Contents lists available at ScienceDirect Healthcare journal homepage: www.elsevier.com/locate/healthcare Original research Centers of excellence: Are there standards? Joan Li a , Randall C. Burson a , Justin T. Clapp a,b , Lee A. Fleisher a,b,* a University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA b Leonard Davis Institute of Healthcare Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA ARTICLE INFO Keywords: Centers of excellence Quality Qualitative research Insurance Employers ABSTRACT Introduction: Centers of Excellence (CoEs) are intended to label hospitals that have met certain quality, process, volume and infrastructure guidelines. However, there are largely no standardized metrics to designate what qualifies as a CoE, leading to entities across the healthcare spectrum creating their own designations. Empirical studies on the impact of CoEs on quality do not consistently show improved care. Given the variability in definitions and outcomes for CoEs, the study evaluated the current status of defining and using CoE designations. Methods: We conducted semi-structured interviews with executives from 10 healthcare organizations (including hospitals, insurers, employers, and benefits managers) who have a role in determining or using CoE designations to make decisions for their organizations. The interviews were conducted in 2016 and 2017. The interviews were audio recorded, transcribed, and de-identified for thematic analysis. Results: We found that there is significant variability in the process for defining CoEs. There are also many operational challenges that hinder the success of a CoE program, including how patients access care at a CoE, the right geographical distribution of CoEs in a network, and coordinating care between the CoE and local providers. Conclusions: The lack of standardization for designating CoEs not only prevents CoEs from fully achieving their intended effects of signaling “excellent” hospitals, but also causes confusion for patients, employers and payers, which dilutes the meaning of the CoE label. Implications: We suggest that the designation and implementation of CoEs should be standardized in healthcare. 1. Introduction At a time when more attention than ever is being given to achieving healthcare value, Centers of Excellence (CoEs) offer one method to recognize quality of care by designating hospitals that have met certain outcomes, process, volume, and infrastructure guidelines. 1 Theoreti- cally, these CoE designations could help patients select hospitals with better outcomes, employers better manage their healthcare allocations, insurers contract with high-value providers, and providers differentiate themselves. Insurers may also use CoE designations to steer patients to specific providers by offering differential co-payments. However, in practice, with the exception of a few specialties, there is no overarching regulatory oversight of what qualifies as a CoE. Different entities can apply their own definitions based on a broad set of criteria. These entities include private health insurers (e.g., Aetna Institutes, Blue Cross Blue Shield Blue Distinction Centers), medical specialty professional societies (e.g., American College of Surgeons and the American Society for Metabolic and Bariatric Surgery accredited bariatric surgery CoEs), government organizations (e.g., National Cancer Institute), employer professional associations (e.g., Pacific Business Group on Health), individual employers (e.g., Lowes, WalMart) and hospitals themselves (e.g., Willis-Knighton Health System 2 ). Each entity has its own criteria and method for defining a CoE. Many of the empirical studies that evaluate whether CoEs have improved outcomes compared to non-CoEs have been conducted on bariatric surgery, and the results are conflicting. In 2006, the Centers for Medicare and Medicaid (CMS) enacted a policy that only re- imbursed bariatric surgery services performed at centers accredited by the American College of Surgeons (ACS) and the American Society for Metabolic and Bariatric Surgery (ASMBS). 3 A study using data from the few years before and after the policy went into effect showed that there was a decrease in deaths, complications, readmissions and patient payments after the accreditation. 4 Similarly, another study showed that accredited academic centers were found to have lower in-house mor- tality compared to non-accredited centers. 5 A review of 13 studies that covered more than 1.5 million patients found that there was a reduction in mortality and morbidity in procedures performed at CoEs compared to those that were not designated. 6 However, other studies found no clinically significant differences in outcomes or costs. 7 89 Even among https://doi.org/10.1016/j.hjdsi.2019.100388 Received 26 March 2019; Received in revised form 19 September 2019; Accepted 6 October 2019 * Corresponding author. Leonard Davis Institute of Healthcare Economics, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, US. E-mail address: Lee.Fleisher@uphs.upenn.edu (L.A. Fleisher). Healthcare xxx (xxxx) xxxx 2213-0764/ © 2019 Elsevier Inc. All rights reserved. Please cite this article as: Joan Li, et al., Healthcare, https://doi.org/10.1016/j.hjdsi.2019.100388