Published in June 2013 Issue             

Reproduced with permission from Bariatric Times. 2013;10(6):8–9.

Wayne English, MD, Co-Chair of the Committee on Metabolic and Bariatric Surgery (CMBS) Standards Subcommittee, describes the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) and provides a preview of the draft standards that will soon be released for a second round of public comment after completing additional reviews.

Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)-- Program Description

The American College of Surgeons (ACS) and American Society for Metabolic and Bariatric Surgery (ASMBS) are now partnering together on national bariatric surgery accreditation with a unified program to achieve a single national accreditation standard for all bariatric surgery programs.

MBSAQIP accreditation represents an institution’s commitment and accountability for high quality care and patient safety and the new standards will continue to build upon the legacy of quality improvement.

The goals of the MBSAQIP are to:

·     Improve overall quality and safety of a program

·     Develop a culture of collaboration and data review with peers

·     Accelerate quality improvement by implementing “best practices”

·     Capture data from all programs across the country

·     Provide feedback for programs and data for public reporting

MBSAQIP includes a high quality data registry with the ability for data feedback to improve outcomes.  The outcomes data can provide regional and national comparison.  This will allow programs to implement best practice changes that will improve patient safety
and effectiveness.

MBSAQIP Structure

The MBSAQIP committee structure consists of an overarching advisory committee and three subcommittees, with equal representation from the ACS and ASMBS.

The Committee on Metabolic and Bariatric Surgery (CMBS) serves the purpose of advising leadership on opportunities for the joint program and offers guidance for MBSAQIP development, transition, and growth with a special emphasis on bariatric and metabolic surgery stewardship. The co-chairs are Drs. Ninh Nguyen and John Morton.

The three subcommittees supporting the CMBS advisory committee provide support to the operations of the program. 

The Standards Subcommittee is responsible for the development of new joint accreditation standards, and producing the new standards manual. The co-chairs are Drs. Wayne English and Ronnie Clements.

The Verification Subcommittee is responsible for validating and certifying programs that meet criteria. The co-chairs are Drs. David Provost and Dan Jones.

The Data Registry and Reporting Subcommittee oversees the bariatric-specific, clinically rich data registry and provides input on analytical and reporting tools to support the needs of the program. The co-chairs are Drs. Matt Hutter and Bruce Wolfe.

Developing the First Draft of Standards

The first draft of the MBSAQIP standards was finalized and approved by the CMBS and then were released for public comments in December 2012. 

The public interest was huge with over 1,100 comments received. The ASMBS Executive Council (EC) also reviewed and provided comments to the initial draft. The Standards Subcommittee then reviewed the EC recommendations and all public comments for the revised version of the standards.

The Standards Subcommittee met weekly to discuss all of the comments and suggestions. The revised version of the standards were reviewed and approved by the CMBS at the SAGES meeting in Baltimore, on April 18, 2013.  The draft standards will soon be released for a second round of public comments after completing additional reviews.

Highlights of the New Standards

  • Volume criteria

There are significant data supporting lower volume criteria than what was previously required in accreditation.  The MBSAQIP established lower volume criteria for stapling procedures, at 50 cases annually.  There are no data supporting volume and outcomes in gastric banding procedures; however, 25 cases annually will be required for banding centers to maintain procedure familiarity and staff training.

  • Approved procedures for Outpatient Centers will include band revisions 

Evidence shows that band repositioning and replacement can be performed safely in an outpatient setting, especially in the hands of an experienced band surgeon.

  • Flexibility for the MBS Coordinator and Clinical Reviewer

Many members commented on the added expense of hiring a full-time FTE for both the MBS Coordinator and the MBS Clinical Reviewer.

Based on this feedback, the committee revised the standard to give centers greater latitude to hire for these positions given potential budgeting restraints. 

  • Emphasize Certified Bariatric Nurse® within the standards

Language will be added to the standards indicating CBN® is a designation that recognizes specialized bariatric nursing training, education, experience and knowledge.

  • Education/Support Groups may be offered at individual surgeon’s practices

In many practices and programs, pre-op and post-op patient care occurs in the surgeon’s office, and not necessarily in the hospital.  The hospital may not have significant involvement with follow-up care, but it is important for a hospital to recognize this aspect of patient care and collaborate with the individual surgeon’s practices to document protocols and follow-up data.

The standard was clarified to reflect that education and long-term care can be performed at the surgeon’s office or hospital.

  • Quality Improvement (QI) projects

The quality improvement process is a new and important aspect of the accreditation program.  MBSAQIP is encouraging programs to collaborate in order to improve outcomes by broadly implementing best practices. 

  • Accreditation documents added for ambulatory surgery facilities

The list of acceptable accreditation documents to measure compliance now includes those that are typically obtained by ambulatory surgery facilities.

  • Individual surgeon accreditation

Many members commented on the need for a unique accreditation for the bariatric surgeon.  This item was seen as an important component of quality in the accreditation program to ensure appropriate experience of the surgeons. The MBSAQIP is working on developing this aspect of accreditation that will also recognize a surgeon’s specialized skills and active practice in metabolic and bariatric surgery, allow surgeons to transport their Accreditation status to another MBSAQIP accredited programs, and allow surgeons an opportunity to demonstrate and bring their specialized skills to a new facility.