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JAMA Patient Page
September 4, 2013

Centers of Excellence

JAMA. 2013;310(9):994. doi:10.1001/jama.2013.277345

Centers of excellence (COEs) exist across the United States in a wide variety of disciplines, including business, technology, government, and medicine.

What Are Centers of Excellence?

There is no single definition for a center of excellence, but as the name implies, COEs generally consist of teams of highly skilled experts and are also often involved in research and innovation to advance the field. Most COEs establish guidelines or standards specific to their endeavors.

In health care, centers of excellence can be established by a medical specialty’s professional society, a government entity such as the National Cancer Institute, or a consumer group organized in response to a disease. Many centers of excellence, however, are independently created by individual hospitals or health care systems. Therefore, the use of the term center of excellence by a hospital or clinic does not refer to a universal certification or set of standards.

Even Walmart recently created its own centers of excellence designation, partnering with 6 nationally well-known health care organizations, including the Mayo Clinic and the Cleveland Clinic.

Centers of Excellence for Weight Loss Surgery

Both the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS) (weight loss surgery) are professional organizations with COE criteria. To become certified as an ASMBS Center of Excellence, a hospital or institution must meet the following standards. The ACS has similar requirements.

  • Perform at least 125 bariatric surgeries per year collectively.

  • Surgeon must have performed at least 125 bariatric operations on his or her own over a lifetime, and at least 50 per year.

  • Report long-term patient outcomes and have an on-site inspection to verify all data.

  • Have a dedicated multidisciplinary bariatric team that includes surgeons, nurses, medical consultants, nutritionists, psychologists, and exercise physiologists.

  • Meet a variety of other requirements.

Medicare Coverage

In 2006, the Centers for Medicare & Medicaid Services ruled that Medicare would pay only for bariatric surgery that was performed at an ASMBS center of excellence or an ACS level 1 bariatric surgery center. (In 2012, the ACS and ASMBS decided to combine their certifications to create 1 set of national standards.)

As a result, patients who need to have their surgery paid for by Medicare must go to one of these COEs, even if it means traveling to another state or from a rural area to an urban area. This can be particularly difficult for follow-up care.

However, recent research suggests that outcomes for patients who undergo bariatric surgery are no better at facilities that perform a larger number of these procedures or that are designated as centers of excellence. After examining this study and many others, a Medicare review group concluded that the COE designation does not provide improved outcomes for Medicare beneficiaries. Because of this, Medicare has proposed removing the requirement that bariatric surgery be performed only in COEs.

The bariatric COE experience shows how difficult it can be to identify health care facilities as being better than others by designating them as COEs. When deciding where to undergo a procedure, ask your doctor what he or she recommends and also ask friends about their experiences at various facilities.

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For More Information

  • Centers for Medicare & Medicaid Services Proposed Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity—Facility Certification Requirement (Report CAG-00250R3)

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Article Information

Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest and none were reported.

Source: Dimick JB, Nicholas LH, Ryan AM, et al. JAMA. 2013;309(8):792-799.

Topic: Health Care Delivery