Bariatric surgery Centers of Excellence did not restrict access to care

In 2006, the Centers for Medicare & Medicaid Services (CMS) required that bariatric surgery be performed only in hospitals that had been designated as a Center of Excellence.
CMS removed the requirement in 2013 because of controversy over whether it impeded access to care.

This study from researchers at the Johns Hopkins Center for Bariatric Surgery, Baltimore, examines whether the Center of Excellence certification requirement proved to be a barrier to patients’ access to bariatric surgery.

An analysis of nearly 135,000 bariatric surgical patients found that the certification requirement actually reduced disparities in access to bariatric surgical procedures. The proportion of patients older than 65 years increased. The proportion of male patients increased. The disparity among the income classes improved, with the proportion of low-income patients increasing significantly. Access for ethnic minorities improved. The proportion of patients with Medicare increased significantly.

The researchers concluded that the findings do not support the hypothesis that restricting bariatric surgical patients to Centers of Excellence reduced access to care or increased disparities. More research is needed to determine whether the 2013 change in policy might sacrifice patient safety without addressing the real cause of limited access to care.

—Bae J, Shade J, Abraham A, et al. Effect of mandatory centers of excellence designation on demographic characteristics of patients who undergo bariatric surgery. JAMA Surg. Published online May 20, 2015.

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