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Welcome to the CDI Quality Institute’s Provider Led Entity

In June of 2016, the Centers for Medicare and Medicaid (CMS) named the CDI Quality Institute as one of the qualified Provider Led Entities (PLE) to assist in fulfilling the ambitious mandate in the 2014 federal Protecting Access to Medicare Act. The mandate will better assure that all Medicare patients receive the right imaging test at the right time.

The Institute’s governing board of physicians is devoted to developing appropriate use criteria (AUC) based on clinical evidence that is also of practical use for community-based physicians.

Below, please find answers to questions you may have about our Provider Led Entity.

We welcome you to our website and invite you to check back to our site in the coming months as we add finalized Appropriate Use Criteria (AUC). Our goal is to be transparent to those interested, so please contact the PLE Administrator, Erik Rockswold, or Institute Executive Director, Liz Quam, if you have questions or seek further information.

The CDI Quality Institute (Institute) began in 2003 as a cooperative activity of independent radiologists who are affiliated with medical imaging centers managed and operated by the Center for Diagnostic Imaging, Inc. (CDI). Initially, as an unincorporated nonprofit association, these radiologists cooperated to peer review the professional radiology services that each provided to patients as a means to improve care and differentiate their services in the market. They also established methods for sharing best practices across geographic areas. In order to better address state statutory requirements for professional review organizations and in response to payer accreditation peer review requirements, the Institute was incorporated as a Minnesota non-profit corporation under Minnesota Statutes Section 317A on January 29, 2013. The corporation has no capital stock.

The Institute has the following purposes:

  • To develop and advance the science and art of medicine and medical education;
  • To promote the public health;
  • To provide continuous quality improvement, peer review and mentoring to the radiologists associated with CDI and InSight Imaging, an affiliated company to CDI;
  • To encourage and foster the spirit of fellowship and cooperation among its members; and
  • To pursue any lawful purpose related to the purposes above.

The Institute is governed by a Board of Directors known as the Council of Medical Directors (Council). The Council is made up of medical directors and/or leaders of primarily radiology practices affiliated with CDI and InSight facilities, with each Medical Practice responsible for appointing one Director. The Council has an Executive Committee composed of the Institute Executive Director and radiologist leaders who have been elected National Section Leaders by the Council because of their sub-specialty expertise. The Council meets annually to address common clinical concerns and to formally assess peer review activity.

Guideline Development
The Institute and its Member physicians are involved in the development of Clinical, Practice and Procedural Guidelines to foster continuous quality improvement of radiology and related services. These Guidelines are evidence-based guidelines intended to facilitate the use of Best Practices for radiology and related services and provide continuity in the provision of these services, including analysis and development of multi-disciplinary care pathways for conditions commonly involving advanced imaging services.

In addition to a robust peer review program conducted across 25 states through a customized software, the Institute facilitates mentoring of individual Member physicians by other Member physicians. Using the Institute’s RQM® portal and system, as well as direct observation and over-reading, individual Member physicians can receive intensive one-on-one, 100% case review for a set period of time and continued mentoring and instruction by other Member physicians with more or different expertise. This mentoring process facilitates providing better and more accurate interpretations and more effective procedures. The mentoring program also allows current physicians to learn additional skills, which may not otherwise be available in their communities. This process both advances the profession and individual practices. Approximately 240 physicians are invited participants in the RQM® programs.

The Institute receives support from CDI Management Corporation’s donation of funds, staff, equipment, including exclusive use of the RQM® software and office space. CDI Management Corp. is a wholly owned subsidiary of the Center for Diagnostic Imaging, Inc. It is anticipated that CDI Management Corp. will continue to be a primary source of funding in the future.

The CDI Quality Institute serves as the provider-led entity (PLE) and the Institute’s PLE Multi-Disciplinary Committee serves as the multi-disciplinary team. Certain functions and responsibilities are performed by contract with third parties.

2018 Multi-Disciplinary Committee Members:

Thomas J. Gilbert, MD, MPP – Chair

Robert Liddell, MD - Vice Chair

Lawrence Cowsill, DO

Robert Y. Kanterman, MD

Vincent Mathews, MD, FACR

Steven R. Pollei, MD

Elisabeth A. Quam

Michael Finch, PhD

Paul Allegra, MD

Under formal resolution by the CDI Quality Institute’s Council of Medical Directors, the PLE Multi-Disciplinary Committee is a free-standing committee within the Institute, created for the purpose of administering all of the functions of the multi-disciplinary team as set forth in the federal regulations. This structure provides for the necessary transparency, autonomy and accountability in carrying out this responsibility. The PLE Multi-Disciplinary Committee has the following characteristics:

  • Members have been appointed by the Executive Committee from among the Members of the Council and employees of the Medical Practices that participate in the Institute, or from affiliated entities where there has been a demonstrated commitment to high quality, community-based health care services as well      as for their independent professional judgment. These members serve indefinite terms, subject to removal for good cause and upon two-thirds vote of the Executive Committee. 
  • Statistical Analysis support is provided by Michael Finch, PhD.


  • The PLE Multi-Disciplinary Committee’s determinations will not be subject to modification or rejection by The CDI Quality Institute, its Members, its Executive Committee or any other party.

The CDI Quality Institute and CDI have a decades-long history of pursuing public policy and medical practice solutions which add value to our patients and partners. The use of clinical decision support tools documents that the right test is done at the right time – and that is a good thing for ALL patients, not just those covered by the federal Medicare program. Therefore, the CDI Quality Institute continues to strive to build bridges which address the challenges of prior authorization for treating clinicians and their patients who are not covered by Medicare.

