Finding Greater Meaning in Stage 2 Meaningful Use
Proposed rules for stage 2 of the federal government’s electronic health record (EHR) incentive program were issued in late February, and the reaction from the radiology community has been somewhat favorable (unlike its response to the rules for stage 1). Proposed rules from CMS and the Office of the National Coordinator for HIT include specific requests from the ACR® that will add relevance and needed flexibility to the program for radiologists, according to Mike Peters, director of legislative and regulatory affairs in the ACR’s government-relations department.


Mike Peters“We have a pretty big platform of asks that we’ve been pushing for in terms of recommended changes to CMS and ONC regulations. I would say that almost all of our asks were addressed, to some degree—not all the way, but they were included, to a certain degree.”
—Mike Peters, ACR


CMS issued proposed rules for health-care professionals and hospitals attesting to meaningful EHR use for incentive payments in stage 2 of the program, while the HHS Office of the National Coordinator (ONC) put out proposed rules for certifying EHR technology. Comments on each set of rules will be accepted through the first week of May, with the final rules expected this summer. Practices that begin attesting this year for stage 1 will not forfeit any of the combined $44,000 (over five years) available, per eligible professional, for complying. Physicians will, however, lose a portion of incentive pay if they wait until 2013, with penalties for noncompliance set to begin in 2015. The federal government had already made $2.5 billion in incentive payments by the end of 2011, according to CMS. More Flexibility for Radiology Some of the biggest improvements for radiologists in the proposed rule include greater flexibility in meeting some of the core measures. For hospitals and physicians, there is a new menu-set objective for access to diagnostic imaging data. It is not clear, however, that this proposed menu set objective is meant to be for the ordering or rendering physicians. In addition, CMS has included clinical quality measures that are directly relevant to radiologists, Peters says. These include:
  • breast-cancer screening rates;
  • use of probably benign assessment in screening mammography;
  • colorectal-cancer screening rates;
  • osteoporosis screening;
  • use of imaging studies for low-back pain, in the absence of progressive symptoms;
  • CT or MRI reports for stroke patients that include documentation of the presence or absence of hemorrhages, mass lesions, and acute infarcts;
  • stenosis measurement in carotid imaging studies;
  • use of contrast in thoracic CT exams;
  • exposure time for fluoroscopy procedures; and
  • radiation-dose limits for oncology.
Another important change in the proposed rules came on the technology side, from ONC: No longer will radiologists or other specialists need to implement technology that corresponds to measures from which they were excluded, according to the proposed rule. Currently, certified EHR technology must have the ability to meet certain requirements, even if the provider using that equipment may be excluded from that particular measure. In many cases, the rule required radiologists, essentially, to buy things that they didn’t need. “We’ve been pushing for this for a long time,” Peters says. “It’s a huge leap in flexibility for eligible professionals and for specialized health IT that doesn’t necessarily fall under what you think of as a traditional EHR product.” Out of the Starting Gate Alberto GoldszalAmong the physicians who have attested to stage 1 meaningful use are 269 diagnostic radiologists, 29 interventional radiologists, 85 radiation oncologists, and seven nuclear medicine physicians, according to the 2011 figures released by CMS. The current regulatory scheme requires those physicians begin stage 2 compliance in 2013. However, the latest proposed rule includes a change that would require these participants to spend a third year in stage 1, beginning stage 2 no sooner than 2014. Of the 85 radiologists of University Radiology (East Brunswick, New Jersey), 75 have attested to stage 1 meaningful use, amounting to an incentive payment of about $1.2 million last year, according to Alberto Goldszal, PhD, CIO. The group serves five hospitals and 12 freestanding imaging centers. While the stage 1 standards were not particularly relevant to radiologists, Goldszal says, he was still able to find benefits in implementing the measures, including one measure requiring laboratory results to be submitted electronically and another measure for submitting orders electronically. Stage 1 requirements include 15 core objectives and five menu-set objectives chosen from a list of 10. Radiologists had largely complained that few objectives applied. “There are many other things I would have liked to do before I spent time and energy absorbing and defining my work flows to acquire the core-set measures,” Goldszal says. “It’s not that it invalidates the core-set measures. We might as well make use of them.” He adds that the true value comes later, when those clinical datasets can be used to exchange information and drive quality improvements. “We are doing this to prepare the terrain and plow the fields,” Goldszal says. “The fruits will come later. We need to plow the fields before we plant the seeds.” In the process of analyzing the various measures that the practice would need to meet, Goldszal says, the group began creating a fairly lengthy document that describes each measure and how to attain it. The document later became something that the practice sold to an EHR vendor to use for its other clients. Few issues have dominated as much of the ACR federal regulatoru affairs team’s time as meaningful use. Peters says, “We have been following this issue very closely since late 2008, when the establishing language was first tacked onto the draft economic stimulus package (later known as the American Recovery and Reinvestment Act of 2009). We’ve actually monitored just about every federal initiative, meeting, and event pertinent to this issue over the past three years. I can’t think of any physician association, of any specialty—including the AMA—that has spent as much time as the ACR has on this issue.” David Rosenfeld is a contributing writer for Meaningful-use Resources Overview of the Meaningful-use Program Stage 2 Fact Sheet ACR Commentary on Stage 2 Proposed Rules List of Certified EHR TechnologyImpact of Stage 2 on Software Integration