Appropriate Use Monitoring Policy

Appropriate Use Monitoring Policy

To ensure that the operation of an AASD certified distributorship does not result in any inappropriate increases in the utilization of implanted medical devices, the American Association of Surgeon Distributors has established the Appropriate Use Monitoring Policy and Program.

Appropriate Use Monitoring Program

The decision for surgery is governed sufficiently by published guidelines, peer review, utilization review, and community medical standards.  Thus, the physician’s recommendation for surgery and implant choice is guided by these factors, not by any perceived inducement. AASD and its ePOD certified distributorships are committed to the premise that instrumentation should only be used by qualified surgeons when medically indicated.  This program is designed to monitor the medical appropriateness of implant cases when a physician member’s utilization practice profile for instrumentation increases disproportionately compared to other clinical practice indicators. It is critical to note that the data measured is generated by the physician’s clinical practice and includes all procedures without regard to whether that procedure included an implant from AASD applicant distributorship or another implant company.

As part of the initial certification and annual renewal, each applicant distributorship shall submit practice profile data elements for each Physician Member. Required practice profile data elements are based on commonly accepted procedure codes (CPT) that will be aggregated into a baseline practice profile for that surgeon.  Annually, the previous year’s data elements shall be aggregated and compared with the baseline profile and prior year.  A net change greater than 15% from the prior year that is not proportionate to non-implant related practice predictors (e.g. total patient visits) shall initiate a series of audits that will either, 1) validate the profile change and reset the surgeon’s baseline, 2) initiate a medical chart audit by an independent auditor, or 3) result in Board action which may include probation, denial of the application, or the revocation of the distributorship’s AASD certification.

Practice Profile Date Elements

  • Years in Practice and Specialty
  • Years at current primary office practice location
  • Total patient visits in previous 12 months
  • Total surgical procedure by type in previous 12 months

Independent Auditor

An independent auditor shall be required to perform all probationary and suspension reviews.  An auditor must meet the following qualifications:

  • For spine implant review: Board certified by the American Board of Neurosurgery, the American Board of Orthopedics with Spine Fellowship training, or the American Osteopathic Board of Orthopedic Surgery with Spine Fellowship training.
  • For non-spine implant review: Board certified by the American Board of Orthopedics or the American Osteopathic Board of Orthopedic Surgery.
  • Minimum of 7 years in surgical practice within the appropriate specialty.
  • In active practice and in good standing with appropriate medical licensing boards.
  • Must not perform surgical cases at any of the hospitals of the surgeon that is the subject of review.

All audit cases shall be de-identified (patient and surgeon) prior to review.

Algorithm for Monitoring Utilization Patterns of Physician Members:

Algorithm for Monitoring Utilization Patterns of Physician Members