Meeting the Challenges of Stage 1 Meaningful Use

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While the news crews have moved on to coverage of the final rule for stage 2 meaningful use, the reality is this: The vast majority of radiology practices still has not met the stage 1 requirements. Their greatest challenge is likely to be understanding how the rule applies to their practice setting, and radiology practices are interpreting that in radically different ways, according to Reynold Yordy, director of marketing, information systems, for FUJIFILM Medical Systems.

Reynold Yordy“The biggest challenge for them is understanding how it actually applies to them—and the bigger part is finally coming to the realization that, for the most part, it doesn’t.”

— Reynold Yordy, FUJIFILM Medical Systems

Nevertheless, with 90% of radiologists thought to be eligible to participate in the program, practices stand to lose 1% of their Medicare billings in 2015 if they do not attest. This figure can escalate to as much as 5% over the subsequent five years, if they can’t qualify for a hardship exemption. For this reason, Yordy expects to see many practices get into the game in 2013 and attest to stage 1 meaningful use.

Customers are following a fairly standard pattern, Yordy explains: They review the objectives and the measures and then say, “‘We don’t do this.’ We then have to go through it with them and explain that stage 1 is really more focused on family practice,” Yordy says. “Stage 2 looks like it will be getting closer.” The objective is to craft a way to make it through the attestation process without adversely affecting workflow—so that they can come into compliance, receive their incentive payments, and guard against penalties in 2015.

A Significant Balancing Act

One decision practices must make is determining how to interpret the phrase seen by eligible provider, which is present in many of the measures. Because only a few radiology subspecialists regularly see patients, practices must decide how many of their patient encounters fall under the rule.

“Nine of the measures have that language in it, and CMS has been great at being vague about what they tell people,” Yordy says. “Their response has been that it is up to providers to determine what that means to them.”

Some groups that Yordy is working with are interpreting that literally and excluding all studies except those that involve a physical encounter with patients. Others are interpreting it broadly to include all patient images. The practices that are using the seen-by-eligible-provider language to exclude many of the studies that the practice performs find that if they exclude too many studies, some radiologists will have zero studies to report.

“If you have physicians that don’t do mammography and don’t do outpatient interventional work, then they probably are not going to see a patient,” Yordy says. “Then, they have to figure out which studies they are going to count, because if they use that rule, then a lot of their radiologists will not be able to attest. We found that it has become a significant balancing act of how they are going to do it. I think that will continue to evolve over the next year.” One practice that will attest to meaningful use of its Fujifilm Synapse RIS in the coming weeks intends to cover its bases by including every study, but intends to work toward a more selective approach.

Decision Support

Finding expert opinions on the subject has not been easy for radiology practices. Where they typically might turn to a lawyer to answer such questions, Yordy says, many lawyers do not consider themselves expert in the meaningful-use regulations, and consultants do not want to be held accountable for definitive answers.

“Probably the biggest challenge for practices is that no one wants to be committal about these questions,” Yordy says. Nonetheless, he advises that practices engage with someone whose job it is to stay on top of the meaningful-use regulations, primarily because the rules continue to change.

“The rules change, making it difficult to understand when an exclusion counts and when it doesn’t count,” he says. Yordy cites the following example: Previously, practices could exclude themselves from the syndromic surveillance and immunization measures. A clarification of the rules disallows practices from excluding themselves from both measures at the same time.

CMS has provided a forum [link to: for physicians and health IT personnel to use in staying