DR. PONCE'S BLOG:

MBSAQIP -- Nearing the Finish Line

Published in August 2013 Issue            


I believe with a strong bariatric accreditation program we can save more lives, improve patient outcomes, reduce costs and demonstrate the true value of bariatric and metabolic surgery from pre-op to post-op. My belief is even stronger today as we enter the final phase before full implementation of the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

Just this month, a study in Surgical Endoscopy, co-authored by Ninh Nguyen, MD, ASMBS President-elect, found non-accredited bariatric centers had an in-hospital mortality rate that was more than three times higher than accredited centers (0.22% vs. 0.06%, respectively) with similar volume. This adds to previous studies, including a study published in the Journal of the American College of Surgeons (JACS) last year, that showed almost identical differences in mortality between non- accredited and accredited academic bariatric centers (0.21% vs. 0.06%, respectively).

MBSAQIP is Almost Here

The first draft standards for MBSAQIP were released in December 2012 and we received many valuable comments from surgeon and integrated health members. These comments along with the input from the ASMBS Executive Council helped to guide a revised version of the standards, which are now available for additional public comment through August 23, 2013. We look forward to receiving and considering any additional comments before the standards are finalized and implemented.

MBSAQIP is critically important to the future of metabolic and bariatric surgery and to ensuring that patients in need have access to quality treatment. MBSAQIP will usher in a new era of continuous quality improvement, acceptance, credibility and understanding for a treatment that until now has been reserved for less than 1 percent of the eligible population.

As you know, the Centers for Medicare & Medicaid Services (CMS) is considering reversing its 2006 decision requiring certification for facilities that perform bariatric surgery on Medicare beneficiaries. In a joint letter to CMS, the ASMBS American College of Surgeons, joined by The Obesity Society, American Society of Bariatric Physicians and The Society of American Gastrointestinal Endoscopic Surgeons, collectively wrote that they "strongly oppose CMS’ decision to overturn current, established policy."

If CMS rules that certification is no longer required it could be a setback for Medicare beneficiaries who have a higher risk of morbidity and mortality than the general bariatric surgery population. We are hopeful CMS considers the implications on its beneficiaries and keeps certification intact.

Most major private insurers support accreditation. I have been in all the conference calls we have held when they have expressed that support. Accreditation may provide the common ground we need to expand access to appropriate patients in consistent fashion.  

One thing is for sure though, no matter what the CMS decision, we as a community are moving forward with accreditation. We have seen firsthand the benefits of interdisciplinary care and we will not turn back the clock on the great strides that have been made in bariatric and metabolic surgery.

We must continue to provide leadership, promote best practices and collect and track our data for continuous quality improvement. We welcome all those committed to quality patient care to join us whatever their geography or stance on the proposed CMS decision on accreditation. Our patients are counting on us.

Our goal has always been to make accreditation universal across health plans, increase access, decrease administrative burden, improve quality, and improve patient safety with continued hospital support at all levels.

On another note related to quality, soon the ASMBS will be announcing the first national quality improvement project. The first meeting will take place Saturday, November 16, 2013 during ObesityWeek in Atlanta. Our goal for this program is to significantly reduce readmission rates, which are currently 8 to 9 percent. Watch for more news about this important program in the coming weeks and months.

I want to thank all those who have worked so hard to make MBSAQIP a reality and who are committed to providing the highest quality care to their patients. And while we are near the finish line for full implementation of MBSAQIP, the race for quality continues, with what I believe will be a head start.