National Coverage Analysis (NCA) View Public Comments

Bariatric Surgery for the Treatment of Morbid Obesity

Public Comments

Commenter Comment Information
Srikanth, Myur Title: Surgeon
Organization: Center for Weight Loss Surgery
Date: 04/28/2012
Comment:

I am puzzled by the CMS's absurd position on the Sleeve Gastrectomy. They have approved multiple operations in several specialties with far less evidence than what is currently available on the Sleeve Gastrectomy.

Existing RCTs and other contemporaneous evidence clearly demonstrate that the Sleeve Gastrectomy has lower mortality and morbidity than the RNY GBP with equivalent results not just in terms of %EWL but also remission rates of several co-morbidities esp

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Girr, Lisabet Title: Unit Based Educator, BSN, RNC-OB, CBN
Organization: Borgess EMdical Center
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Davis, Pam Title: Bariatric Program Director
Organization: Centennial Center for the Treatment of Obesity
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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owens, milt Date: 04/28/2012
Comment:

I have done many sleeve gastrectomies and published on the subject. I find weight loss to be the same as gastric bypass and long term outcomes more free of complications. I have also had to tell many Medicare patients who requested the operation that it was not available to them.

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete

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Peterson, Greg Date: 04/28/2012
Comment:

If this randomized trial goes through as you purpose, if my understanding is correct the Vertical Sleeve (if the collected data proves favorable), would be approved at the earliest 2018. Those of us who have Medicare and need this surgery cannot hold out that long. Many of us have already endured for years holding out for VSG approval as it is.

A careful review and comparison of the VSG to the currently approved bariatric procedures quite clearly shows it has all the perks

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Knapp, Eric Date: 04/28/2012
Comment:

Bariatric surgery is currently a covered service under medicare, but only adjustable gastric banding and gastric bypass are allowed. The recent decision to limit sleeve gastrectomy to prospective trials is really not necessary. Sleeve gastrectomy is part of nearly all bariatric surgeons' practice, and there are certain advantages to the procedure that actually may make it the BEST operation for the medicare population. For example, the small intestine is not involved with this operation,

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dabideen, harris Date: 04/28/2012
Comment:
There is no question that long term trials are needed with the sleeve operation.Intuitively this operation will be associated with regain of most of the weight lost.The residual stomach is apprx.8 times in volume compared to the gastric bypass
Kothari, Shanu Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Cacucci, Brenda Title: MD, FACS, FASMBS
Organization: Meridian Surgical Group
Date: 04/28/2012
Comment:
I have been a Bariatric and General Surgeon in private practice in Indiana for 12 years. My personal experience with the Medicare/Medicaid population is that a majority of the patients seeking bariatric surgery are patients less that 65 years of age. Both patient populations, <65 and >65 years of age, are as a whole higher risk populations, both physically and mentally. Not allowing a patient and their doctor a choice of surgeries that may be safer and more effective is inappropriate. I

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Huberman, Warren Title: Clinical Psychologist
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Hawasli, Abdelkader Title: Director Bariatric Surgery
Organization: Beaumont Hospital Grosse Pointe
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Haffley, Paula Title: Physician Assistant
Organization: IU Health Bariatric and Medical Weight Loss
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Selzer, Don Date: 04/28/2012
Comment:

To Whom It May Concern:

Please allow me to comment on the proposed decision for CMS coverage of the sleeve gastrectomy. Ih the Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2), the proposed decision memo had an incomplete review of available evidence and did not consider the entire Medicare population.

Ultimately, I am concerned that this will diminish access to care for patients in need. CMS should provide the Laparoscopic

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Smith LaFrenz, Hannah Date: 04/28/2012
Comment:
The use of VSG for treatment of Morbid Obesity and Diabetes is the most hopeful intervention we have right now. [PHI Redacted] Anyone who struggles with Morbid Obesity should have this treatment as an option. It works!
Phillips, Steve Title: Senior Director, Health Policy & Reimbursement
Organization: J&J Worldwide Go vernment Affairs & Policy
Date: 04/28/2012
Comment:

(Letter also submitted via e-mail to CMS/CAG. Available upon request from sphilli7@its.jnj.com.)

April 28, 2012

Louis Jacques, MD
Director, Coverage and Analysis Group
Office of Clinical Standards and Quality
Centers for Medicare & Medicaid Services
Mail Stop S3-02-01
7500 Security Boulevard
Baltimore, MD 21244

Dear Dr. Jacques:

I am pleased to provide comments regarding the Proposed Decision Memo for Bariatric Surgery

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Brolin, Robert Date: 04/28/2012
Comment:
Sleeve gastrectomy is the most cost effective of all of the currently used bariatric operations; low incidence of perioperative complications and lowest incidence of later complications relative to lap band and gastric bypass. Late complications lead to readmissions and reoperations which increase cost.
anthone, gary Title: Director of Bariatric Surgery MD 1983
Organization: Nebraska Methodist Health System
Date: 04/28/2012
Comment:
Sleeve Gastrectomy would save Medicare millions of dollars as surgeons and patients prefer it to Lap Band and there is no up front device charge (@3000 for the lap band) or subsequent adjustment charges. As of now, Medicare pts. in our practice are "forced" to choose a lap band or gastric bypass when we know they are much better served with a sleeve gastrectomy. There are so many advantages of a sleeve gastrectomy over a lap band (mainly very few if any long term complications) but the lap

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Ibrahim, Ibrahim Title: President
Organization: Bergen Laparoscopy & Bariatrics
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Greene, Barry Date: 04/28/2012
Comment:

I am a bariatric surgeon with 12 years’ experience treating over 2000 Morbidly Obese patients. Medicare patients comprise 20% of my population and I am concerned that your proposed decision regarding sleeve gastrectomy will continue the limited access to care for many Medicare patients who are particularly vulnerable. They suffer from obesity yet are not eligible or are not good candidates for the gastric bypass or the adjustable gastric band. For example, many obese Medicare

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Duncan, Titus Date: 04/28/2012
Comment:

I would like to comment and ask that you reconsider with regard to your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I treat a large African American patient population that as you know is disproportionately affected by obesity and its related co-morbid conditions. As the obesity incidence continues its upward trend, more and more Americans, and especially those of African descent, continue to be plagued by this increasing

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Cohen, Philip Date: 04/28/2012
Comment:
To whom it may concern: I am writing in opposition to CMS’s decision to exclude coverage for Laparoscopic Sleeve Gastrectomy for Medicare beneficiaries apart from randomized clinical trials. I will not reiterate a literature search here, but it is reasonable to say that there is good clinical evidence that supports LSG as a method of surgical weight loss. I would strongly agree with the ASMBS comment that exclusion of the LSG for treatment of obesity unfairly excludes the very population in

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Drentea, Domnica Organization: american citizen
Date: 04/28/2012
Comment:
Once again, we are told that all citizens are not equal under the law. The rich can affort the best medical treatment, while the poor can not have the same priviledges. That is what we understand from the decison made by medicare not to aprove the Sleeve Gastrectomy for medicare patients. It is a better surgery, with few side effect if any, and it costs less. It should be a WIN-WIN for everybody. plese reconsider, it will help the nation budget deficit too. Sincerely, Domnica Drentea
Fermelia, Richard Title: Bariatric Surgeon, Fellow of the ASMBS and ACS
Organization: American Society for Metabolic and Bariatric Surgery
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Rosher, Wendy Title: Vice President Clinical Services
Organization: Ellis Medicine
Date: 04/28/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Roth, Aaron Date: 04/28/2012
Comment:
I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Morton, John Date: 04/27/2012
Comment:

Given the weight of the clinical evidence in favor of the procedure, for them to decree that M/C cases must be done as part of a research study is unarguably COERCIVE. One of the fundamental tenants of human subjects’ research is voluntary participation in research trials. Since most M/C patient have no other means to access this type of surgical care (out of pocket, other insurance) it is an unacceptable decision. The admonishments against coercion of humans into research studies is

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Gregg, Pam Date: 04/27/2012
Comment:
When I went for the seminar for bariatric surgery,the sleeve was discussed,but was told that Medicare has not approved the procedure.I feel that Medicare should approve the sleeve because it's less evasive and no re-routing of the intestine.I would accept having this procedure if Medicare was to approve it.I have read the ASMBS response to CMS Sleeve Coverage Decision.[PHI Redacted]At least anyone having bariatric surgery,would have a choice in which procedure they

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Crowley, Rondi Date: 04/27/2012
Comment:
I am a Bariatric Program Manager and have been working with Bariatric patients for over 7 years in Sacramento California. Our surgeons have performed over 800 cases of mainly the gastric bypass and band up until about two years ago when the sleeve was introduced. Over the past two years we have added the sleeve gastrectomy procedure as a choice for our patients. We are seeing great success with this procedure, especially over the gastric adjustable band. Many patients are fearful of the

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GOEL, RAJAT Date: 04/27/2012
Comment:

Dear Sir,

We would like that CMS review the new literature evidence submitted in the aforementioned ASMBS and ACS letter including Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes;Obesity, Type 2 Diabetes Mellitus, and Other Comorbidities: A Prospective Cohort Study of Laparoscopic Sleeve Gastrectomy vs. Medical Treatment; and SLEEVEPASS: A randomized prospective multicenter study comparing laparoscopic sleeve gastrectomy and gastric bypass in

