Bariatric Centers of Excellence: Effect of Centralization on Access to Care

In 2006, the Centers for Medicare and Medicaid Services restricted coverage for bariatric procedures to designated high-volume Centers of Excellence. The effect of centralization of elective surgical procedures on the ability of patients to access surgery has not been studied previously.

Inpatient claims data from 2008 to 2011 from 2 high-volume surgical states were used. All patients older than 18 years undergoing a bariatric surgical procedure were included. The number of bariatric procedures and characteristics of patients undergoing bariatric surgery were examined in each year. Nonparametric tests for trend were performed to analyze time trends. Difference-in-difference analyses were performed to assess the rate of bariatric surgery in underserved Medicare patients compared with underserved patients with other payers.

The percentage of procedures performed at Centers of Excellence increased from 60.5% in 2008 to 73.1% in 2011 (p < 0.01). The proportion of Medicare patients receiving surgery at a Center of Excellence increased from 77.7% in 2008 to 88.1% in 2011 (p < 0.01). The proportion of bariatric surgery patients from underserved groups increased over time except among those residing in rural areas, for whom there was no change. Among patients from underserved populations, only black Medicare patients experienced an increase in bariatric surgery use when compared with non-Medicare patients. The travel distance for Medicare patients consistently exceeded travel distance for non-Medicare patients. However, travel distance for Medicare patients decreased slightly during the study period.

Despite the longer travel distance required for Medicare patients, centralization of bariatric surgery to Centers of Excellence did not result in impaired access to care. In fact, in this study, an improvement in access to bariatric surgery was seen and persisted among some underserved populations.