Scott Leggett is CEO of Surgery One, which operates ambulatory surgery centers in the San Diego area.
Q: Should surgery centers consider adding laparoscopic gastric band surgery?
Scott Leggett: Lap-band surgery is definitely something that surgery centers should consider. It is quite viable on an outpatient basis from both a clinical and a business perspective.
Q: How is it covered by payors?
SL: Very few payors are covering lap-bands in surgery centers right now. Cash payments by patients are still the principal type of business. A couple of surgeons at one of our centers started getting into lap-bands a few years ago. The number of cash-paying patients has fallen off since the recession started, but lately our center has begun seeing a slow recovery of cash-paying patients.
Q: Is there any hope of getting insurance coverage?
SL: Several major payors in California are getting interested in covering lap-bands in surgery centers, thanks to an initiative by the California Ambulatory Surgery Association. CASA has been working hard to convince payors to extend coverage beyond hospitals. It has been a lengthy process, and some key insurers still are not showing any movement.
Q: Why has it been so hard to convince the payors to cover lap-bands? Don't they cost less in ASCs than in hospitals?
SL: We believe lap-bands cost substantially less in ASCs than in hospitals, although it has been difficult to get accurate data on how much hospitals are paid. One reason payors have taken so long to budge is that, not so long ago, bariatric surgery was completely an inpatient procedure. That's when the only kind of bariatric surgery was the gastric bypass, which is still inpatient. Since then, bariatrics has progressed to lap-bands, gastric sleeves and similar innovations that can be done in ASCs. Centers such as our own now have substantial experience and great outcomes with cash-paying lap-band patients, but many payors still have not caught up.
Q: What has CASA been doing to convince payors that they should cover lap-bands in ASCs?
SL: We at Surgery One and several others in CASA have been meeting with payors. We've put a lot of time into getting them educated and addressing their concerns. Insurance companies tend to deal with lap-bands through center of excellence programs. Before they grant COE status, they want to see a certain number of cases, which is a Catch-22 for many ASCs. In many instances, you can't have enough cases to qualify for COE status unless the payor has started covering your cases, but the payor won't start covering unless you have a sufficient number of cases.
Q: What has been the outcome of CASA's discussions with the payors?
SL: We have made a lot of headway with Blue Shield of California, WellPoint and UnitedHealthcare. The first step is payors allowing ASCs to apply for COE status; then those applications have to be reviewed. Blue Shield of California has been the most proactive payor to date and has started allowing several centers to apply for COE status for lap-bands.
Q: Is there much competition for outpatient lap-band surgery?
SL: While our center that hosts lap-bands is multispecialty, some surgery centers focus only on lap-bands. These tend to be comprehensive bariatric centers with physicians on site. They spend a lot of money on marketing and put their message up on billboards, on the radio and in newspapers. We do some very limited joint advertising with the general surgeons who do lap-bands at our center, and these surgeons have done some advertising on their own as well.
Q: What should an ASC considering lap-bands do to set up a program?
SL: The first thing is to align with the right physicians. If the physician just wants to do the surgery without a lot of follow-up, the ASC will likely have poorer results and get a bad name. You need to work closely with a surgeon who has a comprehensive program that includes pre-counseling and follow-up with the patient for at least a year.
Learn more about Surgery One.
Related Articles on Lap-Band Surgery:
When Lap-Bands Fail, Bariatric Surgeon Succeeds With Gastric Sleeve Revision
Study: Healthcare Savings Offset Costs of Gastric Banding Within 4 Years
Top 6 Risk Factors for Weight-Loss Surgery