New Medicare Rules for Obesity Surgery

Health care officials applauded new federal regulations announced Tuesday that provide national standards for Medicare coverage of obesity surgery.

Previously, the rules concerning reimbursement for such operations, known as bariatric surgery, varied across the United States. But under the new regulations, a handful of gastric bypass and banding procedures will be covered throughout the country for the elderly and the disabled, said Dr. Steve Phurrough of the Centers for Medicare and Medicaid Services.

The agency had previously proposed excluding coverage of obesity surgery for the elderly and expanding it for the disabled. But the agency said it had reviewed new data and determined that experienced surgeons had similar outcomes for patients of all ages, including the elderly, and there was no reason to exclude them from the procedures.

Phurrough said he did not believe the new rules would have a major impact on how much the government spends on obesity surgery. Over the years Medicare has paid for only about 300 such operations a year for senior citizens, compared with about 2,500 operations a year for the disabled.

"We don't think there will be a huge rush of patients or surgeons wanting to do this in the older population," Phurrough said.

But Dr. Neil Hutcher, president of the American Society for Bariatric Surgery, said the new regulations represent formal recognition of morbid obesity as a severe health problem.

"It will put pressure on private insurers to follow the lead of the government," Hutcher said.

He said that recognition could be good news for younger Americans seeking coverage of bariatric surgery through private insurers.

"We expect and hope that this will encourage employers, managed care plans and patients to take another look at including bariatric surgery in their basic coverage package," the American Obesity Association added.

Medicare won't cover obesity surgery for beneficiaries who are only overweight. The beneficiaries also must have at least one disease associated with obesity, such as hypertension, type 2 diabetes and heart disease.