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Wohlgemuth, Stephen Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Inge, Thomas Title: Professor of Surgery
Organization: University of Cincinnati
Date: 04/27/2012
Comment:

Regarding the proposed CMS decision to limit sleeve gastrectomy to those willing to participate in randomized trials, I believe that this position may well be unethical. Given the weight of the clinical evidence in favor of the procedure, for CMS to decide that M/C cases must be done as part of a research study is unarguably COERCIVE. One of the fundamental tenants of human subjects’ research is voluntary participation in research studies. Since most M/C patient have no other means to

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Kemmerling,MD, James Title: MD
Organization: NEW Surgical Associates
Date: 04/27/2012
Comment:
Please review the available evidence for Sleeve Gatrectomy as a primary treatment for obesity. The procedure offers patients an effective weight loss option that has advantages over the Roux Y or the Lap Band. I have performed more than 120 Sleeve Resections with results that correlate with published studies. A randomized trial would be denying patients access to a proven therapy.
James Kemmerling, MD, FACS
HEPLER, BECKY Date: 04/27/2012
Comment:
I completely believe in Gastric By Pass procedures for treating Morbid Obesity!! [PHI Redacted] To not have this opportunity available for ALL would be a tragedy!! It relieves most patients of all signs of diabetes and high blood pressure, even BEFORE much weight, and often before any weight is ever lost. It saves patients and Insurance companies tons of money on medications for secondary illness associated with Morbid Obesity! I spent 10 yrs. in the Bariatric Community,

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Avara, William Date: 04/27/2012
Comment:

Sleeve gastrectomy has proven to be a reliable,safe and effective treatment for morbid obesity.Medicare patients are excellent candidates and are denied this treatment and forced to undergo alternatives that may not be as suitable. Please reconsider and allow these patients to have this benefit.

Thank You

Pete Avara
LaMasters, Teresa Title: Minimally Invasive Bariatric Surgeon
Organization: Iowa Health Weight Loss Specialists
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Glass, Scott Title: Behaviorist
Organization: Grand Health Partners
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Dayhim, Fariba Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

As a bariatric surgeon, I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need.

I believe CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can

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Geary RN/CBN, Stephen Title: Register Nurse /Cetified Bariactric Nurse
Date: 04/27/2012
Comment:

I have had the opportunity to witness the many benefits patients have had since having a gastric sleeve gastrectomy.Due to mutiple health problems and previous surgires they may have only one weight loss surgery option and that would be lap gastric sleeve.For most patients the benefits of having this surgery far out weight the risk and I stongly believe this surgical procedure should be included in the fight againist the number one health problem in the United States and slowly becoming the

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bertha, nick Title: surgeon
Organization: ALSOM
Date: 04/27/2012
Comment:
Restriction of sleeve gastrectomy is an unwarranted restriction of access for millions of patients. The procedure has been demonstrated to be safe and effective and will likley become the MOST effective procedure performed in your insureds with time.
O'Rourke, Robert Title: Associate Professor
Organization: Oregon Health and Science University
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Machado, Laura Title: Medical Director
Organization: Sacramento Bariatric Medical Associates
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Wolf, Andrea Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Gibbs, Karen E. Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Farrales-Nguyen, Susan Title: Nurse Practitioner
Organization: Lucile Packard Children's Hospital
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Belli, Carolyn Title: Patient Service Coordinator, Weight Management
Organization: Alexian Brothers Medical Center
Date: 04/27/2012
Comment:
I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Oliak, David Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Ditslear, John Title: MD
Organization: Tower Surgical
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Whittwell MD, Augusto Title: MD
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Malladi, Preeti Title: Bariatric Surgeon
Organization: Preeti Malladi M.D., P.A.
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Vosburg, Jr, Melvin Date: 04/27/2012
Comment:

April 27, 2012

Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

To Whom it may concern:

I would like to thank the CMS for their decision to improve access for weight loss surgery through a National Coverage Decision. However I feel there is already enough scientific evidence to justify approval of Gastric Sleeve surgery for Obese Medicare Patients.

[PHI Redacted]

The research

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Dooley, Nancy Title: Administrative Assistant
Organization: IU Health Bariatric & Medical Weight Loss
Date: 04/27/2012
Comment:
Please reconsider your decision to cover the Sleeve Gastrectomy as a covered benefit for Medicare for all patients. I have seen patients go through amazing changes due to weight loss surgery. They become healthier physically and mentally. It is truly a miracle that some patients can stop their diabetic medicine and even insilin after surgery. How could you stop these patients from having access to such a great operation that will make them healthier and live longer lives. Thank you for

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Moore, Rachel Title: Chief, Division of Bariatric Surgery
Organization: Louisiana State University
Date: 04/27/2012
Comment:
Sleeve gastrectomy is a safe and effective operation that should be available to Medicare patients. It can be done faster than gastric bypass, which is beneficial in older/sicker patients. It is also an important option in extremely large or "super-obese" patients where a laparoscopic Roux-en-Y gastric bypass may not be possible. There are also occasions when a patient's surgical history makes sleeve a safer choice.
Mumme, David Date: 04/27/2012
Comment:
The decision to limit coverage for sleeve gastrectomy for obesity patients under CMS is shortsighted and bad for patients. As an anesthesiologist, from time to time I have witnessed patients desperately needing bariatric surgery that when it was attempted was too dangerous and difficult to proceed with a Roux-en-Y gastric bypass. Those patients that are not covered by CMS can then be converted to a gastric sleeve procedure And can get life-saving procedure. Unfortunately for CMS patients the

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Castro, Manuel Title: MD
Date: 04/27/2012
Comment:

Gastric sleeve surgery is an effective weight loss operation with safety profile, results, lower long term risks than either gastric bypass, duodenal switch or Lap band. This is based on experience with approximately 550 gastric sleeve operations done over a 5 year period. I am aware that existing evidence-based data is limited in some respects but so it is with most other operations.

Specific circumstances make this operation a better choice than the other operations. For example,

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Kesler, Jean Title: Jean Kesler, Citizen
Organization: Human Race
Date: 04/27/2012
Comment:

[PHI Redacted]
The Gastric Sleeve is the Gold Standard of weight loss surgery. I certainly hope you will do your research and make your decision in favor of approving this procedure NOW! You'll help millions of people and save $MILLIONS of dollars.
Sincerely, Jean Kesler

Kovler, Janet Title: Bariatric Surgery Program Manager
Organization: Orange Regional Medical Center
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Foote, MD, James Title: Vice President, Grand Health Partners
Organization: GHP
Date: 04/27/2012
Comment:

My name is James A. Foote, MD and I am a Bariatric surgeon in a private practice in Michigan I have been performing the Vertical Sleeve Gastrectomy since 2005. I have performed 2749 bariatric surgery procedures and of that I have performed 670 vertical sleeve Gastrectomy procedures.

I have 65 vertical sleeve patients that I have performed surgery on that qualify for Medicare, however many paid cash or used their secondary insurance to pay for this operation. Of those 65 patients,

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White, MD, Dawn Title: Secretary, Grand Health Partners
Organization: GHP
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Nagle, Derek Title: Vice President, Grand Health Partners
Organization: GHP
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Baker, MD, Randal Title: President, Grand Health Partners
Organization: GHP
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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McCorriston, Kim Title: Office Manager
Organization: Grand Health Partners
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Blackstone, Robin Title: President
Organization: American Society for Metabolic and Bariatric Surgery
Date: 04/27/2012
Comment:

April 27, 2012

Louis Jacques, MD
Director, Coverage and Analysis Group
Centers for Medicare and Medicaid Services
Mail Stop S3-02-01
7500 Security Boulevard
Baltimore, Maryland 21244-1850

RE: ASMBS Response to CMS Sleeve Coverage Decision

Dear Dr. Jacques:

The American Society of Metabolic and Bariatric Surgery would like to respond to your recent Proposed Decision Memo for Bariatric Surgery for the Treatment

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Mattar, Samer Title: Associate Professor of Surgery
Organization: Indiana University
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Nadglowski, Joseph Title: President and CEO
Organization: Obesity Action Coalition
Date: 04/27/2012
Comment:

The Obesity Action Coalition (OAC) appreciates the opportunity to respond to the Center for Medicare & Medicaid Services (CMS) March 29, 2012 Proposed National Coverage Decision (NCD) Memo regarding Bariatric Surgery for the Treatment of Severe Obesity (CAG-00250R2) specific to laparoscopic sleeve gastrectomy (LSG). We are concerned that CMS’ conclusions in the proposed decision memo were based on an incomplete review of available evidence with no prior precedence for the level of review

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stewart, daryl Date: 04/27/2012
Comment:
I do not understand the recommendations requiring further study of the Sleeve Gastrectomy before coverage by Medicare. Medicare already covers it as part of the Duodenal Switch procedure, so there certainly should not be any safety concerns. Medicare also covered the Lap-Band certainly with no greater amount of evidence and the Lap-Band is a much inferior procedure in my experience and the experience of many other bariatric surgeons. The majority of my Medicare patients want the Sleeve

