The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP): An Update

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

This Month’s Interview: Wayne English, MD, FACS
Dr. English is Co-Chair of the Committee on Metabolic and Bariatric Surgery (CMBS) Standards Subcommittee. He is the Clinical Assistant Professor, Department of Surgery, Michigan State University College of Human Medicine and Medical Director, Bariatric & Metabolic Institute, Marquette General Hospital—A Duke LifePoint Hospital, Marquette, Michigan.

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.

This Month’s Topic: The Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP): An Update

Bariatric Times. 2013;10(6):8–9.

Dr. Rosenthal: What is the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program (MBSAQIP)?

Dr. English: The American College of Surgeons (ACS) and American Society for Metabolic and Bariatric Surgery (ASMBS) are now partnering together on national bariatric surgery accreditation with a unified program to achieve a single national accreditation standard for all bariatric surgery programs.

MBSAQIP accreditation represents an institution’s commitment and accountability for high-quality care and patient safety and the new standards will continue to build upon the legacy of quality improvement.
The goals of the MBSAQIP are to achieve the following:
• Improve overall quality and safety of a program
• Develop a culture of collaboration and data review with peers
• Accelerate quality improvement by implementing “best practices”
• Capture data from all programs across the country
• Provide feedback for programs and data for public reporting.

MBSAQIP includes a high-quality data registry with the ability for data feedback to improve outcomes. The outcomes data can provide regional and national comparison. This will allow programs to implement best-practice changes that will improve patient safety and effectiveness.

Dr. Rosenthal: How Does MBSAQIP Work?

Dr. English: The MBSAQIP committee structure consists of an overarching advisory committee and three subcommittees, with equal representation from the ACS and ASMBS.

The Committee on Metabolic and Bariatric Surgery (CMBS) serves the purpose of advising leadership on opportunities for the joint program and offers guidance for MBSAQIP development, transition, and growth with a special emphasis on bariatric and metabolic surgery stewardship. Drs. Ninh Nguyen and John Morton serve as co-chairs for the CMBS.

The three subcommittees supporting the CMBS advisory committee provide support to the operations of the program.
The Standards Subcommittee is responsible for the development of new joint accreditation standards, and producing the new standards manual. Dr. Ronnie Clements and I serve as co-chairs for the Standards Subcommittee.
The Verification Subcommittee is responsible for validating and certifying programs that meet criteria. Drs. David Provost and Dan Jones serve as co-chairs for this committee.

The Data Registry and Reporting Subcommittee oversees the bariatric-specific, clinically rich data registry and provides input on analytical and reporting tools to support the needs of the program. Drs. Matt Hutter and Bruce Wolfe serve as co-chairs on this committee.

Dr. Rosenthal: How were the current draft quality standards developed?

Dr. English: The first draft of the MBSAQIP standards was finalized and approved by the CMBS and then were released for public comments in December 2012.

The public interest was huge with over 1,100 comments received. The ASMBS Executive Council (EC) also reviewed and provided comments to the initial draft. The Standards Subcommittee then reviewed the EC recommendations and all public comments for the revised version of the standards.

The Standards Subcommittee met weekly to discuss all of the comments and suggestions. The revised version of the standards were reviewed and approved by the CMBS at the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) meeting in Baltimore, Maryland, on April 18, 2013. The draft standards will soon be released for a second round of public comments after additional reviews are completed.

Dr. Rosenthal: Can you give us some highlights of the new standards?

Dr. English: Highilghts of the new standards include the following:
• Volume criteria. There are significant data supporting lower volume criteria than what was previously required in accreditation. The MBSAQIP established lower volume criteria for stapling procedures, at 50 cases annually. There are no data supporting volume and outcomes in gastric banding procedures; however, 25 cases annually will be required for banding centers to maintain procedure familiarity and staff training.

• Approved procedures for outpatient centers will include band revisions. Evidence shows that band repositioning and replacement can be performed safely in an outpatient setting, especially in the hands of an experienced band surgeon.

• Flexibility for the MBS Coordinator and Clinical Reviewer. Many members commented on the added expense of hiring a full-time FTE for both the MBS Coordinator and the MBS Clinical Reviewer. Based on this feedback, the committee revised the standard to give centers greater latitude to hire for these positions given potential budgeting restraints.

• Emphasize Certified Bariatric Nurse® within the standards. Language will be added to the standards indicating CBN is a designation that recognizes specialized bariatric nursing training, education, experience, and knowledge.

• Education/support groups may be offered at individual surgeon’s practices. In many practices and programs, pre- and postoperative patient care occurs in the surgeon’s office, and not necessarily in the hospital. The hospital may not have significant involvement with follow-up care, but it is important for a hospital to recognize this aspect of patient care and collaborate with the individual surgeon’s practices to document protocols and follow-up data. The standard was clarified to reflect that education and long-term care can be performed at the surgeon’s office or hospital.

• Quality Improvement (QI) projects. The quality improvement process is a new and important aspect of the accreditation program. MBSAQIP is encouraging programs to collaborate in order to improve outcomes by broadly implementing best practices.

• Accreditation documents added for ambulatory surgery facilities. The list of acceptable accreditation documents to measure compliance now includes those that are typically obtained by ambulatory surgery facilities.

• Individual surgeon accreditation. Many members commented on the need for a unique accreditation for the bariatric surgeon. This item was seen as an important component of quality in the accreditation program to ensure appropriate experience of the surgeons. The MBSAQIP is working on developing this aspect of accreditation that will also recognize a surgeon’s specialized skills and active practice in metabolic and bariatric surgery, allow surgeons to transport their Accreditation status to another MBSAQIP-accredited program, and allow surgeons an opportunity to demonstrate and bring their specialized skills to a new facility.

Dr. Rosenthal: Dr. English, thank you for taking the time to speak with me on this important issue. We are all anxiously awaiting the second-draft release of these standards.

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