In October 2005 the Department of Health and Senior Services (Department) released a report on bariatric surgeries performed in New Jersey using 2003 data. The report was mainly based on discussions and recommendations of a work group formed by the Department to assess bariatric surgery prevalence in the State. The Bariatric Work Group was comprised of bariatric surgeons, representatives of providers and payers, medical directors of managed care plans, health care consultants, and consumer advocates.
The recent rapid increase in the volume of bariatric surgery, coupled with several well publicized cases of serious complications or death following the surgery, and a lack of information specific to bariatric surgery in New Jersey was cause for alarm for the Department to form the Work Group and conduct the study.
The Work Group discussed the following issues in detail:
- What data are currently available on bariatric surgery in NJ, and are these data adequate for needs enhancement?
- What are the appropriate indications of medical necessity for various types of bariatric surgery?
- What are the core elements of a good, comprehensive program?
- What are the professional competencies and training essential to a successful bariatric surgery program?
- Is there a volume/quality association for bariatric surgery?
- Are there agreed-upon standards for assessing the quality of bariatric surgery programs?
- What are the typical complications associated with bariatric surgery, and are there best practices that reduce the risks of these complications as well as mortality?
The Work Group was aware that the Uniform Billing (UB) data set is the only source of information on bariatric surgery cases in New Jersey. The Work Group reviewed efforts in Massachusetts, New York, and Pennsylvania to see how they used their UB data to study bariatric surgeries in their respective states. Moreover, the group consulted with payer representatives from among the Bariatric Work Group members to help with the diagnostic and procedure codes to use to identify bariatric patients. This process resulted in an approach that combines diagnosis codes with procedure codes (discussed later) to identify likely bariatric surgery cases within the UB data.
The Department receives an electronic copy of each claim, or bill, developed by hospitals for each inpatient admission and emergency department visit, roughly four million records per year. This Uniform Billing (UB) data base includes extensive demographic and clinical data, including one primary diagnosis code and up to eight secondary diagnosis codes (scheduled to be expanded to more than eight secondary codes in 2007), and as many as eight procedure codes.
The UB data base uses a standard format governed by the National Uniform Bill Committee. New Jersey is one of many states that collect a copy of hospital UB data for public health purposes. The UB data set is derived from patients’ medical charts, but, since its primary purpose is to collect payments from insurers and other payers, it does not always contain all items that may interest researchers. Additionally, since some items on the form are of less interest to insurers than to researchers, the reliability of data collected using a UB form is not uniform. Even though UB data are not audited, and have well-known limitations, their large size and ready availability have made them the most frequently used public data sets in health services research.
Contents
Acknowledgements
Executive Summary
Introduction
Overview
Preventing Obesity
Types of Bariatric Surgery
Potential Outcomes of Bariatric Surgery
Identifying Bariatric Surgery Cases in the UB Database
Trends in Bariatric Surgery in New Jersey: 1998 -2005
Characteristics of Bariatric Surgery Patients
Severity of Illness and Risk of Mortality by Patient Characteristics
Severity of Illness and Risk of Mortality by Hospital
Bariatric Surgery by Hospital Volume and Readmissions
Readmissions by Hospital
Bariatric Surgery Mortality
Bariatric Surgery Complications and Mortality by Surgeon Volume
Complications
Bariatric Surgery and Hospital Length of Stay
Bariatric Surgery Hospital Charges
Insurance Coverage Issues
Survey Findings of Bariatric Surgery Hospitals
Conclusion and recommendations
References
Appendix A: Diagnostic Codes Considered to Be Directly-related Bariatric Surgery Complications
Appendix B: Baseline Survey on Hospitals Performing Bariatric Surgery in
New Jersey Summary
Appendix C: Overweight Prevention and Treatment Effectiveness: Evolving
Consensus
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