The CDI Quality Institute and AIM Specialty Health are building one of these bridges; it has a wide and high span and therefore will take some time to complete!

  • The Institute is undertaking its AUC development work in collaboration with AIM Specialty Health (AIM).
  • AIM is a leading specialty benefits management company. For the past 30 years, AIM has developed appropriateness criteria for advanced radiology, which are integrated into a review system available online for providers to use through a secure online portal. AIM is accredited by both NCQA and URAC and meets the standards for clinical criteria development established by each of these organizations.
  • AIM has a proven internal process for the development of evidence-based criteria. A primary element of that established process, systematic literature review, is used to support the work of the Institute. For the purposes of this collaboration, AIM provides the Institute PLE Multi-Disciplinary Committee with the literature search results for evaluation in the sole discretion of the PLE Multi-Disciplinary Committee. The subsequent development and modification of AUC is undertaken exclusively by the Institute’s PLE Multi-Disciplinary Committee, and this committee does not endorse any guidelines created specifically by AIM. The autonomous responsibility for developing AUC is firmly vested in the PLE Multi-Disciplinary Committee.


The Multidisciplinary Committee is the initial and final authority on all Appropriate Use Criteria. For each clinical topic area, the Multidisciplinary Committee convenes subject expert panels, consisting of the individuals listed below, to provide an additional level of review and advice on current evidence- and consensus-based practices.

With the Institute’s commitment to prioritize areas of most use to community-based physicians while also adhering to the spirit and intent of the PAMA law and implementation regulations, the following Appropriate Use Criteria (AUC) areas have been developed:

Priority Clinical Area: Low Back Pain (Updated March 2018)

Priority Clinical Area: Cervical/Neck Pain (Updated March 2018)

Priority Clinical Area: Shoulder Pain (Updated May 2018)


Priority Clinical Area: Suspected Pulmonary Embolism (Updated August 2018)


Priority Clinical Area: Headache (Updated September 2018)

Priority Clinical Area: Hip Pain 

Abdomen/Pelvic Imaging


Renal/Kidney Calculus 


Knee Pain



  • PICO-model AUC Questions

  • Panel Experts:
    • Paul Allegra, MD, Cuyuna Regional Medical Center Emergency Department Director; MN
    • Lawrence Cowsill, DO, Internist; McLaren Healthcare, MI
    • Thomas Gilbert, MD,MPP, CDI Chief Clinical Officer and PLE Chair
    • John Lynch, MD, Associate Professor and Division Chief, Stroke, Neurointervention and Critical Care; Medical College of WI
    • Kishan Yalavarthi, MD, Neuroradiologist; CDI, St. Louis

Multiple Sclerosis


Neurocognitive Disorders


The Institute’s PLE process includes a calendar of due dates for the following steps:

1. Development of the PICO-model AUC questions.  PICO is an evidence-based model to define a clinical question in terms of the specific issue.  PICO is an acronym:

P = patient, population or problem

I = intervention, prognostic factor or exposure

C = comparison/intervention

O = outcome/measure to be accomplished

2. Approval of PICO questions by the Multi-Disciplinary Committee

3. Review of relevant literature with preliminary grading, using the ADAPTE method.  This is done by AIM.  ADAPTE Collaboration has developed a systematic approach to aid in the adaptation of guidelines.  The process has three phases.  First is Set-Up.  Second is “Adaptation Phase” and it includes the following steps:

Define questions

Search and screen guidelines

Assess guidelines

Decide and select

Create guideline table (for PLE review)

4. Finalization of the guideline/AUC

As is Step 1, Step 3 is a PLE responsibility.  Step 3 is the “external” review of the Step 2 process as outlined above. It may include additional literature review and updates as well as production of the final guideline/appropriate use criteria.  To date, the CDI Quality Institute’s Mult-Disciplinary Committee, the Expert Subject Panels and AIM have been adhering to the above processes very closely.

For more information on our process or dates which have been set (and sometimes change) for accomplishing each step for each 2017 priority area, please feel free to contact Erik Rockswold, PLE Administrator or Liz Quam, Institute Executive Director.

Thank you for your interest in our PLE activities!


Quality Institute PLE Reference Page

Quality Institute PLE PICO Structure

Quality Institute PLE Quality Evaluation for a Body of Evidence

Quality Institute PLE Strength of Recommendations



The CDI Quality Institute and our PLE have a robust policy to address the issue of actual or perceived conflicts of interest.  The policy was reviewed and approved by the Federal government as part of our qualification process.  Any director, principal officer or member of the PLE Committee, or any person who participates in the Committee’s efforts to develop or modify AUC is subject to this policy.  Persons subject to the policy must disclose (and update) any ownership, investment, compensation or other financial interest with a broad range of stakeholders and are subject to exclusion from participation in the AUC development process based on certain criteria.  The policy is implemented and overseen by the PLE Administrator. 

  • To read our Conflicts of Interest Policy, click here
  • To view our Conflicts of Interest reporting form, click here

© Center for Diagnostic Imaging, 2017

For more information:

Erik Rockswold, MHA, MA
PLE Administrator, CDI Quality Institute

Liz Quam
Executive Director, CDI Quality Institute

Thomas J. Gilbert, M.D., M.P.P.
Chair, CDI Quality Institute PLE
CDI Chief Clinical Officer