Synchronizing Payer Contract Criteria
In time, Morton says, the MBSAQIP hopes to eliminate a major headache for any hospital that takes private health insurance, because the four big insurers—Aetna, Cigna, United and Blue Cross Blue Shield—that are the biggest payers of bariatric surgical procedures (the bills for 70% of all bariatric procedures are reimbursed by private health plans) all have very different minimal requirements for contracting.
"At my institution, we complete about a dozen different accreditation processes for different insurers," Morton says. "What we want to see happen through MBSAQIP is that there would be a single standard that people can rally around, trust, and believe in, and do away with all the redundancy and duplicity that's involved with all these applications." One single accreditation process would be easier on everyone, he says.
Sounds like a good idea.
Bariatric surgery is a growth business in more ways than one, Morton says. It's not just a lucrative profit center for hospitals at an average facility payment of between $15,000 and $35,000. There is also what Morton calls "the echo" effect:
There are physicians' fees, and additional testing for patients with obesity-related conditions like sleep apnea, cardiology evaluation, endoscopic procedures, plastic surgery reconstruction just to name a few. "There's quite a bit of benefit to the bottom line for hospitals that do bariatric surgery," he says.
So why not get accredited?
View a list of hospitals accredited to perform bariatric procedures.