Should Hospital-based Radiologists Pursue Meaningful Use?

CHICAGO - All three radiologists who spoke at an RSNA 2013 session on meaningful use of electronic health records agreed the incentives program is a good idea, but only two were successful in implementing the first phase.

The three-phase program is now moving into Stage 2. The program rewards practices only when they go beyond purchasing and implementing EHRs and using them at a prescribed level.

Keith Hentel, MD, MS, is chief of the division of emergency/musculoskeletal radiology at Weill Cornell Medical Center at New York-Presbyterian. His practice pursued meaningful use but failed, he said.

Among his practice’s challenges were:                                               

• Original confusion on the role of radiologists in meaningful use.
• The great divide: “Our practice only registers our patients in the EHR because it’s our billing system. … We don’t spend a lot of time with the electronic health record.”
• Existing systems didn’t qualify: You have to use certified healthcare technology to achieve MU. “If we were going to be meaningful users, we would have to get radiologists to function in the electronic health record.”
• Up-front costs to overhaul the system seemed to overshadow the benefit.
• Other projects and programs took priority.
• Lack of meaning: “If you look at the core measures, many don’t pertain to radiologists. … To put a lot of effort into a project that doesn’t have meaning to us was a tough sell,” he said.

As the program phases in, Hentel said he has seen many solutions for some of the challenges. He also sees that penalties that will kick in for not having meaningful use starting in 2015 may be “just the tip of the iceberg,” of punitive measures. He said despite the challenges, he wants to try again, and he expects his division to become meaningful users in the near future.

Penn, Brigham achieved meaningful use

Curtis Langlotz, MD, PhD, professor and vice chair for informatics in the Department of Radiology at the University of Pennsylvania, said some of the friction comes because “most radiologists are eligible but the objectives are not tailored toward radiologists. The reason for that is that if you look at the physicians out there, the vast majority of them are in office-based practices where they have visits and outpatients. That’s not the way we generally practice.”

He said a couple of factors were important in their path to meaningful use. One was that “90 percent of patients we see in radiology are referred from within Penn medicine. So these are patients whose medical records are already being kept in our Epic outpatient ambulatory record. That is a critical success factor for us.”

The second is in how they defined “seen by” and “office visit” - a distinction which varies by hospital.  “Our definition did not include that a radiologist was interpreting an exam on a patient so that did not constitute an office visit. That’s what we decided. As far as ‘seen by,’ Penn decided that ‘Yes, if I interpret a radiographic diagnostic imaging exam on a patient, that constitutes that that patient was seen by me.’” The definitions are important in measures used to qualify for MU.

Brigham felt compelled

Ramin Khorasani, MD, MPH, described some factors that led to pursuing and achieving meaningful use at Brigham and Women’s Hospital in Boston where he is vice chair of radiology. One factor was the consideration of the penalty for not achieving meaningful use which, by 2015, could be up to a 5 percent cut off Medicare reimbursements.

“Five percent of collections on Medicare population for our services is a major, major consideration,” Khorasani said.

The organization as a whole also believed “that meaningful use is directionally correct and we felt that because we believe ourselves to be one of the leaders in health IT, we felt compelled to participate.”

It was also important to note, he said that “our professional organizations led by the ACR fought very hard to include radiologists as meaningful users. Initially radiologists were not included in the bill.”

In August, 2011, only one of the 98 Brigham radiologists was a meaningful user. Now 92 have achieved it, Khorasani said. There will be a great incentive for the others to meet the mark as well, because Brigham will soon impose a pay cut individually for radiologists who don’t meet MU requirements, he said.