Memorial Sloan Kettering Is Designated as a Qualified Provider-Led Entity under the Protecting Access to Medicare Act

New York, NY - Memorial Sloan Kettering Cancer Center (MSK) has become the first dedicated cancer center in the U.S. to be designated a qualified provider-led entity (QPLE) under the Medicare Appropriate Use Criteria (AUC) program. This designation allows MSK to establish best practice standards for the use of CT, MRI and nuclear medicine imaging from initial screening and diagnosis through all stages of cancer care, including survivorship.

Effective January 1, 2019, healthcare professionals throughout the country will be required to consult appropriate use criteria (AUC) when ordering advanced diagnostic imaging tests such as CT scans, MRIs, or nuclear medicine scans (such as PET scans) for Medicare recipients. However, the imaging and treatment requirements for oncology patients are often very different from those required for other patients. As a QPLE, MSK is now authorized to develop AUC specifically for cancer patients that will help set the standards for advanced imaging of these patients nationwide. With this designation, they may also endorse or propose modifications to existing AUC created by other entities.

MSK’s multidisciplinary Imaging Disease Management Teams (IDMTs) are charged with defining the AUC for specific clinical domains. While MSK’s initial focus is on the Priority Clinical Areas (PCAs) as defined by the Centers for Medicare and Medicaid Services (CMS), the development of AUC for advanced diagnostic imaging will expand to address the full range of clinical conditions most relevant to patients with cancer. The AUC will also be continuously re-evaluated to ensure that they reflect the latest evidence and state-of-the-art clinical practice.

Comments and Quotes

“We are thrilled that MSK has become the first dedicated cancer center to obtain this CMS designation as a Qualified Provider Led Entity under the Medicare AUC program,” said Jeremy Durack, MD, MS, Vice-chair of Information Technology, Quality, Safety, and Performance Improvement for the Dept of Radiology at MSK. “We see this as a wonderful opportunity for MSK physicians from all medical disciplines to contribute their expertise to the creation of appropriate imaging criteria that will advance cancer care across the care continuum.” Peter Stetson, MD, MA, MSK Chief Health Informatics Officer, added, “Collaborating with our partners and vendors to deliver our cancer imaging best practices through advanced informatics tools, we can ensure value for our patients with high-quality and actionable decision support for our care teams.” Hedvig Hricak, MD, PhD, Chair of the Dept of Radiology at MSK stated, “Our goal is to share knowledge to improve health outcomes for cancer patients nationwide. Now that we have been entrusted as a QPLE, we have a stronger voice and a greater opportunity to be a standard bearer for high-quality oncology care.”

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Background

To be qualified by CMS, a PLE must adhere to the evidence-based processes described in 42 CFR 414.94(c)(1) when developing or modifying AUC. PLEs must apply to CMS to become qualified. The application must include a statement as to how the entity meets the definition of a PLE and document adherence to each of the qualification requirements.

Passed in 2014, the Protecting Access to Medicare Act (PAMA) initially required all Medicare providers who order advanced images for a Medicare enrollee to use imaging Clinical Decision Support (CDS) with reporting of compliance to CMS. The CDS ambulatory requirements mandate is now January 1, 2019.

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