Meeting date Bariatric Surgery Clinical Expert Richard John Lindquist MD Medical Director Swedish Weight Loss Services 1 R ic hard Lindquist MD Apr 22 2015 Summary CV Full Name Richard John ID: 937305
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Health Technology Clinical Committee Meeting date Bariatric Surgery Clinical Expert Richard John Lindquist MD Medical Director , Swedish Weig
ht Loss Services 1 R ic hard Lindquist MD Apr. 22 , 2015 Summary CV Full Name: Richard John Lindquist MD Hm. A
ddress: 1310 Minor Ave. Apt. 508 Seattle, WA 98101 Wk. Address: Swedish Weight Loss Services 801 Broadway Suite 800 Seatt
le, WA 98122 Ph: Home: 541.687.2879 Cell: 206.465.6905 (best number) Work 206.215.2090 Fax (work): 206.215.3099 Personal e
- mail: Rick_Lind@comcast.net Professional e - mail: ric hard.lindquist@swedish.org Professional /Personal Affiliations: o Member, American Societ
y of Bariatric Physicians (ASBP) www.asbp.org x Member, Board of Trustees x 2013 Bariatrician of the Year ƒ The Bariatrician of the Year aw
ard is presented annually and recognizes a physician who has done the most to advance the field of bariatric medicine and the Society o Member, American Society f
or Metabolic and Bariatric Surgery o Trustee, WA State Chapter , American Society for Metabolic & Bariatric Surgery (ASMBS) o Member, The Obesity Socie
ty o Trustee, Obesity Treatment Foundation o Exam writer, American Board of Obesity Medicine o Member, Obesity Action Coalition o Member, Americ
an Academy of Family Physicians (AAFP) o Vice Chair IRB Swedish Medical Center (2009 ± current) 2 o Board Certified Family Medicine x America
n Board of Family Medicine o Board Certified Bariatric Medicine x American Board of Obesity Medicine o Fellow, American Academy of Sports Physi
cians o American Heart Association: x Past National Faculty ACLS (Advanced Cardiac Life Support) ƒ Engaged in leadership, development and QA of Ad
vanced Cardiac Life Support (ACLS) materials and training on national level; Involved in QA national AHA ECC t raining. x Past Chair, ECC Committee, Oregon and S
W Washington ƒ Responsible for leadership in the training and quality assurance aspects of emergency cardiovascular care. o State of Oregon EMS Medi
cal Director of the Year 2001 x Provided training, medical direction and quality assurance over 27 Fire/EMS agencies and approximately 800 First Responders in
Linn, Lane and Douglas Counties in central and south Willamette Valley from 1990 through 2005. Included volunteer and paid departments including Reach air med
ical transport. o Rotary International x Past President, Eugene Metropolitan Rotary Club o American Academy of Family Physicians 2013 - 2014 x )H
DWXUHG 1DWLRQDO 2EHVLW\ 0HGLFLQH 6SHDNHU ³&KDSWHU 6SHDNHU´ o Frequent national presenter on Obesity topics and metabolic syndrome o Consultant Es
ai Pharmaceuticals ƒ Obesity Medicine presentation o Consulant Novo Nordisk Pharmaceuticals ƒ Obesity Clinicians Advisory Board Employme
nt History : Dec. 2014 - current Medical Director Swedish Weight Loss Services Swedish Medical Center Seattle, WA Duties include engagement wit
h administration in development of medical and surgical service lines in a comprehensive weight management program. Involved in program planning and implementation
, day to day clinic operations, qua lity assurance, and direct patient care. Provide support to other Swedish service lines and providers. Act as resource to adm
inistration on obesity care programs and planning. 3 June 2009 - Dec. 2014 Medical Program Director Swedish Weight Loss Services Swedish Medic
al Center Seattle, WA Duties: Coordinate Medically Supervised Weight Loss programs for non surgical and surgical patients (pre, peri, and post op). Develop outr
each, marketing and retail aspects of comprehensive surgical and medical program. Train R.N., ARNP, and PA staff. Develop operational aspects of comprehensive non
surgical and surgical programs. Provide direct patient care to overweight and obese patients. Develop research program to further care of overweight and obese p
atients. Program development focus has been developing weight management and chronic disease infrastructure within the Providence Health and Services and Sw
edish Health Services institutional organizations. Work has been centered around dyad of diabetes and obesit y with target goal to develop improved system wide w
ork flow and metric analysis in context of excellent patient care. Most recent work includes outreach into teen (adolescent) wellness clinics, post partum weight
control in a patient health center, devel opment of program for pregnant women with obesity, and chronic disease models for diabetes and obesity. 2005 - 20
09 Clinical Medical Director Monarch Medical Weight Loss Centers Eugene, O R . +LUHÂ WUDLQÂ DQGÂ VXSHUYLVHÂ 3K\VLFLDQV
 1XUVH 3UDFWLWLRQHUV 3K\VLFLDQ¶V $VVLVWDQWV and Nurses for a multi clinic Baria tr ic Medicine Group. Involved in program development, medi
cal protocols, site supervision, quality assurance, and direct patie nt care. Actively involved in marketing and presentations to employers, KRVSLWDOV
 EXVLQHVVHV SXEOLF DJHQFLHV SK\VLFLDQV¶ JURXSV DQG RWKHUV YLD GLUHFW contact, television and news media, and public presentati
ons. 1996 ± 2006 : Physician , Emergency D epartment McKenzie - Willamette Medical Center Springfield, Or. 2002 - 2009 : ³5HOLHI´ 3K
\VLFLDQ , University Health Center University of Oregon Eugene, Or. 1989 ± 2002: Staff Physician , University Health Center Vice Cha
ir U of O IRB (1993 - 2002) University of Oregon Eugene, Or. 4 1990 - 1995: Physician PeaceHealth Urgent Care Clinic Eugene, Or.
