CMS May Drop Center of Excellence Requirement

cms_coeCurrently, Medicare patients who have bariatric surgery must have the surgery at a certified Center of Excellence (COE) facility. However, CMS has proposed eliminating the requirement, stating that there isn’t sufficient evidence that the requirement has provided improved outcomes.  The American Society for Metabolic and Bariatric Surgery (ASMBS)’s COE designation was created to recognize surgeons and facilities that demonstrate an unparalleled commitment and ability to consistently deliver safe, effective, evidence-based care. The program is structured to help bariatric surgery providers continuously improve care quality and patient safety and the requirements and evaluation processes were developed in conjunction with leading bariatric surgeons, hospital administrators, health plans, researchers and patient advocates. The requirements are comprehensive, research-based and verified through a rigorous site inspection.

In 2006, CMS established the COE requirement and says it was supported by  evidence at that time of “rapid growth of bariatric surgery programs, improved outcomes in the older Medicare population at higher volume facilities and with higher volume surgeons and by consensus opinion for the need for facility standards from the professional societies and other physicians.” However, since the 2006 requirement, CMS states that there has been a lack of sufficient evidence that the certified/COE bariatric facilities have provided improved outcomes in Medicare beneficiaries.

Dr. Sunil Bhoyrul, San Diego weight loss surgeon, disagrees with CMS’ proposal, arguing that COE designation has improved patient care. “I believe that we have made more progress in Bariatric surgery than in just about any other surgical specialty in recent times, in ensuring high quality comprehensive care with excellent outcomes. ”  More evidence has been introduced that emphasizes Dr Bhoyrul’s point: A new study showed that mortality rates are three times great in centers that are not accredited. This new evidence may change the minds of those who are making the decision at CMS.  “Medicare’s decision to expand the practice of Bariatric surgery outside these objectively determined transparent high quality centers threatens to reverse years of progress in taking care of millions of Americans,” Dr. Bhoyrul concluded.

ASMBS President, Jaime Ponce, MD, said “All private payers indicate their willingness to continue to have an accreditation process, and we will continue our process. Patients and payers alike should value the benefits of an accredited center.”

CMS will make a final decision on its proposal.

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