The report was published Tuesday in the Archives of Surgery. Maciejewski says the information about cost of care is important for a variety of reasons. For starters, he says, "The VA system is facing increasing challenges and demands for care from the veterans coming back from Iraq and Afghanistan, and it continues to serve the needs of veterans from the Vietnam War and other wars since. It does not have an unlimited budget to provide all services for all veterans.
"So—and this is my perspective, not that of the VA—the VA needs to make some intelligent decisions about what services it's going to provide and prioritize in some way," Maciejewski says. In bariatric surgery, that's one program where the demand is much greater than the supply, and so the VA needs to figure out how it is going to prioritize that, and make sure the veterans who will have the best outcomes can get it."
He cautions that his paper is in no way meant to indicate a policy for commercial health plans or any other payers to restrict bariatric surgery to younger or female or non-veteran patients. Rather, it may be an important indicator that additional interventions must be implemented to keep older sicker patients from returning to former, unhealthy habits, especially since their health status is more vulnerable.
He adds that after the surgeon's job is done, bariatric surgery patients "have a challenge of weight maintenance, and there's lots of room for improvement to help patients maintain that loss and the clinical benefits from it."