procedure has proven successful for our patients as well.
For patients with hiatal hernias, we can perform what we call a
hybrid, in which a foregut-trained general surgeon performs a laparo-
scopic partial hernia repair. A GI physician then completes the proce-
dure by doing the TIF portion.
It's the best of both worlds: The hernia repair fixes the extra gap in
the diaphragm and the stomach tissue is already loosened up for a
J A N U A R Y 2 0 1 9 • O U T PA T I E N T S U R G E R Y. N E T • 1 9
Reimbursement Outlook For Treating Heartburn
GETTING PAID
The reimbursement landscape for performing TIF procedures is
trending upward. If you also factor in the workup — things like
manometry, Bravo, barium swallow and X-rays of the esophagus
— the procedures become that much more profitable.
It wasn't always that way. When we started doing TIF, many pay-
ers were denying it. Even though many patients were good candi-
dates, and we had years' worth of solid studies and data showing
that the procedure wasn't experimental, payers kept insisting that
it was. What we've learned is that to gain approval, you have to
keep pounding on the door and pushing. That's what we did, and
we slowly turned things around.
So, now we're seeing a lot more approvals and pretty solid reim-
bursements. Our case volume and patient-satisfaction scores
continue to increase. Also, Medicare covers both TIF and the
hybrid procedure, which involves partial hernia repair. That's
huge. If patients with Medicare want a TIF procedure and don't
have any contraindications from the workup, they can get it done.
If they have a 2-centimeter or greater hernia, they don't need pre-
authorization for the hybrid.
— Kriston Brady, BSN, BA, RN
