Obesity Surgery Standards at Risk

The proposal to eliminate obesity surgery standards by the Centers for Medicare and Medicaid Services (CMS) will put the safety of vulnerable patients at risk, according to a coalition of the major professional and patient groups advocating for people with obesity. At present, only facilities certified as centers of excellence can be paid for obesity surgery by Medicare. CMS has proposed to eliminate that requirement and obesity treatment advocates are pushing back.

The groups opposing this move include:

  • The Obesity Action Coalition
  • The American College of Surgeons
  • The American Society for Metabolic and Bariatric Surgery (ASMBS)
  • The Obesity Society
  • The Society of American Gastrointestinal Endoscopic Surgeons
  • The American Society of Bariatric Physicians

A surgeon from the University of Michigan who favors eliminating the standards, Justin Dimick, explained his rationale:

Going back to an earlier point in the evolution of bariatric surgery, there were much higher rates of complications and higher mortality, as high as 9%, according to some reports. Over time, the procedures and selection of patients have improved tremendously. The safety has improved dramatically. One thing that has become obvious as the science has improved is that there is no difference in outcomes between centers of excellence and noncenter of excellence facilities.

ASMBS President Jaime Ponce responds that some recent studies have shown a higher death rate in facilities that are not accredited:

You can have similar complication rates between less experienced and more experienced centers, but the issue is whether the patients can be rescued from the complications. Less experienced centers might not be as prepared to rescue patients from complications, and more patients can die.

Advocates for keeping quality standards in place say that the quality improvements Dimick cites are largely due to the standards he wants eliminated. In a letter to CMS from the Obesity Action Coalition, Joe Nadglowski, Pam Davis, and Ted Kyle were direct in asking to keep the standards:

Please do not jeopardize the substantial progress that has been made in bariatric surgical outcomes by eliminating Medicare’s requirements for facility and personnel resources. Such a decision could have deadly consequences for thousands of future Medicare patients.

Martin Binks, a psychologist who cares for obesity surgery patients, sums up his concerns with the CMS proposal:

Rather than eliminating requirements, how about for once we think about what is optimal for THE PATIENT in terms of success and support with much needed clinical resources.

Binks is right. Patients need to come first — not accountants, not surgeons, and certainly not marginal facilities that want a piece of the action. We need to improve the standards for excellence in obesity surgery programs, not eliminate them.

Click here to read more in MedPage Today.

Surgery, photograph © phalinn / flickr

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