About ACS Accredited Bariatric Centers
Mission | What is ACS BSCN Accreditation? | Benefits of ACS BSCN Accreditation | Background | Program Requirements | Data Collection | Governance
Mission
The mission of the American College of Surgeons Bariatric Surgery Center Network (ACS BSCN) Accreditation Program is to foster high-quality surgical care
for the bariatric patient through the accreditation of bariatric surgery centers that maintain certain physical resources, human resources, and standards
of practice, as well as the documentation of outcomes—including improved surgical care—for the bariatric patient. The Continuous Quality Improvement section
of the ACS Division of Research and Optimal Patient Care administers the program.
What is ACS BSCN Accreditation?
The ACS BSCN Accreditation Program accredits facilities in the United States that have undergone an independent, voluntary, and rigorous peer evaluation in
accordance with nationally recognized bariatric surgical standards. With the expanded range of facilities now engaged in bariatric surgery—from full service
inpatient hospitals to outpatient facilities—ACS BSCN Accreditation symbolizes institutional commitment and accountability for safe, high-quality surgical care,
as evidenced by the documentation of performance indictors and the measurement of outcomes. Bariatric surgery accreditation not only promotes uniform standard
benchmarks, but also supports continuous quality improvement.
Benfits of ACS BSCN Accreditation
- Potential for reimbursement by the Centers for Medicare and Medicaid Services (CMS) for Level 1 Accredited Bariatric Centers
- Recognition by The Joint Commission’s Quality Check Web site at www.qualitycheck.org
- Incentives and rewards for hospitals that participate in The Leapfrog Group’s Hospital Rewards Program
- Participation in the ACS BSCN Accreditation Program’s longitudinal outcomes database for accreditation-based quality improvement
- Provision of evidence-based accountability toward quality assurance
- Ensure patients, payors and the medical community of the center’s self-accountability to maintain high levels of care that conform to nationally recognized standards
- Demonstrate to insurance carriers the medical center's commitment to quality improvement, thereby strengthening the justification to payors and employers on earned reimbursements
- Gain negotiating leverage within the center’s affiliated hospital and/or medical system to obtain resources toward improving patient outcomes, especially as the revenue from surgical procedures accounts for the largest share of a hospital's operating margin (typically more than 60 percent)
- Contribution to health systems improvement
- Streamline data collection for centers that also participate in ACS National Surgical Quality Improvement Program (ACS NSQIP)
- Identify and share best practices with other centers in the ACS BSCN
- Advance field knowledge on the outcomes of surgical procedures and patient trends
- Contribute to the evidence and scientific literature regarding the efficacy and outcomes of innovative and emerging IRB quality-based surgical procedures
- Identify benchmarks
Background
Since its founding in 1913, the American College of Surgeons (ACS) has had a long and prestigious history of engaging in quality improvement for the surgical
patient, and the ACS proudly carries that goal into the 21st century. In February 2005, the ACS Board of Regents recognized the urgent and pressing need to extend
its established quality improvement practices beyond its successful Trauma Verification and Cancer Accreditation programs. The Regents unanimously agreed to expand
the ACS standard setting and accreditation efforts into additional disciplines. Following this action, the ACS BSCN Accreditation Program was established in 2005 in
response to the national obesity epidemic and the growing need to advance high-quality surgical care for patients who undergo bariatric surgical procedures.
Program Requirements
To become, or renew status as, an ACS Accredited Bariatric Center, a facility must complete an application (hyperlink to Apply for Accreditation page) for primary
review by the ACS BSCN Accreditation Program. If the application is approved, a contract must be signed and an accreditation fee paid before provisional approval
is officially granted. Upon provisional approval, a center must complete a site visit during which a site reviewer conducts face-to-face interviews, examines charts,
and tours the facility to verify the information in the center’s application and completed Pre-Site Review Questionnaire. Following the visit, the ACS BSCN Accreditation
Program assesses the results and recommendations from the site reviewer’s final report. Full approval for accreditation is granted upon completion of a successful
site visit.
