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Center of Excellence

CMS to eliminate CoE accreditation for bariatrics?

ASMBS to prepare a vigorous response

The Centers for Medicare & Medicaid Services (CMS) is proposing to eliminate the requirement for facility certification/Center of Excellence (CoE) designation, so centres can perform surgery on CMS patients. According to the proposed decision, the CMS claims that the evidence is sufficient to conclude that continuing the requirement for certification for bariatric surgery facilities would not improve health outcomes for Medicare beneficiaries.  Therefore, CMS proposes to remove this certification requirement.

“In light of the lack of sufficient evidence that the certified/COE bariatric facilities have provided improved outcomes in Medicare beneficiaries since the 2006 National Coverage Determination (NCD), CMS proposes to eliminate the requirement for facility certification/COE designation,” said the ‘Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity - Facility Certification Requirement (CAG-00250R3)’.

They added that the evidence continues to support that open and laparoscopic Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding and open and laparoscopic biliopancreatic diversion with duodenal switch continue to be reasonable and necessary for Medicare beneficiaries who have a BMI≥ 35, have at least one co-morbidity related to obesity, and have been previously unsuccessful with medical treatment for obesity.   

“Given the history of two accreditation programs (the ASMBS and the American College of Surgeons) as well as the ongoing establishment of a unified accreditation program by these two professional societies, we feel it is important the surgical community at large should continue to explore, define and measure the utility of bariatric surgery facility accreditation and quality improvement initiatives. In particular, we continue to be focused on outcomes, especially longer-term outcomes,” the Proposed Decision continued.

The CMS is also proposing to change the title to better reflect the scope of the NCD and to make it clear that under the existing policy the local Medicare Administrative Contractors have the authority to make coverage decisions for ‘any bariatric surgery procedures not specifically identified as covered or non-covered by an NCD’, which would include sleeve gastrectomy.

“The American Society for Metabolic and Bariatric Surgery leadership will prepare a vigorous response,” said ASMBS President, Dr Jamie Ponce. “All private payers indicate their willingness to continue to have an accreditation process, and we will continue our process. Medicare represents only 5-6% of the total bariatric surgery cases. In sum, patients and payers should value the benefits of an accredited centre.”

The ASMBS and the ACS are in the process of creating a single, unified program to be called the ASMBS/ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).  The societies state that the goal is to “finalise the revised standards and begin implementation by year’s end.” 

The complete ‘Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity - Facility Certification Requirement (CAG-00250R3)’, can be viewed here.

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