Rather than serving as a "rubber stamp" program, COEMIG promotes an ongoing, interactive process for achieving and maintaining excellence, he added.
To date, more than 150 programs have registered for the designation and are in various stages of application completion. The process involves:
• Registration and account creation. This is done at the SRC website (www.surgicalreview.org) or through the AAGL website (www.aagl.org).
• Achieving provisional status. This is done by linking accounts of related registrants (surgeons, facilities, and so on) that together comprise the "center," by submitting an application that indicates provisional qualifications are met or exceeded, and paying the fees associated with the application process (currently $7,500 for a facility; $650 for individual surgeons).
• Earning COEMIG designation. This means a site visit by SRC administrators (materials are sent upon receipt of the application to assist with preparation for the site inspection; the site inspection fee is $1,850) and by meeting all qualifications. There are particular qualifications for the individual surgeons and facilities.
Once all applicants for a given center are approved, the surgeons and facilities may publicly announce and market their designation. The annual participation fee is $3,975 for a facility and $650 for individual surgeons.
Designation maintenance requires good standing and verifiable compliance with requirements. Verification is completed approximately every 3 years as part of a designation renewal process; support is provided by SRC as needed.
Dr. Iris Orbuch, a New York–based surgeon who specializes in robotic and minimally invasive surgery for benign gynecologic conditions – particularly endometriosis – is currently in the process of certification for the COEMIG designation.
After hearing a talk about the future of the specialty a couple of years ago – and about the benefits achieved through Center of Excellence programs in other specialties – she was intrigued by the concept. The potential for improved patient outcomes through outcomes data collection was a major selling point, and it didn’t take much convincing before New York’s Beth Israel Medical Center, one of the facilities with which she is affiliated, was on board as well, she said in an interview.
After several months of meetings and preparation, including the creation of planning committees, collection of data, and training of staff, both she and the facility have applied for the COEMIG designation.
Dr. Orbuch, director of the Advanced Gynecologic Laparoscopy Center in New York, said she sees the process – and the designation – as a way not only to promote the value of minimally invasive gynecologic surgery and to plan for an uncertain future in the best way possible, but, most importantly, to improve outcomes for patients by ensuring that they are in the hands of those with the most experience and the greatest skill.
"The direction of medicine is changing, insurance companies are changing, and they may eventually demand that surgeons be part of a Center of Excellence," she said.
Indeed, it’s a pattern that has played out in bariatrics, and there is no reason to think the same won’t be true for gynecology, Dr. Palter agreed.
Neither Dr. Palter nor Dr. Orbuch had conflicts of interest to disclose.
COEMIG REQUIREMENTS
Designation requirements for surgeons include:
1. Experience. This includes at least 50 qualifying laparoscopic procedures and/or 25 qualifying hysteroscopic cases performed in the preceding 23 months.
2. A physician program director. This is a minimally invasive gynecologic surgeon at the surgeon’s facility who is also designated, or in the process of becoming designated, as a COEMIG surgeon.
3. Surgeon experience and qualified call coverage. This means the surgeon must be board certified and spend a significant portion of their efforts on minimally invasive gynecologic surgery, and must have qualified coverage for postoperative patient care.
4. Informed patient decision-making and consent. This includes established procedures for providing patient education and obtaining informed consent.
5. Continuous quality assessment. This includes a willingness to share surgical outcomes data.
Designation requirements for facilities include:
1. Commitment to excellence.
2. Surgical experience and volumes. This means a minimum of 75 qualifying procedures in the preceding 12 months.
3. A designated physician program director.
4. Consultative staff. This means a full complement of consultative services is required for the care of minimally invasive gynecologic surgery patients.
5. Board-certified surgeons and qualified call coverage.
6. Appropriate equipment and instruments. This includes a full line of surgical instruments and related equipment for providing appropriate perioperative care, and also documented training for staff in the safe operation of the equipment.
7. Clinical pathways and standard operating procedures. Eight specific pathways are recommended by SRC.