Weight-Loss (Bariatric) Surgery Introduction Seminar

2013 Kaiser Permanente Colorado

Seminar Outline

 You will receive information about the following groups today:     Kaiser Permanente Metabolic-Surgical Weight Management Team Kaiser Permanente Nutrition Services Kaiser Permanente Financial Services Exempla St. Joseph Bariatric Weight Loss Surgery Center

Metabolic-Surgical Weight Management Department

Englewood Medical Office 2955 S. Broadway Englewood, CO 80113 Franklin Medical Office 2045 Franklin St. Denver, CO 80205 Rock Creek Medical Office 280 Exempla Circle Lafayette, CO 80026

Kaiser Permanente Bariatric Surgeons

 Farah Husain, MD  Frank Chae, MD

Bariatric Multidisciplinary Team

     Physicians and Physician-extenders (PA & NP) Nursing staff Registered Dietitians Behavioral health, Psychologists Management and Administration including:   Financial Services Member Benefits

Why is obesity a problem today?

     Portion distortion Taking the escalator or elevator instead of stairs (decrease in physical activity) Busy lifestyle, prioritizing Food-filled environment Relatively sedentary lifestyle now

Who can have bariatric surgery?

Obesity is a complex medical problem  Approximately 100 lbs over ideal body weight  Body Mass Index >40 and BMI >35 with certain medical problems (KP guidelines)  BMI Calculator: available online at http://www.bmi-calculator.net/

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Expectations

Predictable, maintained weight loss  One year- 65-70% excess body weight  90% of associated health problems resolve  Ability to wean off blood pressure and diabetes medications

Patient Commitment

    Commit to lifelong follow up   Regular follow up visits Regular blood draws You will need to be on vitamin and mineral supplements for the rest of your life Avoid tobacco products lifelong and alcohol for at least 1 year post-op Avoid NSAIDS (Motrin, Ibuprofen, Advil, Aleve, Naprosyn)

Patient Commitment

 Adhere to diet (DO NOT “test your stomach”, see how much you can eat, or try bad foods)  Attend and participate in support group meetings regularly after surgery (sustained weight loss is connected to participation)  Exercise regularly- raise heart rate, sweat, sustain this for at least 30 minutes, 4-5 times/wk

Exercise

  Physical therapy consults available Ideas:      Strength training Dance Walk Water  Walk in pool/aerobics/swim Stretch, yoga

Metabolic (Medical) options

    

Provides medical management for weight loss for members with BMI greater than 30

Patients before, during and after bariatric surgery Patients in Optifast® weight loss program Patients taking prescribed medication for weight loss Patients requiring medical management of medical conditions during weight loss Patients with metabolic conditions that affect nutrition

The KP Bariatric Pathway

7 Steps to Surgery  Step 1: Attend Weight-Loss Surgery Seminar – ( Please call our office if your interest in weight loss surgery changes, and/or prior to losing KP insurance).   Step 2: Wait-list 7-8 months  Optimize medical problems, complete preventative health screening Step 3: Medical and Behavioral therapy intake visits  Are you fit for surgery? BMI <60, no smoking     Step 4: Surgery Connections Classes 6 wks Step 5: Surgery pre-op appointment Step 6: Surgery will be scheduled within 45 days

of completing classes

Step 7: Surgery

Our 6-week program

       Learn about surgery and how to succeed Understand past experiences with weight Identify triggers for weight gain Engage in behavior changes Learn to get through challenges Manage body weight Learn what you can and should eat post surgery

Nutrition

 It is mandatory that you attend all of the 6-week Surgery Connections classes prior to surgery.

The cost for Surgery Connections is $80 to be paid up-front. Surgery Connections classes are located at East, Englewood, Lakewood and Westminster.

 Attending Support Groups is extremely important following surgery to ensure your success and well being.

Support groups for Post-Surgery are offered at St. Joseph's Hospital twice a month and we also offer a support group via webinar once a month.

Eating after surgery

 All surgeries require:     3 high protein, low fat meals Avoid all sugar (even alcohol and juice) Avoid all carbonated and calorie drinks Well chewed, dime sized bites  Eat very slowly (20 minutes per meal) You will learn all about how to eat properly post surgery during your Surgery Connection class.

