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US CMS changes tack on coverage policy for weight loss surgery

This article was originally published in Clinica

Executive Summary

US Medicare is proposing to eliminate coverage of bariatric surgery for beneficiaries aged 65 and over, after concluding that the procedure is too risky for this age group. But the health plan would continue to cover the costly procedure for certain morbidly obese beneficiaries under the age of 65 undergoing one of three commonly performed procedures: open and laparoscopic Roux-en-Y gastric bypass; and laparoscopic adjustable gastric banding. The latter procedure is currently available in the US only via Inamed's LapBand device. "While the best proven 'treatment' is a nutritious diet and regular exercise - and medical treatments are also available - some beneficiaries may significantly reduce their health risks through surgery," said CMS administrator Dr Mark McClellan. The Centers for Medicare & Medicaid Services (CMS) said it decided to stop covering the weight loss surgery for the elderly, based in part on a recent study in the Journal of the American Medical Association that found that patients aged 65 and older had two- to three-fold higher death rates after weight loss surgery.

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