Update on ASMBS/ACS Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program

| October 1, 2017

This column is dedicated to sharing the vast knowledge and opinions of the American Society for Metabolic and Bariatric Surgery leadership—past and present—on relevant topics in the field of bariatric surgery.

This month’s interview with: John M. Morton, MD, MPH, FACS, FASMBS

John M. Morton, MD, MPH, FACS, FASMBS, is Chief of the Section of Bariatric and Minimally Invasive Surgery, Stanford University, in Stanford, California, and Past President, American Society for Metabolic and Bariatric Surgery.

Funding: No funding was provided in the preparation of this manuscript.

Financial disclosures: The author reports no conflicts of interest relevant to the content of this article.

Bariatric Times. 2017;14(10):26–27.


During our last interview, you mentioned that the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP) program would have representation at the 2017 American College of Surgeons (ACS) Quality and Safety Conference.

Dr. Morton: The (ACS) Quality and Safety Conference took place July 21–24, 2017, in New York, New York. For the first time, this conference included discipline- and theme-based tracks focused on the specific needs of various learner groups from ACS Quality Programs, including MBSAQIP. Having a dedicated track during this conference puts us on par with American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) as well as the other prominent programs, including trauma, cancer, geriatric, and pediatric program. It is a whole family of quality programs, and we are proud to be one of them. We will be doing this meeting annually.

Having a presence at this meeting also allows for cross pollination between bariatrics and other disciplines. We present under one roof and get to know each other better. I believe here is an opportunity to extend bariatric surgery among these disciplines. For example, in the general surgery session, we can talk to attendees about the benefits of a patient undergoing bariatric surgery before hernia repair to make hernia repair more durable. We might also talk to the transplant surgeons and let them know we can get a patient’s weight down so he or she can be listed for transplant (a patient cannot be approved for a transplant if his or her body mass index [BMI] is over 35kg/m2). There is also, of course, orthopedics. Orthopedic surgeons are often hesitant to do a joint replacement operation on a patient who has a high BMI. This meeting is a great opportunity for us as representatives of bariatric surgery to tell other surgical disciplines who we are, what we do, and how we can work together collaboratively.

Our track offered presentations from myself and ASMBS Steering Committee members Drs. Wayne English, Anthony Petrick, Stacy Brethauer, Samer Mattar, Raul Rosenthal, and Matthew Hutter. We discussed important topics, such as readmissions, enhanced recovery, utilizing the data (e.g., annual reports), and how to establish quality improvement programs. For people who could not make it to this meeting, we will have similar presentations at ObesityWeek 2017. Look for a program dedicated to quality improvement and also a course for metabolic and bariatric surgery clinical reviewers. Our plan is to cover topics related to quality at both the ACS Quality meeting and ObesityWeek conferences.

I encourage everyone to attend the next ACS Quality and Safety Conference, in July of 2018 in Orlando, Florida. For more information, visit https://www.facs.org/quality-programs/quality-safety-conference. I also hope to see many of you at ObesityWeek2017 taking place October 29 to November 2, 2017 in Washington, DC. For more information, visit https://obesityweek.com/.

 

How many centers are currently accredited under MBSAQIP?

Dr. Morton: There are now 831 centers accredited with MBSAQIP. We estimate that this is greater than 90 percent of hospitals offering bariatric surgery.

 

How often does the program evaluate and modify standards? Is there anything new being working on presently?

Dr. Morton: Standards are constantly being evaluated. We make an effort to not change the standards more often than once per year. We review information all the time. The standards and verifications committee, chaired by Drs. David Provost and Wayne English, is working on a current review that will include consideration of accreditation for ambulatory centers, adolescent designation, and medical and endoscopic weight loss programs. This is all new. We are considering adding medical and endoscopic weight loss program accreditation because we now have balloons and medicines for weight loss, many of which are being placed or prescribed at MBSAQIP-accredited programs. We are considering developing standards for these programs and then compiling a registry and outcomes. I think of centers that offer medical weight loss, endoscopic therapies, and surgery as “metabolic centers plus.

We will potentially work with The Obesity Society (TOS) and Obesity Medicine Association (OMA) to standardize and track medical weight loss programs through MBSAQIP. Many of the medical weight loss programs are in association with accredited bariatric centers. Same with endoscopy—we’ve been tracking balloon placements in MBSAQIP-accredited facilities for over a year now, so this is a natural extension. To me, this metabolic center plus model is a lot like a cancer or heart center. You have everything under one roof. When someone goes to a cancer center, they aren’t sure if they are going to get chemotherapy or surgery, but they know whatever it is they need, they can get it at that center. That is what I hope we can do in weight loss. People may not want to have surgery right away, but they can start thinking about it if they come in for medical weight loss. It is a good way to get people to the treatment they need.

Another new initiative within MBSAQIP that is being led by Dr. Matthew Hutter focuses on patient-reported outcomes. The idea behind this initiative is to learn from patients how they are doing after undergoing bariatric surgery, by largely measuring quality of life. This is different because all the other outcomes we have are from medical records.

 

Are there other MBSAQIP-related topics scheduled to be covered during ObesityWeek 2017?

Dr. Morton: Yes. We will be presenting two important topics. The first is lessons learned from MBSAQIP verifications and site visits. The second is comparing ambulatory centers to fully certified (Level 1) hospitals.

 

We will be looking for those presentations and also official reports from the MSAQIP Program. The last official report addressed readmissions. What will the next report cover?

Dr. Morton: We are aiming to complete an official report on a topic of interest annually.

The next report will detail the initiative titled “Employing New Enhanced Recovery Goals in Bariatric Surgery” or ENERGY, led by Dr. Stacy Brethauer. The program includes 30 to 40 MBSAQIP programs with the goal of implementing enhanced recovery strategies on a large scale. One important focus of the project has been implementing opioid-sparing pain management strategies, a timely concern in the United States.

 

Are there any other initiatives you would like to share with our readership?

Dr. Morton: Yes. We are also working on a program for those we call “surgical champions.” MBSAQIP has done a phenomenal job training and supporting our clinical reviewers, and we want to extend that support our surgeons. We will have a monthly forum where surgeons from different facilities will present what they are doing, unique offerings, and lessons learned. With more than 800 hospitals, we won’t run out of presentations. We welcome surgeons from MBSAQIP-accredited centers to participate. If they have something great going on, we want to hear about it. To participate in the forum, interested surgeons can either e-mail me or Theresa Fraker (tfraker@facs.org).

A lesson for one can be a lesson for all. If somebody figures out how to do it right, then we certainly want to share it.

Another offering during ObesityWeek that readers should look for is a program on quality chaired by myself and Dr. Eric DeMaria. In addition to the course, we are looking forward to the release of a book that will serve as a manual for quality management. This is scheduled to become available in 2018. Lastly, we are updating the current MBSAQIP registry, looking at variables we should add (e.g., insurance status), and removing variables that weren’t as useful.

The idea behind all of these initiatives is to give people tools so they can do better things for their patients. MBSAQIP looks to evaluate everything we have learned about bariatric surgery and apply it to improve clinical practice across the country.

 

 

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Category: Ask the Leadership, ASMBS Foundation News and Update, ASMBS News and Update, Past Articles

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