ASMBS News and Update—December 2012

by Jaime Ponce, MD, FACS, FASMBS

Dr. Ponce is President, American Society for Metabolic and Bariatric Surgery Medical Director for Bariatric Surgery, Hamilton Medical Center, Dalton Georgia; Co-Medical Director for Bariatric Surgery, Memorial Hospital, Chattanooga Tennessee

ASMBS Mission Statement
The American Society for Metabolic and Bariatric Surgery was founded in 1983 to establish educational and support programs for surgeons and integrated health professionals. Our mission is to improve the care and treatment of people with obesity and related disease; to advance the science and understanding of metabolic surgery; to advocate for health care policy that ensures patient access to high-quality prevention and treatment of obesity. For more information, visit www. ASMBS.org. If you are interested in becoming a member or have questions about ASMBS, please contact Georgeann Mallory, the ASMBS Executive Director, via phone: (352)-331-4900 or e-mail: [email protected].

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As the president of an organization that is never stagnant and is always embracing innovation, my first five months in office have been busy and productive. Each of the ASMBS committees have been engaged in interesting and important initiatives. Stay tuned for updates throughout the year. For now, I point your attention to the recent accomplishments of six of our committees and some of our special task forces.

Committee Updates
Access to Care Committee. The ASMBS has long advocated for access to care for the treatment of obesity. I thank and commend John Morton, MD, chair of the Access to Care Committee, for the outstanding work he has done leading this committee and the dialogue with the Centers for Medicare and Medicaid Services (CMS) regarding coverage for laparoscopic sleeve gastrectomy (LSG). This communication helped guide CMS’s decision to retract their initial proposal of approving LSG only in randomized clinical trials. Once that hurdle was cleared, it was discovered that the “Noncoverage” designation was inadvertently left in place even though coverage was approved. The Access to Care Committee again initiated communication. This designation has been removed and local contractors can start making decisions on how they will cover the procedure. (http://asmbs.org/2012/11/important-cms-updates/).

The Essential Health Benefit package decisions at the state level continue to be of key importance. The ASMBS, in collaboration with the Obesity Care Continuum, has provided a great deal of input and education in the form of letters and face-to-face meetings. The goal is to have every state select the best health plan that provides coverage for the surgical treatment of obesity.
Insurance Committee. At the end of August 2012, Matt Bergman, MD, chair of the Insurance Committee, presented supportive information to CMS to improve payment for outpatient gastric banding procedures. A decision was made recently to move the outpatient facility adjustable gastric banding to a higher paying APC (Ambulatory Payment Classification) from 0131 ($3,497) to 0132 ($5,268) for FY2013. (http://asmbs.org/2012/11/insurance-update-cms-apc/). This was great work in collaboration with our industry partners and the Access to Care Committee.

Emerging Technologies and Procedures Committee. Intensive research went into creating an inventory list of all emerging technologies and procedures. This project was directed under the leadership of Bipan Chand, MD, and Aurora Pryor, MD, chair and co-chair of the Emerging Technologies Committee. (http://asmbs.org/2012/10/inventory-of-emerging-technology-and-procedures/). This list will allow all ASMBS members to see the status of new procedures and devices, United States Food and Drug Administration (FDA) status updates, literature synopses, and more. Members are given the opportunity to provide information and updates as well. If members know of specific information regarding a new procedure or device, we encourage you to please send comments.

Bariatric Surgery Training Committee. The Bariatric Surgery Core Curriculum to be followed for an ASMBS Certificate of Acknowledgment of Satisfactory Training in Metabolic and Bariatric Surgery for Fellows has been updated to include more validation from the Program Director, better defined endoscopic experience requirements, clarified research project expectations, and updated minimum numbers and types of procedures to be performed. For detailed information see http://asmbs.org/fellowship/.

Clinical Issues Committee. A call for statement topics was recently sent to the ASMBS membership and new position statements topics are being evaluated. The Bariatric Surgery in Class 1 Obesity (BMI 30–35kg/m2) statement is now published on the ASMBS website, http://asmbs.org/2012/09/bariatric-surgery-in-class-1-obesity-bmi-30-35-kgm2/, and e-published in Surgery for Obesity and Related Diseases (SOARD). The committee has formed a subcommittee led by Shanu Kothari, MD, to begin a systematic review of all existing statements, beginning with the statement titled, “Prophylactic Measures to Reduce the Risk of Venus Thromboembolism in Bariatric Surgery Patients.”

Communications Committee. More visibility and features are coming soon to the ASMBS website. A new section on our website called Bariatric Movies and Images or BMI is now available. Users can view and share important videos and images from field experts. Submitted video sessions from meetings throughout the year will also be available here. The ASMBS Wikipedia page is being updated. Finally, under the leadership of Kevin Reavis, MD, chair of the Communications Committee, collaboration with The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) University will be implemented to improve the bariatric and metabolic surgery content on the SAGES University site.

State and Local Chapters Committee. Congratulations to all of the new ASMBS State Chapters: Alabama, Hawaii, Indiana, Maryland, Washington, and Canada. There are now 24 AMSBS State Chapters. Lloyd Stegemann, MD, and Michael Nausbuam, MD, chair and co-chair of the committee, will be leading a meeting with all the state chapter presidents to address strategies to improve the chapters, address their needs, and make sure the ASMBS has resources available for all chapters to implement their activities.

Task Force Updates
In addition to the committees, there are also several task forces that operate within the framework of the ASMBS. The task forces are appointed to work on specific issues for a limited amount of time. The task forces are active until they have produced the desired results, at which point they become inactive.

I am very happy to report that the Compensation Task Force is nearing the completion of their project. Teresa LeMaster, MD, and John Morton, MD, have worked to provide a good summary of the Physician’s Compensation Survey results. This report will be published in the Members Only section of the ASMBS website soon. We know it was long and tedious survey to complete and we gratefully thank all of you who took the time to complete it.