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knox, sarah Title: clint
Organization: Home maker/ wife
Date: 04/27/2012
Comment:
Thank you for listening, [PHI Redacted] Why not when it is less complication and has a success rate as high as the By pass. The by pass will not work for everyone due to the other problems that they may have. [PHI Redacted] Please don't take away that help. Please listen to more people . Check the data and the people who have done the procedure ; and can testified of the benefits.
Jasak, Robert Title: Deputy Director, Regulatory & Quality Affairs
Organization: American College of Surgeons
Date: 04/27/2012
Comment:

April 27, 2012

Louis Jacques, MD
Director, Coverage and Analysis Group
Centers for Medicaid and Medicare Services

[submitted electronically]

Re: Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2)

Dear Dr. Jacques:

The American College of Surgeons (ACS) is a scientific and educational association of surgeons, founded in 1913, to improve the quality of care for the surgical patient by setting high

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Clarke, Terence Date: 04/27/2012
Comment:
The data is more than sufficient to support the efficacy of Sleeve Gastrectomy. I will not bore you with the medical and financial impact of obesity. Aside from directly treating and improving the myriad of obesity related conditions, we also unearth many other conditions that go unrecognized. The evaluation process for surgery includes being up to date with standard screening and smoking cessation. I personally have found numerous cancers that would have otherwise progressed. Lets not be

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Resurreccion, Clara Date: 04/27/2012
Comment:
Sleeve surgery patients have lost so much weight than band patient. There are a good number of patient population that will benefit sleeve than bypass mostly because of past medical history. SLEEVE should be covered, obese patients needs this --less drastic than bypass, more effective than band.
Lodhia, Nayna Date: 04/27/2012
Comment:
I have seen the benefits of sleeve gastrectomy on patients. It is a great procedure.
Scharf, Keith Date: 04/27/2012
Comment:
I think that CMS should cover sleeve gastrectomy as it is a valuable surgical option to help treat morbidly obese patients with comorbidities related to obesity
Patel, Sheetal Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Ostby, Kate Date: 04/27/2012
Comment:
I am a registered dietitian specializing in bariatric surgery and weight management. The sleeve gastrectomy has been an enormous benefit to patients in improving their health and overall quality of life. The sleeve has actually superceded my expectations and I am extremely excited to see what is in store for the future. Denying medicare patients the opportunity to decide on the appropriate procedure impedes them from obtaining proper healthcare. Full coverage for the sleeve gastrectomy

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Pisciotta, Michael Title: Registered Nurse
Date: 04/27/2012
Comment:
As a health care professional I have seen super results from weight loss surgery. It has been my experience that weight loss surgery has helped decrease long term medical expenses and helped improved quality of life. The results are not just from gastric bypass or band but in my opinion the best surgery the best results and the least complications come with the gastric sleeve.
Esparza, Ovet Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Darte, Brandi Title: controller
Organization: Southern Surgical Hospital
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Melcher, Marc Title: Assistant Professor
Organization: Stanford University
Date: 04/27/2012
Comment:

As a kidney transplant surgeon I see many patients with renal failure secondary to diabetes type 2 and hypertension. I believe the data is getting stronger and stronger that bariatric surgery (including sleave gastrectomy - see recent article in Arch Surg. Published online April 16, 2012. doi:10.1001/archsurg.2012.222) is being shown to be an good treatment modality for these patients. Since the risk of complications for sleave gastrectomies may be lower it seems to be more appropriate

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Wetter, Albert Title: MD, FRCS, Director Bariatric Surgical Services.
Organization: Mills-Peninsula Hospital, Burlingame, CA
Date: 04/27/2012
Comment:
The sleeve gastrectomy operation as a Primary surgical option for the treatment of comorbidities related to morbid obesity is a sound operation that has proven to be safe and effective. It now constintute our favour choice operation specially in the older population as our results in resolving obesity-related problems are superior as compared to the adjustable gastric band without the complications associated with the band nor the risk imposed by the gastric bypass or duodenal switch

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Regan, Joseph Title: Medical Director - CSM Bariatric Center
Organization: Columbia-St Marys
Date: 04/27/2012
Comment:
Sleeve gastrectomy continues to be an important tool in the battle against obesity. Multiple peer reviewed studies have documented that the procedure is safe and effective, and no longer considered investigational. The procedure is an attractive option for patients and treating surgeons as a compromise/contrast to the Lap Band and gastric bypass. Many patients are appropriate candidates for a sleeve gastrectomy, but not for the Lap Band or gastric bypass. Thanks.
Perez, Carrie Title: Bariatric Program Coordinator
Organization: War Memorial Hospital and Advanced Surgical Care
Date: 04/27/2012
Comment:

April 27th 2012

To Whom it May Concern

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient

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Cipriano, Joseph Title: Bariatric Surgeon
Organization: War Memorial Hospital and Advanced Surgical Care
Date: 04/27/2012
Comment:

April 27th 2012

To Whom it May Concern

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient

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Adair, Jamie Title: Bariatric Medical Director
Organization: War Memorial Hospital and Advanced Surgical Carei
Date: 04/27/2012
Comment:

April 27th 2012

To Whom it May Concern

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group

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Marsilio, Cynthia Title: Bariatric Program Director
Date: 04/27/2012
Comment:
I would ask that you review your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). The proposed decision memo has an incomplete review of available evidence, and did not consider the entire Medicare population. In the New England Journal of Medicine, issue March 26, 2012, Schauer et al published “Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes. It was shown that the sleeve gastrectomy outcomes were

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English, Wayne Title: Medical Director, Bariatric & Metabolic Institute
Organization: Michigan Bariatric Surgery Collaborative and ASMBS
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need of these services. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health

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Davidson, Leo Title: MD
Organization: Village Surgical Associates
Date: 04/27/2012
Comment:
I oppose the limitation of access to the sleeve gastrectomy in CMS patients. This group of patients need to a have more options to meet their needs rather than limited options. I agree with our specialtiy organization statement (ASMBS) that there is sufficient research related to this subject and the requirement of additional studies is contrary to other CMS policies.
McKee, Carolyn Title: RN, Bariatric Coordinator
Organization: Clark Memorial Hospital
Date: 04/27/2012
Comment:
I know that gastric sleeve surgery re realtively new, but morbidly obese patients need help. Even though the band is a great successful tool it does require maintenence and some patients that have huge job requirements cannot follow-up as needed. Gastric sleeve is a NOT a malabsortion procedure and only a restrictive procedure and for some patients is needed. Over all I feel this procedure is safe and these patients need help as OBESITY IS A DISEASE. Thank you for listening.
Schroeder, Dana Title: Research Nurse, Program Coordi and Support Groups
Organization: Stanford University and Good Samaritan Hosp San Jose
Date: 04/27/2012
Comment:
Please don't put limitations on the sleeve gastrectomy. I have been working in Bariatrics as a Bariatric Program Coordinator and in Bariatric Research and we have 10 and 12 year studies showing the efficacy and safety profile of this procedure. It has fewer long term issues related to mal-absorption than the gastric bypass. I have worked with thousands of patients over the years and have seen the effectiveness of the sleeve. It is safer and just as effective as the bypass. It is also fiscally

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Gandhi, Alok Title: Bariatric Surgeon
Organization: Rochester General Hospital
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Forrester, Glenn Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Schroeder RN CBN, Dana Title: Research Nurse, Bariatric Coordinator, Support
Organization: Stanford University and Good Samaritan Hosp San Jose
Date: 04/27/2012
Comment:
Please don't put limitations on the sleeve gastrectomy. I have been working in Bariatrics as a Bariatric Program Coordinator and in Bariatric Research and we have 10 and 12 year studies showing the efficacy and safety profile of this procedure. It has fewer long term issues related to mal-absorption than the gastric bypass. I have worked with thousands of patients over the years and have seen the effectiveness of the sleeve. It is safer and just as effective as the bypass. It is also fiscally

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Ewing, Douglas Title: Director, MIS/Bariatric Fellowship
Organization: Hackensack Univeristy Medical Center
Date: 04/27/2012
Comment:

I am a bariatric surgeon in Hackensack, New Jersey. I perform laparoscopic adjustable gastric banding, gastric bypass and sleeve gastrectomy. I have been doing the sleeve gastrectomy for two years. I have found it to be a remarkably safe and effective operation. My patients have been similarly satisfied. Sleeve gastrectomies now represent the majority of the bariatric procedures that my patients choose and that I perform.

