Meaningful Use Stage 2 Rule Offers Radiologists Some Clarity

September 6, 2012

The Meaningful Use Stage 2 final rule clarifies a few sticking points for radiology, including imaging accessibility, CPOE, and hardship exemptions.

The final rule for Stage 2 of the Meaningful Use (MU) program, released last month, clarifies a few sticking points for the radiology industry, but some questions remain, say industry experts who are still digging through the specifics of the rule.

Still considered to be a move toward standards-based health information exchanges, the final rules for Stage 2 - released by CMS and the Office of the National Coordinator (ONC) set to take effect in 2014 -provide some additional clarity for how radiologists and hospitals should approach MU. But they’re little changed from the proposed versions. The similarities, some said, are surprising.

“It’s interesting that CMS’ final rule resembled the proposed rule as much as it did,” said Michael Peters, legislative and regulatory affairs director for the American College of Radiology (ACR), noting the short time between the publication of the proposed and final rules. “This was probably the result of an extremely quick rule-making that spent less time addressing stakeholders’ concerns.”

Individual providers and practices shouldn’t change their daily workflow and activities just yet, Peters said. The final rule, its requirements, and menu items, have not yet been completely analyzed.

However, it’s clear so far that the final rules offered additional guidance in three main areas: imaging accessibility, computerized physician order entry (CPOE), and hardship exemptions for meeting MU requirements. These areas have also been points of concern for the ACR.

According to Keith Dreyer, DO, chair of the ACR IT and Informatics Committee-Government Relations Subcommittee and radiology vice chair at Massachusetts General Hospital, the final rule guidance should make MU compliance easier for practicing radiologists. It combines certification criteria for eligible hospitals and eligible providers (EPs) in hospital settings with certified electronic health record (EHR) technology. The rule also impacts clinical quality measures.

“The clinical quality measures are better aligned with other quality incentive programs, making the overall process simple to achieve,” he said.

Fortunately, the final rule doesn’t require providers to store imaging results in an EHR with the ONC abandoning its proposal that images be available for download and transfer to third parties. Instead, they can offer a link to study results. In addition, CMS is only requiring 10 percent of images to be accessible this way instead of the 40 percent suggested in the proposed rule.

This change is a double-edge sword, Dreyer said. While it does relieve some of the pressure EPs felt regarding image accessibility, it also affects patients.

“It was disappointing to see the removal of the portion of the proposed MU objective requiring the ability for patients to view, download, and transmit their medical image data,” he said. “This was a common request of patients.”

In addition, the Stage 2 requirements offer clarity for how computerized physician order entry (CPOE) will impact radiology. To qualify for MU incentive payments, EPs must use CPOE to order more than 30 percent - instead of the 60 percent CMS originally proposed - of radiology procedures during an EHR reporting period. However, EPs who order less than 100 imaging scans during a reporting period are exempt from this requirement.

Although CMS didn’t expand the CPOE definition to include the clinical decision support (CDS) that often helps providers avoid unnecessary imaging as the ACR had hoped, the agency did acknowledge CDS is a paramount CPOE byproduct. The hope, Dreyer said, is that CDS will be included in the Stage 3 rule.

One of the biggest sticking points for radiologists has been the difficulty many would face in complying with the MU requirements because few providers actually have frequent face-to-face contact with patients. These final rules provided some clarity about the significant hardship exemption that would allow radiologists and other providers to avoid noncompliance penalties at least until 2015. Some radiologists may be able to avoid these penalties through 2019 depending upon the specialty codes used in the Provider Enrollment Chain and Ownership System (PECOS).

Although it’s still unclear which providers will fall into that group, and CMS can review and negate the exemption at any time, this outcome is positive, Dreyer said.

“This was the best we could hope for without a change to the legislation, which is not likely,” he said. “While radiologists are highly encouraged by CMS to participate in the program, the new regulations give those radiologists, with infrastructure limitations, a few more years before penalties begin.”

In addition, CMS also cleared up its definitions for “office visit” and “seen by EP.” The office visit definition from the proposed rule – concurrent or transfer-of-care visits, consultant visits, and prolonged physician service without direct patient contact – remains, but the agency declined to add specific billing codes to the mix. The final rule also gives EPs some wiggle room in deciding when they’ve actually seen a patient. The new definition includes patients EPs see across multiple sites that have EHR technology.

Although the ONC rule incorporated ACR’s requests well, such as adding flexibility to the definition of certified EHR technology and removing the general/ambulatory/inpatient categories to improve compliance, Peters said there is still room for improvement in CMS’s final rule. These problems, he said, likely resulted from the haste in which the final rule was produced.

Providers can expect the ACR to continue to look for new opportunities to offer the radiology community up-to-date information about MU, he said. On Oct. 11, the association will hold its second annual imaging informatics summit in Washington, D.C., including ONC leadership. In addition, the ACR consolidated regulatory summary of both CMS and ONC Meaningful Use final rules will be available online at www.acr.org soon.