Bariatric evals

[Harry3990]

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I'm in the process of getting some supervision in conducing presurgical bariatric evals, and was wondering if there are people on here who are doing them. If so, I'm curious about what instruments and process people are typically using. My workplace has historically used a couple of screeners, in depth clinical interview, and used to sometimes use the MBMD but it sounds like there has been less use of it in recent years due to limited utility and not providing enough to justify cost that the interview and screeners weren't already providing. Some questions:

Use tests beyond screeners? Which ones? Always or only as needed depending on complexity and MH hx?

Any books (have some good Andrew Block resources so far), trainings, or other resources people recommend?

People know anything about the PsyBARI/MPABS? Seems like a nice idea to have a test designed for the population but validity support seems very lacking in my cursory searching.


Thanks in advance

 

[cara susanna]

I'm a member of our local bariatric team and do pre-surgical evals as needed. In addition to a semi-structured clinical interview, I use the MBMD, MHLC, QEWP, DAST, and PAI. I will sometimes throw in PHQ-9, PCL-5, and/or GAD if I think it's clinically indicated.

 

[docloufan]

Have GLP-1s not significantly dented this surgical space?

 

[WisNeuro]

Have GLP-1s not significantly dented this surgical space?

Who knows long-term, but hasn't been the case locally.

 

[Harry3990]

I'm a member of our local bariatric team and do pre-surgical evals as needed. In addition to a semi-structured clinical interview, I use the MBMD, MHLC, QEWP, DAST, and PAI. I will sometimes throw in PHQ-9, PCL-5, and/or GAD if I think it's clinically indicated.

Thanks for sharing that. Any resources that you'd recommend checking out in terms of books, trainings, conferences, etc?

I'm also curious about how people are typically approaching billing insurance if you or others are willing to share re: specific cpt codes and units. Part of the reason I ask is I would love to be able to advocate for more test usage options but want to be informed about how others are getting those costs covered. I am speculating that our reimbursement for these may be pretty low as it currently stands.

 

[cara susanna]

Thanks for sharing that. Any resources that you'd recommend checking out in terms of books, trainings, conferences, etc?

I'm also curious about how people are typically approaching billing insurance if you or others are willing to share re: specific cpt codes and units. Part of the reason I ask is I would love to be able to advocate for more test usage options but want to be informed about how others are getting those costs covered. I am speculating that our reimbursement for these may be pretty low as it currently stands.

I just remembered that I DON'T use the PAI, since I use the MBMD. Sorry! I use the PAI in almost every other eval I do, lol.

I'm VA so I can't be super helpful for billing, sorry.

Have GLP-1s not significantly dented this surgical space?

There have been significantly fewer referrals since the medication became more available, but it's not gone completely.

 

[psych.meout]

Many of the surgeons are freaking out a bit (which has been very salient at the relevant conferences), while others are a bit more tempered and feel that they will have sufficient work from patients who fail GLP-1s, cannot tolerate the side effects, and/or cannot afford to take them indefinitely and regain the weight once they stop taking the meds.

 

[oliversacks4thewin]

Many of the surgeons are freaking out a bit (which has been very salient at the relevant conferences), while others are a bit more tempered and feel that they will have sufficient work from patients who fail GLP-1s, cannot tolerate the side effects, and/or cannot afford to take them indefinitely and regain the weight once they stop taking the meds.

I am not in this line of work, but out of curiosity, is anyone floating the idea of psychological assessments prior to initiation of the GLP-1's? The complexity of the neuropeptide suggests a whole host of possible contradictions, that I think we are still learning more and more about...

 

[Therapist4Chnge]

We are still learning about longer-term effects of GLP-1s, as the rare (but still problematic) responses by the body can definitely cause longer-term problems. I don't do bariatric evals in my private practice, so I don't know the vibe at conferences and in the day to day, but there should still be plenty of work out there for the halfway competent clinicians.

I think a BIG area that doesn't seem to be addressed adequately by providers with GLP-1s is the behavioral impact when on GLP-1s and then what happens when a patient goes off of them. Some patients will have made changes across their lifestyle where the transition off and day to day life off of them is manageable. However, for many, they don't make those changes and the weight all comes back.