Improving the Quality of Surgical Care in Metabolic and Bariatric Surgery
In This Video
- Matt Hutter, MD, MBA, MPH, is the director of the Massachusetts General Hospital Weight Center, medical director of the Codman Center, and a professor in surgery at Harvard Medical School
- His research focuses on measuring and improving the quality of care in metabolic and bariatric surgery
- He discusses his work on the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program and shares his outlook on obesity treatment
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Matt Hutter, MD, MBA, MPH, is director of the Massachusetts General Hospital Weight Center, medical director of the Codman Center for Clinical Effectiveness in Surgery and a professor in surgery at Harvard Medical School. In this video, he discusses his research on measuring and improving the quality of care in metabolic and bariatric surgery.
My research focuses on measuring and improving the quality of care in surgery—specifically in metabolic and bariatric surgery.
Bariatric surgery, or weight loss surgery, is very interesting. Actually, in 2005, the Centers for Medicare and Medicaid Services (CMS), made a non-coverage proposal for bariatric surgery. They thought laparoscopic error was moving along and people were doing more of these operations. They were concerned about safety, so reports about death rates of 2% were being put out in the public: gastric bypass gone bad, people dying to become thin. So in 2005, that's where the concern was.
CMS was about to shut down weight loss surgery, so a group of professionals, the bariatric surgeons and the American College of Surgeons, came together saying that if we did this in high-quality, accredited and high-volume centers, we knew that it could be done safely. So that's when I really started measuring and improving the quality of care in bariatric and metabolic surgery.
We developed a national data collection program for metabolic and bariatric surgery, and currently over 95% of all bariatric operations in the United States are participating in this program. It's called the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program—MBSAQIP, because that's quite a mouthful—and we have risk-adjusted prospective data collection on all of the bariatric operations done at these accredited centers across the country. We have done this with the [help of the] American Society for Metabolic and Bariatric Surgery and the American College of Surgeons, which has really improved the quality of care nationwide.
So currently at all the accredited centers, they get a risk-adjusted report semiannually so that they can see how well they're doing compared to benchmark national averages. They're all risk-adjusted, benchmarked with clinically rich data, so they can see specifically how they're doing at their site, identify the areas for improvement, and improve that quality of care. Those death rates that I talked about of 2%, they're now down to 0.1% or less than 0.1% for metabolic and bariatric surgery across the country.
One of the most exciting things about being a bariatric surgeon is seeing how well our patients do, so I love that I won your appointment. When people come back, they've lost 70% of their excess weight, but more importantly, when I ask, "What's the biggest change in your life?" they tell me things like, "I can go to the movies. I can go on a plane. I can play with my kids." We have developed a program to capture patient-reported outcomes, so we can truly measure what matters most to those patients. So we applied for and got funding from PCORI, the Patient-Centered Outcome Research Institute, in order to create a national patient-reported outcomes metric that could be included as part of this MBSAQIP program, so currently we are very excited to get this up and running. We've got 20 focus groups to identify the metrics that are most meaningful to the patients. We've developed an alpha pilot, the beta pilot started last week and we look forward to national implementation so we can capture the metrics that mean the most to the patients, the patient-reported outcomes, their quality of life, so they can track that over time.
Obesity is a huge problem. It's an epidemic in the United States. The metabolic issues with regards to diabetes, hypertension are even more and more of a concern, and I think going forward, we need to be able to treat the hundreds of thousands of patients who are suffering from this disease right now.
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