The Truven Health Blog

The latest healthcare topics from a trusted, proven, and unbiased source.

By Truven Staff

Hooray for CMS, Agreeing to Reconsider a Longstanding Program!

Jean Chenoweth imageAfter restricting Medicare payment for bariatric surgery to only Medicare approved centers of excellence for seven years, CMS has agreed to reassess its policy. That does not mean that the policy will be adjusted to broaden access to the procedure, but at least CMS will review the previous decision. That reflects a lot of flexibility for a government agency.

What is the cause for the policy reassessment? Results of research by Justin B. Dimick, M.D., Director of Policy Research at the University of Michigan’s Center for Health Care Outcomes and Policy, demonstrated that the Medicare policy made no difference, except to limit access to the procedure. The policy did not drive improvement. The policy did not improve complication rates or outcomes.

Almost everybody thinks development of Centers of Excellence is a great idea – including me! But I must admit that I am chastened by this example. Dr. Dimick allows the data to speak , which we do routinely within the 100 Top research group. Objective data often produces results that are contrary to what seems logical. Dr. Dimick’s results suggest a very uncomfortable idea. Maybe CMS’s channeling of patients to Centers of Excellence is a misguided good idea. Maybe a Center of Excellence makes people feel safer, but might cost them more out of pocket or cause them to seek no care. 

Let’s contrast this approach with the other side of the government coin, the National Cancer Institute, which is unrelated to payment for care. The National Cancer Institute created the National Cancer Information Service (NCIS) because of the huge disparity in physician and patient access to the latest treatments for various types of cancer. The NCIS enables cancer patients to directly call 800-4-CANCER to find out about new diagnostics and treatments as well as clinical trials so that the best possible options are known to all. Maybe the NCIS model which makes vetted, trustworthy diagnostic, treatment and clinical trial information available as widely as possible is a better approach. The NCIS model increases patient knowledge and patient involvement in decision-making. That may be a better approach than CMS deciding for us.

Jean Chenoweth
Senior Vice President, Performance Improvement and 100 Top Hospi