RT Journal
A1 Livingston EH, Burchell I
T1 REduced access to care resulting from centers of excellence initiatives in bariatric surgery
JF Archives of Surgery
JO Archives of Surgery
YR 2010
FD October 1
VO 145
IS 10
SP 993
OP 997
DO 10.1001/archsurg.2010.218
UL http://dx.doi.org/10.1001/archsurg.2010.218
AB Objective 
    To determine the effect on travel distance for Medicare patients before and after Centers for Medicare & Medicaid Services required that bariatric procedures be performed at Centers of Excellence (COEs).Design 
    We calculated the distance traveled to our medical center for the 2 years prior (2004-2005) and 2 years after (2006-2007) COE status was required by Medicare. We also compared the proportion of bariatric cases done in large hospitals with those for esophageal and pancreatic resections, procedures whose effects regionalization would have on patient access have been modeled.Setting 
    University of Texas Southwestern Medical Center, a high-volume tertiary referral center for bariatric surgery.Patients 
    Patients undergoing bariatric procedures.Main Outcome Measure 
    Travel distances.Results 
    Depending on insurance status, before COEs were required, patients traveled a median of 16 to 25 miles to undergo bariatric operations at University of Texas Southwestern. After COEs were required, the median distance Medicare patients were required to travel increased 76% to 44 miles.Conclusions 
    Center of Excellence requirements have increased the travel distance required for Medicare patients. Prior research has shown that outcomes at COEs are no different than those at non-COEs suggesting that the reduced access to care resulting from requiring COE status is not beneficial.