Spotlight on the Bariatric Medical Institute of Texas

| September 21, 2010

Spotlight on the Bariatric Medical Institute of Texas
San Antonio, Texas


by Melinda Hart

Melinda Hart is part of the marketing team at Bariatric Medical Institute of Texas, San Antonio, Texas.

Bariatric Times. 2010;7(9)22–25

Welcome to the Bariatric Medical Institute of Texas
Deep in the heart of Texas you will find San Antonio, which regularly ranks as one of the cities in the United States with the highest rate of obesity.[1] A talented group of surgeons and medical staff is working hard to change this at their comprehensive and efficient bariatric surgery center—one patient at a time. The expert team at the Bariatric Medical Institute of Texas (BMI of Texas) is led by bariatric surgeons and co-founders Dr. Terive Duperier and Dr. Michael Seger. The doctors have invested heavily in a highly trained and skilled patient support team, which also includes Dr. Jennifer Seger, who practices medical weight management and family medicine.

Physician assistant Melinda Verduzco is focused on patient education and helping patients feel more comfortable as they go through the surgical process and beyond on their weight loss journey. Dietitian Jennifer Bowling is skilled at designing the right nutrition program for each patient. Every patient is different and Ms. Bowling works with patients to maximize their weight loss both in the preoperative and postoperative phases of their weight loss journey. Ms. Bowling is an integral member of the team, and patients start working with her at their initial evaluation—learning from her before surgery, while they are in the hospital, and of course, after surgery. There are many variations and nuances to the diet plans associated with the various surgeries. Vitamin and micronutrient levels are carefully monitored by the BMI of Texas team to ensure patients are receiving adequate nutrition.

Office manager Sherry Dwyer keeps the entire team running smoothly, as our patient liaisons, insurance and financing specialists, and talented staff help patients navigate the often confusing path through the insurance process on their journey from the initial educational seminar to surgery. The BMI of Texas team comprises 14 individuals, all of whom have extensive bariatric surgery experience, including laparoscopic gastric bypass, sleeve gastrectomy, adjustable gastric banding, and revision weight loss surgeries, such as banding over a bypass and Stomaphyx. The surgeons also perform general surgery. Each patient is treated as an individual from meeting with their surgeon to discussing which procedure is the most appropriate to working with the BMI of Texas dietitian to create a custom nutrition plan and working with his or her assigned patient advocate to ensure all the appropriate pre-and postoperative tests are performed and necessary paperwork compiled and filed.

A State-of-the-Art Facility
BMI of Texas was designed from the ground up to meet the needs of bariatric surgery patients. From the moment patients enter our doors, they are comfortable and appreciative of the planning that went into the design of our facility. Before attending an educational seminar, patients are encouraged to download all the necessary forms and paperwork from the practice’s website so we can begin collecting the appropriate information and medical test results—saving patients a significant amount of time in the waiting room. We created an online portal where they can upload documents and enter their medical history before they even get to our office. This expedites their appointments and increases the accuracy of the medical information they provide to us. Our waiting room is equipped with furniture designed for patients with obesity and their friends and family who may accompany them to offer support.

One of the most unique aspects of our practice is that we are one of the few practices in the nation that performs fluoroscopic-assisted band adjustments in the office. We have been doing fluoroscopic adjustments for years; however, in the last 16 months we have incorporated this technology into our office setting to maximize patient satisfaction by reducing the amount of time patients spend in the doctor’s office.

Our office is completely electronic. We have invested in electronic medical records (EMR) technology so we can access patient information at any time and from any place. Our EMR is also Bariatric Outcomes Longitudinal Database (BOLD) compatible and all patient encounters are immediately uploaded to Surgical Review Corp. (SRC)/BOLD by the surgeons and the physician assistant (PA) while the patient is in the exam room. Our compliance with BOLD is now an afterthought.

We perform many of our procedures at Foundation Surgical Hospital of San Antonio, Texas, (conveniently located close to our office), which was designed with bariatric patients in mind. The campus includes a clinic, sleep lab, seminar room, and a 2,000-square-foot workout facility with a laminar flow pool. This allows our bariatric patients to access everything they need on one convenient medical campus. We have 20 private patient suites with separate sitting areas and sofas for families and visitors; spacious hospital beds designed for bariatric patients; private, oversized tiled bathrooms with shower; flat screen TV; free Wi-Fi; and floor-to-ceiling windows.

The surgical facilities at Foundation Surgical Hospital of San Antonio include four state-of-the-art operating suites; high definition (HD) technology on all operating room monitors; the newest multi-place hyperbaric chamber in San Antonio; an in-house laboratory and imaging facility; and solid-walled preoperative areas (unlike traditional curtain-divided areas).
As part of the BMI of Texas program, we give each patient a three-month membership to the fitness center located at Foundation Surgical Hospital. The fitness center was designed specifically for bariatric patients; all the gym equipment is built for bariatric patients and the physiologists are trained in working with bariatric patients. The fitness center also includes an aquatic pool for water exercise including an underwater treadmill.