1987 ± 1989: Assistant Professor , Dept. of Family Medicine University of South Florida Tampa, Fl. 1987 ± 1988: Physician,
Emergency Department Palms of Pasadena Hospital St. Petersbu rg Beach, Fl. 1986 ± 1988: Physician , Emergency Department Bayfront Medical
Center St. Petersburg, Fl. Education: Doctor of Medicine 1984 University of Washington Family Practice Residency 1984 - 87 Bayfront Medical Center
St. Petersburg, Fl. 0HGLFDO 'LUHFWRU¶V C ourse 2005 National Association of EMS Physicians Board Preparation pathway and course s American Boa
rd of Bariatric Medicine Swedish University 2014 Physician Leadership Development Seattle, WA Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommitte
e1 Comparative Clinical Effectiveness & Comparative ValueLessler,MedicalOfficer,WashingtonHealthCareAgencyDirector EstimatesarethatU.S.populationhave�35; chronic
associated Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommittee2 AdjustablegastricVerticalsleevegastrectomy(VSB)Rouxbypass(RYGB)Biliopancreaticdiversionswitch
) Background: Types of Bariatric Surgery Bariatric Surgery4 Agency Medical Directors ConcernsSafetyEfficacyCost Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCo
mmittee3 1.Whatcomparativeclinicaleffectivenessbariatricproceduresconventionalweightmanagementa.Adults�(21yrs) b.Childrenyrs),overallagegroups.2.Whatcomponentsma
nagementpatientsundergoingbariatricsurgerycorrelatedlevelstreatmentsuccess?3.Whatarepotentialtermbariatricsurgeryprocedures,ratesproceduregeneralsurgicalcomplications
,longertermmorbidity,mortality,requirementsforprocedurerevisionsand/orreversal? 4.Whatdifferentialeffectivenesssafetybariatricsurgeryproceduresaccordingsystemand/orprog
ramfactors?5.Whatdifferentialeffectivenesssafetybariatricsurgeryproceduresaccordingpatientand/orclinicalfactors?6.Whatarecostscosteffectivenessbariatricsurgeryprocedure
sfocusreview? Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommittee4 Pediatric Bariatric Surgery: Prior HTCC Coverage DecisionPediatricbariatricsurgeryforpatie
ntsagecoveredbenefitinsufficientevidencethatsafe,efficacious,costeffective. Pediatricbariatricsurgeryforpatientscoveredbenefitcriteriaidentifiedreimbursementdeterminati
onIndicationslimitationscoverage:PatientsyearsBariatricsurgicalprocedurelaparoscopicadjustablegastricPatientsmustagencybariatricsurgeryprogramcriteriaPediatric Bariatri
c Surgery: Prior HTCC Coverage Decision Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommittee5 Current State Agency Policyover;diabetesleastfollowing(thathaver
espondedmedicalmanagementareexpectedimprovefollowingbariatricsurgery):HypertensionDyslipidemiaCoronary Medicaidgreaterageyrs,followingTypediabetes;DJDweightjointcandida
teforjointreplacementweightachieved;rareconditionswheretheremedicalevidencethatbariatricsurgerymedicallybenefitsoutweighrisks.Current State Agency Policy Lessler,ChiefM
edicalDirectorCareMayTechnologyClinicalCommittee6 Bariatric Surgery11 0000 2010 2011 2012 2013Total Apple Health Population 2010 -2013 UMP Non-Medicare Bariatric Surger
ies 98420111563142668100100120 dataextractedMCSourcefor Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommittee7 Bariatric Surgery13 $5,000$10,000$15,000$20,000$
25,000$30,000 AverageCostdataextractedMCSourcefor UMP Non-Medicare, Average Cost per Member Bariatric Surgery: EffectivenessMostobservationalstudiessuggestthatbariatric
surgeryimprovessurvivalsevereBariatricsurgerymoreeffectivemedicalmanagementtermyears)respectto:WeightResolutionFewbariatricsurgerystudiesreportvalidtermresults Lessler,