A task force to develop guidelines to recognize or study new bariatric procedures was assigned to the leadership of Marc Bessler, MD, and Ranjan Sudan, MD. These guidelines will enable the Research Committee to suggest the types of studies needed to gather data for validation of new procedures and techniques. I foresee tremendous value in having the expertise of our Research Committee to make recommendations and facilitate pathways for future studies.

The total number of bariatric surgery cases performed in the United States has always been a question asked by many. A task force, led by Anita Courcoulas, MD, allowed us to gather the best estimation using the Bariatric Outcomes Longitudinal Database (BOLD), American College of Surgeons Bariatric Surgery Center Network (ACS BSCN) the National Inpatient Sample data, and the best estimation on outpatient cases. The task force determined that approximately 150,000 to 160,000 cases were performed in 2010. More accuracy will be implemented for future years, as the exact outpatient numbers will become available soon.

Education Update
Congratulations to all who participated in a making the 2012 Fall Educational Event in Las Vegas, Nevada, the best and most attended Fall Event to date. Great courses in smaller groups with more access to faculty led to engaging, vivid discussions. An update on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) new standards was reviewed in a course that was well attended and generated many questions and a discussion. Robin Blackstone, MD, and Ninh Nguyen, MD, the chairs of the MBS Committee, reported that the new standards should be ready for public comments soon.
During the Town Hall meeting, the ASMBS leadership answered questions about the MBSAQIP, CMS sleeve coverage, Obesity Week, and new ideas.

Additionally, the Executive Council and leadership held a strategic planning retreat to discuss several topics, including future financial aspects, new ideas for projects to advance the field and value for our membership, and the development of new message tracks from the Society. Overall, we have become a better-organized society that continues to evolve in preparation for the future.
Collaboration. By networking, coordinating, cooperating, and collaborating with other organizations we can accomplish goals and have a greater impact than we could working in isolation. In this spirit, the ASMBS will be collaborating with other international societies to implement co-sponsored courses, symposiums, and programs. There will be an ASMBS symposium during the next International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) Latin America meeting in Cusco Peru (May 2013). Also, we will co-direct a course in Sao Paulo, Brazil with the Brazilian Society for Bariatric, and Metabolic Surgery (June 21–22, 2013). We will continue to collaborate with SAGES in educational offerings, website content, endorsements, quality projects, and more. Recently the ASMBS endorsed the American Board of Surgery Flexible Endoscopy curriculum for General Surgery Residents along with SAGES, The Society for Surgery of the Alimentary Tract (SSAT), The American Society of Colon and Rectal Surgeons (ASCRS), and The American Society for Gastrointestinal Endoscopy (ASGE). The ASMBS is also a contributor to the soon-to-be-published updated guidelines, Clinical Practice Guidelines for the Perioperative Nutritional, Metabolic, and Nonsurgical Support of the Bariatric Surgery Patient 2013 Update, cosponsored by The American Association of Clinical Endocrinologists (AACE), The Obesity Society (TOS), and ASMBS. Many thanks to Dan Jones, MD for coordinating the ASMBS input.

2013 is going to be a great year of positive changes, with the implementation of the new Accreditation Standards and expectations of having the first Quality Collaborative Meeting at the end of May during the Spring Educational Event in New Orleans (May 31–June 2, 2013). And, of course, our new Annual Meeting setting within Obesity Week will be held in Atlanta, Georgia, November 11 to 16, 2013. It will be the largest and most important obesity meeting in the world, bringing together the resources of TOS and ASMBS to cover the full scope of the obesity issue, from cutting-edge basic science and clinical research to intervention and public policy discussions.

Metabolic and Bariatric Surgery Accreditation clarification. Many of you have received an email from Dr. Neil Hutcher and the Surgical review Corporation (SRC) announcing their “new” Center of Excellence Metabolic and Bariatric Surgery Program. The SRC agreed in our settlement with them last year throughthe federal lawsuit we brought against them not to pursue this course for at least one year, which is January 1, 2013.  We had hoped that the overwhelming strength and message of support for the societies position on this issue with 728 programs reporting to the unified data registry and part of the unified MBSAQIP program, that SRC and Dr. Hutcher would have gotten a clear message.

There are some facts of which you need to be aware in case your administration regarding this issue questions you:
1.    Neither the ACS nor the ASMBS are endorsing this SRC program.
2.    IFSO has terminated their endorsement to the SRC ICE (International Center of Excellence) program (as of September 2012).
3.    BOLD is not up to date, as 728 programs have transitioned to the joint ACS/ASMBS MBSAQIP data registry and program. Most programs stopped reporting March 31, 2012. (Many stopped reporting as early as March 1, 2012).
4.    Insurance companies only recognize accreditation by the ACS and the ASMBS and there is no indication of any interest in recognizing an independent corporation.

The MBSAQIP is the only recognized accreditation program by the ACS and the ASMBS. Currently, over 728 programs are part of the unified quality program and are reporting in the data registry. Expert surgeons (see sidebar “Committee on Metabolic and Bariatric Surgery”) equally nominated by both ACS and ASMBS as well as the Integrated Health President, Karen Schulz, ANP, have worked very hard the last six month in the unified program committees that are defining the standards, verification, and data registry that will enable to implement a national and regional quality improvement process.

We are all looking forward to the public comment period and Town Hall meetings that will be held to discuss the proposed new standards. This will be forthcoming in the next few weeks.

I look forward to 2013 with great anticipation as we continue to grow, embark on new initiatives, and collaborate with our partners around the world to achieve even greater results.

Sincerely,
Jaime Ponce, MD, FACS, FASMBS
ASMBS President

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