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Impact of Centers of Excellence on Bariatric Surgery Outcome

Article: Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence. JAMA. 2013;309(8):792-799.

Summary

Study examines the rates of complications and reoperations before and after the Medicare coverage decision on bariatric surgery.

Abstract

Importance Starting in 2006, the Centers for Medicare & Medicaid Services (CMS) has restricted coverage of bariatric surgery to hospitals designated as centers of excellence (COE) by 2 major professional organizations.

Objective To evaluate whether the implementation of the COE component of the national coverage decision was associated with improved bariatric surgery outcomes in Medicare patients.

Design, Setting, and Patients Retrospective, longitudinal study using 2004‑2009 hospital discharge data from 12 states (n = 321 464 patients) of changes in outcomes in Medicare patients undergoing bariatric surgery (n = 6723 before and n = 15 854 after implementation of the policy). A difference‑in‑differences analytic approach was used to evaluate whether the national coverage decision was associated with improved outcomes in Medicare patients above and beyond existing time trends in non‑Medicare patients (n = 95 558 before and n = 155 117 after implementation of the policy).

Main Outcome Measures Risk‑adjusted rates of any complication, serious complications, and reoperation.

Results Bariatric surgery outcomes improved during the study period in both Medicare and non‑Medicare patients; however, this change was already under way prior to the CMS coverage decision. After accounting for patient factors, changes in procedure type, and preexisting time trends toward improved outcomes, there were no statistically significant improvements in outcomes after (vs before) implementation of the CMS national coverage decision for any complication (8.0% after vs 7.0% before; relative risk [RR], 1.14 [95% CI, 0.95‑1.33]), serious complications (3.3% vs 3.6%, respectively; RR, 0.92 [95% CI, 0.62‑1.22]), and reoperation (1.0% vs 1.1%; RR, 0.90 [95% CI, 0.64‑1.17]). In a direct assessment comparing outcomes at hospitals designated as COEs (n = 179) vs hospitals without the COE designation (n = 519), no significant differences were found for any complication (5.5% vs 6.0%, respectively; RR, 0.98 [95% CI, 0.90‑1.06]), serious complications (2.2% vs 2.5%; RR, 0.92 [95% CI, 0.84‑1.00]), and reoperation (0.83% vs 0.96%; RR, 1.00 [95% CI, 0.86‑1.17]).

Conclusions and Relevance Among Medicare patients undergoing bariatric surgery, there was no significant difference in the rates of complications and reoperation before vs after the CMS policy of restricting coverage to COEs. Combined with prior studies showing no association of COE designation and outcomes, these results suggest that Medicare should reconsider this policy.

Interview with Justin B. Dimick, MD, MPH, author of Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence.

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Repercusión de los centros de excelencia sobre los desenlaces de la cirugía bariátrica

Artículo: Complicaciones de la cirugía bariátrica antes y después de la implantación de la política nacional que limita la cobertura a los centros de excelencia. JAMA. 2013;309(8):792-799.

Summary

En un estudio se examinan las tasas de complicaciones y reintervenciones antes y después de la decisión de Medicare sobre la cobertura de la cirugía bariátrica.

Entrevista con Justin B. Dimick, MD, MPH, autor de Complicaciones de la cirugía bariátrica antes y después de la implantación de la política nacional que limita la cobertura a los centros de excelencia.

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Impact des Centres d'excellence sur les résultats de la chirurgie bariatrique

Article: Complications de la chirurgie bariatrique avant et après l'instauration d'une politique nationale limitant le remboursement aux Centres d'excellence. JAMA. 2013;309(8):792-799.

Summary

Une étude se penche sur les taux de complication et la fréquence des réinterventions avant et après la décision de remboursement de la chirurgie bariatrique par Medicare.

Entretien avec Justin B. Dimick, MD, MPH, auteur de Complications de la chirurgie bariatrique avant et après l'instauration d'une politique nationale limitant le remboursement aux Centres d'excellence.

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Impatto dei centri di eccellenza sull'outcome della chirurgia bariatrica

Articolo: Complicanze della chirurgia bariatrica prima e dopo l'implementazione di una politica nazionale che limita la copertura ai centri di eccellenza. JAMA. 2013;309(8):792-799.

Summary

Lo studio analizza le percentuali di complicanze e nuovi interventi prima e dopo la decisione di Medicare sulla copertura per la chirurgia bariatrica.

Intervista a Justin B. Dimick, MD, MPH, autore di Complicanze della chirurgia bariatrica prima e dopo l'implementazione di una politica nazionale che limita la copertura ai centri di eccellenza.

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卓越中心对减重手术预后的影响

文章: 仅允许卓越中心报销减重手术的医保政策实施前后减重手术并发症比较。 JAMA. 2013;309(8):792-799.

Summary

研究探讨减重手术医保承保决定实施前后的并发症率和再次手术率。

专访 Justin B. Dimick, MD, MPH, 作者 仅允许卓越中心报销减重手术的医保政策实施前后减重手术并发症比较。

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Impact of Centers of Excellence on Bariatric Surgery Outcome

статья: Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence. JAMA. 2013;309(8):792-799.

Summary

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Интервью с Justin B. Dimick, MD, MPH автор Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence.

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Impact of Centers of Excellence on Bariatric Surgery Outcome

Artigo: Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence. JAMA. 2013;309(8):792-799.

Summary

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Entrevista com o Justin B. Dimick, MD, MPH autor de Bariatric Surgery Complications Before vs After Implementation of a National Policy Restricting Coverage to Centers of Excellence.

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Einfluss der Kompetenzzentren auf die Ergebnisse in der Adipositaschirurgie

Artikel: Komplikationen bei adipositaschirurgischen Eingriffen vor und nach der Einführung einer US-Richtlinie zur Beschränkung des Versicherungsschutzes auf Kompetenzzentren. JAMA. 2013;309(8):792-799.

Summary

Studie untersucht die Komplikations- und Reoperationsraten vor und nach der Entscheidung einer Rückserstattung der Kosten für die Adipositasoperation durch Medicare.

Interview mit Justin B. Dimick, MD, MPH, autor Komplikationen bei adipositaschirurgischen Eingriffen vor und nach der Einführung einer US-Richtlinie zur Beschränkung des Versicherungsschutzes auf Kompetenzzentren.

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