The American College of Radiology (ACR) Government Relations Department recently updated its regulatory summary, slide deck, and frequently asked questions regarding the Medicare/Medicaid EHR Incentive Program, or “meaningful use.”
These educational resources were first published in July 2010 and have been updated several times since, most recently in March 2011. The ACR’s consolidated regulatory summary was one of the first publicly available analyses of the EHR Incentive Program and EHR standards, implementation specifications, and certification criteria final rules, and has been used and referenced extensively within the radiology community.
To access these and other resources, such as ACR’s formal comments/testimony and pertinent federal government documents and sites, please visit the ACR Meaningful Use Resource Center.
Online registration for the first annual ACR Imaging Informatics Summit and Dose Monitoring Forum will soon close. To reserve your seat, please visit the registration page by Friday, October 28.
This year’s meeting will take place November 3-4 at the Washington Hilton, 1919 Connecticut Avenue, NW, Washington, DC. Additional information, including the agenda and speaker list, is available online.
Today, the Centers for Medicare and Medicaid Services (CMS) made available the final rule to implement the Medicare Shared Savings Program (the “Accountable Care Organizations” regulation). The rule will be published in the Federal Register on November 2, 2011. Until then, a pre-publication notice will be accessible on the Office of the Federal Register’s (OFR) public inspection desk website.
Of note, the final rule appears to have eliminated the requirement that at least 50 percent of primary care physicians participating in the ACO must be meaningful users of certified EHR technology, per the Medicare/Medicaid EHR Incentive Program. Instead, meaningful use of certified EHR technology is encouraged in the final ACO rule through one of the remaining quality measures from the proposed rule.
The American College of Radiology’s (ACR) Government Relations and Economics Departments recently published the October 2011 ACR Advocacy Update. The ACR Advocacy Update is a monthly newsletter featuring contributions from ACR staff who work on federal and state legislative, regulatory, and coding/reimbursement policy issues.
To view previous issues of the ACR Advocacy Update, please visit the ACR Government Relations website.
ONC HIT Policy Committee-MU Workgroup-Specialist Subgroup Meets to Discuss MU and Specialized Medicine
On October 18, the Office of the National Coordinator for HIT (ONC) HIT Policy Committee/Meaningful Use (MU) Workgroup/Specialist Subgroup held its first meeting to discuss gaps and opportunities regarding MU and specialists. The subgroup was created during the October 6 meeting of the full MU Workgroup.
The focus of the subgroup members was on unique specialties like radiology and pathology; however, they made it clear that the priority is to encourage applicability to as many providers as possible. One of the subgroup members mentioned that ONC’s federal advisory committees “hear the most” from radiology and pathology.
The subgroup members discussed a variety of potential policy options related to MU compliance by specialists, including:
- Specialty HIT product alternatives to “certified EHR technology.”
- Relevant e-specified clinical quality measures.
- Timely exchange of structured data.
- Participation in health information exchange networks.
- Participation in specialty-specific data registries.
- Providing patient educational resources to primary care physicians for passing onto patients post-specialty care.
The insinuation of the discussion was that the subgroup would present its initial thoughts to the full MU Workgroup. Ideally, the subgroup would first get input from specialty societies before finalizing its thoughts.
The vast majority of ACR members are automatically exempt from the incentives and penalties for the Centers for Medicare and Medicaid Services’ (CMS) e-Prescribing (eRx) Incentive Program. In order to be subject to the eRx penalties, a physician would need to meet both of the following criteria, among others:
- 10% of the physician’s Medicare Part B PFS allowed charges must be comprised of the codes listed below, and
- The physician must have at least 100 cases containing one of the codes listed below.
90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 90862, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99304, 99305, 99306, 99307, 99308, 99309, 99310, 99315, 99316, 99324, 99325, 99326, 99327, 99328, 99334, 99335, 99336, 99337, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0101, G0108, and G0109.
If you meet both criteria (or you are concerned you could possibly meet both criteria), you should consider applying for a significant hardship exemption before the November 1, 2011 deadline to avoid the 1% PFS payment reductions in 2012. To do this, simply use your IACS information to sign into the CMS Quality Reporting Communication Support page and follow the links to apply for the eRx hardship exemption.
The available exemption options are briefly listed below and are explained in the CMS final rule:
- Eligible professionals who register to participate in the 2011 Medicare or Medicaid EHR Incentive Program (“meaningful use”) and adopt certified EHR technology.
- Inability to electronically prescribe due to local, State, or Federal law or regulation (e.g., controlled substances).
- Limited prescribing activity.
- Insufficient opportunities to report the electronic prescribing measure due to limitations in the measure’s denominator (i.e., limitations with the aforementioned encounter codes).
- The practice is located in a rural area without high-speed Internet access.
- The practice is located in an area without sufficient available pharmacies for electronic prescribing.
Again, most ACR members do not need to take any further action, as they will not meet the aforementioned criteria and are therefore automatically exempted by CMS from the eRx penalties.
NOTE: The eRx Incentive Program is unrelated to the EHR Incentive Program or “meaningful use,” with the exception of the associated hardship exemption.
On October 12, American College of Radiology IT and Informatics Committee leaders and staff met with Dr. Farzad Mostashari (National Coordinator for HIT), Office of the National Coordinator for HIT (ONC) staff, and Centers for Medicare and Medicaid Services (CMS) staff to discuss the EHR Incentive Program, or “meaningful use” (MU). The meeting was a follow-up to ACR’s involvement in the May 13 ONC HIT Policy Committee-MU Workgroup hearing on “MU and Specialists.”
The ACR reiterated its prior requests for:
- Sharing/accessing imaging data as part of MU.
- Robust radiology order entry requirements for referring physicians with appropriateness clinical decision support.
- Addressing MU challenges within the radiology community and other specialties.
In terms of the challenges, ACR discussed:
- Lack of direct clinical relevance of the functional MU measures;
- Issues faced by many hospital-located practices in terms of working with hospitals on compliance in the eligible professional version of the program (technology/data access);
- Need relief for those without any control over technology availability;
- Inflexible comprehensiveness requirement for “certified EHR technology” via a combination of EHR Modules; and,
- Lack of imaging informatics awareness on ONC’s advisory committees and workgroups.