Medicaid and Medicare Drops Requirement for Bariatric Center of Excellence

On September 25th 2013, the Centers for Medicare and Medicaid Services (CMS) has dropped the requirement that bariatric surgery facilities be certified as a Bariatric Center of Excellence.

CMS released this statement on September 24, 2013 giving their reasons:

            “We believe the available evidence is sufficient to determine that the requirement for facility certification/COE designation for coverage of approved bariatric surgery procedures does not provide improved outcomes for Medicare beneficiaries.”


Why remove the Center of Excellence requirement?Bariatric Center of Excellence Medicaid

They concluded that certifying these facilities did not improve results.  There was also a downside and this was that fewer people could get the services they needed.  These included mostly the disadvantaged.


The Change in Policy

The policy in place since 2006 requiring these facilities be accredited to be covered on Medicare has been reversed.

This National Coverage Determination (NCD) on Bariatric Surgery for the Treatment of Morbid Obesity spelled out certain criteria for patients, procedures that would be covered and specific requirements that bariatric facilities must have in order to have coverage.

At the time every facility performing these services and procedures had to be certified by the American College of Surgeons (ACS) as a Level 1 Bariatric Surgery Center or approved by the American Society for Bariatric Surgery as a Bariatric Surgery Center of Excellence (BSCOE).

In 2005 the thought was that these certifications were beneficial but since then this has not been proven out.


Reconsideration Request

 A formal request to have this 2006 policy lifted was submitted by representatives of the Michigan Bariatric Surgery Collaborative.  The members requesting that CMS consider removing the certification policy were John Birkmeyer, MD, Nancy Birkmeyer, PhD and Justin Dimick, MD.

These doctors spelled out the results of several current studies that showed no real difference in mortality or complications between the centers of excellence and the facilities that were not.

So the CMS opened a National Coverage Analysis (NCA) in January 2013, in order to review the evidence.

They analyzed nine current research articles on the topic, they got input from the public at large and they reviewed professional society position statements.


The following groups opposed the new CMS policy removing accreditation:

  • The American Society for Metabolic and Bariatric Surgery (ASMBS)
  • American College of Surgeons (ACS)
  • The Obesity Society
  • Academy of Nutrition and Dietetics
  • American Society of Bariatric Physicians (ASBP)
  • American Association of Clinical Endocrinologists (AACE)
  • Society of American Gastrointestinal and Endoscopic Surgeons (SAGES)


The issues raised by those commenting had to do with:

  • Access to Care
  • Quality and Outcomes
  • Commitment to Multi-disciplinary Team Approach and Structure
  • Consistency of CMS Policy
  • Medicare Population at Risk
  • Communication with Certifying Organizations
  • Review of the Evidence


The major issue was access to care.  One of the studies concluded that “the Center of Excellence requirements have increased the travel distance for Medicare patients”, making it more difficult to access.


Bariatric Surgery Accreditation

The American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) are responsible for carrying out the accreditation.  Last year they joined forces forming the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP).

This program establishes a national standard for accreditation so that patients have better care before, during and after their procedures.  Across the country there are currently about 750 inpatient and outpatient center accredited by either the ASMBS or ACS.

CMS is the only major insurer to have dropped the certification requirement.  Others still may require accreditation in order to cover bariatric surgery:


Before the decision was made by CMS to drop the accreditation Justin Dimick, MD, who was in favor of this decision said:

“There are definitely two points of view on the issue.  There is the professional association point of view, representing the people who perform accreditation, and obviously they support keeping the requirement, which is certainly understandable.  Doctors Birkmeyer and I represent the scientific perspective, which is about what the evidence shows, and we think the evidence does not support the need for mandatory accreditation.”

“We are not against certification,” said Dimick.  “We just don’t think it should be mandatory.”



Primary Source:  Decision Memo for Bariatric Surgery for the Treatment of Morbid Obesity – Facility Certification Requirement (CAG-001250R3), accessed at



Type II Diabetes Cure: Bariatric Surgery

Looking for a Type II Diabetes Cure? Many health conferences are starting to talk about the ability of bariatric surgery to improve the symptoms of and cure type II diabetes. For years, it has been known that people who undergo bariatric surgery often seen an improvement in their diabetes long before they start seeing weight loss results. If you have type II diabetes you may want to consider bariatric surgery as a way to improve and cure your diabetes.

Consider some more information about the procedure before you decide to talk with your doctor about undergoing the procedure since all surgical procedures should be carefully considered.

Is Bariatric Surgery Really the Answer for Type II Diabetes Cure?

Much talk can be found online about bariatric surgery as a cure for type II diabetes. In fact, some medical studies have bariatric surgery for type II diabeteseven shown the benefit of bariatric surgery in treating or at the least reducing the symptoms of type II diabetes. Perhaps the best news comes from two new studies published in the New England Journal of Medicine. These new tests were done from a random group of people that compared people with bariatric surgery versus those who received conventional or intense medical treatment for their type II diabetes. Before this, there was no definitive test about the effects of bariatric surgery and type II diabetes.

These two new studies were done in Italy and had the goal of dropping a type II diabetes patient A1C to under 7 after 2 years of treatment. Those who didn’t undergo bariatric surgery underwent lifestyle changes such as a low-fat diet and increased exercise based on the American Diabetes Association guidelines. Both of these studies showed that those who underwent bariatric surgery had lower BMIs, lower A1C’s and other health benefits such as lower blood pressure and lipid levels than those who didn’t undergo the surgery.

In addition, these benefits came from the surgery itself and not from any medication help. This is what many doctors and the press are talking about when it comes to bariatric surgeries ability to be the type II diabetes cure.

While these studies show good results from people with type II diabetes that undergo bariatric surgery. It is important to also keep in mind that people who don’t undergo surgery also see improvements in their type II diabetes with rigorous medical treatments. So it is important to carefully look into bariatric surgery and see if it is right for you. Often if you aren’t obese, a doctor won’t recommend this type of surgery just to help with type II diabetes. However, if you are both obese and suffering from type II diabetes it may be reasonable to talk with your doctor about the benefits of undergoing bariatric surgery.

After undergoing the procedure you need to be prepared to deal with a lifetime of nutritional and dietary changes that must be rigorously followed in order to avoid complications. You will need to be vigilant about taking additional supplements to avoid malnutrition. Tracking your nutritional status is important.

Bariatric surgery is certainly an option for people who are looking for a long term type II diabetes cure. You should carefully consider the information above and talk with your doctor to make sure bariatric surgery is right for you. You may want to schedule a free information session that most bariatric practices offer, so the surgeon can help answer any questions you may have about the procedure.