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• W1976004098 endingPage "865" @default.
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• W1976004098 abstract "In Brief Objective: To determine the impact of the Centers for Medicare and Medicaid Services' (CMS) bariatric surgery national coverage decision (NCD) on the use, safety, and cost of care CMS beneficiaries. Background: In February 2006, the CMS issued a NCD restricting reimbursement for bariatric surgery to accredited centers and including coverage for laparoscopic adjustable gastric band (LAGB). Methods: A pre/postinterrupted time-series cohort study using nationwide Medicare data (2004–2008) evaluating rates of bariatric procedures/100,000 enrollees, 90-day mortality, readmission rate and payments. Results: Forty-seven thousand thirty patients underwent procedures at 928 sites pre-NCD and 662 post-NCD. The procedure rate/100,000 patients dropped after the NCD to 17.8 (from 21.9 in 2005) increasing to 23.8 and 29.1 in 2007 and 2008, respectively. Open roux-en-y gastric bypass (ORYGB) and laparoscopic roux-en-y gastric bypass (LRYGB) were common pre-NCD (56.0% ORYGB, 35.5% LRYGB) changing post-NCD with LAGB inclusion (12.8% ORYGB, 48.7% LRYGB, 36.7% LAGB). 90-day mortality pre-NCD was 1.5% (1.8% ORYGB, 1.1% LRYGB) and post-NCD was 0.7% (1.7% ORYGB, 0.8% LRYGB, 0.3% LAGB; P < 0.001). The 90-day rates of readmission decreased post-NCD (19.9% to 15.4%), reoperation (3.2% to 2.1%) and payments ($24,363 to $19,746; P for all <0.001). Differences in outcome and cost were largely explained by a shift in procedure type and patient characteristics. Conclusions: The NCD was associated with a temporary reduction in procedure rate and a shift in types of procedures and patients undergoing bariatric surgery. It was associated with a significant decrease in the risk of death, complications, readmissions, and per patient payments. In 2006, the Centers for Medicare and Medicaid Services issued a national coverage decision (NCD) restricting reimbursement for bariatric surgery to accredited centers and allowing payments for adjustable banding procedures. The NCD was associated with a temporary reduction in procedures per year, shift in types of procedures and characteristics of patients, and sustained decreases in the rate of mortality, complications, and costs." @default.
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• W1976004098 date "2011-12-01" @default.
• W1976004098 modified "2023-10-06" @default.
• W1976004098 title "The Use, Safety and Cost of Bariatric Surgery Before and After Medicare's National Coverage Decision" @default.
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• W1976004098 doi "https://doi.org/10.1097/sla.0b013e31822f2101" @default.
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