Nutrition Services

 Registered Dietitians specializing in medical weight management and bariatric surgery are available by phone or email for specific questions and concerns before and after surgery.  Call 303-614-1070 to get started on managing your weight. Kaiser Permanente offers a variety of classes and resources to assist with lifestyle changes as you prepare to have weight loss surgery.

 Telephone based Health Coaching. To schedule an appointment call the Healthy Living Helpline 1 866-402-4320.

Cost: Free

Questions?

Financial Services

Contact a financial counselor prior to surgery for all financial questions and advice (303) 338-3025

EXEMPLA Saint Joseph Hospital

The Bariatric Weight Loss Surgery Center

Midtown Medical Building 1960 N. Ogden Street, Suite 550 Denver, CO 80218 Phone: (303) 318-3240

The Bariatric Weight Loss Surgery Center at Exempla Saint Joseph Hospital  Della Goedert, RN  Bariatric Coordinator  Vicenta Correa,  Patient Coordinator

   Bariatric Center of Excellence status achieved in 2009 More than 1000 bariatric surgeries performed at ESJH since 2005 More than 400 bariatric procedures performed in 2011    Roux-en-Y Gastric Sleeve Gastric Banding

Before your surgery…

Appointment with ESJH Patient Coordinator  In addition to your PEEC appointment at Kaiser, you will be seen in the Bariatric Weight Loss Surgery Center at ESJH prior to your surgery. This appointment will include:  Pre-registration and insurance verification  Collect hospital co-pay, co-insurance and/or deductible Appointment with ESJH Bariatric RN  Pre-Operative teaching, verify medical information  Medications, allergies, medical history

Hospital Costs

Estimate out-of-pocket expense = $8,000 to $15,000

 This is an estimate of the out-of-pocket expense for bariatric patients.  Your cost may vary depending on your bariatric coverage.

 Most members are responsible for a co-pay, co-insurance and/or deductible for the hospital, surgeon and anesthesiologist.

Hospital Costs

 Bariatric coverage is determined by the Bariatric Benefit on your Kaiser Plan  Co-insurance can range from

10% to 50%,

Deductibles vary by plan  KP Financial Services (303-338-3025) can help you understand your bariatric benefits  ESJH Patient Coordinator (303-318-3241) can help you understand the hospital charges and billing process

Deposits and Payments

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Deposits for facility fee

 ESJH protocol is to collect 25% towards total patient out of pocket cost. 

Payment plans are available

   Interest free, monthly installments Payment plan up to 24 months Financial Counselor available at ESJH

Questions

Bariatric Surgery Today

Three Types of Procedures We Perform

Restrictive Restrictive Combination Adjustable Band Gastroplasty Sleeve Gastrectomy Roux-en-Y Gastric Bypass

Pros/Cons

 Lap Band     Fastest, least invasive procedure Requires frequent post-op adjustments High reoperation rates >20% Lowest weight loss  Gastric bypass   Well-defined results, best weight loss Longer surgery, more complications

Pros/Cons

 Sleeve     Shorter surgery time than bypass No malabsorption Similar complications to bypass Unclear long-term ultimate weight loss (thus far approx 60% EBW)

Mortality Leak Rate PE Rate Hernia Rate Wound Infection Rate

Risks of surgery

Lap Gastric Bypass <1.0% <3.0% <1.5% <1.8% <2%

Schauer and Ikramuddin, Surg Clin North Am, 2001 Oct;81(5):1145-79; Kral, Clin Per Gastroenterology 2001 Sep/Oct:295-305; Nguyen et al. Ann Surg 2001; 234(3)279-291

Complications can happen!

         Dehydration Leak of gastric fluids Bowel obstruction / blockage Stricture- narrowing of stomach Stomach ulcer Band problems Infection Chronic pain Prolonged nausea and vomiting

Appointments for Weight Loss Surgery

      Week of surgery: RN Phone call 1 month after surgery: visit with a provider 3 months after surgery: visit with a provider, Mental Health provider, dietician and lab work 6 months after surgery: lab work, support group 1 year after surgery: visit with a provider, lab work Annual lab work through your PCP

Questions?