Penn Medicine designated qualified provider-led entity

The federal Centers for Medicare & Medicaid Services (CMS) recently awarded Penn Medicine and two other health care organizations with the qualified provider-led entity (QPLE) designation.

With this designation, the health care organizations can develop evidence-based criteria to assist physicians and providers of advanced imaging services in making appropriate imaging decisions for clinical conditions.

The organizations must follow strict CMS guidelines and rules including publication of the appropriate use criteria.

Physicians ordering advanced diagnostic imaging exams will be required to consult qualified, evidence-based “appropriate-use criteria” beginning in January 2020. These are electronic tools that indicate which tests are appropriate for patients with certain medical conditions or diagnoses.

“Our goal is to assure that Penn Medicine patients receive the highest quality and most appropriate imaging exams for their conditions,” Charles E. Kahn, Jr., Penn Medicine professor and vice chair of radiology, said. “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.”

Approximately 5 percent of the gross domestic product is spent on medical tests and procedures that do not improve patient outcomes, according to the United States Congressional Budget Office.