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The Role of a Bariatrician in a Bariatric Surgical Center of Excellence

Dr. Kevin Huffman

President

American Bariatric Consultants

For decades there seemed to be very little cooperation between bariatric medical physicians and bariatric surgeons. Turf wars, mistrust, ignorance, treatment failures were but a few of the underlying problems in this dysfunctional relationship, but times have changed and today we’re seeing many of our bariatric medical and surgical colleagues working together in bariatric centers of excellence for the benefit of their patient’s health.

As bariatric surgical interventions improved in the late 1990s and laparoscopic surgery began to dominate the surgical landscape, bariatric medical physicians began to rethink the value of bariatric surgical referrals. In the early 2000s as health insurers and payors of all kind began to require ‘medically supervised’ preoperative weight loss and long-term outcome data, bariatric surgical programs began to reach out to their bariatric medical colleagues. Today, the field of bariatrics is looking more and more like the field of cardiology where medical and surgical physicians work side-by-side in a comprehensive center of excellence providing both medical and surgical solutions to their healthcare issues.

Bariatricians provide several vital functions within the bariatric center of excellence, including the role of liaison between the bariatric surgeon and the primary care community. In those centers where a bariatrician is part of the surgical team we see increased referrals from the primary care community. The bariatric surgeon is no longer seen as ‘cherry picking’ the surgical cases from the community. The bariatrician may also be more accessible to patients, payors and physicians than a very busy bariatric surgeon, giving the bariatric center of excellence another bariatric authority in the medical community to turn to, for answers. The bariatrician in essence becomes a practice builder for the bariatric center of excellence.

Preoperatively, bariatricians can manage ‘medically supervised weight management’ programs within the center of excellence to ensure risk reduction prior to surgery and to meet payors demands for this service so that surgical authorization can be expedited. They can also help primary care physicians’ document their efforts at ‘medically supervised weight management’ preoperatively which can greatly streamline surgical authorization from this vital referral base.

With the increasing pressure by payors and the medical community to show 5-year outcome data, bariatricians can play a major role in the on-going, long-term care of postoperative patients. Busy bariatric surgical practices have little time to follow up regularly over a 5-year period with patients to discuss nonsurgical issues of diet, exercise, behavior and medical therapies, yet bariatric surgeons are being judge by payors on these nonsurgical issues when they impact 5-year outcome data. Those surgical practices who can’t produce or can’t compete with standard outcome results risk being dropped as a preferred provided by payors. Bariatricians are clinically trained to follow patients long-term, to discuss and document diet, nutrition, exercise, behavior, medical interventions and even help with postoperative LAP-BAND ® adjustments. This additional set of medical eyes on postoperative patients can play a vital role in preventing, recognizing and treating postoperative complications, thus reducing risk to the surgical practice. Again the bariatrician plays an important role in postop communication with the primary care community as a respected medical peer. A final comment on postoperative bariatric medical care, most bariatric surgeons are unaware that bariatric medical therapies can improve surgical outcomes by reducing hunger and weight regain which is commonly seen at 18-24 postoperatively when hunger levels return.

Nonsurgical bariatric care is yet another resource a bariatrician can bring to a bariatric center of excellence. A majority of patients calling into a bariatric surgical center can for one reason or another not qualify for bariatric surgery at the time of the call. These patients may have not met insurer’s demands for preoperative ‘medically supervised weight management’, their current health insurance may not pay for the procedure or they have co morbidities that preclude them from surgery. If surgical practices simply turn these patients away, they may permanently lose the patients to commercial weight loss centers, or surgical unfriendly medical weight management programs. Keeping these patients within the comprehensive practice until payors demands are met, insurance status change, or comorbid conditions resolve through medical interventions, will improve the centers changes of helping these patients with bariatric surgery in the future. Finally there are those millions of American that spend in excess of $45 billion annually out of pocket on nonsurgical weight management products and services. Can’t we in the bariatric community offer them something better? With a bariatrician on board bariatric centers of excellence can offer overweight and non morbidly obese patients medically supervised weight management products and services. These services will not only generate significant cash flow into a bariatric center of excellence but also bring into the center friends, family and coworkers of these nonsurgical patients who may indeed be surgical candidates.

It’s easy to see why bariatric medical physicians and bariatric surgical physicians need to join forces as a bariatric healthcare team in a bariatric center of excellence, in part two of this series, we’ll look at how to build the bariatric partnership.

 

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