Hospital leaders, say goodbye to BSCOE and hello to MBSAQIP.
MBSAQIP (Metabolics and Bariatric Surgery Accreditation Quality Improvement Program) is replacing the COE (Center of Excellence) as well as the BSCN (Bariatric Surgery Center Network) programs, which were operated by ASMBS and ACS, respectively. MBSAQIP is the result of a year-long quality improvement effort and the unification of ASMBS and ACS’s previously separate bariatric accrediting governance bodies. The exact structure of and rules under MSAQIP are still being finalized but are expected to be released by the end of the year, with site visits under the new program slated to begin as early as January 2013.
Why the changes?
One of the core arguments at play is that COE volume thresholds requirement—125 cases per year—no longer works in today’s landscape. The foundational mission behind Center of Excellence programs, whether for bariatric surgery or other service lines like orthopedic surgery, is to ensure high quality of care. The volume thresholds were instituted more than a decade ago when bariatric surgery programs were few and far between, and high volumes could in fact be argued as the best proxy for quality. However—at a time when there are more than 600 accredited bariatric centers —the landscape has become more nuanced and high volumes cannot always be reliably used as a predictor for quality. Today, accrediting bodies must also consider rural centers with low volumes but strong outcomes, or highly-experienced surgeons whose caseloads start to fall as a result of handling more complex patients.
The designers behind MBSAQIP also intend for the new program to move away from the competitive culture created with the Center of Excellence mentality. This is reflected even in the choice of words used to describe the new accreditation model. Under MBSAQIP, bariatric centers are referred to as participants in the quality program as opposed to centers of excellence, a term which invariably creates an inflexible two-tiered structure of superiority and inferiority. The creation of regional collaboratives, a recent addition to the ASMBS agenda, is another example of how the new system is meant to be inclusive and not exclusive.
What will the new requirements under MBSAQIP look like?
ASMBS and ACS stakeholders are still refining the details of the new standards under MSAQIP, with final rules scheduled to be released by the end of this year. Data for the new AQIP database is currently being collected and, once completed, stakeholders will use this to determine the exact parameters of the new quality standards.
Based on what has been disclosed thus far, it appears that the biggest changes in the coming year will be the elimination of the volume requirement, the institution of outcomes-based measures, and the creation of a new database system that will replace BOLD. MBSAQIP participants will also be required to identify a data collector, called a Bariatric Surgery Clinical Reviewer, who will participate in twice-yearly meetings with regional collaboratives (see table below). All of these changes are designed to create a team-oriented culture focused on quality, and not necessarily quantity.
Programs already accredited by either ASMBS or ACS will be grandfathered into MBSAQIP and have already started entering data into the new AQIP database that will be replacing BOLD. New programs, meanwhile, have two options: they can apply now and begin entering data into the AQIP database, or wait until the new standards are in place in 2013.
What does this mean for my hospital strategy?
The elimination of volume requirements will likely open doors to new market entrants, particularly for low-volume programs in rural areas. At the same time, the revamped system may also weed out a small number of centers that fall short of compliance under the AQIP quality mandates. It remains unclear what effect this will have on the number of centers, but it is likely that the market will become, as previously mentioned, more inclusive rather than exclusive.
The new system also holds bariatric providers to a higher level of accountability. The increased scrutiny around clinical outcomes—site visits may be conducted annually—will emphasize bariatric surgery as an “all-in or all-out” investment. Resultantly, these heightened quality measures may help defray critical voices and improve the overall perception of bariatric surgery for the better.
Also significant is the growing emphasis on creating a unified front. The ASMBS and ACS merger points to the trend, and so does the new mandate for MBSAQIP centers to join state- or regional-based collaboratives. A critical point behind this shift is that it could translate into more bargaining power with payors. For on-the-ground stakeholders, this may serve as convincing incentivize to extend an olive branch to other centers in the market, and adopt a more collaborative as opposed to combative stance.