Doctors/Ins Companies Looking for Bypass Alternative

[Observer]

Here's an interesting study -- five million dollars to see if supervised calorie reduction will produce a viable alternative to gastric bypass operations.

http://www.msnbc.msn.com/id/11736510/

[fatlane]

Let's see... eating less might just work... IF THE PATIENTS ALSO EXERCISE MORE! EUREKA!

I should write a diet book, dammit!

[Miss Vickie]

Insurance companies will do whatever they can to save money. Gastric bypass is an expensive operation, and I know mine did everything they could to avoid paying (including trying to deny me COBRA benefits). I eventually had to get the Dept. of Labor involved and they whipped their happy asses into shape.

OTOH, if research like this contributes to the body of knowledge about what DOES work for controlling weight, then I think that's a good thing. And if it shows that dieting doesn't work (as many of us already know) then that's good, too. It just bugs me that they're coming at the study from the angle of avoiding paying for services, rather than how we can optimally nourish fat folks and help us find ways of exercising which are safe.

[fatlane]

I'm actually quite hopeful genetic therapies are able to help in this area.

[Wayne_Zitkus]

I used to work at an HMO, writing proposals. Yes, HMOs are interested in controlling costs - after all, most of them ARE for-profit corporations, and they owe their stockholders a return on their investment. But the HMO I worked at (QualMed) was also interested in the best possible medical outcomes.

I remember once when the question of weight-loss surgery came up in a proposal I was preparing. So I spoke to the Medical Director about it. He told me that they would never authorize weight-loss surgery because the side effects caused an increased need for ongoing medical care, and increased costs. They felt that an aggressive weight management program provided far better (and longer-lasting) results for the patient, while holding the line on medical costs.

Of course, tis was a few years ago - 1995 to 1998. I'm not sure what standard practice is now, because I'm no longer working in that industry.

[Miss Vickie]

I used to work at an HMO, writing proposals. Yes, HMOs are interested in controlling costs - after all, most of them ARE for-profit corporations, and they owe their stockholders a return on their investment. But the HMO I worked at (QualMed) was also interested in the best possible medical outcomes.

Wayne, as someone in the business, do you think HMO's are run very differently from insurance companies like BCBS? I'm just curious how they approach things, given the bottom line is the same. (I'd love to insert a rant here about how I believe everyone is entitled to a minimum of medical care, and it's deplorable how many people are uninsured in this country, but it's probably far too political for this board. But still, I'm sure you know my sentiment.)

They felt that an aggressive weight management program provided far better (and longer-lasting) results for the patient, while holding the line on medical costs.

Of course, tis was a few years ago - 1995 to 1998. I'm not sure what standard practice is now, because I'm no longer working in that industry.

So much of this stuff is based on people's opinions and feelings. I wish we had better -- truthful! -- data to really look at a reasonable approach to managing weight healthily and successfully. But I suppose since it's a complicated issue, just dealing with all the variables would take a decade or more. Even so, I'd rather see the money going toward that than the Presidential Fitness Jamboree or whatever it's called. :rolleyes: Knowing that Laura Bush walks around the White House grounds is so very NOT inspiring to me.

[Wayne_Zitkus]

Wayne, as someone in the business, do you think HMO's are run very differently from insurance companies like BCBS? I'm just curious how they approach things, given the bottom line is the same. (I'd love to insert a rant here about how I believe everyone is entitled to a minimum of medical care, and it's deplorable how many people are uninsured in this country, but it's probably far too political for this board. But still, I'm sure you know my sentiment.)
I've been out of the HMO business since 1998, when QualMed started shutting down operations in Colorado. I don't know much about the inner workings of Blue Cross/Blue Shield, but the managed care methods used by HMOs were intended to give the most bang for the buck.

So much of this stuff is based on people's opinions and feelings. I wish we had better -- truthful! -- data to really look at a reasonable approach to managing weight healthily and successfully. But I suppose since it's a complicated issue, just dealing with all the variables would take a decade or more. Even so, I'd rather see the money going toward that than the Presidential Fitness Jamboree or whatever it's called. :rolleyes: Knowing that Laura Bush walks around the White House grounds is so very NOT inspiring to me.
When I worked at QualMed, everything was based on data. Their medical management system featured a huge database on procedures and outcomes, and it was that data they used to make their medical decisions. Opinions and feelings were taken out of the process - if a particular procedure did not produce the desired outcome, it would not be authorized. And back then, they were not authorizing any form of WLS, based on the contemporary outcome data.

[Zandoz]

As long as it's not being funded by us (tax payers), I don't really care what they study. But it's JMHO that it's silly to spend their money on yet another study, when study after study shows that the success rate for diets is in the single digits...and the failures generally leave people worse off than before.

[missaf]

I think in another post I wrote about Kaiser's weight loss program that worked wonderfully for a friend of mine that had tried everything else in the book. It took an extreme amount of time and counseling and tons and tons of work, not to mention a six week liquid diet, but he did it, and he learned more about himself than he ever had before.

[GenericGeek]

I've been out of the HMO business since 1998, when QualMed started shutting down operations in Colorado. I don't know much about the inner workings of Blue Cross/Blue Shield, but the managed care methods used by HMOs were intended to give the most bang for the buck.


When I worked at QualMed, everything was based on data. Their medical management system featured a huge database on procedures and outcomes, and it was that data they used to make their medical decisions. Opinions and feelings were taken out of the process - if a particular procedure did not produce the desired outcome, it would not be authorized. And back then, they were not authorizing any form of WLS, based on the contemporary outcome data.
True, big companies are big on data and "metrics" -- but how you collect, analyze, & interpret the data are what is REALLY important... Since for-profit entities (whether in health care or elsewhere), are exactly that -- in it to make a buck -- IMHO, this leads to a "pennywise, pound foolish" mentality; it is no wonder that "managed care" has FAILED to drive medical costs down to any significant degree!n it to make a buck -- everything is seen through the lens of what is in the best interests of improving the short-term bottom line. (Bean-counters make lousy health-care providers...)

Whether bariatric surgery is the "best" answer when dramatic weight loss is called for may be open to question, but I know for many that it is the ONLY answer at present. It is not an option anyone in their right mind considers lightly! And I have friends for whom it has been nothing short of miraculous.

There have been recent advances in our understanding of brain chemistry and appetite regulation that MAY offer hope to those whose only other alternative is WLS; and since pills are cheaper than surgery (even new drugs!), it's my hope that getting one's insurance to cover the treatment will be virtually automatic, provided one if over some magic threshold of X% overweight.

But that is at least 5 years off; many people need help NOW!

Anyone have any firsthand data on overseas WLS treatment? More and more Americans are going offshore for a number of surgeries that are horrendously expensive in the US. I have heard that the cost savings are big enough to offset the travel expenses. "Medical tourists" get full airfare to places like Thailand, the surgery, recuperation in a four-star hotel, etc. -- for about half one would shell out in the US. The docs are US board-certified, and Stateside followup visits are part of the package.

The "free market" is indeed an amazing thing!