COEMIG Designation Requirements
Facilities and surgeons are approved for the COEMIG designation when they comply with the requirements set by the AAGL’s Standards Committee. A comprehensive and thorough review is conducted by the Review Committee and SRC to verify compliance.
Once they have earned COEMIG designation, surgeons and facilities are able to publicly announce and market their achievement.
Surgeon Designation Requirements
1. Surgical Experience
Applicant surgeons must have significant, ongoing experience performing minimally invasive gynecologic procedures.
Applicant surgeons must provide a list of cases in which they served as the primary surgeon. The list must include at least 50 qualifying laparoscopic procedures and/or 25 qualifying hysteroscopic cases performed in the preceding 24 months. Click here for a list of qualifying procedures with CPT codes.
Note: Any or all surgeries from all facilities may be used by the surgeon applicant to qualify for COEMIG designation. Physicians can be linked to more than one COEMIG facility. There is no threshold number or percentage of surgeries that an applicant surgeon must perform at the linked facility.
2. Physician Program Director
Applicant facilities must have a Physician Program Director for minimally invasive gynecologic surgery who is an obstetrician/gynecologist and participates in the relevant decision-making administrative meetings of the facility. The program director must have been officially appointed through the facility’s standard administrative process.
This individual must participate in interdisciplinary team meetings to ensure that decisions related to minimally invasive gynecologic surgery are addressed in a comprehensive manner. The director should be primarily responsible for coordinating the interdisciplinary services and systems for minimally invasive gynecology.
The director must be designated, or in the process of becoming designated, as a Center of Excellence in Minimally Invasive Gynecology (COEMIG) surgeon.
3. Surgeon Experience and Qualified Call Coverage
Applicant surgeons must spend a significant portion of their efforts in the field of minimally invasive gynecologic surgery and have qualified coverage for postoperative patient care.
Surgeons must be Board-Certified or an Active Candidate by the American Board of Obstetrics and Gynecology (ABOG), the Royal College of Physicians and Surgeons of Canada (RCPSC) (Specialist Certification in Obstetrics and Gynecology), the Royal College of Obstetricians and Gynaecologists (RCOG), or equivalent.
Applicant surgeons must complete continuing medical education.
Note: A waiver may be allowed if the physician is neither Board-Certified nor an Active Candidate for Board Certification by the American Board of Obstetrics and Gynecology. The physician must meet the qualifications for their respective Board (if applicable) as well as all other criteria set forth for qualifying as a COEMIG surgeon.
4. Clinical Pathways and Standard Operating Procedures
Applicant surgeons must agree to abide by clinical pathways, orders and standard operating procedures that the facility has established for the perioperative care of all minimally invasive gynecologic surgery patients.
5. Informed Patient Decision Making and Consent
All minimally invasive gynecologic surgery patients must be provided with comprehensive preoperative patient education that includes minimally invasive procedure options. Surgeons and facilities must have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for the patient’s condition.
6. Continuous Quality Assessment
Applicant facilities and surgeons must agree to provide surgical outcomes data in a manner consistent with Health Insurance Portability and Accountability Act (HIPAA) regulations or their country’s equivalent patient privacy and confidentiality laws.
Note: A database for the COEMIG program is currently being designed that will enable participants to provide the required outcomes data. Data will be collected and maintained by Surgical Review Corporation (SRC), an independent administrator of the COEMIG program.
Facility Designation Requirements
1. Institutional Commitment to Excellence in Minimally Invasive Gynecology
Applicant facilities must demonstrate a commitment to excellence in the care of minimally invasive gynecologic surgery patients at the highest levels of the surgeon’s practice and the facility’s administration. This commitment includes privileging guidelines for minimally invasive gynecologic surgery as well as documented, ongoing, regularly scheduled in-service education programs in minimally invasive gynecologic surgery.
Note: The facility must hold quarterly meetings for applicable COEMIG staff. Meeting discussion topics may include outcomes review, policy and procedure review, in-service training on equipment, and continuing medical education.
2. Surgical Experience and Volumes
Applicant facilities must have significant, ongoing experience performing minimally invasive gynecologic procedures.
Facilities must have performed a minimum of 75 qualifying primary gynecologic laparoscopic and 25 qualifying primary hysteroscopic procedures in the preceding 12 months, not including sterilizations and diagnostic procedures. Click here for a list of qualifying procedures with CPT codes.