I was shocked and disappointed that CMS did not approve

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Mederos Jr, Raul Title: MD, FACS
Date: 04/27/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Baggs, Aaron Title: MD, FACS
Date: 04/27/2012
Comment:
I have seen the sleeve gastrectomy become one of the best treatments for obesity for patients over the age of 50. The sleeve gastrectomy has a complication rate lower than the gastric bypass and a better weight loss than the lapband. The European data and the American experience have shown it to be an excellent operation in the appropriate patient population. It is inconsistent with patient safety to approve the elderly for gastric bypass without the alternative of the sleeve gastrectomy.
Vierra, Mark Date: 04/26/2012
Comment:
Sleeve Gastrectomy for treatment of severe obesity. I have performed complex GI surgery for 22 years and although we have not called it a "Sleeve" it has been an indispensable surgical option for many patients with complicated motility disorders of the esophagus, previous gastric surgery, and obesity. I believe available medical evidence justifies the use of this procedure and I would encourage you to approve its use.
Ogilvie, James Date: 04/26/2012
Comment:
I urge CMS to provide re-imbursement for gastric sleeve surgery for morbid obesity. As an observer, physician over three years, I've heard testimony from many patients who had the sleeve procedure, who have done very well. In my view it has become an effective, proven surgical tool for the amelioration of obesity and diabetes.
GUANCI, JOSEPHINE Date: 04/26/2012
Comment:
[PHI Redacted] SLEEVE SURGERY IS PROVING THAT THIS WILL NOT HAPPEN AND NOT AS INCONVENINET AS LAP BAD. LAP BAND PATIENTS BECOME VITAMIN DEFICIENT, VOMIT FREQUENTLY, GET FOOD STUCK, FEEL MORE PAIN, LOSE LESS WEIGHT, MUST GO FOR SALINE FILLS, CANNOT TOLERATE MANY FOOD BECAUSE OF CONSISTENCY, ETC. THIS DOE NOT HAPPEN WITH THE SLEEVE AND PATIENT REMAINS HEALTHIER.
Siddiqui, mujeeb Title: DO
Organization: asmbs
Date: 04/26/2012
Comment:
Bariatric Surgery Center of Excellence published in Obesity Surgery 2010 found that all three weight loss surgeries (band, bypass, sleeve) were effective in patients =65 years of age, producing significant EWL, reduction in daily medication use, and improvement in QOL. All surgeries also associated with a zero 30 day-mortality rate and a low morbidity profile.
Medicare beneficiaries tend to be a group of patients with higher operative risks. Sleeve gastrectomy is associated with lower

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Brengman, Matthew Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Orr, Carol L. Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo will result in diminished access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100 million other Americans have enjoyed.

Specifically, CMS should

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Vulcan, Megan Title: Advanced Registered Nurse Practitioner
Organization: Rockwood Clinic Weight Loss Surgery Center
Date: 04/26/2012
Comment:
I am writing in support of Medicare coverage for Vertical Sleeve Gastrectomy. I work at a Bariatric Center of Excellence, where we perform Lap-band, Roux-en-Y Gastric Bypass, and Vertical Sleeve Gastrectomy operations for obesity and co-morbid disease management. Many patients who present to us are not safe candidates for the 2 operations that are currently covered by Medicare-but would be excellent candidates for a Vertical Sleeve Gastrectomy. So, at times because of an insurance limitation,

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hill, michael Date: 04/26/2012
Comment:
The sleeve gastrectomy has allready been proven safe and effective. this is a very valuable tool that gives the riskier patient the safety profile of a restrictive proceedure with the weight los of a bypass. this is even more valuable in the medicare popiulation of the disables and those over 65.
Bond, Rebecca Date: 04/26/2012
Comment:

Thank you very much for your efforts to allow people who are covered under Medicare to have weight loss surgery. I am concerned that only people who are able to participate in a clinical trial will be covered. As someone [PHI Redacted] who has worked in clinical trials for 14 years, I urge you to make this benefit available to all Medicare recipients.

[PHI Redacted] I’m afraid that many people who are older or disabled and have Medicare won’t

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Bovarnick, Ellen Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Dan, Adrian Title: Associate Medical Director - Bariatric Care Center
Organization: Summa Health System
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Moorehead, Barbara Title: Office nurce
Organization: North Texas Bariatric & General Surgery
Date: 04/26/2012
Comment:
In our Bariatric practice we so many patients on Medicare that would benefit from the Gastric sleeve, most are elderly, can't exercise well so the band does so little for them, the gastric bypass is to invasive, our patients who had the sleeve gastrectomy love it and would'nt change surgeries for the world, we do have so many medicare patients that are excellent candidates for the sleeve but unable to pay cash which is their only option other than the band.
Barbara Moorehead LVN,

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Lalor, Peter Title: Medical Director
Organization: Center for Weight Loss Surgery at Wood County Hospital
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Greenberg, Jacob Title: Assistant Professor of Surgery
Organization: University of Wisconsin
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Carter, Tiffanee Date: 04/26/2012
Comment:
I believe that the sleeve gastrectomy should be covered equal to the Lap and roux en Y. The sleeve gastrectomy is a less expensive procedure that has proven successful for weight loss. You have minimal change anatomically. You do not have absorbtion problems like with roux en Y. For some reason it is acceptable to change the anatomy of your body for a more expensive, typically riskier procedure rather than to use this straight forward procedure that offers the same results.....and we

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Murray, RN, BSN, CBN, Mary Title: Bariatric Surgery Program Coordinator
Organization: Westchester Medical Center
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Collins, Joy Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Jacob, Brian Title: Director
Organization: Baricenter at the Laparoscopic Surgery Center of New York
Date: 04/26/2012
Comment:

It is disappointing to see the recent CMS decision that would provide coverage for laparoscopic vertical sleeve gastrectomy, only under a randomized clinical study. This decision would reduce access to proper treatment for Medicare covered patients while the Proposed Decision Memo does not consider all available evidence nor include the entire Medicare population.

Sleeves have been performed throughout the world for years. Considering the thousands of articles, with weight loss

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LeBEAU, Denise Title: Practice Coordinator
Organization: The Chicago Center for Bariatric Surgery
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Timberlake, Anne Title: Certified Bariatric Nurse Specialist
Organization: John Muir Health
Date: 04/26/2012
Comment:
I have been a Bariatric Surgery Nurse Specialist for 10 years. Our surgeons have been performing laparoscopic vertical sleeve gastrectomy since 2006 with excellent outcomes. Average excess body weight loss at 1 year has been 69% with no mortality and only 1 leak (resolved). Co-morbidity resolution in the sleeve patients has approximated the excellent results we have seen in our RNY gastric bypass. Sleeve patients report reduced appetite and effective satiety with small food volume. The sleeve

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Pontillo, Carmela Title: Bariatric Program Manager
Organization: Overlake Hospital
Date: 04/26/2012
Comment:

I am a bariatric program manager and would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same

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Diaz, David Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Freeman, Kathy Title: Bariatric Program Coordinator
Organization: Erlanger Health System
Date: 04/26/2012
Comment:
As Bariatric Coordinator for Erlanger Health Systems, I have personally cared for three patients who have Medicare, who have found other means of getting the Sleeve Gastrectomy done. In two cases the patient was on long-term anti-inflammatory medications. The Sleeve is the only bariatric surgery that it is safe for patients to take anti-inflammatory medications. The Sleeve Gastrectomy should be included in coverage for your patients, especially since there are so many that are on arthritis

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Arioli, Sandy Title: Bariatric Coordinator
Organization: Northwest Medical Center
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Smith, Brian Title: Chief, General Surgery
Organization: VA Long Beach Healthcare System
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Bunnell, Sue Title: Bariatric Manager
Organization: Princeton Baptist Health System
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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lynch, george Date: 04/26/2012
Comment:

I am one of the few bariatric surgeons in a major metropolitan area who actually cares for weight loss surgery patients covered by medicare. Most of my patients are disabled, younger patients. It is hard to imagine that the committee has looked at the available evidence on sleeve gastrectomy and decided to exclude it from coverage. You cover lap bands but not sleeves? Really? We will not operate our way of the obesity epidemic, but there is clearly a role for surgery, and clearly a

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IQBAL, ATIF Title: Leport Surgical Associate.
Date: 04/26/2012
Comment:
I would like to acknowledge the efforts made by ASMBS towards the recognition of Sleeve Gastrectomy as a Primary Bariatric Procedure. It is very unfortunate that after all the world wide data in support of Sleeve Gastrectomy with life changing results in millions still Medicare is not getting convinced. I think it would just be very unfair to Medicare population not to get benefit from this incredible Surgery. I would urge Medicare to please review the facts and data and issue its approval

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Cross, Amanda Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Romero, Roderick Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Huff, Lisa Title: Surgical Weight Loss Behavioral Health Specialist
Organization: King's Daughters Medical Center
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Williams, Brandon Title: Assistant Professor of Surgery
Organization: Vanderbilt University
Date: 04/26/2012
Comment:

Regarding the recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2), it appears that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and certainly will diminish access to care for patients in need.

