v=z35Gb1lNHNU&feature=youtu.be

The move to unify our programs and create a joint accreditation standard was extensively discussed and deliberated upon for more than two years via meetings, town halls, e-mails, and phone calls. Members were overwhelmingly supportive throughout the process. A survey conducted in March 2010 showed nearly 3 out of 4 members (71% with 581 respondents) favored the merger of our centers of excellence programs, while less than 10 percent objected to it. Nearly 20 percent of members surveyed were neutral.

The joint program will be implemented using the current volume-based accreditation standards of both societies. Joint committees made up of the members of the standing bariatric committees of the ASMBS and ACS will control the content of the new joint program and the new proposals for outcome-based standards and credentialing will receive their final vetting through these committees.

All programs will share a joint data collection registry that will be enhanced to provide exceptional functionality and reporting to support the development of local quality improvement efforts through national, state, and local collaboratives. Provisional centers will be able to qualify based on the current volume standards until new outcomes standards are established.

The Big Picture
Over the last few years, our society has undertaken major changes that have increased transparency in decision making, improved patient outcomes and access, forged new relationships among our peers both medical and surgical, and set a course for continuous quality improvement in our discipline.

One of the strong themes of the 2011–2012 presidency has been to align our committee work and subsequent actions with the strategic objectives that were defined by our society in the strategic plan. The vision of the ASMBS is to improve public health and well being by lessening the burden of the disease of obesity and related diseases throughout the world. It is the application of this vision to our daily surgical practices and actions of the society where the rubber meets the road. At the end of the day, quality must take place at the bedside between the surgeon, integrated health team, and patient. The unification of the ACS and ASMBS quality programs establishes a strong foundation upon which to further one of the most important goals of the society.

Upcoming Events on Quality
In order to take advantage of the new paradigm of quality please plan to join us for these educational events at the ASMBS annual meeting June 17 to 21, 2012, in San Diego, California.

Sunday, June 17, 2012—Quality Improvement Workshop, the Nuts and Bolts (free to all registered participants)

Monday, June 18, 2012—Metabolic and Bariatric Surgery Accreditation and Quality Collaboratives: the Next Level of Excellence Course Director: Robin Blackstone, MD, and William Inabnit, MD

Wednesday June 19, 2012—ASMBS Town Hall Meeting with President Robin Blackstone includes: Update on the new National Institute of Health Guidelines (Bruce Wolfe, MD, past president of ASMBS and the only surgeon panel member of the Guidelines taskforce) and A new Direction in Metabolic and Bariatric Surgery Accreditation and Quality

Friday, June 21, 2012—ASMBS National Collaborative Process Improvement and Outcomes from Bariatric Outcomes Longitudinal Database (BOLD) data (All Program Coordinators and Surgeon Medical Directors invited to attend)

Advancing the Science and Understanding of Metabolic Surgery
At the ASMBS annual meeting in June, a number of symposia and courses will offer new and important information in the understanding of the biology of obesity and the way in which metabolic and bariatric surgery acts on a neurohormonal basis to correct these basic biological flaws. As we continue to advance our advocacy agenda in an era of cost cutting measures by government and state based insurance plans, it is more important than ever that our colleagues and the public begin to understand that obesity has defined neurobiological defects and that these problems result in increased incidence of type 2 diabetes mellitus (T2DM) but also cancer and heart disease. At a recent meeting of the Arizona cardiologists, a presentation about surgery actually highlights these neurobiological changes.

We need to incorporate into our communication with patients, colleagues, and payors that bariatric surgery can work through weight-dependent mechanisms, but the most successful weight loss and obesity-related disease remission occur with procedures that also have weight-independent effects.

Restriction of caloric intake is less about the mechanical obstruction offered by any operation than it is about the fundamental change in the signaling to and from the brain that governs how much food you eat. These critical changes in our fundamental paradigm explaining how what we do for patients’ works is critical for the metabolic and bariatric surgeon practicing in 2012. To access the slide presentation given to the Arizona Cardiology group please go to http://bit.ly/cv-presentation

Fostering Communication Between Health Professionals on Obesity and Related Conditions
Education of our primary care colleagues remains a key challenge to all surgeons practicing in this field. Gaining the confidence of our colleagues that our procedures have an important role in providing long-term care in this population is important.

