Bariatric surgery is increasingly moving into ambulatory surgery centers because of payor acceptance. Although weight-loss surgery is still unpredictable with commercial payors, the development of quality standards and the American Society of Metabolic and Bariatric Surgery Center of Excellence designation are encouraging acceptance.
The ASMBS Center of Excellence program was established in 2004 and is open to surgeons, hospitals and freestanding outpatient facilities in the United States and Canada. Since its inception, more than 800 surgeons and 450 facilities have received the Center of Excellence designation.
Michael Bilof, MD, is an ASMBS Center of Excellence surgeon in New Jersey and a physician-owner at Florham Park Surgi Center in Florham Park, N.J., which was recently declared an ASMBS Center of Excellence. It is the only surgery center in New Jersey and one of a few surgery centers in the country to get this designation. The Florham Park Surgi Center is a multi-specialty center with more than 50 affiliated surgeons.
The most common weight-loss surgery done in ASCs is gastric banding, and Dr. Bilof estimates the procedure accounts for 90 percent of bariatric surgery performed in the ambulatory setting. He outlines four key quality measures for bariatric surgery done in an ASC.
1. The center should have a significant volume. The ASMBS Center of Excellence designation requires that a center has performed at least 100 bariatric surgical cases in a 12-month period. Dr. Bilof says having a significant volume is important for more than the ASMBS designation.
"At a very basic level, there has to be enough volume so that the staff is familiar with the procedures and the possible complications and what to do if they occur," he says.
2. The center should have a low infection rate. A low infection rate is a quality measure of any good ASC, but Dr. Bilof says this is an especially important quality measure when looking at gastric banding surgery because the band is implanted into the body. However, infection rates can be hard to measure in an ASC because of the nature of the procedures.
"Patients go home the same day," he says. "Some of the problems, like infections, develop later on. You don't really see the problems during the initial encounter."
The Florham Park Surgi Center relies on inquiries sent to surgeons on a quarterly basis. The inquiries contain a list of all the patients who underwent surgery at the center that quarter, and surgeons self report problems that occurred after surgery. Although there's no way to independently verify the infection rates, Dr. Bilof says he believes most surgeons are honest and accurate in their self reporting.
3. The center should have a low rate of hospital transfers. Dr. Bilof says the number of hospital transfers — or patients who had to be transported to a hospital because of breathing problems, bleeding or other complications — should be as close to zero as possible. Such complications are either due to poor patient selection or because the staff wasn't trained to handle that specific patient. Setting guidelines for appropriate patients can help with patient selection, he says.
At the Florham Park Surgi Center, patients who weigh more than 500 pounds or who have a BMI of more than 55 are not treated in the center. Because breathing and airway issues are the most common cause of complications, the anesthesiologists decide who can and will be operated on in the ASC outside of those guidelines.
4. The center should have appropriate equipment for obese patients. Oftentimes, bariatric patients require special surgical equipment as well as other accommodations. This can include special furniture, wheel chairs, operating room tables, floor-mounted or floor-supported toilets, beds, radiologic capabilities and surgical instruments. Operating tables need to be able to support patients within the weight limits of the center. In the case of the Florham Park Surgi Center, its tables can hold patients up to 500 pounds.
The ASMBS Center of Excellence designation requires centers have surgical instruments for the morbidly obese, fluoroscopic technologies for band adjustments, medical imaging equipment for diagnostic purposes and ICU equipment.
Read more about the ASMBS Center of Excellence designation.
Related Articles on Bariatric Surgery:
Teenagers Unlikely to Receive Insurance Coverage for Bariatric Surgery
Gastric Bypass Has Metabolic Benefits Other Than Weight Loss
5 Points on Weight Loss Surgery, Obesity Coverage
The ASMBS Center of Excellence program was established in 2004 and is open to surgeons, hospitals and freestanding outpatient facilities in the United States and Canada. Since its inception, more than 800 surgeons and 450 facilities have received the Center of Excellence designation.
Michael Bilof, MD, is an ASMBS Center of Excellence surgeon in New Jersey and a physician-owner at Florham Park Surgi Center in Florham Park, N.J., which was recently declared an ASMBS Center of Excellence. It is the only surgery center in New Jersey and one of a few surgery centers in the country to get this designation. The Florham Park Surgi Center is a multi-specialty center with more than 50 affiliated surgeons.
The most common weight-loss surgery done in ASCs is gastric banding, and Dr. Bilof estimates the procedure accounts for 90 percent of bariatric surgery performed in the ambulatory setting. He outlines four key quality measures for bariatric surgery done in an ASC.
1. The center should have a significant volume. The ASMBS Center of Excellence designation requires that a center has performed at least 100 bariatric surgical cases in a 12-month period. Dr. Bilof says having a significant volume is important for more than the ASMBS designation.
"At a very basic level, there has to be enough volume so that the staff is familiar with the procedures and the possible complications and what to do if they occur," he says.
2. The center should have a low infection rate. A low infection rate is a quality measure of any good ASC, but Dr. Bilof says this is an especially important quality measure when looking at gastric banding surgery because the band is implanted into the body. However, infection rates can be hard to measure in an ASC because of the nature of the procedures.
"Patients go home the same day," he says. "Some of the problems, like infections, develop later on. You don't really see the problems during the initial encounter."
The Florham Park Surgi Center relies on inquiries sent to surgeons on a quarterly basis. The inquiries contain a list of all the patients who underwent surgery at the center that quarter, and surgeons self report problems that occurred after surgery. Although there's no way to independently verify the infection rates, Dr. Bilof says he believes most surgeons are honest and accurate in their self reporting.
3. The center should have a low rate of hospital transfers. Dr. Bilof says the number of hospital transfers — or patients who had to be transported to a hospital because of breathing problems, bleeding or other complications — should be as close to zero as possible. Such complications are either due to poor patient selection or because the staff wasn't trained to handle that specific patient. Setting guidelines for appropriate patients can help with patient selection, he says.
At the Florham Park Surgi Center, patients who weigh more than 500 pounds or who have a BMI of more than 55 are not treated in the center. Because breathing and airway issues are the most common cause of complications, the anesthesiologists decide who can and will be operated on in the ASC outside of those guidelines.
4. The center should have appropriate equipment for obese patients. Oftentimes, bariatric patients require special surgical equipment as well as other accommodations. This can include special furniture, wheel chairs, operating room tables, floor-mounted or floor-supported toilets, beds, radiologic capabilities and surgical instruments. Operating tables need to be able to support patients within the weight limits of the center. In the case of the Florham Park Surgi Center, its tables can hold patients up to 500 pounds.
The ASMBS Center of Excellence designation requires centers have surgical instruments for the morbidly obese, fluoroscopic technologies for band adjustments, medical imaging equipment for diagnostic purposes and ICU equipment.
Read more about the ASMBS Center of Excellence designation.
Related Articles on Bariatric Surgery:
Teenagers Unlikely to Receive Insurance Coverage for Bariatric Surgery
Gastric Bypass Has Metabolic Benefits Other Than Weight Loss
5 Points on Weight Loss Surgery, Obesity Coverage