Michael Peters, ACR: The MU–MIPS connection and Stage 3 MU

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 - Michael Peters
Michael Peters, Director of Regulatory and Legislative Affairs, ACR

According to CMS’s latest attestation data, some 4,720 unique diagnostic radiologists have at least one year of participation in Stage 1 or Stage 2 Meaningful Use under their belts. This cohort has made around 9,000 unique attestations since 2011, showing quantifiable and clinically significant use of certified EHR technology.

These figures sound impressive at first blush. However, only around 28% of those 4,720 participants have stuck with MU for more than a year. This means a lot of radiologists who do participate are either “one and done” or just began in 2014.

What’s holding up the profession from broader, deeper and more committed participation? Mainly the fact that so many barriers exist beyond the reach of individual radiologists’ sphere of control. Not least among the barriers are hospital decisions, practice decisions and the availability of certified health IT products.

That’s according to Michael Peters, ACR’s director of regulatory and legislative affairs. In a recent conversation with imagingBiz, he laid out the landscape of these and related matters as things stand now and as the ground may shift in the coming months.

Q. The perception is that many radiologists have proactively opted for the hardship exception under Provider Enrollment, Chain, and Ownership System (PECOS) specialty code 30, citing lack of face-to-face contact with patients. How close is perception to reality?

Peters: To be clear, individuals with primary PECOS specialty codes of diagnostic radiology, nuclear medicine and interventional radiology do not need to take actual, manual action to obtain that particular hardship exception from the penalty. So essentially all of ACR’s non-radiation oncologist members are getting this automatically awarded exception.

We should also note that many radiation oncologists are probably obtaining one of the various other available hardship exceptions that they can manually apply for. They just can’t take advantage of this particular auto-exception for the imaging subspecialties.

So all of the imaging subspecialties should be getting this automatically awarded exception. No one should be getting penalties right now unless something is wrong with their PECOS data.

Q. In light of the announcement by HHS Secretary Sylvia Burwell earlier this year about the Merit-based Incentive Payment System (MIPS) and the accelerated timetable for value-based payment in the Medicare program, has the value proposition of participation in MU changed for radiologists?

Peters: This is an interesting question and critical to understanding the universe over the next several years. When it comes to Meaningful Use specifically in MIPS, there are three facts to consider. The first is that Meaningful Use is one of the four performance categories that comprise MIPS  and would count for about 25% of the MIPS composite score. The overall composite score determines whether the physicians get incentives, penalties or stay flat under MIPS.

The second fact is that the statute directs the secretary to consider circumstances and potential alternatives for ‘non-patient facing professionals’—which, depending on the regulatory implementation, could even mean a Meaningful Use alternative or substitute.

Number three, and I think most critically to this conversation, is that we just don’t know how CMS will implement the law in regulation. The agency recently published a request for information for stakeholder input on the future MIPS rulemaking. But the bulk of the actual, foundational rulemaking activity isn’t going to happen until next year. So, literally, the book on MIPS has not yet been written.

Q. Many hospital-based radiology practices have had difficulty getting the hospital’s support, which they need to participate in MU. What are your observations there?  

Peters: One of the many positives of the appropriate-use criteria (AUC) mandate is that it should promote ongoing dialogue between radiologists and referring providers. I don’t know if these opportunities for communication will better enable radiology practices to convince hospitals to actively facilitate Meaningful Use compliance. If it does, that would obviously be another positive side effect to the AUC mandate.

I do think that, moving forward, CMS needs to address the overall problem that you’re alluding to here—hospital barriers to Meaningful Use by on-site physicians. This is something that ACR, RBMA, the College of American Pathologists, the American Society of Anesthesiologists