As we review the various registries in bariatric surgery, it becomes apparent that long-term follow up is poor, not because surgeons are unwilling to follow their patients, but because patients simply do not return. Perhaps the most eloquent discussion of this was in the recent paper by Dr. Kelvin Higa, Past President of ASMBS, on the 10-year follow up of patients in his practice.1 Clearly other strategies are necessary.

Employing new strategies to get this data will be necessary. Some ideas are to link clinical and administrative databases (from payors) to determine long-term outcomes. Another long-term strategy is to establish a MEDICAL MODEL FOR OBESITY TREATMENT by partnering with our colleagues at The Obesity Society (TOS). The ASMBS has supported efforts by TOS to establish a certification exam in the field of bariatric medicine that will be given for the first time later in 2012. In addition, we have agreed to hold our meetings in conjunction with each other to foster the multidisciplinary collaboration that we will enhance our undertanding of this field. I would encourage each of you to begin, if you have not already done so, to give CME-based educational events to your primary care colleagues, if possible through established meetings where they are gathered.

Being the Recognized Authority and Resource on Metabolic and Bariatric Surgery
Since 2005, the ASMBS has employed a public relations firm to help us become a recognized authority in metabolic and bariatric surgery. While controversial at the time, the help of Roger Kissin and Communication Partners and Associates (New York, New York) have proven invaluable. Last year alone, ASMBS was featured in news stories on television, radio, newspapers, the web, and social media that have reached an audience of over 800 million.

Every year key abstracts are highlighted at the annual meeting, and news releases are created featuring commentary from both the authors and knowledgeable peers. News coverage from last year’s meeting resulted in more than 225 million media impressions. We are currently preparing our media efforts for this year’s meeting.

In addition, the message tracks for major themes within our specialty were reviewed and revised and media training was provided during the fall event for the Executive Council, Chairs, Co-Chairs, and State Chapter Presidents. ASMBS delivers these core messages proactively in news articles throughout the year, and we respond with them when any major article is published. We have become a trusted source for the news media as our visibility as a society has grown.

As important as this effort is, the Communications Committee, led by Dr. Kevin Reavis, and Public Education Committee, led by Dr. Keith Kim, are also working hard to debut a PUBLIC PORTAL that will drive patients to approved content when they have questions and provide information on society members doing metabolic and bariatric surgery in their area. We are currently working on an overall strategic plan for our social media and web presence that will provide a platform for ASMBS to enter the digital era in a more impactful way for our members and the public. The society realizes the value of social media in the future of fulfilling this particular goal and is moving to take advantage in an appropriate way of the opportunities. This will mark the first time that our website has become a valued resource not only for our membership and for our patients. The Executive Council believes this is directly in line with our stated goal.

Advocating for Health Care Policy that Ensures Patient Access to High Quality Prevention and Treatment of Obesity
A tireless effort led by Dr. John Morton and colleagues on the Access to Care Committee in partnership with the Obesity Action Coalition, led by Joe Nadglowski, and in collaboration with TOS has resulted in a reversal of adverse coverage decisions over the last year in venues across the United States. Our battle, however, is not over and the next few years will be pivotal. We now understand the Essential Health Benefit, the key to universal coverage in individual and small employer groups, is going to be determined on a state-by-state basis. As such, we are mounting a new strategy—the “Four Musketeers” strategy using ASMBS members surgeon and integrated health advocates; TOS/American Society of Bariatric Physicians (ASBP) members; and the OAC (including patients) working together through our current state chapters in the fight for inclusion in essential benefits, which will serve as the plan sold in each state’s healthcare exchange. At first glance, it looks like we may have a chance; the new state essential benefit coverage plan will be based on the coverage of one of the top three insurance plans providing coverage to small employer groups, the state employee plans in each state, or Medicaid in each state. Currently, we have coverage in about 90 percent of the state employee and Medicaid plans, but because the public and private insurers still do not understand that obesity is not a matter of personal choice, the private plans are more problematic. The bias and discrimination that exists against coverage will continue to be a key factor in this battle. Dr. Bruce Wolfe, Past President of ASMBS, gave an eloquent discussion of this topic at the recent Minimally Invasive Surgery Symposium (MISS) in Salt Lake City, Utah. To view this presentation please go to http://bit.ly/miss-salt-lake-city

Being a Highly Valued Specialty Society that Serves the Educational and Professional Needs of our Diverse Membership
ELECTIONS: Two years ago, in the context of the elections for officers of ASMBS, changes in the bylaws were made that would promote greater access to nominations and promotion of surgeons who had demonstrated leadership and service to the society onto the Executive Council. This year, we have a number of excellent candidates who are eligible to serve on the council.

