Posted on June 29, 2013 by admin
The flaws in the current Centers of Excellence (COE) program are quite notable and the Michigan group’s data suggesting so are well known. However CMS considering throwing out COE (see links below) is ill-advised and premature. We all remember the ‘wild west’ times when there was NO designation in place to hold back the tide of unqualified upstarts. The American Society of Metabolic and Bariatric Surgery (ASMBS) has worked with American College of Surgeons (ACS) to create a new and improved designation (see link below). Unfortunately as ASMBS and ACS have dismantled the referenced version of COE that was in place in 2010 and have designed this new one it would seem the proposed system is still missing some key points in terms of what should be considered as optimal. It largely ignores comprehensive psychological and behavioral pre-surgery and follow-up care; paying lip service to the need for psychologist/behavioral involvement with a very loosely defined evaluation requirement and a couple token support groups yet still no well-defined comprehensive follow-up TREATMENT program. Furthermore, as we begin to better understand that patients STILL need to implement self-directed lifestyle change AFTER surgery; why does CMS still refuse to pay for evidence-based long term behavioral interventions (e.g. 26 week; weekly attendance; professionally led treatment programs). In the non-surgical literature these treatment programs are shown to be most effective in promoting moderate, long-term weight loss. Surgery is a far more powerful nutritional and metabolic intervention than non-surgical diets by far, so why is no one talking about combining the 2 instead of pretending that a few support groups and dietitian visits after surgery is an optimal program? So rather than eliminating requirements, how about for once we think about what is optimal for THE PATIENT in terms of success and support with much needed clinical resources.
CMS Comments on removing COE:
Michigan group study:
New program for Excellence MBSAQIP