Gastric bypass surgical

Gastric bypass surgical procedures are any of a group of similar operations used to treat morbid obesity—the severe accumulation of excess weight as fatty tissue—and the health problems it causes. Bariatric surgery is the term encompassing all of the surgical treatments for morbid obesity, not just gastric bypasses, which make up only one class of such operations. A gastric bypass first divides the stomach into a small upper pouch and a much larger, lower remnant pouch and then re-arranges the small intestine to allow both pouches to stay connected to it. Surgeons have developed several different ways to reconnect the intestine, thus leading to several different by pass names. Any bypass leads to a marked reduction in the functional volume of the stomach, accompanied by an altered physiological and psychological response to food. The resulting weight loss, typically dramatic, markedly reduces comorbidities. The long-term mortality rate of gastric bypass patients has reduction of up to 40%. The gastric bypass surgical treatments accounts for a large share of the bariatric surgical procedures performed. An increasing number of these operations are by limited access techniques, termed laparoscopy. Laparoscopic surgery uses several small incisions, or ports, one of which conveys a surgical telescope connected to a video camera, and others permit access of specialized operating instruments. The surgeon actually views his operation on a video screen. The method is limited access surgery, reflecting both the limitation on handling and feeling tissues, and also the limited resolution and two-dimensionality of the video image. With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision—with the option of using an incision should the need arise. The gastric bypass reduces the size of the stomach by well over 90%. A normal stomach can stretch, sometimes to over 1000 ml, while the pouch of the gastric bypass may be 15 ml in size. The Gastric Bypass surgical pouch formed from the part of the stomach, which is least susceptible to stretching. That, and its small original size, prevents any significant long-term change in pouch volume. What does change, over time, is the size of the connection between stomach and bowel, and the ability of the small bowel to hold a greater volume of food. Over time, the functional capacity of the pouch increases, by that time, weight loss has occurred, and the increased capacity serves to allow maintenance of a lower body weight.

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Physician Ownership and Other Transparency

SEC. 6001. LIMITATION ON MEDICARE EXCEPTION TO THE PROHIBITION ON CERTAIN PHYSICIAN REFERRALS FOR HOSPITALS.
(a) IN GENERAL.—Section 1877 of the Social Security Act (42
U.S.C. 1395nn) is amended—
(1) in subsection (d)(2)—
(A) in subparagraph (A), by striking   and’’ at the end;
(B) in subparagraph (B), by striking the period at the
end and inserting   ; and’’; and
(C) by adding at the end the following new subparagraph:
(C) in the case where the entity is a hospital, the hospital
meets the requirements of paragraph (3)(D).’’;
(2) in subsection (d)(3)—
(A) in subparagraph (B), by striking   and’’ at the end;
(B) in subparagraph (C), by striking the period at the
end and inserting   ; and’’; and
(C) by adding at the end the following new subparagraph:
(D) the hospital meets the requirements described in
subsection (i)(1) not later than 18 months after the date of
the enactment of this subparagraph.’’; and
(3) by adding at the end the following new subsection:
(i) REQUIREMENTS FOR HOSPITALS TO QUALIFY FOR RURAL
PROVIDER AND HOSPITAL EXCEPTION TO OWNERSHIP OR INVESTMENT
PROHIBITION.—
(1) REQUIREMENTS DESCRIBED.—For purposes of subsection
(d)(3)(D), the requirements described in this paragraph
for a hospital are as follows:
(A) PROVIDER AGREEMENT.—The hospital had—
(i) physician ownership or investment on December
31, 2010; and osection 10601(a)(1) amended this
clause by striking ‘February 1’ and inserting ‘August 1’;
section 1106(1) of HCERA further amended this clause
by striking ‘August 1, 2010’ and inserting ‘December
31, 2010’; shown to reflect probable intent.
(ii) a provider agreement under section 1866 in
effect on such date.
(B) LIMITATION ON EXPANSION OF FACILITY CAPACITY.—
Except as provided in paragraph (3), the number of
operating rooms, procedure rooms, and beds for which the
hospital is licensed at any time on or after the date of the
enactment of this subsection is no greater than the number
of operating rooms, procedure rooms, and beds for
which the hospital is licensed as of such date.

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