We invite you to submit nominations for the upcoming vacant position for President-Elect and two positions for Member-at-Large on the ASMBS Executive Council. According to ASMBS Nominations and Elections Process, voting members (regular members) have the opportunity to nominate other voting members to fill vacant positions: Any voting member in good standing may nominate any other voting member in good standing who appears to meet the stated qualifications by submitting an electronic nomination setting forth the name of the nominee and the position being nominated. Please review the Submission Process and other information provided here and submit your nominee(s). The Nominating Committee will accept nominations through March 30, 2012.

ASMBS Providing VALUE to the Membership
Returning value to the membership has been a central theme of the efforts of leadership over the last two years. Re-aligning our committee structure has resulted in increased productivity from the committees. Committees are increasing focused on things that will enhance value to our membership. Be sure to obtain a copy of the ASMBS annual report (it can be downloaded after the annual meeting in June).

Last year, we changed the rotation of the committees to correspond to the annual calendar, so we have a few committee chairs rotating to position as immediate past chair (still remaining on the committee). I want to personally thank Dr. Samar Mattar for his leadership on the Bariatric Training Committee; he led the society to establish a bariatric fellowship certificate that is now a coveted acquisition of fellows in minimally invasive surgery and is based on completion of a didactic course of study as well as adequate clinical experience. Dr. Scott Shikora replaces him as the Chair of that committee; Dr. Alfons Pomp was selected by the committee as Co-Chair.

In addition Dr. Jaime Ponce provided great insight and made some critical coding changes that allowed the sleeve procedure to be mapped to the correct codes and conducted a course on coding and physician reimbursement that has been very popular. He becomes Past Chair on the Insurance committee, and Dr. Matthew Brengeman becomes Chair with Dr. Paresh Shah as Co-Chair. Dr. David Tichansky has headed up the membership committee, leading the society to achieve a consistent five percent per year growth and enhancing the ability for the ASBMS to have an increasing presence among international surgeons. He is rotating to Past Chair and is replaced by Dr. Samuel Szomstein with Dr. John Kelly as the Co-Chair.

Again, I thank these individuals for their commitment to service within the ASMBS and look forward to their continued leadership in the society.

In other committee news, the ASMBS Clinical Issues Committee, led by Dr. Stacy Brethauer, has put forward important ASMBS statements including one on preoperative weight loss that had a major influence in the decision by Health Care Service Corporation (HCSC [Blue Cross/Blue Shield of Texas, Illinois, Oklahoma and New Mexico]) to drop this requirement in their medical policy.

One of the examples of trying to provide value to membership needs comes from two important questions that arose from the society this year. Dr. Teresa McMasters asked if we could survey the membership about the compensation and construct of medical directorships around the country in bariatric surgery.

A bariatric surgeon compensation survey has been posted online in the ASMBS Newsletter, Five on the Fifth, and the results will be available to all members on our website to help in the negotiation of their Relative Value Units (RVUs)/contract structure. For integrated health teams, the most common need for salary information was for the position of bariatric coordinator. A similar survey will be available for this position in April 2012.

Also of note, call from Indiana about problems with education of general surgeons in community practice, especially with bariatric surgery emergencies, has resulted in the addition of courses on this topic at the annual SAGES and ACS meetings. At SAGES, the Bariatric Liaison committee discussed the topic of education of general surgeons in community practice and called for a joint statement from surgical societies on this topic.

All committees of the ASMBS are now completely oriented to providing value to our membership.
If there is some way in which the society can enhance the value of your membership in ASMBS, please email me at [email protected]

Conclusion
Metabolic and bariatric surgery has taken its place in American surgery. In the last few years, the ASMBS leadership has not flinched from making the necessary changes that will allow our society to lead in the safe treatment of patients affected by metabolic disease and obesity. In our upcoming annual meeting, you will be able to learn about these new approaches and participate in moving our specialty forward. The society is aligned around our vision and goals and poised to lead our specialty into the future.

References
1.    Higa K, Ho T, Tercero F, Yunus T, Boone KB. Laparoscopic Roux-en-Y gastric bypass: 10-year follow-up. Surg Obes Relat Dis. 2011;7(4):516–525. Epub 2010 Nov 26.

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Category: ASMBS News and Update, Past Articles