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Patients’ access to bariatric surgery may be limited by Medicare rule, study finds

University of Michigan study says Medicare’s restriction of coverage for weight-loss surgery to Centers of Excellence had no impact on safety

ANN ARBOR, Mich.

Medicare’s attempt to send patients to the safest hospitals for bariatric surgery may be limiting access to the common weight loss procedures.

A new University of Michigan Health System study shows a 2006 Medicare rule restricting coverage to Center of Excellence hospitals accredited by a professional organization has had no impact on the rate of surgical complications or reoperations.

Instead, the rule may be creating an unnecessary burden for patients seeking a hospital where they can use their Medicare benefits, according to the study appearing Tuesday in the Journal of the American Medical Association.

“If patients seeking this procedure are forced to travel further to find a Center of Excellence, the policy might actually be limiting their access to care,” says lead author Justin Dimick, M.D., M.P.H., associate professor of surgery at U-M. “These results suggest the benefits of going to a Center of Excellence are minimal and that Medicare should reconsider this policy.”

The researchers analyzed Medicare patient data from 12 states before and after the coverage decision went into effect. After accounting for patient factors, changes in procedure type and preexisting trends toward improved outcomes, they found no significant improvements after the policy change.

The rate of serious complication after the change was 3.3 percent compared to a similarly low rate of 3.6 percent before it.

Additionally, the researchers found no difference in serious complications between Centers of Excellence (2.2 percent) and non-Centers of Excellence (2.5 percent).

The study does indicate better safety for bariatric surgery over the analyzed time period, but the improvement can be attributed it in part to a shift toward lower risk procedures, not the Medicare policy.

Between 2004 and 2009, there was a general shift away from open to laparoscopic surgery and an increase in the use of laparoscopic gastric banding -- a safer albeit less effective procedure – both of which contributed to safer outcomes.

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