Accreditation Levels & Requirements
Recognizing that high-quality surgical care occurs in a variety of surgical contexts, the ACS BSCN Accreditation Program offers seven accreditation levels for
inpatient hospitals and outpatient facilities, including newly established bariatric surgery programs. Five accreditation status levels are offered for inpatient
hospitals: Level 1A, 1B, 2A, 2B, and 2-New. Two accreditation levels are offered for outpatient facilities: Outpatient and Outpatient-New.
Difference between A and B Level Centers
All requirements are the same for A and B level designations, except hospitals that participate as an ACS National Surgical Quality Improvement Program (ACS NSQIP)
Site are designated as “Level A” centers (ie, Level 1A and 2A). Level 1 and 2 hospitals that do not participate in ACS NSQIP are recognized as “B” Level centers
(ie, Level 1B and 2B).
Levels for Established Bariatric Surgery Programs
A surgery center must have provided weight loss operations for more than one year before applying for accreditation.
- Level 1 A & B Centers
Level 1 centers are hospitals that have demonstrated they have the capacity to manage and have committed resources to provide complete bariatric surgical care. These
hospitals have high-volume practices and can manage the most challenging and complex patients. These centers engage patients at all levels of obesity and set standards
of care for weight-loss operations, ages, comorbid conditions, and re-operations.
Level 1 facilities must perform 125 or more weight-loss operations annually, with at least two credentialed and experienced bariatric surgeons who have each performed
at least 100 weight-loss operations in the previous 24 months.
- Level 2 A & B Centers
Recognizing that high-quality surgical care occurs in other settings than high-volume centers, ACS BSCN designates certain facilities as Level 2. Level 2 centers possess
the resources to deliver high-quality surgical care to a lower volume of patients than are seen at Level 1 centers. Level 2 centers must perform 25 or more weight-loss
operations annually, with one or more credentialed and experienced bariatric surgeon(s) who have each performed at least 50 weight-loss operations in the previous 24
months.
Currently, Level 2 centers may not conduct weight-loss operations on non-ambulatory patients or perform elective revisional operations for failed weight loss. In addition, Level 2 centers may not perform operations on high-risk patients, who are defined as follows:
- Age: Patients cannot be older than 60 years of age
- Body Mass Index (BMI): Male patients may not have a BMI of 55 or greater; and, female patients may not have a BMI of 60 or greater
- Comorbidities: Patients must have an absence of significant cardiac or pulmonary comorbid conditions
- Outpatient Centers
Also known as ambulatory care centers, outpatient centers provide the application and adjustment of laparoscopic gastric band procedures. Patients who elect to have
this procedure are discharged from the facility in less than 24 hours.
Levels for Newly Established Bariatric Surgery Programs
The ACS BSCN Accreditation Program recognizes and supports the development of newly established bariatric surgery programs that meet its high-quality accreditation standards. Because of this, Level-New applicants are not subject to the guideline that a surgery center must have provided weight loss operations for more than one year before applying for accreditation. ACS BSCN Accreditation Program offers two categories of accreditation for New centers.
- Level 2-New: This designation recognizes newly established bariatric surgical facilities that meet the high-quality standards of accreditation. These centers
are subject to the same criteria as Level 2A and 2B, with the exception of volume and time requirements. Level 2-New Centers must have performed at least 25 primary
weight-loss operations to be eligible for accreditation.
- Level Outpatient-New: This designation recognizes newly established bariatric surgical outpatient centers that meet the high-quality standards of
accreditation. These centers are subject to the same criteria as Level Outpatient, save for volume and time requirements. Once a facility has performed at least 25
laparoscopic adjustable gastric band procedures, it is eligible to apply for this accreditation designation.
Data Collection
In order to maintain accreditation status, all fully and provisionally approved centers are required to report their bariatric surgical outcomes data to the ACS Bariatric
Surgery Database via the Bariatric Workstation, which is a Web-based desktop program that a center installs. The Bariatric Workstation is a secure system with software
checks and user help prompts to ensure completeness and uniformity of data as it is transmitted to the ACS BSCN Bariatric Surgery Database. The data is encrypted and
deidentified to protect the confidentiality of the patient, the surgical facility, and the surgeons. This longitudinal database requires a 100 percent capture of all
cases and the data points. Centers will receive an annual report of their non-risk-adjusted outcomes data collection.
