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CMCOEM Designation Requirements

The CMCOEM program has 10 requirements for bariatric surgery programs based in hospitals.

The requirements pertain to bariatric surgeons, the hospital where they have privileges, and the surgical practice, which is where pre- and postoperative care is typically provided. The hospital requirements also cover any affiliated outpatient facility that provides bariatric surgery care and is located within one mile of the hospital.

Centers are fully approved for the CMCOEM designation when they comply with the hospital requirements that are in effect when they submit their applications for designation. A comprehensive site inspection is conducted to verify compliance.

Surgeons and hospitals are encouraged to publicly announce and market their achievement once they receive the CMCOEM designation.

  1. Institutional Commitment to Excellence
  2. Surgical Experience and Volumes
  3. Designated Medical Director
  4. Responsive Critical Care Support
  5. Appropriate Equipment and Instruments
  6. Surgeon Dedication and Qualified Call Coverage
  7. Clinical Pathways and Standardized Operating Procedures
  8. Bariatric Nurses, Physician Extenders and Program Coordinator
  9. Patient Support Groups
  10. Long-Term Patient Follow-up, including BOLD

SRC Support is available to answer questions about the hospital requirements and designation process during a free one-on-one phone consultation. They can be reached Monday – Friday from 8:30 am – 5:30 pm Eastern time at +1.919.792.3770 or via email at srcsupport@surgicalreview.org (srcsupport null@null surgicalreview NULL.org).

CMCOEM Requirements

Download CMCOEM Requirements

1) Institutional Commitment to Excellence

The applicant demonstrates an institutional commitment at the highest levels of the medical staff and hospital administration to excellence in the care of bariatric surgery patients as documented with an ongoing, regularly scheduled, in-service education program in bariatric surgery. Institutional commitment is also demonstrated by employing credentialing and privileging guidelines for bariatric surgery that are separate from general surgery guidelines.

2) Surgical Experience and Volumes

 The applicant hospital has performed at least 125 bariatric surgical cases in the preceding 12-month period.

Each applicant surgeon has performed at least 125 bariatric surgical cases in his or her lifetime, with at least 50 cases performed in the preceding 12-month period.

The following primary procedures, whether open or laparoscopic, qualify toward volume:

  • Gastric bypass: short- or long-limbed, transected or not transected, banded or not banded
  • Vertical banded gastroplasty
  • Gastric banding
  • Duodenal switch
  • Biliopancreatic diversion
  • Sleeve gastrectomy
  • Revisions (Learn More about Requirement 2, including revisions that qualify toward volume)

3) Designated Medical Director

The applicant maintains a designated Medical Director for bariatric surgery who is a bariatric surgeon and participates in the relevant decision-making administrative meetings of the hospital. The Medical Director must have been officially appointed through the hospital’s standard administrative process.

4) Responsive Critical Care Support

The applicant hospital maintains a full complement on staff of the various consultative services required for the care of bariatric surgical patients.

  • On-site 24/7
    • Physician who is advanced cardiac life support (ACLS)-qualified or has equivalent advanced life support training and certification
  • On-site within 30 minutes of request
    • Anesthesiologist or certified registered nurse anesthetist (CRNA)
    • Physician capable of performing endoscopies to diagnose complications
    • Interventional radiologist or other physician capable of performing each of the following specific procedures:
      • IVC filter placement
      • Percutaneous drainage of intra-abdominal abscess
      • Angiographic arterial embolization
    • Physician with critical care credentials to manage complications (critical care physician/intensivist, hospitalist, cardiologist or pulmonologist)

5) Appropriate Equipment and Instruments

The applicant maintains a full line of equipment and instruments appropriate for the care of bariatric surgery patients, including furniture, wheelchairs, operating room tables, floor-mounted or floor-supported toilets, beds, radiologic capabilities, and surgical instruments. Personnel must be trained to use the equipment and capable of moving these individuals without injury to the patient or themselves.

6) Surgeon Dedication and Qualified Call Coverage

The applicant is a bariatric surgeon who spends a significant portion of his or her efforts in the field of bariatric surgery and has qualified coverage and support for patient care.

The applicant must be a full member in good standing with the Colegio Mexicano de Cirugía para la Obesidad y Enfermedades Metabólicas A.C. (CMCOEM).

7) Clinical Pathways and Standardized Operating Procedures

The applicant utilizes clinical pathways and orders that facilitate the standardization of perioperative care for the relevant procedure, and all bariatric surgical procedures are standardized for each surgeon.

The following pathways must be formally adopted and implemented prior to the SRC site inspection:

  • Four clinical pathways are mandatory
    • Anesthesia, including monitoring and airway management
    • Perioperative care, including monitoring and airway management
    • Deep vein thrombosis (DVT) management
    • Management of warning signs of complications such as tachycardia, fever and hemorrhage
  • Ten of the following 11 clinical pathways are also required
    • Indications
    • Contraindications
    • Initial patient instruction
    • Patient evaluation
    • Laboratory studies
    • Imaging studies
    • Patient education/consent
    • Admission workup and evaluation
    • Preoperative and postoperative nutrition regimen
    • Wound care management
    • Pain management

8) Bariatric Nurses, Physician Extenders and Program Coordinator

The applicant utilizes designated nurses or physician extenders who are dedicated to serving bariatric surgery patients, who are involved in continuing education in the care of bariatric surgery patients and who provide education to bariatric surgery patients. The applicant hospital must have a dedicated bariatric floor or designated group of beds that are maintained in a consistent area.

Bariatric surgery programs must have a designated bariatric coordinator who manages program development, patient and staff education, ongoing CMCOEM program compliance, and multidisciplinary team meetings.

9) Patient Support Groups

The applicant makes available organized and supervised support groups for all patients who undergo bariatric surgery at the hospital.

10) Long-Term Patient Follow-Up, Including BOLDSM

The applicant provides documentation of a program dedicated to a goal of long-term patient follow-up of at least 75 percent for bariatric procedures at five years with a monitoring and tracking system for outcomes. The applicant agrees to provide surgical outcomes data on all bariatric surgery patients to SRC through the Bariatric Outcomes Longitudinal DatabaseSM (BOLD) in a manner consistent with applicable patient privacy and confidentiality regulations.

Learn more about BOLD activation and approvals that enable CMCOEM participants to enter patient information into BOLD.