Improved bariatric surgery outcomes for Medicare beneficiaries after implementation of the medicare national coverage determination.

OBJECTIVE To compare the outcomes of Medicare beneficiaries who underwent bariatric surgery within 18 months before and after implementation of the national coverage determination (NCD) for bariatric surgery. DESIGN Analysis of the University HealthSystem Consortium database from October 1, 2004, through September 31, 2007. SETTING A total of 102 academic medical centers and approximately 150 of their affiliated hospitals, representing more than 90% of the nation's nonprofit academic medical centers. PATIENTS Medicare and Medicaid patients who underwent bariatric surgery to treat morbid obesity. MAIN OUTCOME MEASURES Demographics, length of stay, 30-day readmission, morbidity, observed-to-expected mortality ratio, and costs. RESULTS A total of 3196 bariatric procedures were performed before and 3068 after the NCD. After the implementation of the NCD, the volume of gastric banding doubled and the proportion of laparoscopic gastric bypass increased from 60.0% to 77.2%. Patients who underwent bariatric surgery after the NCD benefited from a shorter length of stay (3.5 vs 3.1 days, P < .001) and lower overall complication rates (12.2% vs 10.0%, P < .001), with no significant differences in the in-hospital mortality rates (0.28% vs 0.20%). Among Medicare patients, there was a 29.3% reduction in the number of bariatric procedures performed within the first 2 quarters after the NCD. However, the number of procedures returned to baseline volume within 1 year and exceeded baseline volume after 2 years of the NCD. CONCLUSION The bariatric surgery NCD resulted in improved outcomes for Medicare beneficiaries without limiting access to care for individuals with medical disability.