Deaconess Surgical Weight Loss Center of Excellence

| May 9, 2008

Deaconess Surgical Weight Loss Center of Excellence is in Cincinnati, Ohio.

Describe your bariatric facility.
Our center was designed for the bariatric patient. Our furniture is scaled for the person dealing with excess weight, and our toilets are floor mounted for added safety. Our hospital gowns, exam tables, pressure cuffs, and other clinical equipment are specifically for bariatric patients. Our scale is a bariatric scale what weighs up to 800 pounds. The operating room and radiology equipment at Deaconess also can accommodate patients with excess weight.
When the hospital was renovated two years ago, a great deal of thought went into the furnishings. Care was taken to ensure that our bariatric patients would be accommodated for center appointments and the hospital stay, from the registration area to the rooms themselves. The furniture is covered in the same fabric as the furniture for non-bariatric patients so that the pieces are just part of the natural décor.

What is the number of patients treated on an annual basis at your facility?
In 2006, the Deaconess Surgical Weight Loss Center of Excellence served 335 patients. This year we are on track to serve between 250 to 300. The average age of our patients is 46 and almost 90 percent are female.

Did you find it difficult going through the process of attaining the ASMBS SRC Center of Excellence certification designations? Also, do you find that potential patients ask if you are certified for either of these prior to coming in for a meeting?

The process of attaining the ASMBS SRC Center of Excellence designation was not particularly difficult. Many of the key components, such as a dedicated center, staff, and patient education, were already in place. In addition, the process is very structured and direct about what is required. It was a matter of fitting all of the existing pieces together. The patients who did ask about our COE status were mostly Medicare patients.

How do you handle patient compliance?
Patient compliance is a very important part of our multidisciplinary program. Our patients sign a contract with us. We feel that they are accountable for their own success, which includes post-surgical follow-up visits. In addition, continued dietary counseling with our dietitian as well as our twice monthly support group sessions help our patients remain compliant with their nutrition and exercise regimens.
We follow our patient’s progress through an electronic medical record. This has built-in notifiers, which let us know when patients have missed their appointments.

The biggest complication occurs when patients change insurance providers. Many insurance companies will not cover follow-up visits after bariatric surgery if coverage does not exist for weight loss surgery. So, when the new insurance company fails to cover post-bariatric surgery visits, we often lose a patient’s follow-up care. We try to stay in touch with them via mail or e-mail.

Please give a general synopsis of how your patients are treated while under the care of your center, including patient education and HIPAA compliance.
Patient education is fundamental and essential to the success of our surgical weight loss Center of Excellence. Our patients start with an hour-long informational seminar that is free to the public. We offer these seminars twice monthly in an effort to educate the public about bariatric surgery. Our surgeons are the presenters, so potential patients not only hear the information firsthand, but also learn about the physician who will be treating them. Then patients participate in preoperative education with our physician, nurse practitioner, insurance coordinator, and dietitian at their first visit to the clinic. We feel that knowledge and understanding of the new diet and nutrition components after bariatric surgery are keys to success.

However, patient education does not stop there. Education regarding activity, pain management, and prevention of complications is also done preoperatively as well as during hospitalization. At each office visit, patients visit with each of the team members to develop a high comfort level with team members and to be sure that all questions are answered, whenever they may arise. In addition to regular visits before and after surgery, we strongly encourage both our preoperative and postoperative patients to participate in the twice-monthly support group, led by our dietitian.

During their hospitalization, patients stay in a designated unit of the hospital, where staff are specifically trained to meet this patient group’s special needs.

To protect their HIPAA rights, patients are given notice of our privacy practices at their first contact with Deaconess Hospital as a patient. All patient information for all of our patients, not just bariatric patients, is considered and treated as confidential.

How is inventory managed in your facility? Who handles the purchasing of equipment and supplies?
Similar to other areas of the hospital, our purchasing is done through the Deaconess Purchasing Department. The center staff had direct input in choosing the design of furniture. The surgeons evaluated the exam tables and the clinical equipment being considered. Even the chairs for our seminars room were a special purchase. The chairs are made of flex steel and hold 700 pounds. Half have arms and half do not.

How do you perform patient assessment to determine who is appropriate for surgery?
Each patient is individually assessed by the bariatric surgeon. The patient completes an extensive questionnaire to capture any potentially high-risk comorbidities. While other practices may use physician extenders, we feel strongly that the surgeon is the appropriate team member to quickly and efficiently identify comorbidities that will increase risk for surgery. After this visit, careful review of the patient’s preoperative workup and psychological evaluation completes the assessment for clearance for
surgery.

