Certification for Bariatric Surgery

Criteria

The criteria outlined below represent the minimum criteria a hospital facility must meet for consideration to be designated a Certified Hospital for Bariatric Surgery. Please note that meeting these criteria is not a guarantee that a hospital qualifies for certification.

CIGNA Criteria

• Maintain current Full Approval by the Surgical Review Corporation and/or Level 1 Full Approval by the American College of Surgeons.
• Meet CIGNA clinical outcome metric thresholds for bariatric open and laparoscopic procedures performed at applicant facility during the most recent 12 month period:
  • Overall mortality rate of < 1%
  • Re-operation rate within 30 days of initial bariatric open surgery of < 2.5%
  • Overall readmission within 30 days post initial bariatric surgery for anastomotic leak, subphrenic abscess, splenic injury, pulmonary embolism or wound infection of < 5%
• Submit to CIGNA a completed Application to Receive Certified Facility for Bariatric Surgery Designation (including outcome metrics) annually.
• Facility must be a participating provider with CIGNA.
• Bariatric program must have at least one CIGNA participating surgeon.

Note: All patients must be benefit eligible and meet medical necessity coverage criteria.

ACS Criteria

To obtain Level 1 Full Approval as an ACS Accredited Bariatric Surgery Center, which assumes a successful site visit and facility review, the following requirements must be satisfied:

• The facility must provide complete tertiary care with resources devoted to bariatric surgery.
• The facility must be able to manage the most challenging and complex patients with optimal opportunity for safe and effective outcomes.
• The facility must engage all levels of obesity, standards of care for weight loss operations, ages, co-morbid conditions, and re-operations.
• The facility must have high volume practices of 125 or more weight-loss operations annually, with at least two credentialed and experienced bariatric surgeons each performing at least 50 primary weight-loss operations annually.

SRC Criteria

To obtain Full Approval as an American Society for Bariatric Surgery (ASBS) Bariatric Surgery Center of Excellence (BSCOE), the facility must first obtain Provisional Status and undergo a site inspection. Site inspections are conducted by a two-person team that follows a prescribed protocol that includes:

• A tour of the facilities
• Evaluation of the center and its quality of care
• Interviews
• Random chart reviews

The Full Approval application process involves the following steps:

• The facility and its surgeons must continue to meet the criteria required for Provisional Status and fully comply with the 10 requirements for Provisional Approval.
• The facility must submit a complete and accurate description of changes in the institution or the staff (since the Provisional Status application) to the Bariatric Surgery Review Committee (BSRC).
• The facility must provide a list of the academic activities of the surgeons including grants obtained, papers published, presentations, participation in courses, etc.
• The facility must report outcomes data for bariatric surgery in an anonymous fashion in accordance with HIPAA regulations. Outcomes data must include a list of all bariatric surgical operations performed within the previous 12-month period including the following information (partial list):
• Age
• Gender
• Weight
• Height
• BMI
• Co-morbidities
• Procedure
• Length of Stay
• Complications including mortality, re-admissions within 30 days of discharge, re-operations within 30 days after the initial operation

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