The Economics of Meaningful Use for Radiology in 2013 and Beyond

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Keith DreyerGoing into 2013, the message for radiology regarding participation in the meaningful-use program has not changed; if anything, it has intensified, according to Keith Dreyer, DO, PhD, vice chair of radiology at Massachusetts General Hospital in Boston and coauthor of The Radiologist’s Guide to Meaningful Use (RMU Press, 2011). “There is going to be a tipping point for radiology soon,” Dreyer predicts. “There is still time for radiologists to gain most of these incentives, but the clock is ticking; they really need to have a solution in place by October 2013.” The economics of participation in meaningful use are about much more than incentives and penalties, Dreyer stresses, although the incentives and penalties are certainly worth considering. “In addition to the financial side of the program, there are a lot of intangibles, and those are actually more concerning from an economic perspective,” he notes. “We are all headed in the same direction here, and those who choose not to participate are going to find themselves not only noncompliant, but left behind.” What to Know in 2013 The biggest thing that radiologists need to understand about meaningful use, going into 2013, is that this is the last year to capitalize effectively on the remaining incentives. Practices beginning attestation in 2013 will be eligible for up to $15,000 in incentives per eligible professional (a designation that could apply to more than 90% of radiologists). Practices that begin attestation in 2014 or later, on the other hand, will lose out because of a clarification in the stage 2 rules for the program, Dreyer explains. “In the September 14, 2012, release, everything got much more specific, and the release did finally talk about what the penalties will do to all of us,” he says. “They start in 2015, but are based on participation previous to that—they will be attributed to your participation from two years before, so what you do in 2013 will matter a great deal in 2015.” Further, Dreyer says, a frequently misunderstood aspect of the meaningful-use program is that no stage can be skipped or shortened. “No matter when you start, you have to do stage 1 for two years and then stage 2 for two years,” he says. “If you start late, it doesn’t mean you can get out early.” The cost of entry for radiology groups is highly variable, Dreyer stresses. “There is no single answer that will apply to everyone,” he notes. “Some groups have to go it alone and buy their own technology to solve the problem, while for others, it may be as simple as getting the OK from the hospital CIO to be included in the dashboards (in technology that has already been purchased). In other cases, where the practice’s RIS vendor has a complete certified solution, there isn’t any technology that the practice needs to purchase. If you have a complete certified RIS, the process gets a lot easier.” The Bigger Picture Focusing on whether the economics of participation balance out in the short term for radiology practices ignores the larger issue at hand, Dreyer says. Already, he points out, “One of the requirements in stage 2 is that ordering physicians have to receive 10% of their results, including the images, as a link to their certified electronic health record (EHR) technology.” As a result, he adds, “For the radiologist who chooses not to participate, it is going to be difficult to understand what those referring physicians want and how best to deliver it to them.” Thus, Dreyer says, radiology groups that choose not to participate in the program could be facing an ominous future. “There is also a defined percentage of referring physicians’ orders for radiology that have to be done through their EHRs,” he notes. “If those orders can’t make it from their EHR technology to the radiology group, their business could shift elsewhere—and that could happen as early as 2014.” Looking even further ahead, Dreyer underscores that the entire meaningful-use program is part of a larger federal effort to position providers for a transition away from fee-for-service medicine. “What is believed is that meaningful use will be an entry point to alternative payment methodologies,” he says. “In Washington, they suggest that meaningful use is a precursor to accountable-care organizations (ACOs), where providers will receive payments for covered lives, but will have to demonstrate performance and quality as they are delivering care.” As payments shift from fee-for-service to bundled models, demonstration of adherence to quality, safety, access, and other performance measures will be a growing challenge for radiology practices—unless they have prepared for the change by participating in meaningful use. “Whatever year it is that your organization winds up participating in or becoming an ACO,” Dreyer says, “it will be very difficult for the radiology group that is not participating in meaningful use to know how to handle all those performance metrics.” In addition to starting with meaningful use this year (if they are not already attesting), Dreyer urges radiology groups to keep the pressure steady on their vendors to provide solutions that will help them position themselves to participate. “I would encourage the vendors to provide their solutions as complete EHR technology, if they aren’t already,” he says. At the 2012 annual meeting of the RSNA in Chicago, Illinois, he adds, “The number of people at the meaningful-use sessions was encouraging. The level of interest in the radiology community is growing, but adoption will still take time.” Cat Vasko is editor of and associate editor of Radiology Business Journal.