title: Impact of a National Bariatric Surgery Center of Excellence Program on Medicare Expenditures.
abstract: BACKGROUND
  In 2006, the Centers for Medicare and Medicaid Services (CMS) issued a national coverage decision restricting bariatric surgery to designated centers of excellence (COE). Although prior studies show mixed results on complications and reoperations, no prior studies evaluated whether this policy reduced spending for bariatric surgery. We sought to determine whether the coverage restriction to COE-designated hospitals was associated with lower payments from CMS.
  
  
  METHODS
  We utilized national Medicare claims data to examine 30-day episode payments for patients who underwent bariatric surgery from 2003 to 2010 (n = 72,117 patients). We performed an interrupted time series analysis, adjusting for patient factors, preexisting temporal trends, and changes in procedure type, to determine whether the 2006 coverage decision was associated with lower Medicare payments above and beyond any existing secular trends. For these analyses, we included payments for the index hospitalization, readmissions, physician services, and post-discharge ancillary care.
  
  
  RESULTS
  After accounting for patient factors, preexisting temporal trends, and changes in procedure type, there were no statistically significant improvements in episode payments after (US$14,720) vs before (US$14,283) the coverage decision (+US$437, 95% CI, -US$10 to +US$883). In a direct assessment of payments for COE-designated hospitals (US$14,481) vs. non-COE-designated hospitals (US$14,756), no significant differences in episode payments were found (-US$275, 95% CI, -US$696 to +US$145).
  
  
  CONCLUSIONS
  We found no significant reductions in 30-day episode payments after vs before restricting coverage to COE-designated hospitals. Center of excellence status is not a proxy for savings to the healthcare system.
authors.affiliation: Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA. cscally@med.umich.edu.|Center for Healthcare Outcomes & Policy, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA. cscally@med.umich.edu.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Scally
authors.affiliation: Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.|Center for Healthcare Outcomes & Policy, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.
authors.forename: Terry
authors.initials: T
authors.lastname: Shih
authors.affiliation: Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.|Center for Healthcare Outcomes & Policy, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.
authors.forename: Jyothi R
authors.initials: JR
authors.lastname: Thumma
authors.affiliation: Department of Surgery, Center for Healthcare Outcomes and Policy, University of Michigan, Ann Arbor, MI, USA.|Center for Healthcare Outcomes & Policy, 2800 Plymouth Road, Building 16, Ann Arbor, MI, 48109, USA.
authors.forename: Justin B
authors.initials: JB
authors.lastname: Dimick
mesh_terms: D000067575:Administrative Claims, Healthcare / Q000706:statistics & numerical data; D000553:Ambulatory Care / Q000191:economics; D050110:Bariatric Surgery / Q000191:economics* / Q000592:standards*; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000331:legislation & jurisprudence; D017050:Episode of Care; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data*; D017721:Hospital Costs / Q000706:statistics & numerical data*; D006761:Hospitals; D006801:Humans; D019458:Insurance Coverage / Q000331:legislation & jurisprudence; D065186:Interrupted Time Series Analysis; D008297:Male; D006278:Medicare / Q000191:economics*; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics; D012086:Reoperation; D014481:United States
keywords: Bariatric surgery/economics; Bariatric surgery/outcomes; Healthcare costs; Obesity/economics