The federal meaningful-use program has been particularly challenging for imaging, both in its inception and in its execution. Initially, it seemed as though radiology would be exempt from the system of incentives and penalties devised to increase electronic health record (EHR) adoption; a rule change reversed that, making 90% of practicing radiologists eligible providers. For specialists, however, the menu set of requirements can be puzzling, at best, and prohibitive to participation, at worst.
Michael Peters, director of legislative and regulatory affairs for the ACR ®, says, “The ACR and other national organizations have had our shares of successes, challenges, and frustrations” when it comes to shaping the regulations. He adds, “Generally speaking, mixed results are typical of the federal rulemaking process, particularly when many stakeholders and different points of view are involved.”
Indeed, the policymaking surrounding meaningful use is a complex conflagration of people and processes. The program is being rolled out in stages, meaning that each stage after the first has been (or will be) subject to input and comment from various sectors of the regulatory and health-care communities. “The Health Information Technology Policy Committee (HITPC) and Health Information Technology Standards Committee (HITSC), and the numerous workgroups under those two federal advisory committees, have regular public meetings and teleconferences,” Peters says. “The two full federal advisory committees meet publicly every month.”
The ACR monitors all HITPC and HITSC meetings and most of the pertinent workgroup meetings; Peters estimates that he as attended or monitored between 150 and 200 of these since 2009. “The HITPC, HITSC, and their workgroups do not meet directly with stakeholder groups,” he notes. “They invite panelists from agencies and the private sector to present on specific topics during their public meetings. In addition, there is a brief public-comment period built into the end of every meeting.” In January 2013 alone, the ACR submitted formal comments on the HITPC’s stage 3 concepts and participated in an AMA-led meeting of the specialty societies with CMS staff.
A common criticism of the committees has been that they are, Peters says, “open to comments, but not open to ideas.” He adds, however, that the staffs of CMS and the Office of the National Coordinator (ONC) are more receptive. “They are generally far more inclusive and appreciative, when it comes to learning about different opinions and real-world compliance challenges,” he says.
Victories for Radiology
So far, the ACR’s biggest successes in influencing meaningful-use rulemaking have been, Peters says, “massively increased flexibility in the CMS user requirements (in July 2010) and much-needed customizability for certified EHR technology in the ONC technology requirements (in September 2012).” He adds, “There is a long list of specific items the ACR and other groups helped get into the regulations or guidance, and there’s an equally long list of items we’d still like to see.”
For instance, he says, the ACR is not done lobbying for changes to the stage 2 final rules that it hopes will be addressed via CMS guidance and/or corrections. “I think the most high-impact ACR-facilitated change, this cycle, was a newly customizable regulatory definition of certified EHR technology, something the ACR has been fighting for and communicating about for years,” Peters says. “ONC also removed the general/inpatient/ambulatory categorization scheme for certification criteria, which could help with the problem of access to certified EHR technology appropriate for physicians inside of hospital settings.”
Looking ahead to stage 3, Peters says, “Much of the discussion, at the HITPC level, has been on dialing back the process-oriented measures and looking more at outcomes, as program participants get to stage 3. It remains to be seen how much of that mindset gets translated into the HITPC’s policy recommendations and/or future regulations.” The HITPC plans to issue policy recommendations for stage 3 in May 2013, but, Peters says, “as always, CMS and ONC staff will be free to use or not use that advice, however they see fit, during the rulemaking process.”
Participation and Progress
According to the most recent CMS data, 862 diagnostic radiologists, 290 radiation oncologists, 67 interventional radiologists, and 22 nuclear-medicine physicians