If you've surfed the GBU website, you've likely come across Center of Excellence (COE) designations on some of our physicians' bios. But what is a Center of Excellence—and why should that matter to patients?

We invited Dr. Angel Marie Johnson, our Director of Women's Health, to share her insights. Dr. Johnson is the only physician in New England with Centers of Excellence designations in Bulkamid and Axonics.

What is a Center of Excellence in healthcare?

Dr. Johnson explains that a Center of Excellence means the surgeon has become a true expert in a specific procedure and has achieved the highest standard of care.

A center of excellence designation is granted by a device manufacturer according to specific studied guidelines. Each company has its own criteria for determining whether physicians qualify for the COE distinction.

Dr. Johnson says, "For example, to be designated a Center of Excellence for Bulkamid . . . this means I've done over a hundred cases in two years. That's the minimum to apply for Bulkamid's Center of Excellence. I also had to provide videos of me performing two cases, which the Bulkamid team reviewed in committee to ensure I was doing the appropriate technique and getting the appropriate results."

She says the Bulkamid team also reviewed her cure rates and "talk tracks," which involve how she describes the Bulkamid therapy to patients, including the risks and benefits. Finally, they looked at her outcomes.

Dr. Johnson adds, "The COE distinction is more than 'Yes, you've been trained to do this procedure, go forth and do it.' If you're a true Center of Excellence, it means that you've been doing the procedure for a long time, and the medical device company has reviewed your work, discussed it in committee, and has determined you are truly achieving the standard of care. So if a patient is concerned about selecting a surgeon who is a true expert in a specific procedure, looking for a doctor with a COE designation can be a good first step."

For Bulkamid, Dr. Johnson has easily exceeded the number of required cases to qualify for the COE designation. She performs approximately 250 a year, making her the go-to physician in New England. Bulkamid can be performed in either the office or the operating room. Patients appreciate having the choice. (It's worth noting, however, that some insurances, like Blue Cross Blue Shield, require the procedure to be done in a surgical center or operating room.)

Different procedures have different COE criteria.

The criteria for different Centers of Excellence designations are unique to the procedure. For example, Dr. Johnson notes that you can't compare the criteria for the Bulkamid COE with the Axonics COE.

 Bulkamid treats stress urinary incontinence (SUI), which affects one in three women. On the other hand, Axonics Therapy (sacral neuromodulation) treats overactive bladder (OAB), which affects one in five women.

Dr. Johnson says, "There are only three treatment options for stress incontinence, and Bulkamid is one of them. For overactive bladder, multiple treatment options exist, and Axonics is the third-line option when you've failed two other things. For example, you failed the behavioral modification, the diet changes, the avoidance of bladder irritants, pelvic floor physical therapy, whether those were exercises at home or in the presence of a physical therapist, and you've also failed one or two medications. Then, you qualify for sacral neuromodulation, one company being Axonics."

Doctors still prescribe what's best for patients, regardless of their COE designations.

Skeptical patients might wonder if physicians with specific COE designations feel beholden to a particular device or procedure.

Dr. Johnson says the COE criteria ensure doctors aren't overprescribing a particular procedure. "The companies also look at your treatment algorithm of how you move patients through the different options," she explains. "They ensure you're doing the appropriate workup beforehand and that you're confirming the diagnosis, which is why you're having those great outcomes."

For example, when it comes to a COE in Axonics, the company makes sure that the physician has done more than 100 Axonics implants and that the physician is a true expert in selecting the most suitable patients for the procedure, placing the device, dealing with complications, and achieving the best outcomes.

As for selecting the right patients, Dr. Johnson finds that more patients are aware of Axonics now, thanks to advertising. But patients can't simply request Axonics—that's not how it works.

"Now I'm getting some patients who walk in and are like, 'I want Axonics,' which is great. It's my job to then step back and make sure to confirm the correct diagnosis and take the patient through the treatment algorithm to see if Axonics is the correct choice for them."

GBU is proud to have doctors with Center of Excellence designations.

In addition to Dr. Johnson's COE in Bulkamid and Axonics, Dr. Stephen Craig Gillard became the first doctor in Massachusetts to receive the Center of Excellence in Greenlight Laser Therapy for treating BPH.

Request an appointment with one of them or our other world-class physicians.