title: Effect of Mandatory Centers of Excellence Designation on Demographic Characteristics of Patients Who Undergo Bariatric Surgery.
abstract: OBJECTIVE
  From February 21, 2006, through September 24, 2013, the Centers for Medicare & Medicaid Services (CMS) required, via the National Coverage Determination manual, that bariatric surgery be performed only in hospitals that had been designated as a Center of Excellence (COE). The effect of this certification requirement on access to bariatric surgery has been reported only anecdotally.
  
  
  OBJECTIVE
  To investigate whether the COE certification requirement proved to be a barrier to patients' access to bariatric surgical procedures.
  
  
  METHODS
  Using the National Inpatient Sample, we retrospectively identified patients who underwent bariatric surgery from January 1, 2006, through December 31, 2011.
  
  
  METHODS
  Bariatric surgery.
  
  
  METHODS
  Logistic regression and χ² tests were used to examine differences in patients' sociodemographic characteristics over time.
  
  
  RESULTS
  A total of 134,227 bariatric surgical patients were identified. The proportion of the population who were older than 64 years increased from 2.9% in 2006 to 7.0% in 2011 (P < .001) and there was a decrease in the proportion of patients who were 49 years and younger (P < .001). The percentage of female patients who underwent bariatric surgery decreased from 80.4% to 78.1% (P < .001) and the percentage of patients who were classified as black, Hispanic, or Asian or Pacific Islander increased from 12.3% to 15.1% (P < .001), 9.7% to 12.5% (P < .001), and 0.3% to 0.4% (P < .001), respectively. The proportion of patients with Medicare increased from 8.5% to 16.3% (P < .001) and those with Medicaid from 6.6% to 11.8% (P < .001). The percentage of patients with private insurance declined from 72.4% to 63.3% (P < .001). The proportion of patients in the lowest income quartile increased from 20.7% to 22.9% (P < .001) while those in the highest income quartile decreased from 25.8% to 23.9% (P < .001).
  
  
  CONCLUSIONS
  The COE certification requirement by CMS did not appear to limit access to bariatric surgery. Future studies should determine whether CMS's recent (2013) change in policy (ie, removing the mandatory COE certification for bariatric surgical insurance coverage) might sacrifice patient safety without addressing the real cause of limited access to health care.
authors.affiliation: Department of International Health, The Johns Hopkins School of Public Health, Baltimore, Maryland2Department of Biochemistry & Molecular Biology, The Johns Hopkins School of Public Health, Baltimore, Maryland.
authors.forename: Junun
authors.initials: J
authors.lastname: Bae
authors.affiliation: The Johns Hopkins Center for Bariatric Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland4Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Jaime
authors.initials: J
authors.lastname: Shade
authors.affiliation: The Johns Hopkins Center for Bariatric Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland4Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland5The Columbian College of Arts and Sciences, The Georg.
authors.forename: Amanda
authors.initials: A
authors.lastname: Abraham
authors.affiliation: The Johns Hopkins Center for Bariatric Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland4Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Brianna
authors.initials: B
authors.lastname: Abraham
authors.affiliation: Department of International Health, The Johns Hopkins School of Public Health, Baltimore, Maryland3The Johns Hopkins Center for Bariatric Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland4Department of Surgery, The Johns Hopkins Unive.
authors.forename: Leigh
authors.initials: L
authors.lastname: Peterson
authors.affiliation: Center for Surgical Trials and Outcomes Research, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Schneider
authors.affiliation: The Johns Hopkins Center for Bariatric Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland4Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Magnuson
authors.affiliation: The Johns Hopkins Center for Bariatric Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland4Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Schweitzer
authors.affiliation: The Johns Hopkins Center for Bariatric Surgery, The Johns Hopkins Bayview Medical Center, Baltimore, Maryland4Department of Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland6Center for Surgical Trials and Outcomes Research, The.
authors.forename: Kimberly E
authors.initials: KE
authors.lastname: Steele
mesh_terms: D000293:Adolescent; D000328:Adult; D050110:Bariatric Surgery; D005260:Female; D006761:Hospitals / Q000592:standards*; D006801:Humans; D015994:Incidence; D019458:Insurance Coverage; D008297:Male; D008484:Medicaid; D006278:Medicare; D008875:Middle Aged; D009767:Obesity, Morbid / Q000191:economics / Q000601:surgery*; D061214:Patient Safety; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D055815:Young Adult