Limiting coverage of weight loss surgery to centers of excellence does not improve outcomes
In 2006, the Centers for Medicare & Medicaid Services (CMS) limited coverage of weight loss surgery to centers of excellence (COEs). Designation as a COE is based on three criteria:
- Hospital structure and process elements.
- Minimum hospital volume.
- A mandate to submit data to a clinical registry.
Implementation of the CMS national coverage decision did not significantly improve the outcomes for any complication of weight loss surgery, according to a new study. The study's examination of hospital discharge data from 2004–2009 on 321,464 patients in 12 States did find improved outcomes during this period, but the improvement was already underway prior to the CMS decision.
When the researchers directly compared outcomes between hospitals designated under CMS criteria as COEs and those without COE status, they found no significant differences for any complication, serious complications, or reoperation.
During the study period, there were major shifts in procedure use that contributed to improved outcomes. Laparoscopic surgery rates rose for all patients undergoing bariatric surgery, and use of open gastric bypass declined for Medicare patients (45 percent before and 10 percent after the coverage decision) and for non-Medicare patients (40 percent before and 9 percent after). Laparascopic band surgery increased greatly for all patients.
The study findings suggest that CMS should reconsider its decision to confine coverage of weight loss surgery to centers of excellence. This study was supported by AHRQ (HS17765).
See "Bariatric surgery complications before vs. after implementation of a national policy restricting coverage to centers of excellence," by Justin B. Dimick, M.D., Lauren H. Nichols, Ph.D., Andrew M. Ryan, Ph.D., and others in the February 27, 2013, Journal of the American Medical Association 309(8), pp. 792-799.