Patient Demographics
We will perform approximately 400 primary weight loss surgeries in 2010. We also do a number of revisional surgeries and endoscopic procedures, including endolumenal revision surgery. We perform approximately 2,500 fluoroscopic-guided band adjustments each year in our office.

Proud to be an SRC Center of Excellence
The Center of Excellence (COE) process was not hard, but it certainly was time consuming for us here at BMI of Texas. We have not had potential patients ask if we are certified, but we have the information displayed prominently on our website and in our office, and with our state-of-the-art EMR system, the COE process will not be an issue going forward. We are compliant and always up to date with every patient encounter.

Committed to Patient Adherence
Patient adherence is very important and it is something in which we have invested because we believe so strongly in its impact on our patients’ weight loss success. We realize that when patients do not follow up, they are more likely to be less satisfied with their weight loss results. It is imperative that they make and continue to follow lifestyle changes in order to reap the maximum benefits of their surgery.

We send each patient a card on the anniversary of their surgery, reminding them that it is time to come in for an annual check up. We distribute a quarterly patient-focused newsletter composed by our dietitian with healthy eating tips and recipes. The newsletter also includes health information and updates, as well as news from our practice and support group updates. We sponsor a support group that meets monthly and a message board on our website where patients share success stories, recipes, insurance advice, and much more. We offer classes where we teach our patients tips on living their lives after surgery. These sessions are recorded and can be accessed via our website for all patients to enjoy. We were the lead sponsor for the San Antonio Walk From Obesity in 2009 and sponsored a team that participated in the walk. We were extremely proud of the turnout from our patients. Our race was ranked the number three fundraiser in the nation and we had the largest number of participants out of all the races across the country.

We are committed to continually making improvements in our postoperative support program to meet the needs of our patients and their families. For example, we recently provided a cooking demonstration given by a former bariatric patient and chef, which was extremely well received.

The biggest obstacle our patients face is the lifestyle so many Americans are accustomed to living. We live in a fast-paced, on-the-go, immediate-gratification society, but in order to be successful our patients must learn to take time to exercise, slow down, make better food choices in order to eat healthier, and to maintain strong willpower to restrain themselves from the many temptations we are continually bombarded by in today’s society.

Importance of Patient Education
Patient education is vital to the patient’s long-term weight loss success and we provide multiple outlets for educating our patients before and after surgery. For example, our patients meet with our dietitian at the very onset of the program—well before their surgery —to discuss the changes they will need to make. We provide them with a three-month gym membership so they can begin working out in an environment where they are comfortable and have access to fitness specialists who are experienced in assisting pre- and postoperative bariatric patients.
We provide each patient with a booklet we developed about the bariatric surgery process, which includes an overview of all the procedures we perform, FAQs, meal recommendations, and much more. Part of our presurgery assessment is a psychological evaluation to ensure that our patients understand the life-changing adjustments they will have to make in order for their surgery to be successful.

Additionally, our psychologists help the patients to identify patterns of behavior or mood disorders, such as depression and anxiety, which may have contributed to their weight gain. The psychologists, as well as Dr. Seger, are then able to make recommendations on ways patients can address these problems and avoid repeating these behaviors in the future.
We encourage our patients to attend our monthly support group meetings, provide them with quarterly newsletters, and ask them to fill out a comment card after every appointment. We believe that ongoing, honest feedback from our patients is one of the best ways for us to understand how we are doing and to improve our services.

Cutting-Edge Technology
Dr. Seger aided in the development of Ethicon EndoSurgery’s REALIZE adjustable gastric band. He has served as a national proctor, teaching other bariatric surgeons how to use the REALIZE band, since 2007. As a result of this experience, Dr. Seger and Dr. Duperier now teach other bariatric surgeons from all over the United States how to optimally perform REALIZE Band adjustments. They provide feedback to Ethicon on how they utilize the band and future versions of the band will include some of their suggestions. In addition, the use of fluoroscopic guidance in the office to manage band patients has been an enormously successful tool for engaging band patients to maximize the benefits of their band. Being able to watch their band being filled helps connect the triad of satiety, portion control, and head hunger. Patients end up losing more weight with fewer band fills because each band fill is tailored to the patient. As a result of our success with this, Ethicon now supports twice monthly band fill preceptorships at our office in San Antonio where we teach practices located throughout the United States how to run a successful band clinic.

Also, the use of the Raintree EMR technology has made the office much more efficient on all levels. It is now second nature for us to be able to perform BOLD submissions, which in many practices requires extra employees for data entry or it becomes a big distraction and time waster for the office’s bariatric nurses or coordinators. Utilizing the system has put us in the position that we can be inspected by SRC at ANY time and not worry about the inspection process.

