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CMS drops bariatric Center of Excellence facilitation

Decision based on ‘sufficient’ evidence that certification does not improve outcomes

The Centers for Medicare & Medicaid Services (CMS) has ruled 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 center they choose, even those facilities with little experience in handling high-risk patients. The decision is effective from 25 September 2013.

The CMS based their decision on ‘sufficient’ evidence to conclude that certification does not improve health outcomes for Medicare beneficiaries. Although the organisation has agreed that there is a role for accreditation programmes, it said that they are not necessary to ensure safe outcomes for Medicare beneficiaries.

"The removal of a coverage requirement does not require facilities to discontinue practices which they find beneficial," according to the decision memo. Facilities may choose to continue with certification in order to distinguish themselves from the competition, for instance.

"While CMS agrees with the value of the multidisciplinary team approach and structure, we do not believe that every valued endeavor needs to be buttressed by a Medicare mandate," the memo states. "We expect all facilities to strive to provide the proper equipment and services to meet the needs of its patient population."

This latest 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.

Medicare will continue to cover open and laparoscopic Roux-en-Y gastric bypass; laparoscopic adjustable gastric banding; and open and laparoscopic biliopancreatic diversion with duodenal switch for Medicare beneficiaries with a BMI >35 in those with at least one comorbidity related to obesity who previously have been unsuccessful with medical treatment for obesity.

Click here to read the reaction from the ASMBS.

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