MDNews - San Antonio

classes. Preparation and support before surgery is extremely important." Even referring physicians have a role to play, Dr. Patel says. "Often patients will come to their primary physicians with sleep apnea, diabetes, infertility and other weight-related issues," he says. "The patient may have tried unsuccessfully to lose weight. Weight loss surgery can be a sensitive topic to broach. At Southwest General Hospital, we have created brochures to place in primary care offices to make those conversations easier." Bariatric surgery is indicated for people with a body mass index (BMI) greater than 40 or for those with BMI greater than 35 with weight-related illnesses such as diabetes, high blood pressure and sleep apnea. Once patient express interest in bariatric surgery, they will receive a health screening with a clinician and education at one of Southwest General's neighborhood bariatric offices. Financial counselors are also available at each office. "It is a sad fact that insurance companies are not always willing to pay for bariatric procedures," Dr. Patel says. "Only 50–60 percent of insured patients actually have weight-loss surgery coverage. We excel at identifying the medical benefits of bariatric surgery and helping patients access coverage." Patients whose insurance will not pay for the procedure find help in payment programs. Also, they may be eligible for BLIScare, a procedural insurance program available through Southwest General Hospital. "Private-pay patients may not be ready for the extra costs of blood transfusions, overnight stays or other unforeseen circumstances," Dr. Patel says. "BLIScare insures surgery-related events for up to three months following a procedure. My practice pays the premiums for our patients. While complications are very rare, this demonstrates that we are serious about patient safety and well-being." Surgical Skill Dr. Patel estimates that he has performed 3,000 bariatric surgeries during his career, with 600 surgeries performed in 2013 alone. "It is seldom I see anything that I cannot manage to the highest level," he says. High surgical volume is associated with quality, research finds. A 2013 study by Michigan bariatric surgeons correlated higher volume with greater skill and fewer adverse effects. Additionally, Dr. Patel is one of the few fellowship-trained bariatric surgeons in the San Antonio area. His colleague, Dr. ChattarCora, is certified by the American Board of Plastic Surgery. "Unfortunately, there are many physicians performing plastic surgical procedures who have not been adequately trained in the basics of plastic surgery," Dr. Chattar-Cora says. "Board certification indicates a basic level of competency that patients and referring physicians should expect." Partners in Bariatric medicine Ultimately, Dr. Patel says, successful bariatric procedures require an appropriate facility partner. "The hospital must stand behind you and be vetted in patient outcomes," Dr. Patel says. "Southwest General Hospital offers a dedicated bariatric coordinator and an entire wing just for bariatric patients." Patients stay in private rooms provided with accommodations for overnight guests. Hospitalists, dietitians, endocrinologists and nurses, all specializing in the care of bariatric patients, attend them during their stay. "It's a multispecialty care team," Dr. Patel says. "That entire unit demonstrates a tangible level of empathy." The hospital also houses the Weight Loss Solutions Center, where patients can find resources related to their weight-loss journey. And, as a bariatric Center of Excellence, Southwest General Hospital maintains a high surgical volume, has facilities and equipment appropriate to bariatric patients, and demonstrates a commitment to topquality care and excellent outcomes. Revision Surgery Revision surgery is an important part of Dr. Patel's practice. "Some people put on weight at unfathomable rates, yet physicians still blame it on their lack of commitment to health," Dr. Patel says. "This is not the right approach. Many bariatric surgery programs propagate this unfair stereotype. When a patient undergoes a procedure at a lower-volume center, at times it may happen that he or "Patients who choose reconstructive procedures after bariatric surgery may have a lot of tissue removed. they will have scars. And while many people think of scars as something to hide, my patients are proud. they will show off their 'battle scars' to demonstrate the hard work they have done and the lifealtering changes they have gone through." — Deowall Chattar-Cora, MD, board-certified plastic surgeon at Southwest General Hospital she is not adequately prepared or given the proper support." In these cases, Southwest General Hospital and Dr. Patel stand ready to provide surgical and psychological care, as well as dietary management and education, to set the patient on the road to successful weight loss. "Time and time again, we meet patients who have gone to their original surgeons mDNewS.COm ■ MD News San Antonio |7

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