Most private insurance providers that cover bariatric surgery have been allowing patients and physicians to chose the sleeve gastrectomy for quite some now. CMS is

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Loosemore, Elizabeth Title: Bariatric Coordinator/Registered Dietitian
Organization: Mission Weight Management Center
Date: 04/26/2012
Comment:
I am writing to ask that you reconsider your decision to not cover sleeve gastrectomies for Medicare patients. As a health care provider I have witnessed the benefits of that surgery for numerous patients who have chosen it. Research has shown it to be an effective treatment for morbid obesity. Based on the research and my personal observations I believe your decision not to cover the sleeve gastrectomy as a treatment of morbid obesity is unfair and discriminatory treatment of those

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Rosen, Jeffrey Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Loggins, Jamie Title: Chief of Surgery
Organization: Central Maine Medical Center
Date: 04/26/2012
Comment:

I am writing as a physician involved in the daily care of patients suffering from severe obesity and its related comorbidities, and as a witness to the life transforming stories of many of these patients who have undergone bariatric surgery. I suspect anyone making "policy decision" would be well served to spend just one day in bariatric surgeon's follow up clinic, because in doing so would truely understand the metamorphasis that occurs both in one's physical wellbeing as well as their

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Schmidt, Hans Title: Director, Bariatric Surgery Center
Organization: Hackensack University Medical Center
Date: 04/26/2012
Comment:

As Director of Bariatric Surgery at Hackensack University Medical Center in New Jersey, I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). We are an ACS Level 1A Center of Excellence and provide life-saving bariatric care to many Medicare patients. I believe that this procedure is, in fact, likely the best choice of bariatric procedure for this group of patients. I am concerned that the proposed decision

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Brent, Laura Title: Bariatric Coordinator
Organization: Galesburg Cottage Hospital
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Cheval, Melanie Title: Bariatric Coordinator
Organization: Spectrum Health Medical Group
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Joyner, Kim Title: Bariatric Coordinator
Organization: New Hanover Regional Medical Center
Date: 04/26/2012
Comment:
Sleeve gastrectomy has proven to be an viable treatment for morbid obesity. Long term data for the Lap Band has proven to be less than desireable. Patients need an option when gastric bypass is not an option. At present, the sleeve gastrectomy is the best option. As a bariatric coordinator, I ask that you continue coverage of sleeve gastrectomy. At best, it should be covered as a front line treatment option. At worst, it should be covered as an adjunct treatment option when gastric

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runyan, susan Date: 04/26/2012
Comment:
is the sleeve going to be approved and what would be the time table for the first approved surgery?
Sabir, Mubashir Title: Doctor
Organization: St. John Providence Medical Center
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Twynham, Crystal Title: Owner
Organization: Crystal Twynham MD PLC
Date: 04/26/2012
Comment:

Dear Committee,

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health

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Covert, Laura Title: RN
Organization: Surgical Associates Bariatrics Division
Date: 04/26/2012
Comment:

Our staff appreciates the efforts being made to improve access to weight-loss surgery.

Our office sees patients from a wide variety of backgrounds with a broad spectrum of comorbidities. Many patients have researched the gastric sleeve and are interested in pursuing this surgical procedure. Because it is currently not a covered benefit under Medicare and various health insurances, patients are choosing to not pursue weight loss surgery and are incurring extensive medical bills

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Sales, Scott Title: Administrator
Organization: Premier Metabolic & Bariatric Associates
Date: 04/26/2012
Comment:

4/26/12

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages

More

Moore, John Title: Physician
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Ziemer, Donna Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Dvorak, PA-C, Melissa Title: Physician Assistant
Organization: Fairview Southdale Weight Loss Surgery
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. Sleeve gasterectomy is shown to improve or resolve diabetes.

CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this

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Wilson, Jessica Title: RN Bariatric Coordinator
Organization: Medical Center Hospital
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Powell, Joann Title: Education & Outreach Coordinator
Organization: The Bariatric Center, Georgetown Community Hospital
Date: 04/26/2012
Comment:
I have been in the field of bariatric surgery for 9 years, and have seen many different procedures performed during that time. It is my opinion that the Gastric Sleeve is a wonderful solution to many helth issues suffered by the morbidly obese population. It provides a quick weight loss that is comparable to Gastric Bypass without the additional risks of cutting and rerouting the bowel. That in itself lessens the risk of complications while in the hospital. The fact that the patient

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Denton, Tammy Title: Coordinator, Center for Healthy Living
Organization: King's Daughters Medical Center
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Lebowitz, LMSW, Rachel Title: Licensed Social Worker
Organization: Rachel's Comfy Couch
Date: 04/26/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

[PHI Redacted]

I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can

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Sugerman, Harvey Title: Emeritus Professor of Surgery
Organization: Virginia Commonwealth University
Date: 04/25/2012
Comment:

To Medicare:
Although I am in strong support of the American Society for Bariatric Surgery (ASMBS) comment, which I have also signed, regarding the recent decision by CMS to limit coverage of the laparoscopic sleeve gastrectomy (LSG) to randomized, controlled studies, I feel obligated to emphasize a few of the points that were made.

The decision was totally focused on Medicare patients = 65 years of age. Many patients covered by CMS

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Roslin, Mitchell Title: Medical Director
Organization: Manhattan Minimally Invasive and Bariatric Surgery
Date: 04/25/2012
Comment:

It is with surprise and disappointment that I forward this response to CMS regarding the recent decision to provide coverage for laparoscopic vertical sleeve gastrectomy, only within a randomized clinical study. With a lengthy resume of professional experience in this area, I think that this decision is going to reduce access to proper treatment for Medicare covered patients, and not expand medical knowledge.

The role of a clinical trial should be to determine the effectiveness of

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Beaumont, Tammy Title: Director Methodist Weight management Institute
Organization: Methodist Dallas Medical Center
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

Many surgeons will be writing to you asking you to review additional literature. I'd like to approach this from another view.

We all know that Gastric Banding is only successful in a small, very unique group of individual. The Gastric Bypass, the gold standard, produces phenomenal results, but at an increased risk to the

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Malhotra, Sandeep Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Jenkins, Cynthia Date: 04/25/2012
Comment:

First I want to thank CMS for helping to improve access through National Coverage.

[PHI Redacted] my understanding is that Medicare has not recognized the gastric sleeve surgery. I hope you can reconsider this decision. Any tools available to help improve the health of our citizens is a valuable step toward treating obesity.

My family and I hope that there will be continuing efforts made to expand the treatment of obesity in our country. It affects so

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Sanchez-Geswaldo, Lilibeth Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Carter, Jonathan Date: 04/25/2012
Comment:

It seems registry data and controlled trials from Europe easily justify sleeve gastrectomy as a bona fide bariatric procedure.

There are some patients who suffer from obesity-related disease and are poor candidates for existing procedures. Sleeve gastrectomy is a viable alternative.

Halpin, Valerie Title: Bariatric Surgeon
Organization: Legacy Health
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Ihde, Glenn Title: President
Organization: Texas Association for Bariatric Surgey
Date: 04/25/2012
Comment:

Morbid obesity is an epidemic in America. Unlike other epidemics, the policy decision to limit the use of all proven therapies shows significant prejudice on the part of the CMS decision makers. Although we can continue to work on non-surgical therapies, research has clearly shown that these therapies are ineffective. Surgical therapy has so far been shown to be the only effective therapy. Like most disease processes, there is never one therapy treats all presentations, and surgical

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Hargroder, Andrew Title: MD
Organization: Bariatric Surgical practice
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Zografakis, John Title: Director, Bariatric Care Center
Organization: Summa Health System
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Buchin, David Title: Director of Bariatric Surgery
Organization: Huntington Hospital
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Lopes, Jim Date: 04/25/2012
Comment:

Lack of CMS coverage for sleeve gastrectomy may potentially imperil future commercial coverage. The sleeve is a great stand alone operation and for most pstients with medicare and medicaid, may be their only option- they are the sickest and the have the highest BMI. They need an effective weight loss solution with the least morbidity- and the sleeve is an ideal option for this group

please consider and listen to the physicians- for a change....

Lopes, James Organization: Advanced surgical associates
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Kukreja, Sachin Title: Director of Minimally Invasive and Bariatric Surge
Organization: Mount Sinai Hospital
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Ing, Richard Title: Director
Organization: Bariatric Center of Bryn Mawr Hospital
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Bauman, Roc Title: Medical Director Surgical Weight Loss
Organization: Carolinas Medical Center Northeast
Date: 04/25/2012
Comment:

As "obesity surgery" becomes more and more apparent to be in fact metabolic surgery and the treatment of disease states including diabetes, CMS must hone it's choices of covered benefits to those that are truly metabolic therapies of efficacy and safety. As a bariatric surgeon since 2000 and after 4000 gastric bypasses, I was reluctant to embrace the sleeve gastrectomy until late 2011 when the utter failure of the adjustable gastric band as a metabolic surgery (a CMS covered procedure)

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williams, bunny Title: director, bariatric services
Organization: trinity hospital of augusta
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Kindelan, Tamara Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Stegemann, MD, Lloyd Title: President
Organization: The Better Weigh Center
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am very concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over

More

Jensen, Candice Date: 04/25/2012
Comment:
Sleeve Gastrectomy is a safe, effective treatment option for morbid obesity. Please approve this procedure for CMS patients
Partridge, Sheila Title: MD, Assoc. Chair of Surgery
Organization: Newton-Wellesley Hospital
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Stiles, Sasha Title: MD
Organization: Kaiser Permanente
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Afthinos, John Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Wittgrove, Alan Title: MD
Date: 04/25/2012
Comment:
I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am a past president of the ASMBS and have been doing bariatric surgery for over 25 years. I did not start performing the sleeve gastrectomy at the start. I wanted to see if there was enough data to support its use. I believe there is adequate data and I have now been performing the Sleeve for over two years. The operation is quite beneficial as it shows

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Onopchenko, Alexander Title: Medical Director
Organization: AtlantiCare Regional Medical Center
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Dally, Paul Date: 04/25/2012
Comment:

I would like to comment on your proposed Decision Memo for Bariatric Surgery for the treatment of Morbid Obesity (CAG-00250R2) I believe the decison memo is based on an incoplete review of available evidence for Laparoscopic Sleeve Gastrectomy. I belive CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit for Medicare patients seeking tretment for morbid obesity and related co morbid conditions. The following reports should be included in your review.

