The American Institute of Medicine in conjunction with most of the specialty boards have compiled a list of procedures that are considered unnecessary and or over-utilized when used outside of appropriate care parameters. Clinigence Health has identified a growing number of Choosing Wisely criteria that can be measured from our present data sources and visualized on our platform. The report can be filtered by PCP and procedures to obtain the next level of detail regarding these procedures.

 

 

Target Audience for this Report 

Chief Medical Officer, Compliance & Regulatory Department, Finance Department and CFO, Leadership Team, Physician Relations, and Quality Management.

 

Business Processes Impacted by this Report

Choosing Wisely is a “best medical practice” type report and identifies tests and or treatments that when performed outside of accepted best medical practices are not necessary based on input from specialty boards and the American Institute of Medicine.  The medical affairs department and the CMO will make primary use of the report to effect a change in use of resources at the PCP level.

 

Detail and Definitions

The procedures (and associated categories) driving this report are identified in a table called “Commonly Over Utilized Procedures” (COPS) and are available for review in Appendix D.  

 

Header

  • Choosing Wisely Procedures
  • Servicing Providers
  • Patients
  • Savings Opportunity

 

Primary Care Providers

  • PCP
  • PCP Name
  • Paid
  • % OverUt.
  • Avg Risk

 

Service Category & Type

  • Service Category and Type
  • Total Paid

 

Cost By Procedure

  • Procedure
  • Paid
  • Procedures/1000

 

Procedures by Choosing Wisely Group

  • Group
  • Paid
  • % of Procedures