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  • Meaningful Use not Entirely Meaningful for Radiology

    February 01, 2011

    While the vast majority of radiologists are eligible for federal "meaningful use" incentives for adopting health information technology (HIT), organized radiology contends the provisions are not directed at the specialty and is urging federal agencies to revisit the recommendations.

    More than 90 percent of all radiologists are considered eligible for some of the more than $20 billion in health information technology (HIT) incentives up for grabs under the meaningful use policy issued by Centers for Medicare & Medicaid Services (CMS) as part of the 2009 American Reinvestment and Recovery Act. Registration for meaningful use got under way Jan. 3 in the first of a three-phase rollout of the program.Listen In as Dr. Dreyer discusses the origins of meaningful use.

    However, radiologists have "a big hill to climb" in qualifying for incentives under the current rules, according to Keith Dreyer, D.O., Ph.D., vice-chair of radiology for informatics at Massachusetts General Hospital and an associate professor of radiology at Harvard Medical School in Boston. Listen In as Dr. Dreyer discusses criteria for radiology.

    Meaningful use provisions are geared primarily toward primary care physicians, according to Dr. Dreyer, a member of RSNA's RadLex Steering Committee and chair of the American College of Radiology (ACR) IT and Informatics Committee-Government Relations Subcommittee. Since its inception—and most recently in January—ACR has urged the Office of National Coordinator for (ONC) HIT Policy Subcommittee to revisit the meaningful use vision for radiology.

    "Because the first phase of the provision does not apply to radiology in any meaningful way, we requested a number of changes that we hope will redirect the focus of meaningful use as it applies to the daily practice of radiology," Dr. Dreyer said.Listen In as Dr. Dreyer discusses organized radiology's push for changes.

    For example, under Phase 1, which requires physicians to have a certified electronic health record (EHR) that meets federal eligibility requirements, criteria include meeting the 15 "core" measures, five of 10 "menu" measures and six of 44 "quality" measures, each with specific objectives. Even though radiologists may be excluded from a number of these measures, they are still required to use certified EHR technology that meets all 25 meaningful use objectives—even those from which they're excluded.

    "Why buy IT-based equipment you are not going to use?" Dr. Dreyer asked. "Practitioners should be allowed to only purchase certified technology for the measures from which they are not excluded. This is one issues that several specialties, including radiology, are pushing hardest on." Listen In as Dr. Dreyer discusses equipment criteria under meaningful use. 

    Criteria Presents Obstacle to Funding

    The money at stake is not insignificant. Qualifying physicians who meet the requirements stand to receive as much as $44,000 in incentive package dollars. Panelists at the RSNA 2010 informatics session, "Healthcare Reform Through Meaningful Use of Healthcare IT: Implications for Radiologists," also spoke of how radiologists are at something of a disadvantage in terms of meeting criteria required to receive that funding.

    "While the law did not exclude radiologists, it turns out that these measures are not necessarily friendly to radiologists," said presenter David Mendelson, M.D., a professor of radiology and director of radiology information systems at Mount Sinai Medical Center in New York City. "They are not really directly relevant to the things we do on a daily basis."

    "It is highly unlikely this money will go into the pockets of individual radiologists," said presenter Ramin Khorasani, M.D., director, information management systems at Brigham and Women's Hospital. "How the dollars will be spent is going to be very much determined by your employer. You may need to spend those dollars to meet the meaningful use requirements."

    EHRs are one example of where radiologists face more of a challenge in meeting the criteria, Dr. Mendelson said. "The traditional electronic medical record systems that are going to get certified, for the internists and the surgeons, are different than the systems we use, which are RIS and PACS generally," he said. "You have to have a certified system to qualify."

    Radiologists should be working with vendors to get their current systems certified or to purchase new IT equipment that meets federal standards, Dr. Dreyer said. Products that don't meet certification criteria can be submitted on a modular basis, he added. "Any IT technology can be submitted for certification," Dr. Dreyer added.

    Another clause in the law states that hospital-based physicians do not qualify for the incentives, which could exclude many radiologists working at academic centers. Place of service billing codes are essential in determining whether or not a physician is considered hospital-based—if 90 percent of a physician's work is coded with 21 (inpatient) or 23 (emergency room), that physician is considered hospital-based.

    This formula has interesting ramifications for radiologists, Dr. Mendelson said. "In many academic centers, interpretations are made in both inpatient and ambulatory settings," he said. "The key is to make sure you've documented that correctly, because if you fall below that 90 percent cutoff, you may qualify for the stimulus money."

    Radiologists should also be aware of which criteria they are not expected to meet, Dr. Mendelson said. For example, a measure in the law calls for electronically prescribing at least 40 percent of the prescriptions written. The requirement does not apply, however, to physicians who write fewer than 100 prescriptions per year.

    "Most radiologists will not be writing 100 prescriptions per year," Dr. Mendelson said. "So there's a measure we might be able to exclude." 

    Phases Increasingly Complex

    While the details are still being worked out, Dr. Dreyer cautions that Phases 2 and 3, set to begin in 2013 and 2015 respectively, will add more requirements to the progressively challenging program.

    Although it is technically a voluntary program, noncompliance in 2015 and beyond will result in payment reductions for those who are eligible, Dr. Dreyer said.

    "We are hoping to be able to include more radiology-related measures by the time they release rules for Phase 2," Dr. Dreyer said. "And there could be more phases added after Phase 3. This is not going to go away."

    On the bright side, radiology's early involvement in HIT puts the specialty at something of an advantage over those physicians just beginning to implement the process.

    "Radiologists have historically been at the forefront of HIT," said presenter David Avrin, M.D., Ph.D., vice-chair of informatics in the Department of Radiology at the University of California, San Francisco. "We are the solution, not the problem."

    Listen In

    In an interview with RSNA News, Keith Dreyer, D.O., Ph.D., discusses meaningful use requirements, the impact on radiology, working with vendors, potential revisions to the rules and the timeline for participation in the program.

    Websites Helps Decipher Meaningful Use

    Meaningful Use for Radiologists (radiologyMU.org) is an online tool that provides objective information about meaningful use criteria and quality measures as they relate to medical imaging. Features include Meaningful Use Practice Analyzers to help determine eligibility, practice-specific technical requirements and provide a better understanding of the financial impact of the incentive programs on an individual practice.

    Other websites offering meaningful use information include:

    Keith Dreyer, D.O., Ph.D. (clockwise from top left), David Mendelson, M.D., Ramin Khorasani, M.D.
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