Medicare Changes Requirements for Bariatric Surgery

Posted: Oct 30 in Weight Loss Surgery by Staff

Due to a recent change in policy, Medicare recipients have more options about where they can have bariatric surgery performed under their current coverage limits.

In 2006, the Centers of Medicare & Medicaid Services (CMS) decided that bariatric surgery would be covered under traditional Medicare plans, but only when the surgery was performed at a designated Center of Excellence. This stipulation was created to reduce the surgical risks associated with bariatric surgery, thus reducing the complication rate and associated medical costs.

This stipulation was labeled the Bariatric Surgery Facility Certification, and it required hospitals and surgical practices to work hard to become a designated facility.

Requirements to become a Bariatric Surgery Center of Excellence (BSCOE) include:

• Extensive surgical experience
• Institutional commitment to excellence
• Designated bariatric medical director
• Critical care support systems
• State-of-the-art equipment
• Patient support groups
• Long-term follow up programs

These stipulations are enforced by the Surgical Review Corporation (SRC), who advertises that gaining their seal of excellence is one of the most challenging accomplishments a hospital can receive. There are many hospitals that meet the qualifications of a center of excellence, but have not been awarded the label.

Without this certification, surgeons at the hospital were still permitted to perform bariatric procedures, but patients would often have difficulty finding funding for their procedure through their insurance—especially Medicare patients. This created yet another obstacle for individuals to work through before undergoing bariatric surgery. By reversing the mandate, hospitals with the distinction are still highly recommended, but the options as to where surgery can be performed are much larger.

In addition to Medicare programs, certain policies under CIGNA, Humana and Blue Cross & Blue Shield have required the BSCOE certification.

While the requirement for this certification was intended to improve safety outcomes for patients, there is little evidence that it accomplished this. More often, Medicare patients would find themselves unable to get weight loss surgery with their bariatric surgeon of choice, being forced to find a center that met the guidelines of their coverage—and sometimes having to travel to do so.

The decision to remove this requirement means that individuals with Medicare coverage who had difficulty finding treatment through a center of excellence may now be able to undergo weight loss surgery in Napes or Ft. Myers.