Bariatric surgery in minority patients before and after implementation of a centers of excellence program.

Bariatric Surgery inMinority Patients Before andAfter Implementation of a Centers of Excellence Program Numerous studies documenting better surgical outcomes at hospitals with higher procedure volume havemotivated proposals toconcentrateelectivesurgery inhigh-volumesettings.1 However, concerns about access to care, doubts about causality of the volume-outcomes relationship, and lack of easily identified volume thresholds have limited use of selective referral policies. In 2006, the Centers for Medicare & Medicaid Services (CMS) implemented a national coverage decision (NCD) restrictingMedicare patients to centers of excellence (COEs) for bariatric surgery. Professional organizations designate hospitals as COEs for bariatric surgery if these hospitals submit data to a registry, have adequateprotocols for careof morbidlyobesepatients, andperformat least 125bariatric proceduresannually.2Recently,CMSproposedeliminatingtheCOE requirement after studies suggested little if any safety benefit.3,4 The NCD restricting patients to COEs could lead to many potential harms, including reducing access to bariatric surgery forvulnerablepopulations.5Wecompared ratesofbariatric surgery for minority Medicare vs non-Medicare patients before and after implementation of the NCD.