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"Vigilant' physician and the ISMA help secure changes in proposed law
The 2006 Indiana General Assembly passed SEA 266 mandating reporting requirements for morbid obesity surgery. As draft rules were being promulgated for the new legislation, Samer Mattar, M.D., was moving to Indiana to accept his position as Program Director at Clarian Bariatric Center in Indianapolis.
After starting in his new position and joining the ISMA, Dr. Mattar learned about the draft rules affecting his medical practice. “The health department intended to publish data about bariatric surgery that I feared would lead to unfair selection of patients,” he said. “I wanted the data to be anonymous.”
Upon contacting the ISMA Government Relations staff, Dr. Mattar secured both advice and support for his effort to affect change in the proposed rules. The Indiana State Department of Health (ISDH) welcomed his input.
“The health department wanted the data to be monitored, not regulated, so bariatric centers would take steps to improve their outcomes,” he explained. “I wanted the agency to gather information not only about complications, but also about good outcomes and details about patients making progress.”
The surgeon raised concerns about reporting times, initially set for 30, 60 and 90 days. Dr. Mattar pointed out that although facilities see their patients regularly during the first postoperative year, they may not all follow the exact pattern (30, 60, 90 days) described in the rules for reporting. He also raised serious concerns about confidentiality.
The rules are out
Issues raised by Dr. Mattar were addressed in the Final Rule published April 3 and now in effect. The rule requires reporting of body mass index and waist circumference at the time of surgery and at regular intervals thereafter.
In addition, the new rules provide the exact CPT codes affected, and require the physician who performs bariatric surgery to make reasonable attempts to monitor patients for five years after a procedure.
Review the rules>>
Before June 30, the date for the first required reporting period, a form will be available on the ISDH Web site.
“To my knowledge, we are now the only state in the country that has this type of legislation,” said Dr. Mattar. “It is definitely a pioneering effort, although I hope other states will follow our lead.”
The process to secure this rule change underscores the importance of physician involvement in legislative action. When the initial law was proposed, the ISMA’s Commission on Legislation did not receive comments from physician members about its provisions.
“We never had a complaint about the bill and no one raised concerns,” said Elizabeth Eichhorn, associate director of Government Relations. That is, until Dr. Mattar arrived in the state.
Dr. Mattar urged his Indiana colleagues to be vigilant. “We cannot just bury our heads in our charts and keep working hard in our own offices,” he said. “Others not charged with the care of patients might try to introduce legislation that is not beneficial to our patients. That is why there must be some mechanism like the ISMA to help us.”
A physician who performs a surgical treatment for the treatment of morbid obesity must monitor the patient for 5 years following surgery and report by June 30 and Dec. 31 on cases for the previous 6 months on the following:
- Death
- Serious side effect
- Major complication
- Body mass index
- Waist circumference
- Comorbidities
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