The American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) have partnered with the Center for Medicare and Medicaid Innovation (CMMI) to offer a new verification measure, the Bariatric Surgery Standards for Successful Programs, as part of CMMI’s Bundled Payments for Care Improvement Advanced (BPCI-A) programme. This partnership will offer meaningful quality measures for hospitals participating in the BPCI-A programme.
The new verification measure is a voluntary measure for participants in the Bariatric Surgery Clinical Episode. The verification measure focuses overarchingly on the care of the patient, including the goals and outcomes important to the patient, while also valuing the infrastructure, resources, and processes needed to deliver optimal care and improvement.
The measure follows the standards set forth by the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP), a joint quality program of the ACS and ASMBS. The MBSAQIP registry is the first ACS registry to be affiliated with the BPCI-A programme. Hospitals participating in MBSAQIP that currently participate in another BPCI-A Clinical Episode have been invited to enrol in the Bariatric Clinical Episode for Model Year 4 (Calendar Year 2021).
Bundled payments cover all the care a patient receives for a specific condition or medical event, unlike traditional fee-for-service payments where providers are paid separately for each service. Bundled payment models aim to incentivize better care coordination and efficiency by improving quality at lower costs.
“This collaborative effort to develop and implement this measure is novel because for the first time, we have been able to align facility [hospital] efforts to promote a programmatic approach to quality that is valued as part of a national value-based payment program. This approach to quality, coupled with strong local surgeon leadership, supports improved patient care, and shifts the focus toward outcomes meaningful to patients.” said Dr Clifford Ko, Director, ACS Division of Research and Optimal Patient Care. “We view this achievement as a meaningful and necessary first step.”
The new verification measure includes a systematically organised set of standards that represents the elements of an effective quality program and will be implemented as part of this national value-based payment programme. The measure follows the criteria set forth in the Optimal Resources for Metabolic and Bariatric Surgery (MBS) 2019 Standards, which promote the critical elements necessary to provide safe, effective, and high-quality care. The standards outline requirements for facilities to follow when seeking MBSAQIP Accreditation. Under the new BPCI-A verification measure, participating hospitals will be scored on six criteria, which were chosen from the MBSAQIP standards.
“The College’s quality programs have a long tradition of improving the quality of surgical patient care,” said ACS Executive Director, Dr David B Hoyt. “We think this partnership between MBSAQIP and the Center for Medicare and Medicaid Innovation will be a beneficial one. It will use important programme standards developed by MBSAQIP to create a robust national value-based payment programme to enhance bariatric surgical care.”
This collaboration will help to ensure that CMS value-based payment models rely on clinically relevant measures that can have a meaningful impact on the surgical care of patients. MBSAQIP was selected as a partner by CMMI because of its role as a verification program and the 100 percent data registry capture of metabolic and bariatric procedures performed at its accredited hospitals. The ACS anticipates that the implementation of this programmatic approach will help optimise the need to reward excellence in care by turning insurers’ attention to the major elements for creating and sustaining a functioning and effective quality program.
Any MBSAQIP hospital that chooses to participate in this alternative measure set for 2021 must update its current existing agreements with the Centers for Medicare and Medicaid Services by 10th December 2020.
“Working with ACS, MBSAQIP, and CMMI, we are working to define ‘quality as a programme’ with a team-centred approach which focuses on the patient’s goals,” said Dr Frank Opelka, Medical Director of Quality and Health Policy, ACS Division of Advocacy and Health Policy. “We hope to find this program aligns the elements of the care model more around a patient and less focus on checking off measures to assure payment.”