Creation of nutrition support centers of excellence: is it truly an excellent idea?

In response to external pressures and events that threatened to adversely affect the field of bariatric surgery, the American Society for Metabolic and Bariatric Surgery created a mechanism for certifying surgeons and their facilities to guarantee that bariatric surgery would be performed with the greatest degree of patient safety. Those surgeons and facilities that satisfied the requirements were designated as Bariatric Surgery Centers of Excellence (BSCOE). That process involved creating an independent, not-for-profit corporation, establishing the best practice criteria for certification, and developing the mechanism for evaluating surgeons and programs. After the successful implementation of this program, the American College of Surgeons introduced a similar program, Bariatric Surgery Center Network. It was believed that implementing a BSCOE program in the field of bariatric surgery would counteract the forces threatening to reduce patient access to surgery. Although some of the predicted benefits have been realized, many have not. Additionally, the process has been shown to be costly in terms of labor and monetary expense. The field of nutrition support has many similarities to bariatric surgery. Although no acute crisis threatens to adversely affect the field, leaders are considering the creation of a similar credentialing program. The decision to proceed with the development of a Nutrition Support Center of Excellence should be made after significant discussion centered on the potential benefits and problems related to such a program. The BSCOE process can be used as a successful model. This article reviews the issues leading up to the creation of the BSCOE, describes its certification process, mentions some of the benefits, and offers recommendations for the consideration of an NSCOE program.