title: Effect of Center of Excellence requirement by Centers for Medicare and Medicaid Services on practice trends.
abstract: BACKGROUND
  To report the effect of the American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence designation in Michigan on our practice trends and patient populations. As of February 2006, weight loss surgery for Medicare beneficiaries are reimbursed when procedures are performed at American Society of Bariatric Surgery or American College of Surgeons-designated Centers of Excellence.
  
  
  METHODS
  Patients who underwent laparoscopic Roux-en-Y gastric bypass surgery by an individual surgeon from June 1 to October 31 in 2004, 2005, and 2006 were stratified according to use of private third-party insurance versus Medicare (MC) insurance. The demographic data, body mass index, numbers of medications and co-morbidities, operative time, lengths of stay, morbidity, and mortality were analyzed. Significance was assessed at P <.05.
  
  
  RESULTS
  From June 1 to October 31 in 2004, 2005, and 2006, 255 patients with MC or private third-party insurance underwent laparoscopic Roux-en-Y gastric bypass surgery, with the percentage of MC patients increasing from 15.3% and 10.2% in 2004 and 2005 to 30.9% in 2006. The MC patients were older (56.1 +/- 1.3 yr versus 44.1 +/- 0.7 yr; mean +/- standard error of mean), had more co-morbidities (5.1 +/- 0.2 versus 3.5 +/- 0.1), required more medications (10.3 +/- 0.6 versus 5.6 +/- 0.3), had undergone more previous operations (2.1 +/- 0.2 versus 1.3 +/- 0.1), and had longer operative times (148 +/- 11.1 versus 121 +/- 3.1 min) than the private third-party insurance patients; the differences were all significant. The differences in gender, body mass index, and length of stay were not significantly different.
  
  
  CONCLUSIONS
  The Centers for Medicare and Medicaid Services requirements for Centers of Excellence designation resulted in a significant increase in the Medicare case load within our institution. This population tended to be older and more complex, with longer operative times. The changes present new challenges in patient care, including the coordination of care for the multiple co-morbidities of older obese patients with a multispecialty care team.
authors.affiliation: Grand Rapids Medical Education and Research Center/Michigan State University General Surgery Residency, 221 Michigan Southeast, Grand Rapids, MI 49503, USA.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Keto
authors.forename: Paul R
authors.initials: PR
authors.lastname: Kemmeter
mesh_terms: D000328:Adult; D005260:Female; D015390:Gastric Bypass / Q000191:economics / Q000379:methods / Q000592:standards*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013531:Surgicenters / Q000191:economics / Q000592:standards / Q000639:trends; D014481:United States