Dallas Doctor Tops State in Taxpayer-Funded Weight-Loss Surgeries

Categories: Healthcare

joekuhn.jpg
wlsdocs.com
Dr. Joseph Kuhn
Over the weekend, the Texas Tribune published one of those eye-opening, number-crunching reports the website has made its niche. This one is about weight-loss surgery, specifically weight-loss surgery that is paid for by taxpayers.

This is a relatively new phenomenon, the Tribune notes. Medicare only started covering weight-loss surgery in 2006, Medicaid in 2009, the argument being that surgical intervention in the most obese patients will actually reduce what the government spends treating those patients over the long term. And while the $3 million spent in Texas represents a miniscule slice of overall healthcare spending, that number did triple between 2007 and 2010.

The largest number of Medicaid-funded bariatric surgeries between 2007 and 2011 occurred, oddly, in McAllen, with Houston and Dallas coming in second and third, respectively. But Dallas boasts by far the single most prolific provider, Dr. Joseph Kuhn, who received Medicare reimbursement for 576 procedures since 2004. Also, as someone "uniquely capable of gathering information, making observations, and reaching conclusions about scientific discoveries," he thinks evolution is bunk.

According to his website, Kuhn has performed more than 3,500 bariatric surgeries that range in price from $10,850 and $16,000. The site does not explicitly advertise that it accepts Medicare patients, at least so far as I can tell, though with about 100 per year, it's hard to imagine there isn't some targeting of Medicare patients.

I'm curious as to what portion of his business Medicare comprises, his views on the relative effectiveness of publicly-funded efforts to prevent obesity versus surgical intervention, if and why the surgery is a wise public investment, etc. I've called Kuhn's office and was directed to Sharon, his office manager, who I'm told is out for the day. So maybe tomorrow.


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8 comments
FallingLeaves
FallingLeaves

It's so frustrating to me that Medicaid covers bariatric surgery when so many private insurers don't.  I work full-time as a public library director. Over the last couple of years, I've seen at least a dozen patrons get bariatric surgery when they don't work at all.  It's probably cost-effective in the long run.  But the truth is unavoidable - I have pay for people on welfare to get it, but I can't even work with my doctor on non-surgical interventions and get them covered.  I don't mean to be bitter.  It just doesn't seem fair at all.

Dr. Joe Kuhn
Dr. Joe Kuhn

This is Dr. Kuhn.  Our practice has a genuine servant heart, caring for all.  I think we have done a relatively large number of Medicare patients because we simply do not discriminate.  Only about 5% of Bariatric surgeons even accept Medicare.  Reimbursement for most Medicare weight loss procedures is about $1500, which includes 3 months of postop care.  The patients are usually quite ill, with vascular disease, diabetes, kidney failure, sleep apnea, and immobility.  Quite a few are in wheelchairs.  The approval process typically takes 4-5 months, with intensive physical and psychological testing and diet instruction.  The physical transformation within 12 months is breathtaking.  The cost recovery for the surgery is achieved within 13 months by some calculations, taking into account the reduction in medication and avoidance of other procedures.  Actually, the weight loss procedures markedly prolong life as shown in numerous studies.  No other operation comes close to the life saving, life prolonging, and life changing benefits of bariatric surgery! Please understand that obesity is convincingly related to at least 70 different gene variations which code for energy storage, hunger, and metabolism.  Some research even shows a partial viral etiology.  In any event, I am amazed that 95% of gastric bypass patients will lose 70% of their excess weight.  We haven't instilled willpower.  The surgery markedly reduces the hunger hormone "ghrelin" and "evens the playing field".  Their metabolism remains much lower than genetically thin patients (about 8 cal/lb compared to 13 cal/lb).  But the anatomy allows for signals to the brain with lower calorie input. I actually appreciate the reference to the first peer-reviewed article identifying the "challenges that other scientists have raised against Darwinism".  I encourage the reader to read the original article (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3246854/)  and a nice reviewer who addresses the typical harsh slant of the Darwin Devotee:  http://www.evolutionnews.org/2012/05/darwin-doubting059241.html

YourPills YourBills
YourPills YourBills

So the government can further reward people for sitting on the couch with their supersized combo meals.

Another Patient
Another Patient

Yep, he's a busy surgeon - not just limited to WLS procedures. As a patient I benefited from his experience while on the operating table; and from the PA's and other staff that come w/a busy practice during recovery.

RTGolden
RTGolden

Not. Really. However, I did overlook an apparently rather obvious mistake in the headline, so maybe my literary criticism should be taken with several grains of salt.

GuiltyBystander
GuiltyBystander

3,500 surgeries at $11,000 per ... my calculator says that's $38.5 million. That's a lotta cuttin' and stitchin'.

Patient of Dr. Kuhn
Patient of Dr. Kuhn

"The site does not explicitly advertise that it accepts Medicare patients, at least so far as I can tell, though with about 100 per year, it's hard to imagine there isn't some targeting of Medicare patients." 576 procedures over an eight year period averages out to just over 70 per year, not 100.  At that rate, Dr. Kuhn, is averaging only six bariatric surgeries a month paid for by Medicare.  For a surgeon who has performed 3,500+ bariatric procedures that's a tiny percentage. And if -as you suggest there is "some targeting of Medicare patients" - he's awfully bad at it. As a former (non Medicare) patient of Dr. Kuhn's I think it is more likely that the support staff of his busy practice affords his office to navigate Medicare patients for whom the procedure is medically necessary through the numerous obstacles the program has in place to secure program approval. From my own experience as a privately insured patient whose primary physician first attempted - and failed - to obtain approval for Weight Loss Surgery, it was not until I was referred to Dr. Kuhn's office, which then made sure all necessary documentation for my claim was obtained by my primary care physician --- was I finally approved by my insurer. By then I was a sicker patient which necessitated a more complicated surgery with more risk of complications - but thankfully Dr. Kuhn is an experienced surgeon and the facility in which I was treated has one of the best recovery room & floor staffs for this surgery in Dallas. As a result, not only have I lost a large amount of excess weight, I no longer must wear a CPAP mask for sleep apnea, or take large amounts of blood pressure medication, nor do I require pain medication for osteo-arthritis, etc.  I am healthier, more mobile, and require far fewer doctors visits --- all of which reduces my costs to my insurer. Taxpayers would come out ahead by funding more -- not fewer-- weight loss surgeries for those could benefit from them.

guest
guest

There is more profit to be made putting the band aids on instead of treating the source. One example is that most of the hospitals in the DFW are have closed their diabetes education centers in the last 5-10 years because they are not profit centers. The doctors and hospitals make a lot more money treating the complications like heart attacks , strokes, amputations and dialysis instead of teaching patients how to prevent them. 

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