ASMBS News and Update—February 2011

ASMBS President testifies at the Institute of Medicine on behalf of the ASMBS, the Obesity Society, and the Obesity Action Coalition
The Institute of Medicine (IOM) has been tasked by the Secretary of Health and Human Services to define the criteria and methods for establishing essential benefits and updating them in the state insurance exchanges. American Society for Metabolic and Bariatric Surgery (ASMBS) President Dr. Bruce Wolfe was an invited speaker at a public forum sponsored by the IOM on this issue. He urged the IOM to focus on the following key considerations: 1) Obesity is a life-threatening disease associated with multiple comorbidities; 2) Behavioral, medical and surgical treatments are effective for obesity, resulting in prevention of obesity-related events including death, cardiovascular disease, and cancer; and 3) Access to prevention and treatment is severely limited. For full details and a copy of Dr. Wolfe’s slide presentation, please visit http://asmbs.org/html/pdf/IOM.pdf

Operation “MORE”: Monies for obesity research and education hits the mid-point of its fundraising goal
The ASMBS Foundation was founded in 1997 as a nonprofit organization to raise funds for the specific mission of research and education. Earlier this year, the foundation launched a significant push to raise one million dollars by the end of 2011. To date, through individual and corporate contributions, Operation MORE has raised almost half a million dollars toward this goal.
“I am calling on every member to make a pledge. I am calling on industry, hospitals, and everyone who is no longer willing to sit on the sidelines to make their voices heard. I am calling on every patient who was fortunate enough to have access to life-saving treatment to help those who do not. It is time to demonstrate our resolve,” said Kelvin Higa, MD, President of the ASMBS Foundation.
Many of our hospitals have their own foundations that commonly contribute to charity organizations. Dr. Higa recently encouraged his hospital to make a donation.  Find out who chairs your hospital foundation and connect them with the ASMBS Foundation Executive Director, Joe Nadglowski, or ASMBS Foundation President, Dr. Higa at 866-471-2727. Make a personal commitment to contribute today. www.asmbsfoundation.org.

ASMBS and 23-hour length of stay for gastric bypass
In April 2010, the new Milliman Guidelines were released recommending a goal length of stay of less than 24 hours for gastric bypass patients. Many insurance companies moved to utilize these guidelines. The ASMBS has been working hard to get the recommendation repealed on the basis that guidelines that have the potential to diminish patient safety have the obligation to be based on strong supporting data. The effort led by Dr. John Morton, Chair of the ASMBS Access to Care Committee, has resulted in an exchange of letters with Milliman, contact with the major insurance carriers, and the examination of large databases, including Bariatric Outcomes Longitudinal Database (BOLD). At the ASMBS 2011 annual meeting, two abstracts based on large databases demonstrating the safety data regarding less than 23-hour length of stay for gastric bypass will be presented. The ASMBS supports surgeon judgment as the only and final arbiter of the safe length of a patients hospital stay. For the full report and a copy of the letter, please visit http://www.asmbs.org/Newsite07/resources/asmbs_items.htm

The patient’s voice in advocacy: The Obesity Action Coalition
In 2004 at an early advocacy meeting with the National Women’s Caucus in Colorado, a Senator from the state of Colorado got up and said, “I could cancel the benefit for state employees tomorrow and there wouldn’t be one person on the steps of the capitol.”
Since 2004, the statistics have not changed much; only one percent of people with obesity who need treatment can access treatment. One of the important voices that needs to be heard by congress (both national and state) and regulatory administrators is that of the patient. The ASMBS partners with the Obesity Action Coalition (OAC) to achieve synergy between the message our data and studies provide and the voice of the patients seeking treatment. The OAC is a nonprofit organization, formed in 2005 solely focused on increasing access to evidence-based treatment for patients with obesity. The advocacy voice of the OAC has been effective, but in order to secure wider access to evidence-based treatment, that voice needs to grow to a loud roar. The numbers of patients who are represented by an organization increase that group’s voice to the national leadership, who will be shaping the future of healthcare.
An innovative program has been put in place to allow surgeons and programs to help us grow the number of patient members of the OAC through the OAC Sponsored Member Program. The surgeon/program purchases one-year individual memberships for each patient operated on during the year for $10 per patient. The patient benefits by staying connected to advocacy and education through their membership. When needed, this group of patients can be mobilized at both the state and national level to help us with this battle.

