Center of Excellence question

What exactly qualifies a hospital as a Center of Excellence? The hospital I'm working through does not have this designation, is that something I should be concerned about?

what insurance do you have and what hospital? Linda

I have BCBS PPO, so not really a condition of approval -- It's more of me asking the question. I am currently going through Barix in Ypsi.

I'm not sure on this one. I did a search on bcbs website and found this. I would call them tomorrow and ask. DETROIT, July 18, 2005 -- A new initiative by Blue Cross Blue Shield of Michigan and Blue Care Network partnering with hospitals and doctors is designed to make weight-reducing bariatric surgery safer and potentially less costly across the state. Working with researchers at the University of Michigan Health System, the Michigan Blues have invited all Michigan hospitals performing bariatric surgery to share information on procedures and outcomes in a data registry. It will be used to help determine which practices produce the least risk, fewest complications and the best results while, at the same time, help reduce costs for the increasingly popular and expensive procedures. "This collaboration among hospitals, physicians and health plans represents an important new model to achieve better outcomes for patients and lower costs to customers," said David Share, M.D., M.P.H., clinical director for the Blues' Center for Health Care Quality and Evaluative Studies, who is leading the company's participation in the Michigan Bariatric Surgery Collaborative. "These surgeries are expensive and there appears to be wide variation in the ways they are done and how pre- and post-operative care is structured," Share said. "The goal is to compile data that helps to better explain what is optimal care so hospitals and practitioners can implement procedures that achieve the best possible care statewide." Creating a registry to track bariatric procedures and determine best practices will be directed by Nancy Birkmeyer, Ph.D., an epidemiologist and associate professor in the Department of Surgery at the University of Michigan Health System. John Birkmeyer, M.D., a University of Michigan professor of surgery and director of M-SCORE, is co-director. "While all insurers care about the costs of bariatric surgery, most only give lip service to quality," says Nancy Birkmeyer. "Blue Cross Blue Shield of Michigan is the first to demonstrate its seriousness by investing considerable resources in quality improvement." "We're hoping that this collaborative partnership among hospitals will result in safer and more effective surgery that will ultimately translate to lower costs," she said. The Blues will fund the creation of the registry and most data collection costs at the hospitals for bariatric procedures it covers, as well as services covered by government programs and those provided to individuals without health care coverage. The bariatric consortium is based on the model of the Blue Cross Blue Shield of Michigan Cardiovascular Consortium, which has enhanced the safety and care of patients undergoing artery-opening angioplasty procedures across the state while saving more than $8 million in medical care costs annually, Share said. Obesity rates continue to rise, and for many morbidly obese Michigan residents, surgery is considered one of the few effective treatments, he added. "There is mounting evidence that obesity drives the onset and severity of chronic illnesses such as diabetes, heart disease, high blood pressure and bone-joint problems," Share said. "Quality of life and ability to function are compromised and ultimately, the price that everyone pays is higher health care costs. In 2000, Michigan's obesity-related medical costs were estimated at $3 billion, placing it third out of the 50 states. There is good evidence that surgery leads to decreased rates of chronic diseases and that it gets people back functioning again." Share added that "with the advent of newer, less invasive techniques, this surgery, once considered extreme, has become an increasingly popular treatment option." Blue Cross Blue Shield of Michigan began covering bariatric surgeries under certain conditions in 2001. Bariatric surgeries increased more than 160 percent between then and 2002 for Blue Cross Blue Shield of Michigan and are expected to rise further in the coming years. A Michigan Blues "Valuegram" states that in 2004, the average cost to the health plan per admission for such surgeries was $23,000. The Valuegram report is at: http://www.bcbsm.com/pdf/BariatricValuegram-6-16-2005.pdf. Blue Cross Blue Shield of Michigan, a nonprofit corporation, provides health care benefits to just over 4.7 million members through a variety of plans: Traditional Blue Cross Blue Shield, Blue Preferred, Community Blue and Healthy Blue PPOs; Blue Choice Point of Service; Blue Care Network HMO and Blue HSASM plans compatible with health savings accounts. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.

okay -- I did ask for info Very interesting. THANK YOU!!

Hi all - I am from Toronto, Canada, & our insurance does NOT require a centre to be a "centre of excellence" for coverage approval. However - I came across it when i was looking for a surgeon outside of Ontario - & close to home / great credentials etc. The Centre of Excellence is a designation given to a Dr., and to the facility, by the American. Bariatric Society (is it ABSB?) There are many components to be evaluated prior to being awarded the designation ... all aspects of care & after care, surgical experience & good stats on survival / complications, how much of the practice is devoted to bariatric surgery ... etc. I went to the ABSB website & had a look while I was doing my research -- they outline the criteria there, & also identify who has achieved this. Also - the facility I was hoping to use (Synergy Bariatrics in Buffalo, with Dr. Caruana) had just been awarded the designation in Q1'06 ... (but they aren't supported by our Ont. Health plan). It was disappointing - great surgical experiences, fabulous patient reviews, great stats, facility etc -- and SOOO much closer to Toronto! So - I am also going to Barix in Ypsilanti -- also gets rave reviews & has good stats. It, however, is not designated as a Centre of Excellence - not sure why -- I have my consult with them next week & will ask!

I have Anthem BC/BS of MI PPO and in order for my insurance to pay I have to go to a Center of Excellence which is contracted through their BlueCard network. I was going to go with Barix of Ypsilanti but cant since they are not one. SO I am going with the CORI center now, Harper Univ hospital is a center of excellence and I was told that CORI received theirs on July 14th. The list I got from my insurance is; Harper Univ hospital, Henry Ford (but I think it is just the main hospital), Hurley (Flint), Mercy (Muskegon), Munson (Traverse City), and Spectrum (Grand Rapids).

You'll have to let me know what Barix has to say about why they don't have the designation?? That is where I am going and have very comfortable with them to this point. I have a friend who had her surgery there about 4 years ago and has done great! I have also spoke with some others who have only had positive things to say!! Which surgeon are you seeing?

UofM has that designation and MCare requires that we use a Center of Excellence so I'm in the process of getting approved there. I read that the facility has to have performed a certain number of procedures per year and that the doctors themselves have to have performed a certain number of procedures. At my orientation, they told us that they even have to have certain types of furniture, toilets, beds, etc. to accomodate larger patients comfortably as part of being a center. It isn't totally related to their performance or records, so not being a "center of excellence" doesn't mean they aren't highly qualified.

I don't know what qualifies a hospital for "Center of Excellence" but I do know there are only two hospitals in Michigan that have been certified. One is Hurley Medical Center in Flint and the other is Sprectrum Health in Grand Rapids. All other MI hospitals are in the process to be certified.