Kaitlin M Love1, J Hunter Mehaffey2, Dana Safavian2, Bruce Schirmer2, Steven K Malin3, Peter T Hallowell2, Jennifer L Kirby4. 1. Department of Medicine, University of Virginia, Charlottesville, Virginia. 2. Department of Surgery, University of Virginia, Charlottesville, Virginia. 3. Department of Kinesiology, University of Virginia, Charlottesville, Virginia; Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, Virginia. 4. Department of Medicine, University of Virginia, Charlottesville, Virginia; Division of Endocrinology and Metabolism, University of Virginia, Charlottesville, Virginia. Electronic address: JKD2A@virginia.edu.
Abstract
BACKGROUND: Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. METHODS: Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. RESULTS: A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; P<.001); primary care physician letter of necessity (P<.0001); laboratory testing (P = .019); and evaluation by cardiology (P<.001), pulmonology (P<.0001), or psychiatry (P = .0003). Using logistic regression to control for co-morbidities, longer diet requirement (odds ratio [OR] .88, P<.0001), primary care physician letter (OR .33, P<.0001), cardiology evaluation (OR .22, P = .038), and advanced laboratory testing (OR 5.75, P = .019) independently predicted surgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, P<.0001). CONCLUSION: Many prebariatric surgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care.
BACKGROUND: Many insurance companies have considerable prebariatric surgery requirements despite a lack of evidence for improved clinical outcomes. The hypothesis of this study is that insurance-specific requirements will be associated with a decreased progression to surgery and increased delay in time to surgery. METHODS: Retrospective data collection was performed for patients undergoing bariatric surgery evaluation from 2010-2015. Patients who underwent surgery (SGY; n = 827; mean body mass index [BMI] 49.1) were compared with those who did not (no-SGY; n = 648; mean BMI: 49.4). Univariate and multivariate analysis were performed to identify specific co-morbidity and insurance specific predictors of surgical dropout and time to surgery. RESULTS: A total of 1475 patients using 12 major insurance payors were included. Univariate analysis found insurance requirements associated with surgical drop out included longer median diet duration (no-SGY = 6 mo; SGY = 3 mo; P<.001); primary care physician letter of necessity (P<.0001); laboratory testing (P = .019); and evaluation by cardiology (P<.001), pulmonology (P<.0001), or psychiatry (P = .0003). Using logistic regression to control for co-morbidities, longer diet requirement (odds ratio [OR] .88, P<.0001), primary care physician letter (OR .33, P<.0001), cardiology evaluation (OR .22, P = .038), and advanced laboratory testing (OR 5.75, P = .019) independently predicted surgery dropout. Additionally, surgical patients had an average interval between initial visit and surgery of 5.8±4.6 months with significant weight gain (2.1 kg, P<.0001). CONCLUSION: Many prebariatric surgery insurance requirements were associated with lack of patient progression to surgery in this study. In addition, delays in surgery were associated with preoperative weight gain. Although prospective and multicenter studies are needed, these findings have major policy implications suggesting insurance requirements may need to be reconsidered to improve medical care.
Authors: Mohammad K Jamal; Eric J DeMaria; Jason M Johnson; Brennan J Carmody; Luke G Wolfe; John M Kellum; Jill G Meador Journal: Surg Obes Relat Dis Date: 2006 Mar-Apr Impact factor: 4.734
Authors: Timothy S Kuwada; Sarah Richardson; Maher El Chaar; H James Norton; John Cleek; John Tomcho; Dimitrios Stefanidis Journal: Surg Obes Relat Dis Date: 2010-09-19 Impact factor: 4.734
Authors: Ramzi S Alami; John M Morton; Rob Schuster; Jie Lie; Barry R Sanchez; Anna Peters; Myriam J Curet Journal: Surg Obes Relat Dis Date: 2007-02-27 Impact factor: 4.734
Authors: Jeffrey I Mechanick; Adrienne Youdim; Daniel B Jones; W Timothy Garvey; Daniel L Hurley; M Molly McMahon; Leslie J Heinberg; Robert Kushner; Ted D Adams; Scott Shikora; John B Dixon; Stacy Brethauer Journal: Obesity (Silver Spring) Date: 2013-03 Impact factor: 5.002
Authors: Erin Fothergill; Juen Guo; Lilian Howard; Jennifer C Kerns; Nicolas D Knuth; Robert Brychta; Kong Y Chen; Monica C Skarulis; Mary Walter; Peter J Walter; Kevin D Hall Journal: Obesity (Silver Spring) Date: 2016-05-02 Impact factor: 5.002
Authors: Michael C Harnisch; Dana D Portenier; Aurora D Pryor; Rebecca Prince-Petersen; John P Grant; Eric J DeMaria Journal: Surg Obes Relat Dis Date: 2008 May-Jun Impact factor: 4.734
Authors: J Picot; J Jones; J L Colquitt; E Gospodarevskaya; E Loveman; L Baxter; A J Clegg Journal: Health Technol Assess Date: 2009-09 Impact factor: 4.014
Authors: Selim G Gebran; Brooks Knighton; Ledibabari M Ngaage; John A Rose; Michael P Grant; Fan Liang; Arthur J Nam; Stephen M Kavic; Mark D Kligman; Yvonne M Rasko Journal: Obes Surg Date: 2020-02 Impact factor: 4.129
Authors: Colleen Tewksbury; Nina Crowley; Julie M Parrott; Laura Andromalos; Kellene A Isom; Elizabeth Smith; Kelly C Allison Journal: Obes Surg Date: 2019-11 Impact factor: 4.129
Authors: Amresh D Hanchate; Danyang Qi; Michael K Paasche-Orlow; Karen E Lasser; Zhixiu Liu; Mengyun Lin; Kristina Henderson Lewis Journal: JAMA Health Forum Date: 2021-10-08
Authors: Jonathan Sivakumar; Lynn Chong; Salena Ward; Tom R Sutherland; Matthew Read; Michael W Hii Journal: Obes Surg Date: 2020-01 Impact factor: 4.129
Authors: Kaitlyn D Ibrahim; Lauren A Tragesser; Rohit Soans; Abdullah Haddad; Vikram J Eddy; Joseph McComb; Martin G Keane; Isaac R Whitman Journal: J Am Heart Assoc Date: 2022-05-27 Impact factor: 6.106