The Affordable Care Act: Key Elements and What It Means for Bariatric Surgery

This column is dedicated to sharing the vast knowledge and opinions of the American Society for Metabolic and Bariatric Surgery leadership on relevant topics in the field of bariatric surgery.

This Month’s Interview with:

John M. Morton, MD, MPH, FACS, FASMBS
Chief of the Section of Bariatric and Minimally Invasive Surgery, Stanford University, Stanford, California, and Secretary-Treasurer of ASMBS

This month’s topic: The Affordable Care Act: Key Elements and What It Means for Bariatric Surgery

Funding: No funding was provided in the preparation of this manuscript.
Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.

Bariatric Times. 2013;10(10):8.

Dr. Rosenthal: Can you outline the key elements of the Affordable Care Act and explain how it will effect us in the field of bariatric surgery?

Dr. Morton: Health care is, in large part, a government industry with 56 percent of health costs paid by government including Medicare, Medicaid, Children’s Health Insurance Program (CHIP), Tricare, Veteran’s Affairs (VA), Indian Health, Federal/State Employees Health Plans, and National Institutes of Health (NIH) clinical care. With 16.3 percent of the United States population uninsured, 46 percent bankruptcies due to medical debt and 16 percent gross domestic production devoted to health care, the federal government enacted the Affordable Care Act (ACA) in 2010. Regardless of political affiliation, the ACA is now the law of the land and how the ACA affects us in bariatric surgery is important. The following is a breakdown of key elements.

2010
Patient Protection
Several patient protection regulations were enacted, including removing annual and lifetime restrictions on amount of insurance coverage. This is important as we look at obesity as being a chronic disease and there will be more potential need for revisional surgery.

Access
In terms of access, young adults can stay under their parents’ plan until the age of 26. Even more importantly, the ACA provides coverage for preventive services, such as obesity screening. ACA calls for coverage for obesity screening and referral to intensive, multicomponent, behavioral interventions. Obesity screening and behavioral treatment is a Level B recommended service by the United States Preventive Services Task Force and consequently mandated under the ACA. I anticipate bariatric surgery will gain further acceptance and access as more patients are screened and counseled regarding obesity. I believe we should also advocate for bariatric surgery as a preventive service as it provides tertiary prevention or prevention of further progression of disease.

Prevention
ACA stipulates that restaurants and food vendors with 20 or more locations are required to display the caloric content of their foods on menus, drive-through menus, and vending machines. This provision will raise awareness regarding obesity and potentially drive patients toward treatment.

2011/2012
The Center for Medicare and Medicaid Innovation was implemented with the ACA. This center is looking for ways to increase quality of care for Medicare recipients, including linking payment to quality outcomes like 30-day readmissions and hospital-acquired conditions, such as surgical site infections. Beginning in 2014, the first Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) will be directly relevant to this center by creating a nation-wide collaborative to decrease re-admissions with DROP® (Decreasing Readmissions through Opportunities Provided).

2013/2014
The Essential Health Benefit
The Essential Health Benefit (EHB) is an important centerpiece of the ACA with each state required to provide a sample plan and benefit package to be approved by Health and Human Services (HHS). In October 2013, enrollment will begin for the EHB state plans, which are generally based on the largest small business plan. The EHB is designed for those citizens who do not have current coverage and based by state. Bariatric surgery has good coverage with large employers, but, less coverage with small employers. With the ACA, more small employers (<500 employees) will be required to provide coverage. As a result, it is critical to have each state have bariatric surgery as a covered benefit in their EHB. Twenty-two states have bariatric surgery coverage to date and we will need to have the remaining states to do the same through state chapter advocacy.

Patient-Centered Outcomes
Research Institute
Charged with examining the “relative health outcomes, clinical effectiveness, and appropriateness” of different medical treatments by evaluating existing studies and conducting its own. Important for comparative effectiveness of surgery versus medical therapy for obesity.

Dr. Rosenthal: Dr. Morton, thank you for taking the time to speak with me on this important issue.

Category: Ask the Experts, Past Articles