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Schirmer, Bruce Title: Stephen H. Watts Professor of Surgery
Organization: University of Virginia Health System
Date: 04/25/2012
Comment:
I wish to strongly urge the Committee to reconsider their coverage for laparoscopic sleeve gastrectomy to only those patients in prospective randomized trials. This decision will significantly limit access to care for many patients who are recipients of Medicare insurance, especially those under age 65 who are disabled. I am a bariatric surgeon and have done bariatric surgery for 26 years. Over this time, operations have come and gone. I myself was initially skeptical that the sleeve

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Krishnaraj, Pandurangan Title: General and Bariatric Surgeon
Date: 04/25/2012
Comment:
Sleeve Gastrectomy has lower morbidity , is good option for patients who donot want To go for bypass surgery. Request CMS approval for this procedure.
You, Christopher Title: Medical Director
Organization: MedStar Franklin Square Medical Center Bariatric Program
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Allen, Alicia Title: Dietitian
Organization: St. Mark's Hospital
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Cywes, Robert Title: director
Organization: Jacksonville Surgical Associates
Date: 04/25/2012
Comment:
I am a bariatric surgeon and I do sleeve gastrectomies amongst other procedures. I agree completely with the CMS position that it is PREMATURE to give open coverage to sleeve gastrectomies in the CMS population since there is insufficient data on medium nad longterm efficacy, risk and need for second stage or conversion surgeries. While early weight loss results are good in my practice, a plateau effect seems to occur at 1-2 years with weight regain in over 2/3 of my patients after 4-5 years.

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Luz, Lisa Title: Bariatric Program Coordinator
Organization: Mount AuburnHospital
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Bour, Eric Title: Bariatric Surgeon and Bariatric Medical Director
Organization: Greenville Hospital System
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Sharp, Lindsey Date: 04/25/2012
Comment:

I am a Bariatric and general surgeon who cares for patients with Medicare. I have seen that these patients often have a great need for weight loss surgery to improve their health and QOL. It is not infrequent that the gastric bypass is too high risk and the lap band is too ineffective to help them. They may also have specific situations like chronic steroid use or need for chronic NSAIDS where a sleeve gastrectomy would be a perfect option because it does not carry the risk of marginal

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Husain, Farah Title: MD, Minimally Invasive and Bariatric Surgery
Organization: Exempla St. Joseph Hospital
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Fraker, Teresa Title: Director, Outpatient Services
Organization: Genesis Health System
Date: 04/25/2012
Comment:

4/25/2012

To Whom It May Concern,

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can

More

Czerniach, Donald Title: M.D.
Organization: UMass Memorial Health Care
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Rogers, Ann Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Hinz, Sandra Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Knight, Scott Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Knight, Marissa Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Fabian, Matthew Title: Bariatric Surgeon
Organization: Sanford
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Berger, Robert Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Gluck, Brian Title: Brian Gluck, DO, FACOS, FASMBS Bariatric Surgeon
Organization: Life Without Limits
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Okerson, Ted Title: Sr. Med. Dir. - Device, Global Medical Affairs
Organization: Allergan, Inc.
Date: 04/25/2012
Comment:

April 25, 2012

VIA Electronic Mail to: CAGinquiries@cms.hhs.gov

Joseph Chin, MD, MS
Lead Medical Officer
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Mailstop S3-19-07
Baltimore, MD 21244-1850

Maria Ciccanti
Lead Analyst
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Mailstop S3-02-01
Baltimore, MD 21244-1850

RE: Proposed Decision Memo for Bariatric Surgery for

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Perez, Michael Title: Dr
Organization: Holy Cross Hospital
Date: 04/25/2012
Comment:
Sleeve Gastrectomy is a highly effective alternative to other already approved surgical weight loss options.In many cases it is more successful, and can carry a lower risk profile.Hundreds of pts in my practice have already benefitted from this procedure.
Kinniburgh, Desiree Title: Bariatric Program Coordinator
Organization: Chesapeake Regional Medical Center
Date: 04/25/2012
Comment:

To whom it may concern:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same

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Wasco, Kevin Title: Co-Founder /Director Midwest Bariatrics
Organization: WI Obesity Coaliation - President (ASMBS Chapter)
Date: 04/25/2012
Comment:

To Whom It May Concern.

I would like to join many of my professional associates and physicians across the country to comment on your recent proposed decision memo for bariatric surgery for the treatment of morbid obesity (CAG-00250R2). I am concerned that the proposed memo is an incomplete review of available evidence. It does not consider that the population is aging and becoming more and more obese. In short, it does not consider the entire Medicare population and it will

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CHIASSON, PATRICK Title: MD
Organization: Southern Arizona Center for Minimally Invasive Surgery
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Gillott, Jessica Date: 04/25/2012
Comment:

I am writing to urge CMS to consider offering FULL COVERAGE of sleeve gastrectomy for Medicare beneficiaries. Newer available evidence that the committee should examine, in addition to the data already presented, includes:

1. New England Journal of Medicine, March 26, 2012, Schauer et al. "Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes."
2. Archives of Surgery, April 16, 2012, Leonetti et al. "Obesity, Type 2 Diabetes Mellitus, and Other

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Nawrocki, Mary Lou Title: RN
Organization: Inova Fair Oaks Hospital
Date: 04/25/2012
Comment:
As a nurse with over thirty years experience, I am concerned about our health care delivery in the US & especially in chronic diseases. The March 22,2012 proposed national coverage decision (NCD) regarding sleeve gastrectomy is making a mistake, in my opinion, by limiting the availablity of coverage to randomized controlled trials (RCT) only.
I work in a small community hospital that is a center of excellance for Bariatric surgery & we have been sucessfully performing sleeve gastectomies

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Babineau, Hugh Title: Surgeon
Organization: Tyler Bariatrics
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Tavakkoli, Ali Organization: Brigham and Women's Hospital, Harvard Medical School
Date: 04/25/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that

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Angstadt, John Title: Surgeon
Organization: New York Bariatric Group
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Kuwada, Timothy Date: 04/24/2012
Comment:

I am a fellowship trained bariatric surgeon and have been in practice for 8 years. I am an ACS COE surgeon as is my practice and hospital. I have been performed about 125 laparoscopic sleeves over the past 3 years.

The sleeve is a quick and relatively simple procedure to perform. It is about an 1hr quicker than a bypass and has fewer periop complications and almost no long term complications. Weight loss is comparable (about 60% excess wt loss at 1yr) to the bypass and far

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Jossart, Gregg Title: MD, FACS
Organization: Sutter Pacific Medical Foundation
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Mancine, Renee Title: A Future Medicare Beneficiary
Date: 04/24/2012
Comment:
I have been in the health care field going on 26 years, and I have worked in a number of specialties. Even though I am not an RN or Doctor, I worked on the Administration and Billing side, I can not understand why Medicare and all insurances rather pay MORE monies and funding for patients because they are MORE sick from the diseases that develop because Medicare and all insurance have chosen not to pay for procedures that are proven to reduce these diseases. I can provide an example where an

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Howell, Dan Date: 04/24/2012
Comment:

I would like to comment in support of the Bariatric sleeve procedure. [PHI Redacted] had this procedure approximately one year ago. She needed the procedure as medical necessity due to other issues affecting her overall health. Since her surgery, she has lost approximately 80 pounds. Her overall health has improved immensely, taking her off virtually all her medications. She continues to exercise but is able to do much more and with little or no pain and continues to

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O'Neil, Dawn Date: 04/24/2012
Comment:
After researching all weight loss surgeries I think the sleeve by far has the best long term results and least problems over all. [PHI Redacted] I am hoping that this is approve for us that are Over weight and tried options before as well.
Katz, Leon Date: 04/24/2012
Comment:

Hello,

As a busy bariatric surgeon, I would like to mention to you the important role that the sleeve gastrectomy plays in the safe management of high risk morbidly obese patients. Those taking aspirin for life or requiring steroids would have tremendous problems with the gastric bypass. The band is an alternative, but the outcomes are so poor long term that most of us are very hesitant to offer the band to patients that have limited mobility.

Please don't make the

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Gilmore, Megan Organization: Gundersen Lutheran Hospital
Date: 04/24/2012
Comment:

I wish to take this opportunity to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health

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Ponce, Jaime Title: Medical Director for Bariatric Surgery
Organization: Hamilton Medical Center
Date: 04/24/2012
Comment:

Would like to comment on the recent proposal by CMS for restricted coverage of laparoscopic sleeve gastrectomy only under clinical trials. I am in complete support of the response and comment submitted and signed by the American College of Surgeons, SAGES and ASMBS.
The points of my comments are:
1. CMS analysis didn’t include recent studies that can add to the data validation of this procedure.
2. CMS patients are in many instances not acceptable candidates to the options

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Kini, Subhash Title: Asst
Organization: Mount Sinai Medical Center
Date: 04/24/2012
Comment:
A sleeve gastrectomy is have better weight loss than a Lap-Ban. It is very safe and had good outcomes. There are potential savings with a greater reduction in oomorbidities, less complications in the long term - no slippages and erosions. It is especially good for diabetes mellitus.
Berry, Ray Date: 04/24/2012
Comment:
[PHI Redacted] Why wouldn't you want to cover a procedure that is cheaper than the cost of paying for sick people? I see how much it costs people I know with diabetes, heart issues, mobility issues, and can't see why you don't cover it.
Mehran, Amir Title: Director of Bariatric Surgery
Organization: UCLA Dept of Surgery
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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parikh, manish Title: director, bariatric surgery
Organization: Bellevue Hospital
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Jack, Angela Date: 04/24/2012
Comment:

Below is my comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). CMS should provide coverage for the Laparoscopic Sleeve Gastrectomy. The Medicare population is at an extreme disadvantage in that at the present time, they cannot enjoy the numerous health benefits that result from safe, dramatic weight loss that occurs after the Sleeve Gastrectomy.

