The RAYUS Quality Institute Earns Provider Led Entity Designation from CMS
Minneapolis, MN, July 8, 2016 – The RAYUS Quality Institute, a nonprofit affiliate of RAYUS Radiology, has been designated a Provider Led Entity (PLE) by the Centers for Medicare and Medicaid Services. As a PLE, the RAYUS Institute will collaborate with AIM Specialty Health, to create and utilize Appropriate Use Criteria (AUC) for diagnostic imaging services for Medicare fee-for-service beneficiaries.
The PLE designation is granted to a select group of organizations nationwide to provide real-time clinical guidance to treating clinicians ordering diagnostic imaging procedures such as MRI, CT and PET exams for their patients.
The innovative collaboration between the RAYUS Institute and AIM allows the extensive expertise developed by AIM to be tapped by the new PLE and blended with the guidelines work done within the RAYUS Institute.
“Our history with AIM began a decade ago when our radiologists had the opportunity to review and comment on AIM’s set of imaging guidelines,” said Liz Quam, executive director of Rayus Institute. “Our skills and experience complement each other.”
“Working with the RAYUS Quality Institute allows AIM to leverage our decades of experience in clinical research and guideline development to benefit Medicare fee-for-service beneficiaries,” said Brandon Cady, president and CEO of AIM. “We look forward to partnering with RAYUS Institute on the AUC development process as well as the delivery and use of clinical guidelines.”
The unique working relationship provides evidence-based care guidance through the delivery of rigorous AUC criteria to guide clinicians to the right test at the right time. These clinicians will access this guidance through qualified Clinical Decision Support (CDS) software platforms, a PLE website and other electronic health record integrations.
“We are pleased with the intent of the federal law and have made a commitment to help implement it,” said Dr. Tom Gilbert, chief clinical officer for RAYUS and co-chair of the Institute’s PLE Committee. He said that the partnership with AIM allows for innovation in bringing continuity to the workflow for clinicians. “A primary reason to seek the PLE designation is to allow the RAYUS Quality Institute to develop and package utilization guidelines so that they are practical and easily accessed by physicians.”
Quam stressed that the RAYUS Institute “will continue to work closely with other PLEs, especially the American College of Radiology and the American College of Cardiology to ensure that the federal law is implemented successfully.” Quam has been a key player in the push for adoption of CDS over the past 10 years, including cofounding the Imaging E-Ordering Coalition and advocating for the passage of a Medicare bill in 2014, which requires treating clinicians to consult appropriateness data prior to ordering advanced imaging procedures.
Other members of the RAYUS Institute PLE committee include co-chair, Dr. Robert Kanterman, former chief of radiology for St. Luke’s Hospital in St. Louis, Missouri; Dr. Larry Cowsill, a senior medical director for the McLaren Physician Partners in Auburn Hills, Michigan and Dr. Laura Lehmann, an internist who cares for patients under the innovative clinic model developed by the Twin Cities Pipe Trades Health Fund in St. Paul, Minnesota.
About The RAYUS Quality Institute
The nonprofit RAYUS Quality Institute is located within RAYUS’s headquarters in Minneapolis, MN. The Institute is governed by a Council of 40 community and academic medical directors affiliated with RAYUS and offers guidelines development, nationwide peer review and other physician mentoring activities for more than 250 participating physicians. RAYUS Institute staff also support the charitable organization, Imaging for a Cause Foundation.
RAYUS Radiology is one of the nation’s leading providers of high-quality diagnostic imaging and interventional radiology services through its network of centers and mobile imaging solutions. The organization, with nearly 2,000 associates nationally, is committed to delivering clinical excellence in communities across the U.S. driven by its affiliated and community-based subspecialized radiologists, as well as its compassionate, safe and cost-efficient care, and superior service to referring providers and patients. For more information, visit www.rayusradiology.com.
AIM Specialty Health® provides clinical solutions that drive appropriate, safe and affordable care. Serving more than 45 million members across 50 states, D.C. and US territories, AIM promotes quality care through use of evidence-based medicine guidelines, provides consumer value and delivers significant cost of care savings in radiology, cardiology, oncology, specialty drugs, sleep medicine, musculoskeletal and pain management, and genetic testing. As a national leader in specialty benefits management, AIM positions health plans, providers and employers to deliver on the promise of quality improvement in health care through an integrated suite of solutions combining clinical excellence, technology and superior customer service. AIM is a wholly owned subsidiary of Anthem, Inc. (ANTM). For more information, visit www.aimspecialtyhealth.com.