Update on American College of Surgeons Bariatric Surgery Center Network Accreditation Program: An Interview with Ninh T. Nguyen, MD, FACS

An Interview with Ninh T. Nguyen, MD, FACS

Dr. Nguyen is from University of California, Irvine Medical Center, Orange, California.

Financial Disclosures: Dr. Nguyen reports no financial disclosures relevant to the content of this interview.Introduction

The American College of Surgeons Bariatric Surgery Center Network (ACS BSCN) Accreditation Program was established in 2005 in response to the national obesity epidemic and the increasing need to advance safe, high-quality care for bariatric surgical patients. The ACS BSCN Accreditation Program offers seven levels of accreditation that encompass a broad range of facilities that are engaged in the practice of high-quality bariatric surgery in the United States and Canada. These facilities undergo an independent, voluntary, and rigorous peer-reviewed evaluation in accordance with nationally recognized bariatric surgical standards.

ACS BSCN Accreditation affords many benefits including potential for reimbursement by the Centers for Medicare and Medicaid Services (CMS) and participation in a longitudinal outcomes database that yields evidence-based outcomes in support of continuous quality improvement.

In this issue of Bariatric Times, we interview Ninh Nguyen, MD, FACS, from the University of California, Irvine Medical Center, Orange, California who is the Chair of the ACS Bariatric Advisory Committee.

How is the ACS working to improve bariatric outcomes?
The ACS has a long tradition of improving surgical care and patient safety through education and setting standards. The ACS has established the Trauma Verification Program and the Commission on Cancer, recognizing that effective trauma care and cancer care require more than trauma centers and cancer centers, but also require a system of integrated resources and processes. The ACS Board of Regents recognized the need for improving the quality of surgical care in other surgical disciplines, with bariatric surgery being one of the important disciplines because of the obesity epidemic and growing number of bariatric operations being performed in the United States. In 2005, the ACS initiated the BSCN for accreditation of centers performing bariatric surgery. This is a major effort in streamlining the entire process of care for the bariatric patient by establishing clinical standards, requirements for bariatric-specific facilities and human resources needed to care for patients with obesity, and providing a validated reporting system based on the National Surgical Quality Improvement Program (NSQIP). Establishing this system of integrated resources and processes in bariatric surgery has been shown to improve the quality of surgical care for patients with morbid obesity.

Why is it important for bariatric surgery centers to become ACS BSCN accredited?
It is important for all centers performing bariatric surgery to become accredited as accreditation recognizes the center as providing the highest level of bariatric surgical care that represents the optimal quality of care. Additionally, the CMS has mandated that bariatric surgery for Medicare beneficiaries now can be performed only at centers accredited by either the ACS BSCN or the Surgical Review Corporation (SRC). Unlike with the SRC, even centers that perform a low volume of bariatric surgery can be recognized by the ACS BSCN as a level 2 center if the center implements defined standards of care; provides experienced personnel, equipment, and other resources; reports outcomes; and participates in periodic reviews and on-site verification. Level 2 centers are not currently recognized by CMS, but our committee is working to provide data to substantiate that acceptable outcomes can be achieved at these centers when performed within the context of a comprehensive, structured program.

Can you describe some of the recent changes to the ACS BSCN program standards and discuss how they will benefit existing and new centers seeking accreditation?
We have made some recent changes to the program standards. One important recent change is the requirement of a single surgeon rather than two bariatric surgeons per center. The requirement of two surgeons was put in place to provide continuous bariatric coverage for the center. Although it is preferable for centers to have two bariatric surgeons in place, the committee understands that not every bariatric program has resources to meet this requirement. Bariatric coverage by a surgeon qualified in caring for patients with obesity is still an important part of the standards. This change will benefit centers that currently have only one bariatric surgeon. These centers will now have the option to apply and be part of the ACS BSCN program.

Can you describe the recent efforts made to create a more parsimonious data set and how this will benefit bariatric centers participating in the program?
Data represent an important component of any quality improvement program. The ACS BSCN is utilizing the ACS NSQIP as the platform for acquisition of quality bariatric outcome data. Unlike most other databases, data within the ACS NSQIP database are acquired by an independent data abstractor. The program is the first nationally validated, benchmarked, outcome-based program to measure and improve quality of care. Key components of this program are the ability for report generation, data analysis, and feedback to the participating centers.

One of the most common complaints from bariatric centers is the difficulty in entering all of the required data to maintain accreditation. This process is time-consuming and costly. The recent streamlining of data points strikes a balance between including the needed data to perform risk-adjusted outcome calculations and eliminating unnecessary data points that may be collected purely for research purposes. Streamlining the amount of required data can be a tremendous benefit for the participating programs as it minimizes the burden of data collection and hence enables the program to enter 100 percent of the data.

How does the ACS BSCN accreditation program compare to other quality initiative programs?
The ACS BSCN compares well with the Center of Excellence program established by the SRC; however, the ACS BSCN is the only program that utilizes a nationally validated, risk-adjusted ACS NSQIP for acquisition and reporting of outcome data. Additionally, the ACS BSCN also accredits level 2 centers, recognizing that not all centers are able to perform the required minimum volume of bariatric surgeries to be a level 1 center, but that with standardized resources and processes, excellent bariatric outcomes still can be maintained.

Category: Interviews, Past Articles