How has managed care affected your facility and the care that it provides patients?
As most local doctors will admit, Cincinnati’s reimbursement rates are among the lowest in the country—often very near or below cost. We operate in a Fortune 500 city, and reimbursements here are substantially lower than Dayton, Columbus, or Indianapolis, just two hours away. Ultimately, the employer determines if bariatric coverage is offered. In Cincinnati, two patients may both have the same insurance company from different employers, and one is covered and the other is not. Some payers would like to see bariatrics be an outpatient service, but it remains to be seen if this is the safest choice for the patient. We think not. An eight-hour stay does not allow enough time for complications to be detected. Of course, outpatient surgical fees usually do not even cover costs. It is problematic all the way around. Midterm managed care contracts may not be renegotiable. The bariatric champions must constantly monitor faltering reimbursement levels.

What measures has your facility implemented in order to cut or contain costs and improve efficiency?
Admittedly, this is a continual struggle. Of course, we scrutinize OR supplies and center supplies. We are quick to change when something does not seem to be working. But the patient’s health and safety always come first. We are careful to never compromise on that pivotal point.

How does your facility deal with the issue of patient safety and staff safety?
Furniture, stretchers, and X-ray tables are marked with “Extended Capacity” yellow tape that includes the label “EC pounds/kg,” which alerts staff as to the safety guidelines they should enact for weight awareness. Patients are also oriented to watch for yellow EC labels on furnishings. Hoverjack and Hovermat equipment is available for safe lifting, and all staff are taught its use upon employment. In addition, staff are also educated in body mechanics and lifting techniques.

How are employees oriented and trained for working with the bariatric patient?
All employees at our surgical weight loss center, as well as our hospital employees, participate in bariatric sensitivity training. Also, each of our surgeons participates in routine scheduled in-service talks for hospital staff, addressing the varied issues of importance that relate to the successful outcome for bariatric patients.

Upon employment, all hospital staff attend general orientation where patient safety, lifting, and cultural sensitivity are taught. Staff who will be caring for bariatric patients also complete a regular clinical orientation in addition to patient care modules that are specific to the care of this patient group. An annual review of care specific to the bariatric patient is held in the spring as well.

What trends do you see emerging—including new technologies as well as what patients seem to be looking for?
It is very clear that patients are interested in success. They want to specifically know the range of weight loss for bariatric procedures performed at our Center of Excellence. They are always asking for the least invasive procedure that will allow them to return to their normal life as quickly as possible. Increasingly, they seem to be aware that in order to achieve success, they have to follow the rules. They have to be compliant. And for that, they need a true center, with all of the support a center can bring.

Are there new technologies or equipment you would like to see utilized in your facility?
Deaconess Hospital has made certain that we have all equipment necessary to address the needs of bariatric patient. We have already instituted the use of sleeve gastrectomy as another tool to treat obesity. We are looking forward to the release of the gastric stimulator and the intragastric balloon. We stay on the cutting edge so that we can offer patients a variety of options.

How do you feel about your patients?
Most of our patients have a long history of failed dieting attempts and multiple comorbidities. People have lost marriages, jobs, and friendships because of weight issues. We’ve had couples have their surgeries one week apart. The coach concept is one we foster, and a spouse is often the coach. We’ve also had brothers, husbands, and mothers come to seminars to learn about this surgery and then go home and convince their loved ones to have surgery. This is a population that has been ignored and treated badly most of their lives so they tread carefully until they know they are safe and supported. The Deaconess Center of Excellence also performs revisions for patients who have problems with surgery done elsewhere, perhaps in another country. Our surgeons are at a skill level where they have seen everything and can handle anything with tested expertise and great compassion.

What makes your facility unique?
Deaconess Hospital has identified weight loss surgery as a niche service line. It has dedicated a substantial portion of its resources to providing the best care in our community for the bariatric patient. We also have a dedicated medical/nutrition program that is available for patients who are not ready for bariatric surgery.

Our bariatric surgery team encounters the prospective patient many times along the way in his or her course preparing for surgery. This allows every team member to pick up on important nuances that could derail the patient’s successful path to surgery. With all our team members directly involved in every step, we can act immediately on patients’ urgent needs.

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Category: Bariatric Center Spotlight, Past Articles

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