Level 1A and 2A Accredited Bariatric Centers that participate in the ACS NSQIP will have access to a NSQIP bariatric software application. This application automatically
establishes the case in the Bariatric Surgery Database, if the bariatric case is collected during an ACS NSQIP program site’s eight-day cycle. Any bariatric cases that
fall outside the NSQIP collection cycle must be entered separately via the Bariatric Workstation.
FAQs on Data Collection
How much does it cost to use the database?
The database is free and is included in the $12,000 fee for three years of ACS BSCN accreditation. There are no activation or submission fees
(for example, no additional fees per case) for the database.
How often does a center collect data on patients after an operation is performed?
The database guideline for post-surgical patient follow-up is 30 days, six months, and annually thereafter.
When do we start data collection for the ACS Bariatric Surgery Database?
Once your facility receives formal notification of its provisionally approved status, you must schedule database training for your center’s designated
bariatric data collector(s) prior to implementing the Bariatric Workstation, the Web-based desktop program designed for ACS BSCN data collection. Only
those who have undergone training may utilize the Bariatric Workstation to upload patient information, in order to ensure data integrity and consistency.
After training, the data collector(s) will abstract information and conduct data entry starting from the first of the month in which they received training.
If an ACS Accredited Bariatric Center also participates as a NSQIP Site, how are bariatric cases included?
The ACS Bariatric Surgery database was designed to be compatible with ACS NSQIP so that data from bariatric cases that are captured through the ACS NSQIP
sample will automatically populate in the Bariatric Surgery Database. This arrangement means that Level A hospitals, will have a subset of their required
ACS NSQIP cases/data elements automatically transferred into the Bariatric Surgery Database. If a bariatric case is not included in the ACS NSQIP case sample,
it needs to be entered into the Bariatric Workstation. Your center’s bariatric data collector will be responsible for collecting any additional bariatric data points or cases not captured in the ACS NSQIP sample.
Our Accredited Bariatric Center needs to hire a data collector. What are the requirements for this position?
- You will need one designated data collector per center. If there is more than one practice group, there may be more than one data collector per group,
if so desired. If someone will be assisting the primary bariatric data collector, that person is required to complete a data collector training session as well.
- The data collector cannot be a bariatric surgeon performing operations at your center.
- Preference is given to medically trained personnel, a data collector with experience in medical database entry, or another dedicated staff member who is on
your bariatric team (excluding bariatric surgeons
Our Accredited Bariatric Center also participates in NSQIP, so can the NSQIP SCNR be the data collector?
No. Please do not designate the NSQIP SCNR as the bariatric data collector, as s/he will not have adequate time to fulfill the role of a primary bariatric
data collector, given her ACS NSQIP duties. Please contact ACS BSCN staff if this requirement presents a concern for your facility.
Our facility currently uses different software for outcomes data collection. Can we use this software instead of the ACS BSCN software to meet the data collection requirements?
No. All Accredited Bariatric Centers, provisionally and fully approved, must submit 100 percent data into the ACS Bariatric Surgery Database to meet the data collection requirements for accreditation.
Governance
Advisory Committee
The program is guided by a 12-member Advisory Committee. The Advisory Committee consists of bariatric surgeons who are ACS Fellows and have expert knowledge and
experience in developing and supporting a bariatric surgical program. The committee responsibilities include reviewing and approving BSCN applications, assessing
site reviewer final reports, reviewing and updating the program standards if necessary, and guiding the development and growth of the ACS Bariatric Surgery Database.
Click here to learn more about the Advisory Committee members.
Site reviewers
Unlike other bariatric quality improvement certification programs, in which site reviewers are allied health professionals, the site reviewers for the ACS BSCN are
all experienced bariatric surgeons who are Fellows of the American College of Surgeons. Site reviewers have expert knowledge in the management and operations of
multidisciplinary bariatric surgery programs and data collection. These surgeons have undergone training specific to ACS BSCN accreditation, and they are
experienced in conducting peer-reviewed site visits.
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