October 30, 2012
Editor's Note
While primary care continues to be the main focus of the federal meaningful use (MU) healthcare incentive program, the final rule for Stage 2 of MU integrates imaging into the process in ways that Stage 1 did not. Objective-level exclusion opportunities added to the final rule should even make MU compliance easier for radiologists, experts say.
"Overall, there are some very good wins here for radiology and it should be easier for radiologists to participate in Stage 2 than Stage 1," said Keith Dreyer, D.O., Ph.D., vice-chair of the Department of Radiology at Massachusetts General Hospital, Boston, chair of the American College of Radiology (ACR) IT and Informatics Committee and the ACR Government Relations Subcommittee and a member of RSNA's Radiology Informatics committee. "The majority of ACR's recommendations were included in the final rule of Stage 2."
The inclusion of imaging is especially meaningful for radiologists. "This is the first time that images themselves are now included in meaningful use measures and objectives," Dr. Dreyer said.
Imaging will be one of six menu objectives for eligible professionals (EPs) in the Stage 2 final rule (three must be met). Stage 2 also contains 17 core objectives for a total of 23 objectives; 20 must be met for Stage 2 compliance. Stage 1 contains 15 core objectives and 10 menu objectives (five which must be met) for a total of 25; 20 must be selected for Stage 1 compliance.
Although not all objectives and measures align perfectly with radiology, the Stage 2 final rule offers exclusion opportunities that may benefit the specialty, Dr. Dreyer said.
For example, the final rule offers flexibility in the definition of the terms "office visits" and "seen by EP" and increases use of those terms throughout the regulations providing reduced patient population requirements for numerous MU objectives, far reducing the workload required for program compliance.
The final rule also changes exclusions for the vital signs measure to include a separation of height/weight exclusion from blood pressure exclusion. Meaning, in 2013, if an EP determines that blood pressure is not relevant to his or her practice but height/weight is (as possibly may be the case in CT, MR imaging or PET examinations), that EP may opt out of recording blood pressure —currently a challenge for many radiology groups seeking compliance.
The final rule issued by CMS impacts imaging in other key areas.
To qualify for meaningful use incentives, eligible professionals must order more than 30 percent of radiology procedures using a computerized provider order entry (CPOE) during the electronic health record (EHR) reporting period. CMS originally proposed a 60 percent threshold, signaling a desire to increase this threshold in future stages. Physicians who write fewer than 100 radiology procedure orders during an EHR reporting period are exempt from this requirement.
The final rule doesn't require providers to store imaging results in an EHR so that images are available for download and transfer to third parties, as was presented in the proposed rule, but again, this concept may appear in future stages of meaningful use.
CMS also modified its proposal that more than 40 percent of all tests ordered by eligible providers that result in images have the images accessible through their certified electronic health record technology (CEHRT). In its final rule, CMS revised the threshold to more than 10 percent of all imaging tests be accessible through CEHRT—easing the imaging to EHR integration for all eligible providers, but delivering a powerful message to providers regarding the agency's position on the importance of imaging data in the electronic health record.
The final rule also includes a significant hardship exception that allows radiologists—as well as anesthesiologists and pathologists—to apply for exemption from MU penalties, giving these providers the ability to avoid noncompliance penalties temporarily.
While this is an important safety net for radiologists in difficult situations, Dr. Dreyer points out that the exception also precludes them from taking advantage of federal meaningful use incentives. "It also takes radiologists off the road that the rest of healthcare is quickly moving down, so I would only consider this exemption if complying with the program is not an option," he added.
Regardless of when they start, all providers must achieve meaningful use under the Stage 1 criteria for two years before moving to Stage 2, Dr. Dreyer said, "Therefore, we must all follow a similar path for our first two years of participation, regardless of when they occur."
As of October 1, 2012, CMS reported over half of all eligible professionals are registered for the MU program, yet (while specific specialty data is less frequently reported) data from August 2012 suggests that less than a thousand radiologists were participating at that time. With the vast majority of radiologists yet to begin their participation in the program and the opportunity for incentives diminishing over the next several years, knowledge of Stage 1 (and, now, Stage 2) remains critical for radiologists to quickly acquire.
The final rule of Stage 2 for meaningful use and changes to Stage 1 provided by the final rule are available here.