On June 30, the Centers for Medicare & Medicaid Services (CMS) announced that the Johns Hopkins University School of Medicine has been designated a so-called “qualified provider-led entity.” This allows Johns Hopkins to develop criteria that meet the requirements of the federal Protecting Access to Medicare Act of 2014 when ordering diagnostic imaging tests such as computed tomography (CT) scans, MRI scans and nuclear imaging in the emergency department and ambulatory settings. Johns Hopkins joins 21 other institutions across the nation that CMS has formally approved to design these criteria.
“We are honored by this approval, as it dovetails nicely with our effort to improve the value of medical care in our health system and across the nation,” says Pamela Johnson, M.D., vice chair of quality and safety in the Department of Radiology, professor of radiology and radiological science at the Johns Hopkins University School of Medicine and director of the High Value Practice Academic Alliance. “Our goal is to deliver health care of the highest quality, safety, efficiency and effectiveness for our patients. By helping doctors and advanced practice providers use evidence in the literature at the point of care to know which tests to order, which treatments to prescribe and when patients can safely be discharged from the emergency department, we aim to avoid unwarranted variation in care and avoid unnecessary use of medical resources that does not add value, while delivering the best outcomes for our patients.”
Physicians learn best practices during their training. However, as health care and technology evolve and improve, medical best practices also must change. And while professional societies publish clinical practice guidelines annually, adopting change can be slow. “Studies estimate that it takes an average of 17 years for new evidence in the literature to translate into changes in practice by the greater medical community,” says Johnson. “We wanted to skip that 17 year delay and improve health care quality as quickly as possible so our patients start benefiting right away.”
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Even before the Johns Hopkins University School of Medicine was designated a qualified provider-led entity, Johnson and colleagues had established teams of physicians from multiple specialties to review primary medical literature and identify the best data to use to design the criteria. After mining the data and writing the criteria, the Johns Hopkins teams integrated them directly into diagnostic decision-making guidelines in the electronic medical record system used by the hospitals and ambulatory practices in the Johns Hopkins Health System. From the electronic medical record system, clinicians can access calculators, forms, consultation guides, videos and other resources to make it easier to locate the latest knowledge and best practices when they diagnose and treat patients. To optimize care delivery for each patient, decision trees guide selection of tests and treatments according to clinical symptoms.