The ASMBS Access to Care Committee, chaired by John Morton and his team of volunteers nationwide, works constantly to maintain and secure wider access. You and your patients can join the fight. Dr. Lloyd Stegemann is leading the committee’s project to build the number of OAC sponsored membership programs. He will be happy to answer questions and help you operationalize the program in your practice. For more information, call the OAC at (800)-717-3117 or visit www.obesityaction.org/membershipsponsoredmemberprogram.php.

Avoiding liability through a strong consent process
Common prosecution of claims in bariatric surgery cases have involved preoperative qualifications of the patient for surgery, education, and training of the surgeon and delay in the recognition of complications.[1,2]

A focused review of 100 lawsuits of bariatric surgery claims showed that only 22 of the 100 lawsuits had comprehensive consent forms.[3] With these data in mind, the Professional Liability Committee, led by Chair Ramsay Dallal, completed a project to provide a prototype of consent forms for the use of ASMBS member surgeons and their programs. Please see the ASMBS Members section of the website to access these up-to-date consent forms. http://www.asmbs.org/html/Private/informed_consent.html.

The ASMBS thanks Jim Saxton from Novus and Michael Hartney, ASMBS attorney, for their expert help with this project. A recent publication by Dr. Wee et al4 outlines current recommendations for the consent process in bariatric surgery.
1.    Kaufman AS, McNelis J, Slevin M, La Marca C. Bariatric surgery claims—A medico-legal perspective. Obes Surg. 2006;16:1555–1558.
2.    Guidelines for Institutions Granting Bariatric Privileges Utilizing Laparoscopic Techniques. Society of American Gastrointestinal and Endoscopic Surgeons. July 2009. http://www.sages.org/publication/id/31/. Accessed February 7, 2011.
3.    Cottam D, Lord J, Dallal RM, et al. Medico legal analysis of 100 malpractice claims against bariatric surgeons. Surg Obes Relat Dis. 2007;3:60–67.
4.    Wee CC, Pratt JS, Fanelli R, et al. Best practice updates for informed consent and patient education in weight loss surgery. Obesity (Silver Spring). 2009;17(5):885–8888.

Entering data begins to yield results for bariatric surgeons and their patients—research data requests increasing for ASMBS BOLD and ACS BSCN databases
Surgeons who have been entering data into the BOLD and/or Amerian College of Surgeons (ACS) National Surgical Quality Improvement Program (NSQIP) bariatric network databases are beginning to see their hard work pay off in the peer-reviewed data emerging from these extremely large collections of data. Both the ASMBS Center of Excellence (COE) and ACS Bariatric Surgery Center Network (BSCN) programs require surgeons to enter 100 percent of their patients in the respective databases. Currently, there are 442 approved ASMBS COEs, five of which are freestanding centers. There are 121 ACS BSCN facilities, approximately 80 of which are Level 1, which are qualified to treat Medicare patients. Requests for data for research purposes are increasing in frequency for both groups.

You can request data from BOLD. The ASMBS and Surgical Review Corporation (SRC) encourage access to BOLD data. SRC’s Data Dissemination Policies and Procedures (D2P2) were developed to govern the use and sharing of BOLD data with COE program participants, outside investigators, and other third parties. The D2P2 protects the integrity of BOLD data, safeguards participant and patient information, and promotes timely and scientifically accurate presentation and publication of data.

The Data Access Committee (DAC) and Data Dissemination Committee (DDC) are responsible for implementing and monitoring compliance with the D2P2, which includes review and approval of the following data-related requests:
•    The DAC reviews and approves requests to use BOLD data for research, general information, commercial, and internal quality improvement purposes.
•    The DDC reviews and approves manuscripts, presentations, and other works containing data from BOLD.
•    The D2P2 Overview describes the process by which ASMBS COE participants and other parties can submit BOLD data access and dissemination requests. More specifically, it discusses the types of requests, acceptance criteria, request processes, and fees related to data access and dissemination.
•    BSCOE participants seeking additional data on their own programs that are not contained in the standard BOLD reports as well as any party who wants to use BOLD data for research or general information purposes must submit a formal BOLD Data Access request, which is reviewed by the DAC.
•    If the requested data will also be used for publication purposes, a BOLD Data Dissemination request must be submitted along with the material for publication for review by the DDC. This process provides the necessary checks and balances for the use of BOLD data

Deborah A. Winegar, PhD, is the Director of Research at SRC. She oversees the committees that review research proposals and disperse data for the ASMBS COE program. If you are interested in using BOLD data for research, please contact Dr. Winegar.

ASMBS 5 on the 5th
The ASMBS provides a regular monthly update of all the activities of the society in the 5 on the 5th newsletter. To access the newsletter, please visit http://www.asmbs.org/news_archive.html.

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 email: [email protected].

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