Obesity big enough for both of us, hospitals say
December 4th, 2005
Cleveland Clinic may be advertising its bariatric surgery in UPMC’s back yard, but there are still plenty of candidates to go around
Sunday, December 04, 2005
By Christopher Snowbeck, Pittsburgh Post-Gazette
A battle of the bulge is brewing between hospitals in Pittsburgh and Cleveland over patients who need bariatric surgery, an increasingly popular treatment for severe obesity that has become a lucrative revenue source for hospitals.
The Cleveland Clinic began running newspaper ads in Pittsburgh last month courting patients who are more than 100 pounds overweight and considering the gastric bypass.
While the marketing director for the Cleveland hospital said it was unintentional, a line from the new ad campaign closely echoes a former slogan for the University of Pittsburgh Medical Center by stating: “Choose a bariatric program as if your life depends on it.”
Officials at UPMC and other hospitals in the Pittsburgh area say they aren’t scared by the competition. They say hospitals and surgeons that perform bariatric surgeries here are plenty good, so patients don’t need to travel.
And they say they aren’t noticing any drop-off in demand for the procedure. Considering the number of number of obesie people in Pittsburgh, Cleveland and across the country, there’s plenty of business to go around, the local hospitals contend.
“Four percent of American adults are morbidly obese,” said Dr. Anita P. Courcoulas, director of bariatric surgery at the University of Pittsburgh Medical Center, referring to patients who are potential candidates because they have body mass indexes above 40, which often correlates to being 100 pounds overweight. People with slightly lower indexes might be candidates if they also have certain health problems related to weight.
That means that even while the number of gastric bypass operations performed each year is increasing dramatically, it’s still reaching “only a fraction” of the number of people who could benefit from surgery, Dr. Courcoulas said.
The Cleveland Clinic is reaching out to bariatric surgery patients not just in Pittsburgh but also in Akron, Canton and Erie this year, and will extend the effort to other parts of Ohio and Michigan next year, said James Blazar, chief marketing officer. Pittsburgh doesn’t represent a uniquely large market of obese patients compared to Cleveland, he added.
The Centers for Disease Control and Prevention does not rank cities in terms of the proportion of obese residents, but it does collect the results of phone surveys about health risks in all 50 states. During 2002, those surveys found that the statewide populations in Ohio and Pennsylvania, respectively, were 23 percent and 23.9 percent obese — greater than the national average of 22.2 percent.
While it’s unclear whether Pittsburgh is the fatter city, it likely has a larger number of patients who know Dr. Philip Schauer, the staff director of the bariatric surgery program at the Cleveland Clinic. That’s because Dr. Schauer left UPMC last year after practicing here for several years, and building a large practice.
Bariatric surgery patients often undergo tests and counseling for months prior to undergoing surgery, so it wouldn’t be surprising if some patients who met Dr. Schauer at UPMC followed him to Cleveland for care, said Dr. Neil Hutcher, a bariatric surgeon in Richmond, Va., and president of the American Society of Bariatric Surgeons.
He said patients often are willing to travel long distances for surgeons they’ve never met personally but have learned about on the Internet.
“My understanding is that it’s only 100 miles from Cleveland to Pittsburgh,” said Dr. Hutcher. “Even though it’s different states, 100 miles is not an inordinate distance for a bariatric patient to travel.”
The Cleveland Clinic says more than 100 patients have traveled from Western Pennsylvania already. But Dr. Courcoulas, the UPMC surgeon, insists the Pittsburgh program isn’t suffering a lack of demand. On the contrary, UPMC has a waiting list of patients seeking the surgery.
Nor have patients been bypassing the North Side in favor of the drive to Cleveland, according to officials at Allegheny General Hospital, which is one of least seven medical centers in the region that perform bariatric surgeries.
“There’s certainly no shortage [of hospitals] here,” said Dr. Joe Colella, director of bariatric surgery at Allegheny General. “Patients who would want access to surgical medical care for weight problems would really be hard-pressed to do better elsewhere.”
The Cleveland Clinic’s marketing push comes at a time when more health insurers are trying to restrict access to bariatric surgery. At a cost of about $25,000 each in simple cases — and much more in more complicated ones — the growing popularity of the celebrity-promoted procedures has been troubling to health plans.
A 2004 report from the Pennsylvania Health Care Cost Containment Council found that 6,791 gastric bypass surgeries were performed in the state in 2003, up tenfold from 1999 when only 674 were performed. Between 1999 and 2003, the number of surgeons performing gastric bypass surgery increased from 31 to 84, the council reported, and the number of facilities increased from 26 to 49.
At a time of runaway health care costs, some employers and insurers are drawing the line at the surgery.
HealthAmerica decided that, effective June 1, groups renewing their health benefits with the insurer no longer will receive obesity surgery coverage in their basic medical plan. Firms with more than 250 employees can obtain coverage if they purchase a rider for obesity surgery. HealthAmerica’s move follows similar steps taken by national insurers Aetna and Cigna.
Gastric bypass surgery is still part of basic health insurance coverage at Highmark, but the number of surgeries covered by the region’s largest health insurer dropped during 2004 after the insurer tightened the criteria for patients seeking operations.
While insurers say they are restricting access due to safety concerns — and doctors fire back that such claims are vastly overstated — proponents of the surgery noted that Medicare appears poised to cover more of the procedures for patients under age 65.
“I think it’s a major positive,” said Dr. Schauer, the Cleveland Clinic surgeon, in reference to Medicare’s decision late last month to seek public comment on a proposal to expand coverage. A final decision from Medicare is expected next year.
“That may influence the national market in this area in terms of whether other payors will cover the procedure,” Dr. Schauer said.
Source: post-gazette.com
Entry Filed under: Weight Guides, Nutrition News
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