Patient Assessment
Choosing weight loss surgery is a very personal decision. Drs. Seger and Duperier are experienced with the three mainstream weight loss surgery operations: 1) the laparoscopic gastric bypass, 2) adjustable gastric band, and 3) sleeve gastrectomy procedures. They regularly perform revisions, and Dr. Seger also performs the Stomaphyx procedure. Some patients are better candidates for one procedure versus another, but oftentimes the most important factor in determining long-term success is the patient. In our practice, since we are trained in performing all the operations, we feel that the different operations are really personality decisions and we want the decision to be made by the patient after hearing all the information delivered in a nonbiased fashion.

The surgeons encourage patients to attend a free educational seminar (conducted by a surgeon) to learn about the different kinds of procedures, and perhaps go to a support group as well, before making a decision. Patient selection is made based on the patient’s body mass index (BMI) and comorbidities. Most people with BMIs greater than 40 are ideal candidates for surgery, but someone may be a candidate if their BMI is greater than 35 and they are suffering from sleep apnea, diabetes, and/or hypertension. Our patients also go through a rigorous presurgery psychological evalution to ensure that they are aware of the lifestyle changes that will be necessary in order for their surgery to achieve success.

The Effect of Managed Care
Managed care is a continual challenge. New legislations require us to jump through new hoops and understand the new laws, which decreases the amount of time we have to care for our patients. It is also frustrating to run into an insurance situation with limits and maximum amounts, e.g., if a patient had a procedure years ago, which is no longer considered “standard care,” then he or she may not qualify for revision surgery because of financial restraints from the insurance company. It sometimes feels like managed care is more about the bottom line than it is about patient care, and as a healthcare facility, that is frustrating.

Focus on Efficiency
Embracing technology has enabled us to be much more efficient. When we launched our practice, investing in a robust EMR was one of our top priorities. It has enabled us to gather and review patient data electronically, and it also helps our office staff be much more efficient with scheduling and ongoing patient communication. We distribute a patient newsletter electronically, as well, to provide our patients with news and information and to remind them to come back at least annually for a check-up.

Dedicated to Employee Training
Many of our patients have experienced prejudice about their weight for a very long time. And oftentimes the numerous comorbidities they are suffering from make them very uncomfortable. All of our employees participate in a comprehensive sensitivity training program to ensure that they understand the challenges our patient population faces so that they can provide the best customer service possible. We understand our patients’ frustration and pain and want to help them overcome these challenges.

Emerging Trends
EMRs and the ability to communicate electronically with our patients is an improvement. With EMRs, we can collect information from our patients before they come into the office and we can access their data from anywhere. We encourage our patients to share their success stories with us—and others—via our Facebook site. Nothing makes us prouder than looking at the healthier lives our patients are living—going on airplane trips, visiting theme parks and sports arenas—it’s thrilling to see their results.

A Most Interesting Case
In 2009, Dr.Seger was approached by a woman with obesity who was suffering miserably from severe and debilitating headaches that were the direct result of her pseudotumor cerebri. As a result, she was unable to participate in her children’s activities and her quality of life was compromised. The only way to relieve her suffering was to pack her head in ice. She eventually developed hydrocephalus (in addition to the pseudotumor cerebri) and required a brain shunt to drain the fluid. She initially sought care on base as she was part of a military family, but several neurosurgeons told her that they could not help. She could not get authorized to seek care off base—she became depressed and started eating for comfort. Before long, she weighed 254 pounds, wore a size 24, and developed high blood pressure. Our BMI of Texas team learned of her situation, sprung into action, and began to work through the necessary channels. Dr. Seger recommended the gastric bypass procedure and it was the turning point the patient had been seeking. She had surgery in July 2009 and has lost 100 lbs, wears a size 16, and is still losing weight. Her cerebral shunt has been turned down from 120mL to 90mL and she is going into remission. Her head no longer hurts, she is off her blood pressure medicine, and says she feels like she is living a normal life for the first time in 12 years. She is no longer in pain or suffering from nausea and dizzy spells. Our patient is now living the life she always hoped she would.

A Unique Facility
When we co-founded BMI of Texas, we knew we could provide the best patient care if we had the right team and created a great place to work. Employees are the biggest asset we have and the office is run from the “bottom up.” We were determined to make an environment where our staff enjoyed coming to work and where they felt empowered to be able to influence us and help the patients. We believe this is what separates us from other practices in our state—we were recently honored to receive a “Best Places to Work” award from the San Antonio Business Journal in recognition of the office environment we have created.

In addition, national companies like Ethicon are bringing surgeons from all over the United.States to spend time at our office and learn how we have built our center. The combination of EMR technology and doing fluoroscopic-assisted band fills in our office has made us extremely efficient and compliant – and our patients have never been happier.

Images:

The team at Texas BMI

Dr. Jennifer Seger consulting with a patient about the importance of nutrition

Dr. Michael Seger performing a band fill

Dr. Terive Duperier and Dr. Michael Seger, co-founders of the Bariatric Medical Institute of Texas, San Antonio, Texas

References
1.    Men’s Fitness 2009 Fittest/Fattest Cities. http://www.mensfitness.
com/lifestyle/215 Accessed September 3, 2010.

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Category: Bariatric Center Spotlight, Past Articles

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