Minister Provides Update on Policy for Excess Skin Removal

A review by the Department of Health and Community Services regarding surgeries for the removal of excess skin has been completed and it has been determined that no changes will be made to the current practice.

“After a detailed examination and discussion with my colleagues, we know that the current MCP policy for coverage of these procedures is consistent with best practices and is based on demonstrated medical necessity as determined by a surgeon,” said the Honourable Susan Sullivan, Minister of Health and Community Services. “The decision whether or not to perform a surgery of this nature rests with the surgeon who will perform the surgery and we recognize and respect that professional expertise. MCP does not have a role in that determination and the surgeon does not require pre-approval.”

Since 2009 the Provincial Government, through MCP, has paid for 13 patients who received panniculectomy procedures, a surgery that removes excess skin from the lower abdomen. To ensure that the policy was being applied consistently, the Department of Health and Community Services conducted a review. Three areas were considered:

• A review of the policies of other provincial health insurance plans;
• A review of professional guidelines and private insurers’ policies in North America; and,
• A review of MCP responses to inquiries about coverage to assess whether the policy was being applied consistently.

It was determined that eight out of 10 provinces, including Newfoundland and Labrador, will cover the removal of excess skin on all parts of the body if medically necessary. These provinces all define medical necessity as skin breakdown and chronic infections which are unresponsive to treatment. The remaining two provinces, Ontario and Manitoba, will consider coverage for the removal of lower abdominal skin only, and if, it is deemed medically necessary.

The American Society of Plastic Surgeons, the world's largest organization of board-certified plastic surgeons and a leading authority and information source on cosmetic and reconstructive plastic surgery, recommends coverage for removal of lower abdominal skin only and when medically necessary. The organization recommends that surgery to remove excess skin from other areas of the body, such as the upper abdomen and flanks, be considered cosmetic in nature.

During the review it was noted that some insurers in the United States do not cover the removal of loose skin after weight loss and other insurers will only cover these surgeries when the criteria for medical necessity are met.

“These findings confirm that the practice currently carried out in Newfoundland and Labrador in applying our policy is in line with jurisdictions across Canada and throughout North America,” said Minister Sullivan. “We are aware that some people feel these surgeries should be covered by the province. However, our coverage policy is consistent with the rest of the country, which requires that medical necessity be determined by a surgeon in order to have these procedures paid for by MCP.”

The third step in the review looked at the 19 written submissions, since 2009, that were sent to MCP regarding the removal of excess skin. Of these 19, seven met MCP’s definition of medical necessity. Each of the 19 submissions was reviewed to ensure that the policy was applied appropriately. It was determined that the policy was applied appropriately in 100 per cent of the cases. As a result of the review and to ensure clarity of the policy, it will be provided to all physicians

“Excess skin removal is a major surgical procedure and the decision to perform such a surgery occurs between a surgeon and a patient who is a possible candidate,” said Minister Sullivan. “MCP policy does not interfere with the decision-making process between the surgeon and the patient. I understand there is significant risk to a patient, as in all major surgeries, and the outcome could lead to negative health implications such as post-operative infections, wound breakdown, skin necrosis, significant scarring or simply dissatisfaction with the results. Through our review and discussion, we are satisfied that the MCP coverage policy is reasonable and does not require any changes at this time.”

- 30 -

• Video of news conference (33.5 MB)

Media contact:
Jennifer Tulk
Director of Communications
Department of Health and Community Services
709-729-1377, 699-6524
JenniferTulk@gov.nl.ca

2012 03 07                       1:10 p.m.