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RSNA 2012: Radiology meaningful use attestation tougher than it looks

RSNA 2012 attendees say choosing to pursue radiology meaningful use is a thorny decision for inpatient and outpatient facilities and practices.

CHICAGO -- Few radiologists have taken up the federal government's offer for meaningful use EHR incentives. Of roughly 30,000 U.S. radiologists, 90% are eligible but only 150 attested to radiology meaningful use in 2011, according to data from the Centers for Medicare & Medicaid Services, which projects that 850 more will attest in 2012.

However, several leaders of radiology groups here at the Radiological Society of North America (RSNA) 2012 annual meeting indicated they know of large groups that recently attested or are about to attest. They felt the CMS projection was conservative.

Fewer than 10% of radiologists will have attested for stage 1 by year's end, and they can't just skip stage 1 and go directly to stage 2.

Still, it's probably safe to say that fewer than 10% of radiologists will have attested for stage 1 by year's end, and they can't just skip stage 1 and go directly to stage 2. The program requires that a hospital or provider attest to stage 1 for two full years before moving to stage 2. It's getting late, then, to avoid Medicare and Medicaid reimbursement penalties associated with avoiding meaningful use. Physicians who are eligible for incentives but don't attest are subject to reimbursement reductions.

One major reason radiologists and their specialist peers in pathology and anesthesiology, among others, might delay meaningful use adoption is their five-year exemption from Medicare and Medicaid penalties. Because these specialists don't see a lot of their patients face to face, and therefore have a tough time collecting data related to clinical quality measures, the CMS delayed their penalties until 2020. That is the maximum delay the regulatory rulemaking process allowed, according to RSNA speakers familiar with the process.

Other speakers said they were adopting meaningful use -- even though they didn't want to -- because they suspected the CMS would change its mind and reduce the delay because of fiscal instability in the federal government and deficit hawks looking to find revenue to reduce budget shortfalls.

Attesting to radiology meaningful use probably will be easiest for hospital radiologists, said David Weis, M.D., of the Carilion Clinic in Roanoke, Va., who convinced his health system's administrators to add radiology to the incentive program. That's because the hospital is already using an electronic health record that is certified for meaningful use by the Office of the National Coordinator for Health IT, and already collects the clinical and demographic data from patients that the incentive program requires, even before the radiologist reads a scan.

Curtis Langlotz, M.D., vice chair for informatics in the department of radiology at the University of Pennsylvania Health System (UPHS), pointed out that the records-sharing facet of meaningful use might come easier for hospital-based radiologists. Like UPHS, hospitals attesting for radiology meaningful use incentives are likely to have a compliant Web portal where patients can quickly download radiology test results. There's less likely to be pushback from referring physicians if they're all employed by the same health system.

It's not as easy for radiologists to attest for meaningful use if they're working in outpatient practices, are travelers serving multiple hospitals, or are doing some combination of the two. Outpatient radiologists must attest via an ONC-certified EHR system or radiology information system (RIS); travelers must somehow aggregate patient data from their various workplaces, and probably don't own their own ONC-certified RIS or EHR system. Furthermore, some radiologists fear that making test results available directly to patients, as meaningful use requires, could foul the relationship between them and their referring physicians, the financial lifeblood of their practices.

These complications of meaningful use compliance -- coupled with the CMS delay in enforcing reimbursement penalties -- probably account for the low percentage of radiologists signing up for meaningful use so far. In the end, however, radiologists might very well find business reasons to jump on the bandwagon.

For example, stage 2 mandates that radiology reports be made available to patients in one day. Stage 2 also requires physicians referring patients to radiologists to submit 30% of those orders electronically. To help their referring physicians achieve meaningful use -- and therefore, keep those referrals from going to a competitor -- radiologists probably are going to have to build most of the IT infrastructure that meaningful use requires, anyway. So why not reap the meaningful use incentives to defray some of the cost of building that infrastructure?

Because "some of the stuff is pretty complicated," Ramin Khorasani, M.D., vice chair of the department of radiology at Boston's Brigham & Women's Hospital, told SearchHealthIT. His department successfully attested 78 radiologists for meaningful use this month after a long period of training and workflow adjustments. "You can't just make one [meaningful use] measure; you have to make all of them. You have to receive electronic orders and, oh by the way, get smoking status."

Let us know what you think about the story; email Don Fluckinger, Features Writer or contact @DonFluckinger on Twitter.

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