Several articles have been recently published which demonstrate

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Albert, Deborah Title: RN, Ph.D.
Date: 04/24/2012
Comment:
I am very concerned that CMS is not covering gastric sleeve procedures due to lack of enough scientific evidence. [PHI Redacted] had the procedure. Both have lost over 100 lbs, and [PHI Redacted] no longer has diabetes. Perhaps you should communicate with people who have already had the procedure. This is a real shame. Luckily [PHI Redacted] could afford theirs. I really think this decision was a big mistake on CMS's part.
Rajajoshiwala, Paresh Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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cummings, sarah Date: 04/24/2012
Comment:
[PHI Redacted] Medicare and Medicaid cover every other weight loss surgery. Not covering this one, which has the least risks and side effects, and an overwhelming long term success rate is not only wrong, but counter productive.
Ewton, Kimberly Title: RN, Program Manager
Organization: Baylor Grapevine Weight Loss Surgery Center
Date: 04/24/2012
Comment:

I wish to take this opportunity to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health

More

VanderMeer, Thomas Title: Chief, Section of General Surgery
Organization: Guthrie Clinic
Date: 04/24/2012
Comment:

I am writing to urge CMS to consider offering FULL COVERAGE of sleeve gastrectomy for Medicare beneficiaries. Newer available evidence that the committee should examine, in addition to the data already presented, includes:

  1. New England Journal of Medicine, March 26, 2012, Schauer et al. "Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes."
  2. Archives of Surgery, April 16, 2012, Leonetti et al. "Obesity, Type 2 Diabetes Mellitus, and Other

    More

Golovaty, Ilana Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over

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Burleson, Jean Date: 04/24/2012
Comment:
I would like to express my opinion regarding coverage of sleeve gastrectomy. [PHI Redacted] It makes more sense to me to cover the surgery than continue to provide a lifetime of medications and treatments for medical conditions that can be cured or greatly improved with the sleeve gastrectomy and weight loss. (hypertension, Type II diabetes, increased cholesterol and triglycerides, back pain, knee pain, sleep apnea, potential for stroke and heart attack). The sleeve

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Klonsky, Jonathan Title: Advanced Laparoscopic, General & Bariatric Surgeon
Date: 04/24/2012
Comment:

I have read and whole heartedly agree with Dr Morton's Statement quoted below. I would like to second his motion will continue to support all efforst to promote the safety and efficacy of Bariatric Surgery.

"I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population,

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MAffei, Anthony Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Kelly MD, John Title: Chief General and Bariatric Surgery
Date: 04/24/2012
Comment:

Please would ask you to reconsider your decision for restriction of Sleeve Gastrectomy to just RPT.

You will have plenty of info from others as to the literature or rationale as to why Sleeve produces reproducible, effective, and safe outcomes in morbid obese populations. I will not reiterate here

I will comment that RPT's do not often make sense or are feasible in the bariatric surgery realm. PRTs often make sense in surgery when you are refinig a technique of a

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Beltre, Wiljon Title: MD
Organization: Center For Metabolic and Obesity Surgery
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity. I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100 million other

More

Drapeau, Ashley Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Tortorici, RN, NP, Sara Date: 04/24/2012
Comment:

To whom it may concern,

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same

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Posey, Rebecca Title: RN, Director of Bariatric Surgery Services
Organization: St. David's Medical Center
Date: 04/24/2012
Comment:

With obesity being among the top health concerns in the United States, I feel CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit to medicare recipients.

Based on the decision memo, it appears an incomplete review of the literature has occurred and I would like to suggest that CMS specifically review the following:

  1. New England Journal of Medicine, March 26, 2012, Schauer et al published “Bariatric Surgery versus Intensive Medical Therapy in

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Lindstrom, Walter Title: President
Organization: Lindstrom Obesity Advocacy
Date: 04/24/2012
Comment:
Our company assists patients in obtaining access to healthcare for various innovative procedures and diagnostics including all forms of bariatric and metabolic surgery. Patients face myriad challenges obtaining fair access to surgical treatment and CMS'recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2) creates further barriers which are wholly without the support of evidence-based medicine. Whether it is the FDA creating a higher barrier for

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Houston, Patricia Title: Bariatric Program Coordinator
Organization: Beebe Medical Center
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Spitz, Jonathan Date: 04/24/2012
Comment:

Laparoscopic sleeve gastrectomy is a bariatric procedure that has withstood the scrutiny of peer reviewed analysis. There are numerous scientific publications that support the safety and efficacy of this bariatric procedure. In many circumstances it is the most appropriate bariatric procedure for a given patient. With supportive 5-year data and an affirmative position statement from The ASMBS, individual consideration should be given to selected patients who are contemplating this

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Hughes, Jeff Date: 04/24/2012
Comment:

To whom it may concern:

First of all let me say thank you for being an insurance provider to many patients in the United States and for the many procedures that you currently do cover. However, in regards to your decision to only cover the vertical sleeve as a randomized controlled trial, I do not agree. This surgery has been around for several years now and has been proven successful over those years. As a matter of fact, it is just as successful, if not more, than gastric

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Renick, Erika Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Binenbaum, Steven Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Noria, Sabrena Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

scott, john Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Ali, Amjad Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Johnson, Stelin Title: Physician Assistant
Organization: Center for the Surgical Treatment of Obesity
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Mills-Jude, Lyndis Title: FNP
Organization: United Medical Surgical Associates, Staten Is University Hospita
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

nepomnayshy, dmitry Date: 04/24/2012
Comment:

it is absolutely inconceivable to me that medicare would NOT want to cover sleeve gastrectomy - there are multiple studies showing it's effectiveness:
The bottom line - as a surgeon that operates for morbid obesity, the sleeve gastrectomy is associated with similar weight loss to bypass, superior weight loss compared to lap band, and LESS long term complications that bypass! in the long term, it will likely be the operation of choice for morbid obesity. Please save the government

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Datta, Tejwant Title: Director, Minimally Invasive and Bariatric Surgery
Organization: Southside Regional Medical Center
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Laker, Scott Date: 04/24/2012
Comment:
It is with great disappointment to learn that CMS has limited access to sleeve gastrectomy to institutions that are performing the procedure under a randomized trial. With the available data demonstrating a clear reduction on co-morbid states, weight loss on par with gastric bypass and a complication profile that is low and in line with gastric bypass the decision appears unfounded and unfair. Please review Schauer's recent article in NEJM regarding sleeve and diabetes. In addition, the

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Chu, Uyen Title: MD
Organization: Surgical Specialist of Louisiana
Date: 04/24/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100 million other Americans have enjoyed.

Currently, I am performing Sleeve gastrectomy on patients with high risk factors for complications because I know it will give them great resolution of

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Jamal, MD, Mohammad Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Bhasker-Rao, Bobby Title: Bariatric Surgeon
Organization: Lite Life Surgery
Date: 04/23/2012
Comment:
I have had several patients that have done their own in depth research and have approached me for a procedure like the Sleeve Gastrectomy for weight loss. Based on my own research and experience in performing this procedure I've seen nothing but success stories. It is less invasive than the gastric bypass with similar weight loss response, and slightly more invasive than the lap band but with much superior weight loss. The sleeve gastrectomy does not require an industry driven foreign

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Bhoot, Nilesh Title: MD
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Rasmussen, R Richard Title: MD
Organization: UCSA
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

King, Delores Date: 04/23/2012
Comment:
[PHI Redacted] from all that I have read & for 3 out of the 4 people I know that have had banding, I believe that LSG is much safer. Also, there are many more medical visits for after care with the banding & many more emergency rooms visits, which is more expensive for the insurance companies in the long run.
Stanish, Paul Title: Medical Director Healthy4Life
Organization: Community Healthcare System
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Baker, Amber Title: Nurse Practitioner
Organization: BMI
Date: 04/23/2012
Comment:

As a Nurse Practitioner who treats morbidly obese patients, I have seen the sleeve work as well or better than Lap-Band and/or Gastric Bypass in the last 3 years. I offer comment for your recent decision.

