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Patient Outcomes No Different For Bariatric Surgery Performed At Centers Of Excellence Versus Other Hospitals

INTRO: Just this month, the Centers for Medicare and Medicaid Services has re-opened a discussion concerning its 2006 decision to only cover weight loss surgery performed at centers of excellence. This decision was prompted after concerns about care patients received before, during and after the surgery. A new study examined outcomes of bariatric procedures before and after this policy was implemented. Catherine Dolf explains in this week’s JAMA Report.

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Various shot of bariatric surgery

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ABOUT TEN YEARS AGO GASTRIC BYPASS PROCEDURES LIKE THIS ONE STARTED TO GAIN IN POPULARITY ACROSS THE UNITED STATES.  HOWEVER, BACK THEN THERE WERE CONCERNS ABOUT THE SAFETY OF THESE OPERATIONS ESPECIALLY AMONG MEDICARE PATIENTS.

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SOT/FULL Super @:16 Justin B. Dimick, M.D., M.P.H., – University of Michigan, Ann Arbor Runs:10

“And because of that Medicare put in place a rule where they would only reimburse you for the surgery if it was performed at a center of excellence.”

(Video covering 1st half of bite: surgery)

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Bariatric surgery,Dr. Dimick walking down hallway, more bariatric surgery

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TO BE CLASSIFIED A CENTER OF EXCELLENCE, HOSPITALS MUST ADHERE TO CERTAIN CRITERIA, BE ACCREDITED BY EITHER THE AMERICAN COLLEGE OF SURGEONS OR THE AMERICAN SOCIETY FOR METABOLIC AND BARIATRIC SURGERY. THEY MUST ALSO PERFORM AT LEAST 125 BARIATRIC PROCEDURES EACH YEAR.

DR. JUSTIN DIMICK FROM THE CENTER FOR HEALTHCARE OUTCOMES AND POLICY AT THE UNIVERSITY OF MICHIGAN AND CO-AUTHORS EXAMINED HOSPITAL DISCHARGE DATA FROM MEDICARE PATIENTS WHO UNDERWENT BARIATRIC PROCEDURES COMPARED TO NON-MEDICARE PATIENTS. THE DATA CAME FROM 12 STATES BETWEEN 2004 AND 2009. RESEARCHERS MEASURED OVERALL AND SERIOUS COMPLICATION RATES ALONG WITH REOPERATIONS.

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SOT/FULL Super @:57 Justin B. Dimick, M.D., M.P.H., – University of Michigan, Ann Arbor Runs:09

“Outcomes did get dramatically better over the study period but this improvement was already underway before Medicare made this rule.”

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GXF FULL JAMA COVER

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THE STUDY APPEARS IN JAMA, JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

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SOT/FULL Super @ 1:10 Justin B. Dimick, M.D., M.P.H., – University of Michigan, Ann Arbor Runs:10

“When we directly compared outcomes at centers of excellence to non-centers of excellence they were equivalent. So, the so-called centers of excellence actually did not have better performance.”

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Bariatric surgery

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RESEARCHERS ALSO SAY THERE WERE TWO SIDE EFFECTS OF THIS POLICY.

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SOT/FULL Super @ 1:23 Justin B. Dimick, M.D., M.P.H., – University of Michigan, Ann Arbor Runs:09

“Patients aren’t getting the surgery in the first place and patients who are getting surgery have to travel further, sometimes away from their home and their family to undergo the procedure.”

(Video covering 1st half of bite: bariatric surgery)

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Various shots of bariatric surgery

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SURGICAL EXPERIENCE AND TECHNOLOGY HAS ALSO IMPROVED OVER TIME AND RESEARCHERS SUGGEST THAT MEDICARE SHOULD RE-EVALUATE THIS POLICY. CATHERINE DOLF, THE JAMA REPORT.

TAG:RESEARCHERS SAY OUTCOMES HAVE ALSO IMPROVED BECAUSE BARIATRIC SURGEONS HAVE MORE EXPOSURE TO THESE OPERATIONS IN BOTH RESIDENCY AND FELLOWSHIP TRAINING PROGRAMS.