CMS Coverage Guidelines Tied to Better Bariatric Surgery Outcomes
By Jane Anderson
Elsevier Global Medical News
National coverage rules adopted by Medicare for bariatric surgery resulted in improved outcomes for beneficiaries without limiting access to care for individuals with medical disability, according to a study published in the January issue of Archives of Surgery.
Dr. Ninh T. Nguyen and colleagues examined results for procedures performed before and after implementation of the National Coverage Determination (NCD) for bariatric surgery, which was issued by the Centers for Medicare and Medicaid Services (CMS) in February 2006. They found a 29% drop in the number of bariatric procedures performed on Medicare patients in the 6 months after the NCD policy was implemented. But the number of procedures returned to the baseline volume within a year and exceeded that baseline within 2 years, while outcomes improved, stated Dr. Nguyen, a surgeon at the University of California Irvine Medical Center (Arch. Surg. 2010;145:72-8).
The NCD expanded coverage for laparoscopic and open Roux-en-Y gastric bypass, laparoscopic adjustable gastric banding, and laparoscopic and open biliopancreatic diversion with duodenal switch. It also broadened coverage to patients older than 65 years.
CMS covers these procedures if they are performed at a high-volume center with a low mortality rate that is certified by the American College of Surgeons or the American Society for Metabolic and Bariatric Surgery. Before the NCD was implemented, 60 institutions were performing bariatric surgery for Medicare patients. That number dropped to 45 after the policy was put in place.
Using the University HealthSystem Consortium database, which includes more than 90% of U.S. nonprofit medical centers, the investigators examined outcomes from bariatric procedures performed on Medicare patients between Oct. 1, 2004, and Sept. 31, 2007. A total of 3,196 bariatric procedures were performed in the 16 months before the NCD was implemented, and 3,068 were performed in the 20 months after the policy was implemented.
After the NCD policy was put in place, the volume of gastric banding doubled and the proportion of laparoscopic gastric bypass increased from 60%, to more than 77%. In addition, patients who underwent the surgery after the NCD had a shorter average length of stay and lower overall complication rates, with no significant differences in the in-hospital mortality rates. Hospital stays decreased from 3.5 to 3.1 days, and complication rates dropped from 12% to 10%.
These improvements in outcomes could extend beyond Medicare patients, the study said. “Although we only examined the Medicare beneficiaries population in this analysis, we suspect that the improvement in outcomes will also be extrapolated to the population that is not eligible for Medicare,” they concluded.