How weight-loss drugs are affecting bariatric services

According to a poll from KFF, around one in eight American adults, or about 15 million people, say they've taken a GLP-1 — a number that could grow if more insurers decide to cover the drugs for weight loss. Currently, an estimate from J.P. Morgan projects that as many as 30 million Americans could be taking GLP-1 drugs by 2030.

As GLP-1 drugs continue to grow in popularity, there has been a decline in bariatric surgeries, with data showing a 30% drop in one year. As a result, some health systems have scaled back their bariatric surgery centers and are reconsidering some of their other investments.

For example, Norman Regional Health System recently decided to close its Journey Clinic, which offered medical and surgical weight-loss options for patients. According to Norman Regional CEO Richie Splitt, the hospital has seen a decline in surgery referrals.

"We've been seeing ­that decline in volumes over time, which led us to have some very frank conversations and then ultimately to the difficult decision to close the Journey Clinic and bariatric operations," Splitt said.

Separately, a health system in the Philadelphia region canceled plans for a bariatric surgery expansion.

"For a lot of these health systems, they do plan kind of far out and they're having to rethink a lot of their capital expenditures in terms of what they're going to build," said Grant Geiger, CEO and founder of the industrial design firm EIR Healthcare. "I think you'll see a lot of things that were on the drawing board probably get revisited.

"It stands to reason that if one drug can change the trajectory of health outcomes, it can change how hospital care is delivered over the long term," said Lisa Goldstein, managing director of Kaufman Hall.

Commentary

According to Advisory Board's Sebastian Beckmann, healthcare volumes are changing as medical innovations like GLP-1s, as well as high-revenue procedures moving to outpatient care, reduce demand for hospital care.

Going forward, "health systems need to change how they think about their facility footprint to respond to those trends, with a greater emphasis on outpatient sites like ambulatory surgery centers and freestanding clinics," Beckmann said.

Advisory Board's Nicholas Hula also noted that GLP-1s could fuel more site-of-care shifts. For example, if the average patient's body mass index (BMI) goes down, there could potentially be an increase in the proportion of patients with a BMI that clinicians are more comfortable operating on in a non-hospital setting.

Beckmann also noted that population growth, aging, and rising disease prevalence are all driving up demand across sites of care, including inpatient hospital care. "While those volumes will change what kind of volumes are delivered in the hospital of the future, sacrificing capacity in the short term without reinvesting in supply elsewhere could prove shortsighted," he said.

According to Advisory Board's Chloe Bakst, reducing bariatric services may feel necessary for some health systems, but there may be a larger "missing the forest for the trees" moment when it comes to the future of obesity care.

"GLP-1s and bariatric surgery don't have to compete with one other," Bakst said. "The boom in demand for weight management methods could actually feed the interest in and demand for bariatric surgery. The key is a comprehensive obesity care program that has multiple entry points and an array of service offerings. Patients who came in seeking a GLP-1 could find they are a better fit for surgery, and vice versa."

Lana Nelson, director of metabolic and bariatric surgery at Norman Regional, was told she'd be losing her job. "They think that there's no future in bariatric surgery because medications will replace what we do," Nelson said. 

"But the very difficult and frustrating thing is that they are not clinicians. They are administrators. They made these decisions based upon no conversations with the clinical staff who are actually there taking care of patients and seeing trends," she added.

Separately, Craig Kent, CEO of UVA Health, said that while GLP-1s are highly effective, there may not be enough evidence to change long-term capital planning at the moment.

"There's no question [GLP-1s will] have an effect on the number of joints we do. They have to have an effect on the number of heart bypasses or amputations or whatever that we do over time," Kent said.

"But it's really difficult to plan for what's going to happen 10 years from now or 15 years from now. What you have to ask yourself is, 'What if we're wrong?'"

Advisory Board's related resources

For more insights on GLP-1 drugs, as well as site-of-care shifts, check out these Advisory Board resources:

Obesity care/GLP-1:

• 4 ways comprehensive obesity care can boost surgical services
• 3 paths to the future of obesity care (and how to get there)
• Diabetes and obesity care growth forecast: What you need to know
• 4 key elements of comprehensive obesity care (and how they look in practice)

Site-of-care shifts:

• Site-of-care shifts: Healthcare's $50B opportunity
• Radio Advisory: Site-of-care shifts: It's time to go on offense
• Why health systems need to embrace site-of-care shifts
• 5 trends (re)shaping site-of-care shifts

(Reed, Axios, 8/13; Denwalt, The Oklahoman, 7/11)