ChiefMedicalDirectorCareMayTechnologyClinicalCommittee8 Bariatric Surgery: Comparative Effectiveness Across Procedure TypesRYGBhavetermoutcomesrespectweightRYGBgreatert
ermweightresolutioncomparedLAGBresultsgreaterweightRYGBRYGBbettertermoutcomesyrs)LAGBtermsweightimprovement Bariatric Surgery: SafetyPerioperativemortalityassociatedbar
iatricsurgeryappearsrangePerioperative mortality varies by procedure and approachLowest mortality for LAGB and VSG; higher for laparoscopic RYGB; highest for RYGB and B
PD Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommittee9 Bariatric Surgery: SafetyPerioperativecomplicationratesvaryprocedureBroadrangeestimatesVaryprocedurea
pproachlargeprospectivestudy*standardizeddatacollectionthatcompositepointforcomplications,ratesacrossprocedureswere:LAGBLaparoscopicRYGBRYGBFlum DR, Belle SH, King WC,
et al; Longitudinal Assessment of Bariatric Surgery Consortium. Perioperative safety in the longitudinal assessment of bariatric surgery. N EnglJ Med. 2009;361(5):445-4
54. Comparative Effectiveness and Safety in Children and AdolescentsLimiteddatasuggeststhatLAGBeffectiveadolescentsachievingsubstantialweightimprovingRYGBretrospectives
tudyLAGBTheretermdataevaluatingsafetychildrenadolescents Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommittee10 Management Components Associated with Treatmen
t SuccessDiverseinconsistentliteratureregardingprogramand/orpatientfactorsassociatedgreatertreatmentSeveralstudiesfoundratessurgicalfollowpostsurgerypatientsanxietydiso
rders, Differential Outcomes: Program FactorsSurgeonexperience/volumeOutcomesbettervolumesurgeons/centersvs.volume(generally,procedures/yr)Evidencemixedoutcomesaccredit
edaccreditedfacilitiesEvidencesuggestsbetteroutcomesmultidisciplinarycarePre/postoperativeconsistentevidencepreweightoutcome;evidenceforpredietarycounseling;betterevide
nceforpostdietarycounseling Lessler,ChiefMedicalDirectorCareMayTechnologyClinicalCommittee11 evidenceaccumulateddatesuggeststhatbariatricsurgerycommonlyacceptedthreshol
dsforcosteffectivenesscomparisonstandardcareacrosscategories,horizonsprocedure Medicare Coverage DecisionRYGB,coveredforbeneficiariesfollowingcriteria:�35 morere
latedFailedmedicaltreatmentforspecificallystatesthatconsideredforcoverage,makesmentionanyrelatedadjustablegastricVSGarecovered Lessler,ChiefMedicalDirectorCareMayTechno
logyClinicalCommittee12 Local Medicare Coverage DecisionNoridianHealthcareLCDforWashingtoncoverslaparoscopicpatientsMedicarecriteriaareyounger State Agency Recommendati
on:�Adults (21 years)Coverfor�40comorbidities Coverfor�35forpatients: leastrelatedconditionFailedmedicalmanagementcoveredfor�30 Wherecovered
,patientsmustagencysurgeryprogramcriteria(e.g.centerspractitioners;prepsychologicalevaluation;participationprepostoperativemultidisciplinarycareprograms) Lessler,ChiefM
edicalDirectorCareMayTechnologyClinicalCommittee13 State Agency Recommendations: Pediatric Bariatric SurgerycoveredforpatientsagePediatricbariatricsurgeryforpatientscov
eredbenefitcriteriaidentifiedreimbursementdeterminationIndicationslimitationscoverage:PatientsyearsBariatricsurgicalprocedurelaparoscopicadjustablegastricPatientsmustag
encybariatricsurgeryprogramcriteria MoreInformation:Lessler,Daniel.Lessler@hca.wa.gov Order of Scheduled Presentations : Bariatric Surgery Name 1
Robert Michaelson, MD, PhD, FACS, FASMBS President, Washington State Chapter , American Society for Metabolic and Bariatric Surgery Diplomate, American Board of