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CoE decision

Surgical groups disappointed with Medicare CoE ruling

Decision may lead to higher risk of mortality for Medicare
Dr Jamie Ponce

The American Society for Metabolic and Bariatric Surgery and the American College of Surgeons have expressed their disappoint at the Centers for Medicare & Medicaid Services (CMS) recent decision that it will no longer require Medicare patients to undergo bariatric surgical procedures at accredited facilities. The ruling means that eligible Medicare patients may have bariatric operations performed at any centre they choose, even those facilities with little experience in handling high-risk patients.

"We are disappointed and in strong disagreement with a ruling that appears to disregard overwhelming scientific evidence and medical opinion that bariatric accreditation programs save lives, improve patient outcomes, and enhance the quality of care," said Dr Jaime Ponce, President of the American Society for Metabolic and Bariatric Surgery (ASMBS).

Approximately 750 inpatient and outpatient bariatric centres throughout the US are accredited by either the ASMBS or ACS. In 2012, the two surgical societies combined their respective programs and formed the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), to establish a national standard for accreditation and quality improvement that requires participating facilities to undergo a peer-evaluation process, follow data submission requirements, and demonstrate experience in managing bariatric surgical patients before, during, and after their procedures in order to receive accreditation.

"The standards required for accreditation provide important lifesaving safeguards for patients, particularly for Medicare beneficiaries, who have a higher risk of morbidity and mortality than the general bariatric surgery population," said Dr David B Hoyt, Executive Director of the ACS. "We encourage Medicare patients to continue to select an accredited centre for bariatric surgery.”

The new ruling marks a reversal of a CMS policy enacted in 2006 that made facility accreditation a requirement for Medicare coverage. It also makes CMS the only major insurer that does not require bariatric surgical procedures be performed at an accredited center. Blue Cross Blue Shield, Aetna, Cigna and United Healthcare have each embraced and continue to support accreditation 

In addition to the ASMBS and ACS, other professional groups supporting accreditation and opposing the new CMS ruling are The Obesity Society, Academy of Nutrition and Dietetics, American Society of Bariatric Physicians (ASBP), American Association of Clinical Endocrinologists (AACE), and Society of American Gastrointestinal and Endoscopic Surgeons (SAGES).

"MBSAQIP will continue to build upon bariatric surgery's legacy of quality improvement, which has previously included a four-fold decline in mortality over the past decade, by initiating a new program in decreasing readmissions," said Dr John Morton, ASMBS Secretary-Treasurer and Associate Professor of Surgery at Stanford University.

"We have made great strides in surgical techniques, patient care, and in identifying potential risks and managing cmplications," Ponce wrote in a message to ASMBS members. "But we cannot become complacent when it comes to patient safety and procedure effectiveness. We are committed to continuous quality improvement and accreditation is the mechanism by which we can best achieve it."

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American Society for Metabolic and Bariatric Surgery

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