Ninh Nguyen, MD, FACS, president-elect of ASMBS, responds to the CMS decision to drop its bariatric surgery accreditation requirement. In July, the Centers for Medicare and Medicaid issued a memo that proposed a loosening of its policy on bariatric surgery. For the past seven years, CMS would only provide reimbursement for bariatric procedures performed in an accredited facility. The proposed CMS ruling would not alter the number of bariatric procedures that are covered by Medicare, but would begin reimbursing procedures performed in non-accredited facilities. John D. Birkmeyer, MD, a board-certified general surgeon of the University of Michigan in Ann Arbor, led a team of health services researchers in a request to change the policy.
The memo states that CMS officials have found sufficient evidence that the cessation of the requirement would have no effect on Medicare beneficiary surgery outcomes. The initial proposal was met with strenuous opposition from professional societies including the American Society for Metabolic and Bariatric Surgery, American College of Surgeons, Obesity Society, Academy of Nutrition and Dietetics, American Society of Bariatric Physicians, American Association of Clinical Endocrinologists and Society of American Gastrointestinal and Endoscopic Surgeons.
The ASMBS President-Elect Ninh T. Nguyen, MD, FACS, vice chair of the department of surgery at the University of California Irvine School of Medicine, co-authored a study of bariatric procedures performed in accredited facilities in comparison with procedures performed in non-accredited facilities. The study, published in the journal Surgical Endoscopy, found non-accredited bariatric centers had an in-hospital mortality rate of 0.22 percent, while accredited centers had a mortality rate of .06 percent.
Despite the coalition of opposition from professional groups and the results of this study, CMS officially dropped the rule on Sept. 25. "The decision is perplexing," says Dr. Nguyen.
This study included only academic medical centers, raising questions of limitation, but another study Dr. Nguyen co-authored came to light on the heels of the CMS decision. This time, bariatric surgery outcomes were analyzed using a national database, covering bariatric surgery centers in multiple settings. The results mirrored the first study. Mortality rates in accredited bariatric surgery centers are lower. The second study found the mortality rate of the sickest patients to be 0.17 percent in accredited centers, while the mortality rate at non-accredited centers accelerated to 0.45 percent.
ASMBS remains steadfast its support of accredited facilities. Beginning Oct. 1, researchers will begin to examine bariatric surgery outcomes. The results prior to the CMS decision will be compared to the results going forward. "The question is: will there be any issue in quality of care for Medicare beneficiaries undergoing bariatric surgery?" says Dr. Nguyen. "Going forward, we are certainly going to keep an eye on this. Anything we find, we will plan to report it to CMS."
Though CMS no longer requires bariatric surgery to be performed in an accredited facility, major insurers including Aetna, Blue Cross Blue Shield, Cigna and United Healthcare still support the requirement. "Medicare patients undergoing bariatric surgery, even though they do not have to, should seek out accredited centers for their care," says Dr. Nguyen.
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