The bariatric surgery center of excellence model was developed with the goal of concentrating these complicated surgical procedures at established programs that could demonstrate the ability to deliver efficient, effective, and safe care. As payers align with the center of excellence model and we enter what is effectively becoming a pay-for-performance era in bariatric surgery, there have been several unintended consequences. Programs that have delivered quality bariatric surgical care for years find themselves unable to meet center of excellence annual volume requirements. For many programs, this is secondary to a lack of appropriate patients with health insurance that includes benefits relating to bariatric surgery, not to a lack of appropriate patients. Insurance coverage for bariatric surgery, and as a direct result, access to care for those in need, is currently extremely limited in many parts of the United States.
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