What is a "Bariatric Center of Excellence?"

BOTH of my failed lap bands as well as BOTH of my daughters failed lap bands were done at COE.
( Centers of Excellence.)  I guess COE mean dick huh ?

.

They limit access to surgeons who cooperate accept their low reimbursement rates.
They limit time in the hospital post-op.
They limit access to second opinions.
They set requirements that are for the purpose of saving the insurance company money, such as pre-op mandatory weight loss requirements, which often discourage people into dropping out.
They limit access of the patient to their surgeons post-op, making them go through non-MD gatekeepers.

Need I go on?

I've never had any of these limitations placed on my care.

I think your aggravation/ire/disgruntlement/whatever you want to call it   is misplaced.  This is not a fault of physicians or the medical community.

This is a problem with insurance companies.

Because YOU haven't experienced it (that you know about) doesn't mean it doesn't exist.

This initiative was a CONSPIRACY (and possibly even an anti-trust problem) between the insurance companies and the upper echelons of the ASBS.  The net effect was to make it even more difficult for patients to get access to lower volume procedures such as the DS, and to steer patients into RNY and band mill operations rather than surgeons who had their own individual lower volume practices.

I didn't say it didn't exist.  I said I had no limitations placed upon my care.  And yes, I would know about it.

Conspiracy is a emotion laden word, that you are chosing to use.   

I find this to be quite the generalization.   My surgeon is COE, another in town is very well known and respected but is not COE.  Both have the same expected hospital stay.  My surgeon has a 5yr aftercare plan, where you see him or the nurse  - 1wk, 3wk, 6 wk, 3 mth, 6mth then every 6mth.   I'm also not so sure I buy the pre-op weight loss as a cost saver only - my friend's brother is an anesthesiologist (sp) and he said pounds lost = lowering the risks.

And your friend's brother can believe what he wishes, but studies do not back up that belief.

http://www.asmbs.org/Newsite07/resources/ASMBS%20Position%20Statement%20on%20Preoperative%20Supervised%20Weight%20Loss%20Requirements.pdf (Published March 23, 2011)

Class II comparative studies have consistently demonstrated that patients who achieve preoperative weight loss, regardless of the magnitude, do not have better long-term weight loss after bariatric surgery compared to groups with no weight loss or weight gain preoperatively. Additionally, the requirement for a 6 or 12 month pre-operative dietary management prior to bariatric surgery delays surgical care

(7) and can reduce the number of patients who ultimately undergo bariatric surgery through attrition. (3, 8-12)
......

Although many believe there may be benefits to acute preoperative weight loss in the weeks before bariatric surgery, the available Class II-IV data regarding acute weight loss prior to bariatric surgery are indeterminate and provide conflicting results leading to no clear consensus at this time. Preoperative weight loss that is recommended by the surgeon and/or the multi-disciplinary bariatric treatment team due to an individual patient’s needs may have value for the purposes of improving surgical risk or evaluating patient adherence, but is supported only by low-level evidence in the literature at the present time. And while your SURGEON may have an aftercare plan, is it fully covered by insurance?  Paid in advance?  What happens if you lose coverage post-op?  This is NOT part of the COE "benefits" - this is a suggestion, and one which I believe is not followed by the majority of patients, for many reasons.  The point being, the COE "requirements" do not have a significant real benefit to the vast majority of patients, and are primarily a smoke screen for limiting access to specific locations and surgeons who comply with insurance reimbursement rates.

Both of those surgeons having an expected hospital stay of X days does NOT mean **** about what happens when the patient is determined to need an extra day or two.  I'll bet it is is harder to get that approved at the COE hospital. 

And your comments don't address the other issues at all.  Look at Pumpkin's situation - she is not able to even see her Lap band surgeon.

Diana, about ten years a go--maybe a bit less--the then ASBS suggested developing a CoE program wherein the CoE meant "Centers of Expertise," and the designation was about hospital and surgeon experience and proficiency...and there was discussion about how to set up the program and establish criteria for earning the title and all that.  Blue Cross saw that and ran with it, changing the "E" to "Excellence," which, in Blue Cross Language meant "willing to deal with us."  That's where the name and the concept originated.

I don't know if I can find some OLD ASBS threads about that topic, but there were there and suddenly, there were CoEs everywhere and not one of them involved the word "expertise."

Yup.  And even the ASBS proposal itself was fraught with conflicts of interest - they even created a private company to administer "accreditation" of COEs, which was essentially run by the ASBS management (as I recall - this was several years ago).  Now the insurance companies are managing this directly.  http://surgicalreview.org/

... Surgical Review Corporation, an independent, nonprofit organization governed by industry stakeholders and dedicated to advancing the safety, efficacy and efficiency of bariatric and metabolic surgical care worldwide.

Interesting choice of the word "conspire".     SHM

Equating a BCoE to a surgery mill is really reaching.