American College of Surgeons Bariataric Surgery Center Network Levels of Accreditation

The standards established for the American College of Surgeons (ACS) Bariatric Surgery   Center Network (BSCN) Accreditation Program delineate five levels for accreditation of inpatient facilities, identified as Level 1a, 1b, 2a, 2b, and 2-New as well as two levels of outpatient surgical care facilities, identified as Outpatient and Outpatient-New.

High quality surgical care requires documentation of reliable outcome measurements. Level        1a and 2a centers will use the ACS National Surgical Quality Improvement Program (ACS NSQIP) adapted for bariatric surgery, requiring a trained Surgical Clinical Nurse Reviewer (SCNR) to collect and submit the required data.  These centers will have access to benchmark reports containing national aggregate data and individual facility data to assess patterns of care and outcomes relative to national norms.  Level 1b, 2b, 2-New, Outpatient, and Outpatient-New Facilities will report outcomes data to the ACS Bariatric Surgery Database for accreditation purposes only.  A designated nurse of the bariatric surgery service will enter the data using the  established ACS protocol.

Level 1a and 1b

Level 1 centers will provide complete care, with resources devoted to bariatric surgery.  These hospitals can manage the most challenging and complex patients with optimal opportunity for safe and effective outcomes.  These centers are prepared to handle patients at varying levels of risk, standards of care for weight loss operations, ages, co-morbid conditions, and re-operations. They will have high-volume practices with 125 or more weight-loss operations being performed annually, with at least two credentialed and experienced bariatric surgeons each performing at least 100 primary weight-loss operations in the previous two years.

Level 2a and 2b

Recognizing that high quality surgical care also occurs in facilities other than high-volume centers, the ACS will designate certain facilities as Level 2 centers.  These centers will provide high quality care to a lower volume of patients, performing 25 or more weight-loss operations annually, with one or more credentialed and experienced bariatric surgeon(s) performing at least 50 primary weight-loss operations in the previous two years.  Level 2a bariatric surgery centers are not approved for operations on high-risk patients, such as males with a BMI > 55, females with a BMI > 60, and the medically disabled.

Level 2-New

A bariatric surgery center may apply for Level 2-New designation once 25 primary weight loss operations have been performed.  The facility must satisfy existing Level 2 center standards with the exception of volume and time requirements.  A site visit is conducted, within 3 months of provisional approval to verify the center’s infrastructure and evaluate the data.  A Level 2-New center will be eligible to apply for Level 1 designation after one year of accreditation and once the volume requirement of 125 weight-loss operations and all other level 1 standards have     been met.

Outpatient

Outpatient centers will provide the application and adjustment of laparoscopic gastric bands. These centers’ surgeons will perform 50 or more weight-loss operations annually, with at least one credentialed and experienced bariatric surgeon performing at least 50 primary weight-loss operations annually.

Outpatient-New

An outpatient bariatric surgery center may apply for Outpatient-New center designation after      it has performed 25 laparoscopic gastric band procedures.  The center must meet all Outpatient center requirements with the exception of volume and time requirements.

Revised October 1, 2007

Bariatric Surgery Center Network Program

Continuous Quality Improvement