ASGE Peroral Endoscopic Myotomy (POEM) Pearls to Practice: LIVE and Virtual | July 2022-Ming Xu

Ming Xu_Setting up a POEM practice

Pdf Summary

The document discusses the process of setting up a POEM (peroral endoscopic myotomy) practice in an HMO (health maintenance organization) setting, specifically focusing on Kaiser Permanente West Los Angeles. Kaiser Permanente is one of the largest HMOs with 12.6 million patients and is divided into geographical regions of coverage. The HMO advantages include integrated healthcare system with no pre-approval or billing authorization needed, a large built-in referral base, and streamlined workup with shared electronic medical records (EMR) and imaging. However, there are challenges in building a new program, such as limiting volume to one POEM center and getting buy-in from regional GI and surgery chiefs.<br /><br />The document also outlines the steps taken to establish the POEM program, including acquiring technology and equipment, credentialing and privileging, and securing approval from the institutional review board. The timeline for the program started in June 2016 with the IRB approval and it successfully performed the first POEM case in February 2018.<br /><br />The document provides insights into the workflow and operations of the foregut clinic, which includes case manager screening referrals and a multi-disciplinary team of gastroenterology, surgery, and thoracic surgery addressing patient cases. It emphasizes the importance of education, maintaining relationships with referring physicians, and understanding the institutional process for credentialing and privileging.<br /><br />The document concludes with lessons learned, including educating referring physicians about achalasia vs. GERD, discussing post-POEM expectations with patients, and supporting the motility program through referrals and complex cases. It also includes information about the team involved in the POEM practice at Kaiser Permanente West Los Angeles.

Keywords

POEM

peroral endoscopic myotomy

HMO

health maintenance organization

Kaiser Permanente

West Los Angeles

integrated healthcare system

electronic medical records

institutional review board

foregut clinic