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Research Letter
October 2, 2013

Bariatric Surgery in Minority Patients Before and After Implementation of a Centers of Excellence Program

Author Affiliations
  • 1Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
  • 2Department of Surgery, University of Michigan Medical School, Ann Arbor
JAMA. 2013;310(13):1399-1400. doi:10.1001/jama.2013.277915

Numerous studies documenting better surgical outcomes at hospitals with higher procedure volume have motivated proposals to concentrate elective surgery in high-volume settings.1 However, concerns about access to care, doubts about causality of the volume-outcomes relationship, and lack of easily identified volume thresholds have limited use of selective referral policies.

In 2006, the Centers for Medicare & Medicaid Services (CMS) implemented a national coverage decision (NCD) restricting Medicare patients to centers of excellence (COEs) for bariatric surgery. Professional organizations designate hospitals as COEs for bariatric surgery if these hospitals submit data to a registry, have adequate protocols for care of morbidly obese patients, and perform at least 125 bariatric procedures annually.2 Recently, CMS proposed eliminating the COE requirement after studies suggested little if any safety benefit.3,4 The NCD restricting patients to COEs could lead to many potential harms, including reducing access to bariatric surgery for vulnerable populations.5 We compared rates of bariatric surgery for minority Medicare vs non-Medicare patients before and after implementation of the NCD.

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