SEMPI Accredited as Qualified Provider-Led Entity by CMS for Advanced Diagnostic Imaging Services

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Nonprofit supports enhancing quality of care through latest evidence-based knowledge

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“We are proud to be acknowledged by CMS, allowing us to provide more robust content, and latest evidence-based knowledge to help enhance the overall quality of care through appropriate advanced diagnostic imaging services.”

Sage Evidence-based Medicine and Practice Institute (SEMPI), a nonprofit provider-led entity using evidence-based medicine to improve healthcare delivery, announced that it has been accredited as a qualified provider-led entity (PLE) for purposes of developing, modifying or endorsing appropriate use criteria (AUC) as required under 414.94(b) and (c) Center for Medicare and Medicaid Services’ (CMS) proposed rule for calendar year 2018.

Through this qualification, CMS – the nation’s largest health payer – recognized SEMPI as an organization that is qualified to develop AUC for all eight current priority clinical areas fulfilling the requirements of the 2014 Protecting Access to Medicare Act (PAMA).

“We are proud to be acknowledged by CMS, allowing us to provide more robust content, and latest evidence-based knowledge to help enhance the overall quality of care through appropriate advanced diagnostic imaging services,” said Ayis Pyrros, MD, Chair, SEMPI.

Passed in 2014, 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. In addition, the implementation of a qualified CDS mechanism (CDSM) can be used to meet the MACRA Improvement Activities requirements for improving quality scores.

PAMA also requires that AUCs developed by qualified PLEs for outpatient-advanced diagnostic imaging services are made accessible to the practicing healthcare professionals through a qualified CDSM. To this end, all the priority areas are available at http://www.sempi.org and hyperlinked with any qualified CDSM that has licensed its clinical content.

PAMA also included new process requirements for qualified PLEs to develop evidence-based AUC and established a process for organizations to apply to become qualified PLEs. To be qualified by CMS, a PLE must adhere to evidence-based processes to “develop AUC, modify AUC developed by another qualified PLE or endorse AUC developed by other qualified PLEs.” SEMPI has chosen the GRADE methodology for determining the strength of the recommendation and quality of the evidence as reviewed by clinical content experts.

SEMPI has licensed its clinical content to Sage Health Management Solutions, Inc.® for the RadWise® qualified CDSM providing EHR-integrated evidence-based, symptom driven recommendations.

About SEMPI
SEMPI is a nonprofit, 501(c)4, headquartered in Minneapolis, MN. The professionals serving on the clinical review panels, however, represent many practicing professionals across the United States, who are interested in the goal of using evidence-based medicine to improve the practice of medicine for the benefit of patients and the community. The panelists also practice in a broad array of organizations , including the military, academic health institutions, private practices, Evidence-based Practice Centers, clinics, and hospitals. To learn more about SEMPI, click here.

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Matthew Langan
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