A minimally invasive approach is increasingly accepted as the standard of care when it comes to gynecologic surgery, and insurance payers, who were slow to accept this approach, now recognize its value for improving outcomes and lowering costs, according to Dr. Steven F. Palter.
Enter COEMIG – the Center of Excellence in Minimally Invasive Gynecology Program.
"COEMIG is a revolution in minimally invasive gynecology. Instead of focusing on a single operation or doctor, it ensures an entire system is in place to deliver the highest quality of care," said Dr. Palter, medical and scientific director at Gold Coast IVF in Syosset, New York.
Dr. Iris Orbuch
COEMIG was officially launched in November 2011 by the AAGL to establish a comprehensive network of surgeons, hospitals, and ambulatory care centers that have demonstrated excellence in advanced minimally invasive techniques. The program, administered by the nonprofit Surgical Review Corporation (SRC), also provides a central outcomes database known as the Bariatric Outcomes Longitudinal Database (BOLD), which is designed to advance the delivery of evidence-based medicine. The database is accessible by all COEMIG surgeons for use in clinical decision-making.
For years, the AAGL has worked to promote its vision of "serving women by advancing the safest and most efficacious diagnostic and therapeutic techniques that afford less invasive treatments for gynecologic conditions through integration of clinical practice, research, innovation, and dialogue," but acceptance of minimally invasive approaches was limited, and patients were too often unaware that such approaches even existed, said Dr. Palter, who founded and directs the COEMIG program and chairs the program’s outcomes committee.
"We know the minimally invasive approach results in a quicker recovery, lower morbidity, and lower costs. Now that insurance companies are also recognizing this, we are in a position to create a network of Centers of Excellence based on the highest quality of care," he said in an interview.
Questions have been raised about if and how the Center of Excellence model will change the landscape for minimally invasive gynecologic surgeons, and the answers, Dr. Palter said, are yes – and in potentially very beneficial ways.
The scenario has played out in several other specialties, which have had great success with Centers of Excellence programs, he said. In fact, the field joins more than half a dozen other specialties in pursuing this model as a means of raising the level of care in the specialty and verifying those centers that perform at the highest level. Those in the program generate and own the evidence and data needed to answer the most pressing clinical questions in the debate about the value and benefits of minimally invasive procedures. As a result, care will improve, patients will benefit, and participating surgeons will have improved access to patients and improved levels of reimbursement, he added.
Ultimately, COEMIG is about bringing patients and surgeons together, and improving outcomes, he said, providing the field of bariatric surgery as a classic example of this.
Bariatric surgery moved to this model beginning in 2003, as procedures for obesity increased and a need for the development of benchmarks for quality and patient safety was recognized. In fact, SRC was founded to administer center of excellence programs for this purpose.
Additionally, the BOLD database for bariatric and metabolic surgery, launched in 2007, is the world’s largest and most comprehensive repository of related clinical bariatric surgery patient information. Data are included from more than 500,000 patients, allowing surgeons to obtain meaningful data through daily reports based on individual practice and national data summaries. BOLD data also provide an "unmatched infrastructure for clinical studies," according to information from SRC, which works with investigators to design such studies in addition to administering and supporting the Center of Excellence programs.
The experience of bariatric surgeons has been that participation in a Center of Excellence program leads to greater patient access and the highest levels of reimbursement, SRC reports.
COEMIG will do the same for minimally invasive gynecologic surgery, Dr. Palter predicted.
"COEMIG is meant to be inclusionary, not exclusionary," he said, noting that the designation of Center of Excellence is open to any surgeon, hospital, or ambulatory surgery center performing minimally invasive surgery. Certainly there are quality standards and infrastructure requirements, and there is particular emphasis on the entire team, but the AAGL and SRC will work with those who don’t currently meet the guidelines to improve.
Participation is meant to allow those surgeons to have continued access to patients who might otherwise be steered away by insurance companies that will mandate care through approved centers in a network. For the first time, centers around the world will be able to share and learn from each other’s best clinical pathways and raise their performance to the highest possible level, he said.