ACR Meaningful Use Stage 2 Presentation at AuntMinnie.com RadExpo 2012 – Frequently Asked Questions
I recently presented for AuntMinnie.com’s RadExpo 2012 on the Centers for Medicare and Medicaid Services (CMS) and HHS Office of the National Coordinator for HIT (ONC) proposed rules to update the user and technology requirements of the EHR Incentive Program (“meaningful use”). I have received several questions about that presentation and subsequent Q&A session.
Q: You stated that ONC’s proposed redefinition of “certified EHR technology” was the most significant thing for radiologists and radiology HIT vendors. Why is that, and why not the imaging related items in CMS’ proposed rule?
A: ONC’s proposal to remove the comprehensiveness requirement for combinations of certified EHR Modules to meet the regulatory definition of “CEHRT” is beyond huge for users and vendors of “non-EHR” EHR technology. If finalized and improved, specialized HIT products with EHR Module certification can by themselves, or with minimal added functionality, meet the “CEHRT” regulatory definition. It also would mean that radiologists would not be forced to implement unused functionalities (like eRx, etc) just to meet a regulatory requirement of limited utility. ACR has been pushing for such a change in ONC’s regulations since our comment letter on the original ONC Interim Final Rule back in early 2010 when the problem was easily foreseeable.
On the other hand, while the imaging data-related menu set objective in CMS’ proposed rule is important from a policy perspective (and a long, hard-fought advocacy victory for ACR and patients regardless of whether or not that item makes it into the final rule), it would have no impact on the ability of radiologists to comply with the various requirements of the program. In fact, that proposed objective as written appears to be meant for ordering/referring physicians and not diagnostic radiologists.
Also note that the CMS Stage 2 proposals are fundamentally more of the same. There are no specialty-specific pathways to compliance or any revolutionary changes that would change existing perceptions. On the other hand, the ONC’s proposed redefinition of “CEHRT” and perhaps even the removal of the General, Inpatient, and Ambulatory criteria categorization scheme are quite revolutionary and potentially helpful to specialists.
Q: In the slide about avoiding penalties, you mentioned a July 3 deadline for eligible professionals (EPs) to begin complying if they have not complied already. Isn’t the EP deadline for compliance to avoid penalties in early October?
A: I should have been more clear in the verbal explanation of that particular slide. July 3 is proposed by CMS to be the last date when EPs would need to begin their 90-day EHR Reporting Period to complete attestation by October to avoid penalties in the following calendar year. This is different than the current (incentive year) paradigm in which EPs’ first 90-day EHR Reporting Period simply needs to fall within the calendar year and attestation could be completed as late as two months into the following calendar year. The three month difference between the attestation deadlines for incentive years versus penalty years is the result of CMS needing some time to determine who should receive reduced rates before billing actually begins.
While we are discussing this, I should also note that on the same slide I made a verbal error explaining the first bullet. EPs who are already participating in the program would avoid 2015 penalties by virtue of their “2013” compliance, not “2011.” Clearly, 2011 is not 2 years before 2015.
Q: You barely touched on Stage 1 requirements and certain aspects of the proposed rules, such as eligible hospital and Medicaid requirements in CMS’ proposed rule, and concepts such as gap certification in ONC’s proposed rule. Why?
A: I only minimally covered main concepts from the existing CMS and ONC regulations because the presentation was intended to focus primarily on the March 7, 2012 Notices of Proposed Rulemaking from CMS and ONC. To do that, however, I needed to do a quick refresher of the way things are currently for comparative purposes.
I did not cover everything in CMS’ proposed rules for two reasons: 1) ACR’s focus is exclusively on the Medicare EP version of the program because most ACR members will not meet the Medicaid version’s patient volume threshold eligibility requirement; and 2) the hospital version of the program does not incentivize, penalize, or otherwise impact physicians in a direct fashion.
I did not cover everything in ONC’s proposed rule because of time limitations and relevance to end-users and their patients. Even though I chose not to cover it, key stakeholders like HIT vendors should explore the ONC proposed rule in depth and note important concepts like “gap certification.” My personal hope is that radiology HIT vendors also submitted detailed comments to ONC on that particular proposed rule.