Weill Cornell Physicians Organization (WCPO) has the privilege of authoring appropriate use criteria (AUC) as a Provider Led Entity (PLE) under the rules set forth for the Protecting Access to Medicare Act of 2014 (PAMA).
AUC are created by multidisciplinary panels that under the requirements of the AUC program are comprised by a minimum of seven participants including at least one practicing physician with expertise in the clinical topic, related to the appropriate use criterion being developed or modified, at least one practicing physician with expertise in the relevant imaging studies, related to the appropriate use criterion, at least one practicing primary care physician (as described in sections 1833(u)(6),1833(x)(2)(A)(i)(I), and 1833(x)(2)(A)(i)(II) of the Act) and experts in clinical trial design and statistical analysis.
These multidisciplinary panels autonomously create and modify the criteria in their area of expertise. Panels report to an oversight committee tasked with assigning topics, maintaining membership of the panels, and monitoring progress.
Our multidisciplinary panels are required to perform literature searches related to the clinical condition/imaging that is being considered and is responsible for identifying relevant scientific studies, meta-analyses, reviews and published professional society guidelines.
These panels are responsible for creating criteria for specific clinical presentations based on their review of the literature and professional society guidelines as well as incorporating their own expertise/local best practices. The Weill Cornell criteria are constructed to provide advice on what (if any) advanced imaging may be required as well as to direct ordering providers to ordering the safest and most optimal type of imaging. AUC are adopted based on consensus of a majority of the panel members.
Each recommendation is based on specific scientific studies/reviews/consensus and/or local best practices. When available, the evidence used to construct AUC is scored using a published and widely accepted evidence scoring system (Oxford 2011 or GRADE).
If no evidence is available and the AUC is based on local expertise/best practice this will be clearly indicated.
This review of the evidence is available on the AUC source documentation.
Our AUC are translated into digital logic and implemented by vendors with Qualified Decision Support Mechanisms (QDSMs) who have licensed our criteria.
Once published, our AUC are reviewed by the appropriate panel at a minimum frequency of once annually. This includes identification of any additions to the literature as well as feedback from practices that have implemented our criteria.
Current versions of the AUC are available on our website and contain scoring of the references/evidence, the members of the panels who have contributed to the AUC, and any potential conflicts of interest that may exist.
