for Medicare & Medicaid Services (CMS) recently announced it will cover
bariatric surgery for Medicare beneficiaries who are morbidly obese and have
type 2 diabetes. Morbidly obese individuals are those with a BMI of 35 or
greater. In 2006, CMS expanded coverage of four types of bariatric surgery to
those with a BMI of 35 or higher, and at least one co-morbidity related to
obesity. The recent bulleting specified type 2 diabetes as a co-morbidity.
The CMS said beneficiaries with BMIs lower than 35 will not have the surgery covered because “current evidence has not proven that bariatric surgery will lead to improved health outcomes in these people.” Those beneficiaries covered will be required to receive the surgery at facilities certified by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery. We applaud the direction that CMS is headed – although the costs for surgeries are high ($20,000-plus), the cost of serious diabetes complications dwarf the price of surgery, especially because diabetes is a progressive disease and costs every year will go one direction only without intervention – up, up, up.