Few carriers back bariatic surgeries
That's one reason behind Atrium's recent closing of its center in Middletown.
Sunday, July 06, 2008
Kathy Cranor can't remember a time when she wasn't overweight.
At 61, she has ballooned to 370 pounds despite repeated attempts to lose weight through dieting.
"I've been on a diet since I was 8 years old. I'd lose it and then gain it right back and then some,'' said Cranor of Middletown, who now has diabetes and other obesity-related illnesses.
In May, the Middletown resident sought help at Atrium Medical Center's Bariatric Wellness Center and had hoped she'd be recovering from surgery now.
But after a series of tests at the center, Cranor learned last week that the center was closing and was referred to a hospital in Dayton.
The closure of Atrium's center comes at a time when interest in bariatric surgery is up, but the number of hospitals offering it in Ohio has dropped from 35 to 15 since 2005, said Philip Schauer, professor of surgery at the Cleveland Clinic Learner College of Medicine, who is an expert in the field.
The reason, Schauer said, is that few insurance companies pay for the surgery and those that do require facilities to be named a Center of Excellence.
COEs must complete at least 125 surgeries per year and pass a rigorous evaluation process by the American Society for Metabolic and Bariatric Surgery.
Atrium's bariatric center is a COE, but hospital officials said competition for patients in the region was too stiff to continue.
Schauer said plenty of people are seeking the service, but only one in four actually gets the surgery.
"Over the last four years, the number of bariatric cases in Ohio dropped 30 percent and it's not because of patient demand,'' Schauer said. "The challenge is the commercial carriers that control funding.''
Cranor has an appointment at Miami Valley Hospital on Wednesday, July 9. But she doesn't know whether her insurance company will pay for the procedure.
"I hope they cover it,'' Cranor said. "I have diabetes, my knees hurt. I have (Chronic Obstructive Pulmonary Disease.) If I get it done I could lose my diabetes and live a normal life.''