PHILADELPHIA— The United States Congressional Budget Office estimates that 5 percent of the country’s gross domestic product (GDP) is spent on medical tests and procedures that do not improve patient outcomes. In an effort to reduce unnecessary testing, procedures and related spending, the federal Centers for Medicare & Medicaid Services (CMS) has named Penn Medicine and two other organizations among a select few health care organizations in the country designated as a “qualified provider-led entity” (QPLE).
The designation will allow Penn to develop its own evidence-based criteria to assist physicians and providers of advanced imaging services in making the most appropriate imaging decisions for clinical conditions. This process will also help reduce the number of unnecessary procedures.
"Our goal is to assure that Penn Medicine patients receive the highest quality and most appropriate imaging exams for their conditions," said Charles E. Kahn, Jr., MD, MS, professor and vice chair of radiology. "Penn Medicine already uses a set of national appropriateness guidelines, but the QPLE designation allows us to extend those guidelines to meet the needs of our patients who receive highly specialized care."
These guidelines will help improve quality of care for patients while making the most efficient use of radiology services. Beginning in January 2020, physicians ordering advanced diagnostic imaging exams—such asCT scans, MRIs, nuclear medicine exams, and PET scans—will be required to consult qualified, evidence-based “appropriate-use criteria” housed in a clinical decision support mechanism. Clinical decision support mechanisms areelectronic tools that indicate which tests are appropriate for patients with certain medical conditions or diagnoses.
For example, the American College of Radiology has developed a CMS-approved tool that Penn Medicine currently uses, which includes over 250 medical conditions and possible diagnoses, ranging from cardiac and gastrointestinal problems to headaches, chronic back pain, and vaginal bleeding. Clicking on “Crohn’s disease” produces a chart showing that a CT scan of the abdomen with IV contrast is “usually appropriate” while a certain form of PET scan is “usually not appropriate” in assessing these patients.
Each organization approved as a qualified provider-led entity must follow strict CMS guidelines and rules for developing appropriate-imaging criteria, including: a multidisciplinary team; management of conflicts of interest; formal topic development and evidentiary review processes; publication of the appropriate use criteria; and a public comment form.
Penn Medicine’s Imaging Appropriate Use Criteria program is overseen by a multidisciplinary steering committee headed by Kahn. The committee will use a formal, peer-reviewed, and widely-accepted methodology to assess the quality of evidence and strength of recommendations for proposed new or revised diagnostic tests or strategies. This new designation also means that Penn’s can provide additions, deletions, and refinements to any CMS-approved clinical decision support mechanisms that are currently in use.
“In just the past week, CMS reconfirmed that January 1, 2020 will be the start date for the congressionally-mandated program,” said co-author of Penn’s QPLE application Ari Borthakur, PhD, MBA, Advisor, Center for Practice Transformation, Department of Radiology. “With an early approval, Penn Medicine gets a head start in developing its own imaging recommendations to best serve its mission.”
The authors of proposed new items must adhere to a rigorous process, including supplying a detailed narrative discussing relevant medical literature and providing evidence for adopting the proposed new guidelines. Authors might, for example, recommend adding or removing procedures or treatments as a result of new technology or evidence-based findings. An extensive, multi-round review of the proposal then will take place. Approved changes will be posted on the committee’s website and disseminated internally to Penn Medicine physicians and imaging providers.
Penn Medicine is one of the world’s leading academic medical centers, dedicated to the related missions of medical education, biomedical research, excellence in patient care, and community service. The organization consists of the University of Pennsylvania Health System and Penn’s Raymond and Ruth Perelman School of Medicine, founded in 1765 as the nation’s first medical school.
The Perelman School of Medicine is consistently among the nation's top recipients of funding from the National Institutes of Health, with $550 million awarded in the 2022 fiscal year. Home to a proud history of “firsts” in medicine, Penn Medicine teams have pioneered discoveries and innovations that have shaped modern medicine, including recent breakthroughs such as CAR T cell therapy for cancer and the mRNA technology used in COVID-19 vaccines.
The University of Pennsylvania Health System’s patient care facilities stretch from the Susquehanna River in Pennsylvania to the New Jersey shore. These include the Hospital of the University of Pennsylvania, Penn Presbyterian Medical Center, Chester County Hospital, Lancaster General Health, Penn Medicine Princeton Health, and Pennsylvania Hospital—the nation’s first hospital, founded in 1751. Additional facilities and enterprises include Good Shepherd Penn Partners, Penn Medicine at Home, Lancaster Behavioral Health Hospital, and Princeton House Behavioral Health, among others.
Penn Medicine is an $11.1 billion enterprise powered by more than 49,000 talented faculty and staff.