Final Meaningful Use Rule Throws Radiology Some Curves

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CMS and the Office of the National Coordinator scaled back their requirements for demonstrating meaningful use of information technology in an 864-page final rule released yesterday, trimming by 20% the criteria physicians and hospitals are required to meet in order to receive HITECH funds for electronic health record system purchases.

In the process, they may have dashed or at least delayed radiology community hopes that the rule would propel the adoption of radiology decision support and computerized order entry systems (CPOE) with a final rule that made the CPOE requirement apply to medications only, eliminating imaging and laboratory.

“It seems so short-cited: Here we have all of these grandiose IT goals, and the places where we should be focusing, or could be focusing, for quick success gets caught in the sludge,” says Liz Quam, executive director of the Quality Institute at the Center for Diagnostic Imaging in Minneapolis and a founding member of the Imaging e-Ordering Coalition.

In the final rule, physicians must meet 20 of 25 criteria, 15 mandatory and 5 selected from a choice of 10; hospitals must meet 19 of 23 criteria, and they also have flexibility to choose 5 additional criteria from 10 options.

More flexibility also is built into meeting the requirement for measuring clinical quality: eligible professionals and hospitals now need to follow six total, including three core clinical quality measures, and three others from a list of 44.

In revising the rule, the Office of the National Coordinator (ONC) and CMS acknowledged that the previous all-or-nothing rule would have placed too great a burden on healthcare providers. “The DHHS received many comments that this approach was too demanding and inflexible, an all-or-nothing test that too few providers would be likely to pass,” wrote David Blumenthal, MD, MPP, in a commentary in the latest issue of the New England Journal of Medicine.

The rule also backpedals on the requirement that physicians would have to run at least 80% and hospitals 10% of orders through the CPOE during a 90-day period in the first year of the program.

“Our intent in the proposed rule was to capture orders for medications, laboratory or diagnostic imaging,” the rule stated. “However, after careful consideration of comments, we are adopting an incremental approach by only requiring medication orders for Stage 1.” The final rule requires all providers to hit a threshold of 30% of medication orders in Stage 1.

“In terms of the CPOE, obviously the ACR would like to see a bigger push toward CPOE with integrated clinical decision support for radiology services,” says Michael Peters, assistant director of regulatory and legislative portfolio, the American College of Radiology “That is something the ACR has been pushing for not only in meaningful use but in many other areas. It was a little disappointing that the CPOE focused on medications. All is not gloom and doom, however.”

Peters points out that there will be two more rule-makings over the next five years, so the window of opportunity remains open, in addition to these points of interest for radiology:

• Eligibility requirements remain virtually identical to the proposed rule: all physicians are eligible except for those hospital-based physicians who provide >90% of their total Medicare (or Medicaid) services in POS Codes 21 (inpatient hospital) or 23 (ER hospital) locations. CMS is expecting only 14% of all Medicare physicians to be hospital-based.

• Contrast media/drug-to-drug and drug-allergy tests: CMS said they are not linking these checks to specific drugs or agents. The rule notes: “It is common practice in radiology to identify a patient's past drug and food allergies and take appropriate interventions if necessary. Therefore, the drug-drug, drug-allergy, and drug formulary checks would be appropriate prior to administration of contrast media and imaging agents to patients."

• In the ONC certification criteria final rule, released last week, the ONC specifically discussed the issue of RIS and some other HIT as EHR modules, verifying that EHR modules can be anything: They simply must be able to be certified as covering at least one of the certification criteria.

The rule also specified the calculation payment amounts; payment adjustments for eligible professionals and hospitals that fail to demonstrate meaningful use of EHR technology; and other program participation requirements.

Ongoing Frustration
Quam expressed