3. Physician Program Director
Applicant facilities must have a Physician Program Director for minimally invasive gynecologic surgery who is an obstetrician/gynecologist and participates in the relevant decision-making administrative meetings of the facility. The program director must have been officially appointed through the facility’s standard administrative process.
This individual must participate in interdisciplinary team meetings to ensure that decisions related to minimally invasive gynecologic surgery are addressed in a comprehensive manner. The director should be primarily responsible for coordinating the interdisciplinary services and systems for minimally invasive gynecology.
The director must be designated, or in the process of becoming designated, as a Center of Excellence in Minimally Invasive Gynecology (COEMIG) surgeon.
Note: A waiver may be allowed if the physician is neither Board-Certified nor an Active Candidate for Board Certification by the American Board of Obstetrics and Gynecology. The physician must meet the qualifications for their respective Board (if applicable) as well as all other criteria set forth for qualifying as a COEMIG surgeon.
4. Consultative Staff
Applicant facilities must have available a full complement of consultative services required for the care of minimally invasive gynecologic surgery patients and their potential complications.
- During surgery and until discharge from the post-anesthesia care unit (PACU)
- Anesthesiologist or Certified Registered Nurse Anesthetist (CRNA) who supervises anesthesia delivery on all minimally invasive gynecologic surgery patients, and is physically present until the patient is discharged from the PACU. Following PACU discharge, the anesthesiologist or CRNA will be available on-site within 30 minutes if needed.
- On-site 24/7 while patients are in the facility
- Physician who is advanced cardiac life support (ACLS)-certified or has equivalent advanced life support training and certification
- On-site within 30 minutes of request
- Vascular surgeon
- General surgeon
- Urologist
- Radiologist
- Gynecologist skilled in open procedures (may be a minimally invasive gynecologic surgeon)
- Critical care specialist OR transfer agreement in place
If applicable, facilities must have a written transfer protocol that details the transfer plan of minimally invasive gynecologic surgery patients to other emergency or critical care facilities.
5. Surgeons and Qualified Call Coverage
The covering physician should be a gynecologist, but other physicians may qualify upon review if they have admitting privileges at a hospital and are qualified, by experience or education, to identify and treat complications of minimally invasive gynecology when they occur. The facility may provide a list of names of covering physicians and does not have to submit separate agreements from each indicating that they are available within 30 minutes.
6. Equipment and Instruments
Applicant facilities must maintain a full line of surgical instruments and related equipment to provide appropriate perioperative care for minimally invasive gynecologic surgery patients. Facilities must have documented training for appropriate staff in the safe operation of this equipment.
7. Clinical Pathways and Standard Operating Procedures
Applicant facilities must utilize clinical pathways, orders and standard operating procedures that facilitate the standardization of perioperative care for the relevant minimally invasive gynecologic procedure, and all minimally invasive gynecologic surgical procedures must be standardized for each surgeon.
It is recommended that the following 8 clinical pathways be formally adopted and implemented prior to site inspection:
- Intraoperative anesthesia, including monitoring and airway management
- Perioperative care, including monitoring, pain management and airway management
- Deep vein thrombosis (DVT) prevention and management
- Instructions for the management of perioperative and postoperative complication warning signs such as tachycardia, fever or hemorrhage
- Evaluation and plan of action for patients at high risk for malignancy, including when a malignancy is detected
- Counseling for patients undergoing sterilization, including hysterectomy (if not previously sterilized)
- Fluid management in hysteroscopy
- Preoperative patient preparation checklist, including education, consent and instruction
The first four pathways will be deemed satisfied if the facility has accreditation from the Joint Commission (formerly known as JCAHO).
8. Designated Surgical Team and Support Staff
Applicant facilities must have nurses and/or physician extenders who provide education and care to minimally invasive gynecologic surgery patients. Facilities must also have an operative team trained to care for minimally invasive gynecologic surgery patients.
9. Informed Patient Decision Making and Consent
All minimally invasive gynecologic surgery patients must be provided with comprehensive preoperative patient education that includes minimally invasive procedure options. Surgeons and facilities must have a process for obtaining informed surgical consent and selecting procedures that are most appropriate for the patient’s condition.
10. Continuous Quality Assessment
Applicant facilities and surgeons must agree to provide surgical outcomes data in a manner consistent with Health Insurance Portability and Accountability Act (HIPAA) regulations or their country’s equivalent patient privacy and confidentiality laws.
Note: A database for the COEMIG program is currently being designed that will enable participants to provide the required outcomes data. Data will be collected and maintained by Surgical Review Corporation (SRC), an independent administrator of the COEMIG program.