The Value of Accreditation

Published in July 2013 Issue             

The accreditation standards for MBSAQIP are near completion. This program will define best practices, establish efficient and reliable processes for data collection, and further identify and support high-impact, evidence-based interventions that improve patient outcomes. It may also lead the way toward a universal process of accreditation that is recognized, accepted and embraced by the entire payor community.

Getting universal agreement on anything is difficult, but the ASMBS and American College of Surgeons (ACS) are committed to this goal and have the expertise, credibility and resources to support this vision for the specialty. Even within our own society there are some who are critical of accreditation, but a recent survey of our membership revealed that 75 percent of surgeon respondents and 87 percent of Integrated Health respondents support accreditation.

Most recently, the Centers for Medicare & Medicaid Services (CMS) has questioned the value of accreditation. The agency issued a draft decision memo that would reverse its 2006 decision requiring certification of facilities that perform bariatric surgery. The official position of the ASMBS is that the elimination of the certification requirement is unjustified and may lead to reduced safety and effectiveness, and higher mortality rates among Medicare beneficiaries undergoing bariatric surgery.

In its proposed decision memo, CMS "proposes that the evidence is sufficient to conclude that continuing the requirement for certification for bariatric surgery facilities would not improve health outcomes for Medicare beneficiaries." We strongly disagree.

The evidence is sufficient that certification does not improve outcomes? There were seven studies in support of facility accreditation and two studies against. Since then, yet another study has shown the positive impact of accreditation. It found non-accredited bariatric centers performing 50 or more bariatric stapling procedures had an in-hospital mortality rate that was more than three times higher than accredited centers (0.22% vs. 0.06%), with similar volumes. This study, in press for publication in Surgical Endoscopy, will be submitted to CMS along with other supporting evidence as the agency considers a final ruling, which is expected by the end of September.

We are not alone in our concern over the proposed CMS decision. Several organizations have joined the ASMBS in urging CMS to maintain its certification requirement. They include the American College of Surgeons, The Obesity Society, Academy of Nutrition and Dietetics, American Society of Bariatric Physicians, the American Association of Clinical Endocrinologists and SAGES. The vast majority of the 300-plus comments on the public comment section of the CMS web site support accreditation.

We hope CMS does the right thing. We know, and the evidence supports, accreditation works, saves lives, improves patient outcomes, reduces costs and expands access to quality care. It creates a culture of quality that lives before, during and after the day of surgery. This is what will live on in MBSAQIP bariatric centers across the nation, whatever the final
CMS decision.