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Best Practices in Policy and Access (Coding and Reimbursement) for Weight Loss Surgery
Author(s) -
Shikora Scott A.,
Kruger Rayford S.,
Blackburn George L.,
Fallon John A.,
Harvey Alan M.,
Johnson Elvira Q.,
Kaplan Lee,
Mun Edward C.,
Riley Stancel,
Robinson Malcolm K.,
Sabin James E.,
Snow Roger L.,
LoNigro Robert,
Steingisser Lee J.,
Lautz David B.
Publication year - 2009
Publication title -
obesity
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.438
H-Index - 199
eISSN - 1930-739X
pISSN - 1930-7381
DOI - 10.1038/oby.2008.573
Subject(s) - reimbursement , medicine , grading (engineering) , medline , cochrane library , systematic review , incentive , health policy , health care , best practice , public health , actuarial science , public economics , business , nursing , political science , surgery , randomized controlled trial , economics , civil engineering , microeconomics , law , engineering
To update evidence‐based best practice guidelines for coding and reimbursement and establish policy and access standards for weight loss surgery (WLS). Systematic search of English‐language literature on WLS and health‐care policy, access, insurance reimbursement, coding, private payers, public policy, and mandated benefits published between April 2004 and May 2007 in MEDLINE, EMBASE, and the Cochrane Library. Use of key words to narrow the search for a selective review of abstracts, retrieval of full articles, and grading of evidence according to systems used in established evidence‐based models. We identified 51 publications in our literature search; the 20 most relevant were examined in detail. These included reviews, cost‐benefit analyses, and trend and cost studies from administrative databases. Literature on policy issues surrounding WLS are very sparse and largely focused on economic analyses. Reports on policy initiatives in the public and private arenas are primarily limited to narrative reviews of nonsurgical efforts to fight obesity. A substantial body of work shows that WLS improves or reverses most obesity‐related comorbidities. Mounting evidence also indicates that WLS confers a significant survival advantage for those who undergo it. WLS is a viable and cost‐effective treatment for an increasingly common disease, and policy decisions are more frequently being linked to incentives for national health‐care goals. However, access to WLS often varies by payer and region. Currently, there are no uniform criteria for determining patient appropriateness for surgery.