Bariatric care belts loosen as fiscal belts tighten






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Publication: Healthcare Purchasing News
Author: Akridge, Jeannie
Date published: February 1, 2012

Not a single state in the nation can claim a population with obesity levels below 20%, finds the 2011 Edition of Amenca's Health Rankings1. In fact, obesity has grown an astounding 137% in the two decades since the 1990 Edition, from 11.6% of the adult population then to 27.5% today. Three-quarters of all states are now saddled with obesity rates above 25%; in 15 of those the prevalence is above 30%. The population especially tips the scales in Mississippi, which struggles with an obesity rate of 35%. Colorado maintains its position as harboring one of the more svelte populations in the U.S., but crept past the 20% mark to 21.4% obesity. If these trends continue, warned the report, 43% of the population could be obese by 2018.

Across the nation, we're loosening our belts to accommodate this increasingly heavy populatioa Just one example, fewer passengers are now allowed onboard the Washington State Ferry in compliance with updated Coast Guard rules based on Centers for Disease Control and Prevention estimates that put the weight of the average citizen at 185 pounds compared to the previous 160.

As the numbers inch upward, the healthcare system is left to deal with the fallout. Heart disease, hypertension, diabetes, osteoarthritis and sleep apnea are just a few of the conditions that have been linked to obesity. Medical care costs of obesity in the U.S. have been estimated at $150 billion annually.

Cathy Denning, vice president, sourcing operations at Novation, noted that obesity treatments such as bariatric surgery have historically been out of reach for those who fail to qualify for Medicare or insurance reimbursement. As a consequence, untreated obesity may lead to individuals presenting at hospital emergency rooms for heart attacks, ruptured gall bladders, appendicitis or any number of obesity-related conditions. "There hasn't necessarily been an emphasis on reimbursement for the treatment of obesity, but there is a lot of emphasis on the treatment of the co-morbidities for obesity," lamented Denning.

Novation's 2011 annual Bariatric Survey2 of its VHA Inc. and UHC member hospitals confirmed an increase in admissions of morbidly obese patients for 58% of responding facilities in the past 18 months; along with expanded services, supplies and training to accommodate this population.

Nearly three-quarters of Novation survey respondents (72%) indicated that their emergency rooms are equipped to handle morbidly obese patients. The types of bariatric equipment available for exclusive use in the ER include durable medical equipment (85%), stretchers (84%), lifts (74%), transfer devices (70%) and beds (63%).

Bariatric outpatient programs offered in Novation member facilities include fitness programs (53%), weight loss (61 %) and counseling programs (62%).

It was announced in November that Medicare would be adding coverage for preventive services including screening for obesity and counselingfor eligible beneficiaries by primary care providers.

"There is a high level of recidivism in people that have had any kind of weight loss," Denning maintained. "The statistics demonstrate that treating obesity as a chronic illness and providing counseling along with it is the best way to decrease recidivism and increase success for the patient. In a best practice setting, counseling is a prerequisite for bariatric surgery. In fact many people are turned down due to their pre-surgical consultation. Or they are followed more closely based on what is identified in their pre-surgical consultation. Best practice dictates that there is counseling that is associated with all bariatric surgery, both pre and post."

"Coverage for screening should do a few things that affect facilities," suggested Tom Loriek, product marketing manager, Winco Mfg. LLC. "One is that those patients who may not have been able to afford to visit in the past may now have the incentive to seek medical help. Second, it helps to reduce the negative stigma often associated with extremely obese patients allowing them to feel a little more comfortable in seeking assistance. There may not be a huge influx of patients, but the pressure will be on the facilities to be able to accommodate and in fact even seek out those patients as a revenue source and to maintain accreditation standards as they will undoubtedly shift as well."

Of the 41 % of Novation survey respondents who offer bariatric surgery programs in their facilities, (63% of which are certified as a Bariatric Center of Excellence) the most common type of surgery performed is gastric banding (94%). Sleeve gastrectomy (gastric sleeve) is among the newer bariatric procedures and is being performed in 60% of facilities. Nearly 70% perform open gastric bypass surgeries and 72% offer endoscopic gastric bypass.

Associated reconstructive surgery is also rising along with the number of weight loss surgeries, with 78% seeing an increase in the number of bariarric-related reconstructive surgeries. "These are necessary [post weight loss] cosmetic procedures," said Denning, noting that extra skin folds pose an infection risk.

Broad range of bariatric products

Products purchased by VHA and UHC hospitals to accommodate obese and morbidly obese patients range from DME, acute care beds, patient lifts, scales, stretchers, OR tables and air transfer devices, to blood pressure cuffs, longer urinary and IV catheters, antiembolism stockings, pneumatic compression sleeves, incontinence products and orthopedic softgoods. Hand held dopplers that magnify sound are used to help caregivers hear the pulse of heavier patients through a thick layer of adipose tissue. The comprehensive offering of bariatric products includes even post mortem body bags such as the BioSeal sizeable, sealable containment solutions now offered on contract through Novation.

In response to the growing patient population, Winco raised the minimum weight capacity for the majority of its chairs by over 22% last year. "In addition we have added XL versions of most of our blood draw chairs and recliners to address even higher specific requirements," said Lorick. "Finally we have added bariatricspecific products including the Stretchair, and bariatric exam tables capable of up to 1,000 pound capacities,"

Advised Lorick, "When evaluating a seating solution, it is critical to take into account the setting for use. For instance, in long term care a position lock is desirable, and drop arms make transfer to and from wheelchairs and beds easier. In dialysis and oncology settings, swing-away arms assist with the same issues, but also increase convenience for cleaning and disinfection tasks. In clinical settings, powered hi/lo/recline operations assist the caregiver in patient transfer situations and in achieving treatment positioning that is optimal for the care provider and patient. These features allow the caregiver to assist the bariatric patient while reducing their own movement activities (bend, twist and lift) that represent opportunities for injury to the caregiver. Finally, in addition to bearing higher weight capacities, the furnishings must also offer more generous seating areas, appropriate arm rest height, leg support points etc., that take into account unique bariatric patient shape requirements."

Winco's Stretchair features hi/lo/recline operations and is cleared by the FDA as a transfer device, said Lorick. "Because it can be used in the upright position as a chair and then power reclined to a fully flat transfer device, it offers exceptional versatility as a general purpose treatment, transfer and recovery room device in a variety of settings and applications. The footprint of the Stretchair is smaller than a stretcher while offering the advantages of power assisted patient positioning."

The Triera Extra walking table from Ergolet is a new bariatric ambulation and gait training product designed to support patients up to 525 pounds in gait training or rehabilitation situations, and can be utilized in post-operative situations to encourage early patient mobility. It features electric drive and a widened base for extra space and stability.

Most hospitals responding to the Novation survey (92%) offer staff training on special procedures for dealing with morbidly obese patients, with nearly half (49%) increasing such training. Types of training include safe transfer of morbidly obese patients (91%), use of size-appropriate equipment (81%), as well as sensitivity training for working with morbidly obese patients (56%). "No lift" policies are in place at 38% of facilities.

For the extended story visit www.hpnonline.com/ inside/2012-02/2012-OR-Bariatric.html

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