A comprehensive investigative report by the Boston Globe has found that, even though they fail to meet voluntary patient-safety guidelines, at least five Massachusetts hospitals continue to perform obesity surgery. But starting in 2007, Blue Cross and Blue Shield of Massachusetts, the state’s largest health insurer, will no longer pay for the procedure at hospitals that do not meet these and other standards.
In the wake of a highly publicized patient death, the state-appointed committee of health officials urged (in August 2004) that the medical community in Massachusetts adopt strict standards for gastric bypasses and other popular obesity surgeries.
The committee offered several suggestions to hospitals, one being that they handle more than 100 cases per year, and that individual surgeons perform a minimum of 50 operations per year.
The Globe surveyed hospitals that did not meet this volume standard in 2004 and found that at least five hospitals still perform obesity surgery, even though they treat fewer patients than recommended by the committee: Caritas St. Elizabeth’s Medical Center in Boston, Morton Hospital in Taunton, Beverly Hospital, Tobey Hospital in Wareham, and Winchester Hospital.
Although the hospitals did between seven and 70 of the surgeries during the fiscal year that ended Sept. 30, 2005, they defended their programs. Several said they expect to exceed 100 cases by the time the Blue Cross payment policy takes effect in 2007.
The panel had other recommendations for hospitals and doctors, including how to train surgeons, the level of hospital staff expertise, and how to select patients. The Globe did not ask hospitals whether they comply with these recommendations, however.
According to state officials, 22 Massachusetts hospitals performed 3,040 obesity surgeries in the fiscal year that ended Sept. 30, 2004. Just 402 obesity operations were performed in 1998.
On average, obesity surgery carries a 1% risk of death and a 1% to 15% risk of complications, according to the panel. A recent study found that the risk of death is elevated for the elderly: 2% within 30 days of surgery and 4.6% within a year.
Blue Cross spent $20.5 million to cover obesity surgery for 1,214 members in the year ended June 2004. Executives at Blue Cross believe that the surgery should be done only at hospitals that demonstrate high-quality care and a good performance record.
"We know there is a significant variability in care across Massachusetts," said Dr. John Fallon, Blue Cross’s chief physician executive and a member of the committee that developed the surgery guidelines.
Hospitals will receive applications from Blue Cross next month, asking for detailed information on obesity surgery programs. The hospitals will have one year to comply with the panel’s recommendations.