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population,

More

Nease, Blaine Title: Medical Director
Organization: Center for Surgical Weight Control
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Stapleton, Connie Title: Owner
Organization: Mind Body Health Services, Inc
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Christophersen, Matt Date: 04/23/2012
Comment:
Sleeve Gastrectomy should be a covered benefit. The available studies clearly show significant weight loss and low morbidity. Further studies prior to coverage are not necessary and would prevent a surgical option which can help patients with severe obesity
Parrent, Bryan Title: Surgeon
Organization: Brazos Surgical Group
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Kaul, Ashutosh Title: Director Minimally Invasive and Robotic surgery
Organization: New York Medical College
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Kharbutli, Bilal Title: M.D.
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Faulkenberry, M.D., Tim Title: Partner
Organization: Southwest Bariatric Surgeons
Date: 04/23/2012
Comment:
Please reconsider the mound of data that ASMBS has provided on sleeve gastrectomy. In our practice the results have been outstanding and many of the patients choosing this procedure have been in the medicare age or very near. The complication rates have been extremely low and minor. The weight loss results have outpaced the band patients in every case. Moving this procedure to a status of acceptable will benefit many patients, many of which will otherwise choose a band with less ultimate

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McKenna, Daniel Title: Assistant Professor of Surgery
Organization: Indiana University School of Medicine
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I have several concerns regarding the proposed decision memo. First, there is a cursory review of the available data. Asking for controls within every study borders on ridiculous since countless studies have demonstrated the expected weight loss in dietary controls. Second, critical studies were excluded including:

  1. New England Journal of

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Laricos, Barbara Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Klittich, Christine Title: Bariatric Program Coordinator
Organization: Jefferson Regional Medical Center
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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hudson, alan h Date: 04/23/2012
Comment:
I was shocked to hear of the possibility of CMS limiting gastric surgery for treatment of morbid obesity. The dollar amounts for bariatric surgery vs the co-morbidities of obesity can NOT be any where near equal. It would seem to me a comprehensive study WITHOUT limitations or trial phases would be more prudent. A study of those who have received the surgery in the past vs those of equal weights without surgical intervention would provide the necessary data without causing interruption of

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Trostle, Doug Trostle Date: 04/23/2012
Comment:

I am writing to urge CMS to consider offering FULL COVERAGE of sleeve gastrectomy for Medicare beneficiaries. Newer available evidence that the committee should examine, in addition to the data already presented, includes:

  1. New England Journal of Medicine, March 26, 2012, Schauer et al. "Bariatric Surgery versus Intensive Medical Therapy in Obese Patients with Diabetes."
  2. Archives of Surgery, April 16, 2012, Leonetti et al. "Obesity, Type 2 Diabetes Mellitus, and Other

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ABBADI, CHAKIB Organization: AMERICAN SOCIETY FOR METABOLIC AND OBESITY SURGERY
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Acholonu, Emeka Date: 04/23/2012
Comment:

Thanks for accepting my comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I believe this was an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100 million other Americans

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Stahl, Richard Title: Assistant Professor of Surgery
Organization: University of Alabama at Birmingham
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Ruckman, Tami Date: 04/23/2012
Comment:

It is becoming obvious to the trained and untrained that obesity surgery is about more than losing weight. It is life-saving and life-lengthening. It is the closest thing to a cure for Type II Diabetes that exists.

Physicians have performed sleeve gastrectomies for hundreds of years with negligible negative effects other than weight loss. For many patients, it is a better alternative than the Bypass, or a step in the right direction.

To limit gastrectomies to a

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chin, channing Date: 04/23/2012
Comment:

I would like to comment on the Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am deeply concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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Treen, MD, David Title: President and CEO
Organization: Surgical Clinic of Louisiana
Date: 04/23/2012
Comment:
I am a bariatric surgeon, and hereby formally protest the recent CMS decision regarding Vertical Sleeve Gastrectomy. This IS NOT an experimental procedure, tens of thousands of patients have reclaimed their lives with this procedure at lower risk than some currently approved procedures! It is outrageous that this bureaocracy refuses to admit that the time has come for this procedure to be offered to medicare beneficiaries. WAKE UP and do the right thing.
Henderson, Sandi Title: co-founder
Organization: Banded Living, LLC
Date: 04/23/2012
Comment:

[PHI Redacted]

All modalities of treatment for obesity need to be accessible to all of us who suffer from this disease. Limiting access to vertical sleeve gastrectomy surgeries will only increase the numbers of patients who continue to suffer multiple co-morbidities including Diabetes[PHI Redacted]. The JAMA reports and the American Diabetes Association supports weight loss surgery as a better means of controlling diabetes than medication, yet you

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Potter, Michael Title: Dr
Organization: Reliant Medical Group
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

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McCullough, Daniel Title: M.D., FACS
Organization: Delmarva Bariatric and Fitness Center
Date: 04/23/2012
Comment:

I strongly encourage and endorse the CMS to fully-approve laparoscopic vertical sleeve gastrectomy for the treatment of morbid obesity. The data strongly supports LVSG as an excellent adjunct, not only for successful long-term weight loss, but also in the long-term management of type II diabetes.

My patient population that has chosen LVSG as a weight loss tool has almost universally been completely satisfied with the results of the operation. A 5-year "trial period" is

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Villanueva, MD, FACS, Ian Title: Bariatric Surgeon
Organization: Carolinas Healthcare System
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Rizzo, Julianne Title: Bariatric Coordinator
Organization: Westlake Hospital
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

English, Wayne Title: Medical Director, Bariatric Surgery
Organization: Bariatric & Metabolic Institute at Marquette General Hospital
Date: 04/23/2012
Comment:

I wish to take this opportunity to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2).

I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health

More

Looser, Kevin Date: 04/23/2012
Comment:
I am a practicing surgeon In Portsmouth NH and I wish to strongly protest the recent decision re sleeve gastrectomy by CMS. Multiple studies have shown the efficacy of this procedure ion morbidly obese patients. Is safety has been well documented. This decision is just another in a long line of decisions that are not investigative, but rather look to cost control by putting patient's at risk. I strongly urge CMS to reverse this decision (not to cover sleeve gastrectomy) and do the right

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irgau, isaias Title: MD
Organization: Christiana Institute of Advanced Surgery
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Kupchik, Nicole Title: Clinical Nurse Specialist
Organization: Swedish Medical Center
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Baker, John Title: Senior Past President
Organization: American Society for Metabolic and Bariatric Surgery
Date: 04/23/2012
Comment:

I should like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I have several concerns that if unaddressed will diminish access to care for patients in need. I am concerned that the proposed decision memo had an incomplete review of available evidence. It did not consider the entire Medicare population as most of the patients who utilized Medicare coverage for NCD 100.1 were the young disabled under the age of 65.

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Cunneen, Scott Title: Director of Barric Surgeriat
Organization: Cedars-Sinai Medical Center
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Joyce, Christopher Title: President
Organization: Illinois Association of Bariatric Surgeons
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Herron, Daniel Title: Chief, Section of Laparoscopic and Bariatric Surg
Organization: Mount Sinai School of Medicine
Date: 04/23/2012
Comment:

I am writing to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need.

I have treated many Medicare patients suffering from obesity who would benefit very substantially from the sleeve gastrectomy. Regrettably, this option

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Sloan, Dale Title: Medical Director, Lutheran Bariatric Center
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Bell, Brent Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Stuck, Judy Title: Nurse Practitioner
Organization: Palmetto Health Weight Management
Date: 04/23/2012
Comment:

I would like to comment on your proposed decision for the treatment of morbid obesity (CAG-00250R2). I am concerned that the proposed review may have an imcomplete review of available evidence, did not include the entire Medicare population, and will diminish access to care for patients in need with significant disease (morbid obesity.) CMS should provide the Laparoscopic Sleeve gastrectomy as a covered beneift os that this patient group can experience the same health advantage that over

More

Farnworth, Amy Date: 04/23/2012
Comment:
Sleeve gastrectomy should be an available surgical option for this group of high-risk patients. Medicare patients should NOT be forced to have a less suitable procedure that is not medically appropriate just because their insurance does not offer coverage.
Marks, Julie Title: Clinical Exercise Physiologist
Organization: Lafayette General Medical Center
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Nusbaum MD, Michael Title: Surgeon
Organization: Obesity Treatment Centers of New Jersey
Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Teixeira, Leicia Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

DeNamur, Wendy Date: 04/23/2012
Comment:

I believe that the sleeve should be approved for bariatric surgery. Personally,speaking as a nurse working in bariatric surgery, it is much less invasive than the gastric bypass, but much more effective than the lap band. It helps with the co-morbidities, but patients don't have as many complications from mal-absorption.

Many lap band patients do not lose much weight and do not get over their medical problem and then end up converting to other procedures. Why would you not approve

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Dakin, Gregory Date: 04/23/2012
Comment:

I would like to comment on your recent Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity (CAG-00250R2). I am concerned that the proposed decision memo had an incomplete review of available evidence, did not consider the entire Medicare population, and will diminish access to care for patients in need. CMS should provide the Laparoscopic Sleeve Gastrectomy as a covered benefit so that this patient group can experience the same health advantages that over 100

More

Cavazos, Ramiro Title: MD, FACS, FASMBS, Med. Director of Bariatric Surg.
Organization: Texas Center for Medical and Surgical Weight Loss, Northeast Bap
Date: 04/23/2012
Comment:

I have 6,000 bariatric patients in my practice. If you are going to approve coverage of any bariatric operations, then I can tell you that the most "sound" decision that Medicare could possibly make would be to approve coverage of Sleeve Gastrectomy. I have been performing Lap Band, Gastric Bypass, and Sleeve Gastrectomy, as well as revision and endoscopic procedures for the past 8 years. In my practice I only perform bariatric surgery and no longer perform general surgery procedures

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Myers, RN, Debbie Title: RN - Bariatric Program Coordinator
Organization: Seton Medical Center - Austin
Date: 04/23/2012
Comment: