Postoperative Care and the Self-Paying Patient: Sometimes Surgeons Need to Compromise to Save Patients the Expense of Presenting to the Emergency Room with Unclear Symptoms

| March 22, 2012

Dear Readers of Bariatric Times:

I just returned from San Diego, California, where I attended the annual meeting of the The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES). This conference was, as in previous years, another great success orchestrated by program co-directors Drs. Daniel Scott and Daniel Jones. The highlights of this meeting were the robots, my friends that I hate so much, and the outstanding presidential address delivered by Dr. Steven Schwaitzberg. My congratulations to Steve for a great year as the Society’s president.

Last December, I attended the First Canadian Bariatric Surgery Summit organized by Dr. Teodor Grantcharov and his terrific team at the Li Ka Shing International Healthcare Education Centre at St. Michael’s Hospital in Toronto, Ontario. The meeting was exceptionally well organized and the live surgery day as well as the lectures were of the highest caliber. In this issue, Karthik Raj, presents a synopsis of that meeting.

Dr. Robin Blackstone, MD, FACS, FASMBS, current president of the American Society for Metabolic and Bariatric Surgery (ASMBS), gives us her monthly update detailing the happenings of the society. As you all well know, there is “ a lot” going on, mainly related to the merger of ASMBS with American College of Surgeons (ACS) and the new Centers of Excellence and accreditation program. As you can see from her report this month, these are exciting times for our society. ASMBS is making plenty of conference calls available to the membership in order to get questions answered. As mentioned in previous editorials, this was in my opinion the right move for our society, and we will all start seeing the benefits of it in years to come.

The second chapter of the Metabolic Applied Research Strategy (MARS) project delivered by Drs. Lee Kaplan and Randy Seeley is a must read in this issue. I wish we could make choices for our patients based on scientific evidence, but unfortunately, in our country, insurance companies are still the ones making the calls. I cannot understand why some medical insurances, including Medicare, are waiting to approve the sleeve gastrectomy. There is enough evidence in the literature that supports this procedure as safe, efficacious, and in many aspects, superior to adjustable gastric banding (AGB) and gastric bypass—but, we have to wait.

Regi Schindler gives us an update on BLIS, a special insurance that will cover the risks of post-surgical complications. This is, in my opinion, a must for those who have a significant amount of self-pay patients. It is important for patients to understand that if they pay for the surgery, they will also pay for the short- and long-term complications of it, and BLIS can at least reassure them that they will be covered in the short term. Sometimes we have to compromise postoperative care in the flat-fee patient by trying to keep them from spending fortunes when coming to the emergency room with unclear symptoms.

I would like to thank Jaime Ponce, MD, our incoming ASMBS president, for his contribution to our column “Surgical Pearls: Techniques in Bariatric Surgery.” This month he presents Part 1 of a two-part installment on AGB. In Part 1, he describes placement of an adjustable gastric band. Contrary to what many people think, I am convinced that banding will remain a valid treatment alternative in bariatric surgery. Nevertheless, I see the majority of bands moving toward the low body mass index (BMI) category and, hopefully, when combined with some sort of anorectic drug (when United States Food and Drug Administration [FDA] approved) they will be more efficient without the need to create too much obstruction.

In closing, I am privileged to announce the newly launched Body, Mind, Inspiration or BMI, a peer-reviewed, evidence-based e-journal providing lifestyle and health information for individuals interested in combating obesity, diabetes, and metabolic disorders and improving their overall health and well being. For many years Robert Dougherty (Publisher of BT and President of Matrix Medical Communications) and myself debated the value and timliness of this project. It is finally launched and is available to you and your patients online at www.bodymindinspiration.com. Please visit http://mmcmeetings.com/body-mind-inspiration-bmi/ to sign up and spread the word to your patients. We invite you to provide feedback on BMI, comment on articles, and suggest topics that you would like to see featured in upcoming issues.

Sincerely,
Raul J. Rosenthal, MD, FACS
Editor, Bariatric Times

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