University of California Certified by Center for Medicare & Medicaid Services

The University of California (UC) has been certified by the Center for Medicare & Medicaid Services (CMS) to create appropriate use criteria for imaging: rules that define when it is appropriate to use powerful but expensive methods of imaging such as CT, MR and nuclear medicine. To be deemed appropriate, the expected health benefits from a procedure must exceed expected health risks.

This certification as a qualified provider led entity (QPLE) will make the rules created by UC valid under the requirement for computerized clinical decision support that is part of the 2014 Protecting Access to Medicare Act (PAMA). The rules created by UC will be publicly available at qple.ucop.edu and will be considered valid for any healthcare entity in the country.

The effort to become certified involved a team from across the five medical campuses of UC—Davis, San Francisco, Los Angeles, Irvine and San Diego—led by Dr. John Mongan of the UCSF Department of Radiology and Biomedical Imaging.

UC is one of only 11 entities nationally to be certified as a QPLE. It is also one of only seven healthcare delivery organizations to be certified; the rest of the entities are national medical specialty societies. This certification represents recognition of UC’s leadership in effective, judicious and appropriate use of medical diagnostics and treatments, and demonstrates its commitment to combining technology with evidence-based medicine to improve the cost-effectiveness and quality of healthcare.