IN DEPTH: QUARTERLY HEALTH CARE REPORT
From the December 3, 2004 print edition
The Cost of Obesity
Long-term benefits of obesity surgery outweigh initial price tag, experts say
Scott D. Smith
Staff reporter
At 447 pounds, Ed Walsh's weight, diabetes and life was out of control.
The sheer mass of the 65-year-old retired 3M plant worker made him a prisoner in
his own home. He would "huff and puff" taking out the trash. He suffered through
a frightening episode of kidney failure. His blood-sugar level was more than
twice the acceptable levels -- at 300 milligrams per deciliter (mg/dL).
But just a year after having bariatric surgery, which cost about $25,000,
Walsh's weight is down to 264 pounds, and he no longer takes insulin for his
diabetes.
"I'm getting my life back."
Minnesota's dramatic increase in bariatric surgeries is greatly adding to the
cost of health care in the state. But experts say those surgeries should save
money in the long run as patients such as Walsh avoid costly medical procedures
later in life.
That's why these surgeries have become a big business in Minnesota.
Obesity operations include gastric banding, gastric bypass -- so-called "stomach
stapling"-- duodenal switch and others. The procedures attempt to make stomachs
smaller and limit the amount of food a person can ingest or metabolize.
Between 2002 and 2003, the number of obesity surgeries in Minnesota jumped about
50 percent to 4,217. Minneapolis-based Allina Hospitals & Clinics performed
about 1,600 surgeries last year and is on pace to match that this year.
Eagan-based Blue Cross and Blue Shield of Minnesota saw a 128 percent increase
in claims for the procedures between 2001 and 2003. During that period, it paid
out $42.9 million. The surgeries cost between $14,000 and $40,000, said Dr.
Keith Folkert, medical director, Blue Cross and Blue Shield of Minnesota.
And that is just the start. Only a small number of Minnesotans who qualify for
the surgery actually get it. Nationally, it is estimated that about 8 to 10
million Americans are overweight by 100 pounds or more, but only about 140,000
surgeries were done this year.
Despite the high cost, all the major insurers in Minnesota cover obesity
surgery. However, it must be a last resort and patients must meet a number of
guidelines, such as being 100 pounds overweight.
"My belief is that in the long run it will actually be cost effective for
insurance companies," said Janet Rudlong, program manager for the Bariatric
Center at Mercy & Unity Hospitals, which performs more obesity operations than
any other program in the Twin Cities. She points to patients such as Ed Walsh.
"If someone is going to have diabetes for the next 20 years, that can easily run
over $700 a month."
A University of Minnesota researcher recently completed a study indicating that
bariatric surgery is a cost-effective way to treat obesity, because it pays for
itself as the loss of weight alleviates other diseases.
"Obesity surgery is cost effective in about 3.5 years," said Dr. Henry Buchwald,
director of the Fairview University Obesity Surgery Center and a surgery
professor at the university.
Buchwald was the lead author of the study appearing in the Oct. 13 issue of the
Journal of the American Medical Association that reviewed 136 existing studies
on bariatric surgery -- encompassing more than 22,000 obese patients.
The review analyzed the impact of obesity surgery on diabetes, cholesterol,
sleep apnea and hypertension.
The study found that when patients lose weight, 80 percent of those diseases are
reversed or cured, Buchwald said. Insurers who say the surgery isn't cost
effective are correct only if they can't keep a person in their insurance pool
for more than three years, he said.
"The public should know that this surgery is available and can help them."
Folkert, from Blue Cross, said it is generally accepted that the surgery will
help a patient avoid further problems down the line.
However, the potential monetary benefit of the surgery can be lost if
complications arise during the procedure.
"If there are serious, major complications, it could wipe out the profitability
of the surgeries," Rudlong said.
Complications occur in about 20 percent of the surgeries, according to some
studies, with about 1 percent of patients dying. However, obese people often
have complications with any major surgery they may receive.
Obese patients often have difficulty breathing after the surgery. If the person
is put on a respirator, the costs can easily top $100,000, Folkert said.
"The most expensive cases we've had have been over $300,000," he said.
To minimize expensive complications, Minnesota insurers are starting to send
patients to "centers of excellence" or surgeons that have the best track
records. For example, Bloomington-based HealthPartners only allows surgeons in
its network who have performed at least 100 procedures. Minnetonka-based Medica
also notified the program at Mercy that it will start only sending its bariatric
surgery patients to centers of excellence in 2005, Rudlong said.
Health insurers and employers are also doing more to promote exercise and good
nutrition in the hope of preventing morbid obesity in the first place.
"What has happened is that all of the health plans are looking into earlier
interventions," Folkert said.
During the past year, insurers such as HealthPartners, Medica and Blue Cross
have all started offering their members incentives to attend health clubs and
build exercise into their daily routines.
"This used to be considered a cosmetic surgery," Rudlong said. But now people
walk into her office and say, "I have to have this done or else I am going to
die."
ssmith@... | (612) 288-2107
© 2004 American City Business Journals Inc.