CMS Questions Value for Bariatric Centers of Excellence

In a proposed decision memo, the U.S. Centers for Medicare and  Medicaid (CMS) services concludes that certification requirements for bariatric centers of excellence “do not improve health outcomes for Medicare beneficiaries.” And thus, CMS is proposing to remove the requirement for bariatric centers of excellence to receive reimbursement for Medicare patients.

This proposed decision was prompted by a request from John Birkmeyer, Nancy Birkmeyer, and John Dimick to remove the requirement. In 2010, they and others from the Michigan Bariatric Surgery Collaborative study group published a study that found accreditation for bariatric centers of excellence did not predict the rate of serious complications for patients undergoing bariatric surgery. The lead author, Nacy Birkmeyer, commented:

Centers of Excellence status may not predict better outcomes because accreditation is based on unreliable, self-reported outcomes data and other unimportant variables. The relatively low complication rates in Michigan suggest that collaborative quality improvement may be more effective than COE programs.

The American Society of Metabolic and Bariatric Surgery (ASMBS), the American College of Surgeons, and the Surgical Review Corporation all registered their support for keeping the requirement for accreditation. Of 214 comments CMS received during their decision-making process, 162 supported the the requirement and 47 opposed it. The most cited reason for removing the requirement was to improve access to care.

Watch this space. Bariatric centers of excellence and other strategies for quality assurance will continue to be a hot topic for debate. Providers and payers are maneuvering for an advantage in setting these standards.

Patients need a guidepost to surgeons and centers they can trust.

Click here to read the CMS proposed decision, click here to read the 2010 study by Birkmeyer et al, and click here to read more about ongoing changes to the ASMBS Centers of Excellence program.

Surgeon, photograph © Spirit-Fire / flickr

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