Qualifications

Participation in Gateway Quality Physician Alliance (GQPA) is an opportunity available to any person practicing medicine as a physician or any medical entity through which a participating physician is employed.

Status as a participating physician in GQPA will be limited to good-standing physicians on the medical staff of SSM Health or independent physicians approved by the Board of Managers due to the need for access to specialty or primary care services or due to the practice patterns of such physician.

Additional participating requirements include:

  • High speed internet access in the physician's office
  • Actively used email addresses for the physician and appropriate support staff
  • Electronic claims submission capability 
  • A signed and current Network Participation Agreement
  • Participation in clinical integration information system training as prescribed by the GQPA Board of Managers
  • Use of CPT 2, ICD-9 or other successor billing methodologies that provide standardized billing codes to record quality and process measures
  • Leadership skills and advocacy for Clinical Integration principles among physician peers
  • Willingness and ability to provide sufficient data, in the opinion of the Board of Manager, to allow an adequate review of the physician's compliance with GQPA quality standards
  • Approval of the application for admission by the GQPA Board of Managers
  • Allow GQPA to negotiate contracts with payers on their behalf according to payer contracting policies approved by the Board of Managers and available to participating physicians

In order to continue as a participating physician within GQPA, a physician must actively participate in the GQPA Clinical Integration Program (CIP) including performance relative to the clinical initiatives approved by GQPA, as well as continue to meet all of the participation criteria as described in this policy.

A physician who otherwise meets the standards set forth above shall no longer qualify for participation in GQPA if he/she has been or becomes excluded from participation in Medicare, Medicaid, or any other federal health care program. Disqualification for membership is to be limited to the duration of exclusion from the aforementioned program. Physicians excluded from a private payer program shall not automatically be excluded from participation. In such circumstances, participation is subject to review and approval from the GQPA Board of Managers.