Quality, Access, and Utilization Requirements Sample Clauses

Quality, Access, and Utilization Requirements. Physician shall ensure that Covered Per- sons receive medically necessary Covered Services in a timely and appropriate manner and that meet requirements for quality of care as reasonably established by Hospital based on industry standards. Physician must meet or exceed the BPCI ADVANCED Pro- gram Quality Metrics set forth in Exhibit C attached hereto in order to participate as a BPCI ADVANCED Program Network Physician. Hospital, with approval of Physician, reserves the right to revise the BPCI ADVANCED Program Quality Metrics set forth in Exhibit C annually as a prerequisite for continued participation in the BPCI AD- VANCED Program. Physician shall not discriminate in the acceptance or care of any Covered Persons based on health needs or status. Physician may not seek to transfer a Covered Person to a different Physician based on the degree of utilization of medical ser- vices needed by such Covered Person or based on the Covered Person’s medical condi- tion, except where required for the benefit of the Covered Person; nor may Physician limit, delay, restrict or withhold access to medically necessary services by Covered Per- sons. Physician shall comply with Hospital quality assurance programs and shall xxxxxx- ate with Hospital’s efforts to review the appropriateness of care rendered to Covered Per- sons by Physician. In the event that Hospital reasonably believes that Covered Persons are not receiving appropriate quality or access to care by Physician, or that Physician is causing the inappropriate transfer of Covered Persons due to their health status, Hospital shall have the right to terminate Physician’s participation in the BPCI ADVANCED Pro- gram.