What the MU stage 3 proposed rule means for radiology

The Centers for Medicare and Medicaid Services (CMS) and the Office of the National Coordinator for Health IT (ONC) has issued proposed rules for stage 3 Meaningful Use (MU) and the proposed 2015 edition EHR criteria under the Medicare and Medicaid EHR Incentive Programs.

According to ONC, the stage 3 Meaningful Use proposed rule makes the program more flexible for providers by:

• Establishing a single, aligned reporting period for all providers based on the calendar year.
• Allowing providers the option to start stage 3 of meaningful use in either 2017 or 2018 (required in 2018), which gives providers an extra year beyond what the current regulation allows.
• Simplifying meaningful use objectives and measures and reporting requirements by allowing flexible measures under health information exchange, consumer engagement and public health reporting that would fit their own patient population or practice.
• Reducing the overall number of objectives to eight to focus on advanced use of EHRs.
• Removing measures that are redundant or received wide-spread adoption; and • Aligning clinical quality measure reporting with other CMS programs.

The ACR has responded with a document outlining the “points of interest” for radiologists in the proposed rules.

Changes to stages and reporting periods

In its document, the ACR pointed out that under the CMS proposal, Meaningful Use stage 3 will eventually be the only stage for MU for all participants. In 2017, participants will have the opportunity to demonstrate for any MU stage, but by 2018 all participants—regardless of prior participation or nonparticipations status—will be in stage 3.

CMS also is proposing to eliminate different reporting period lengths and attestation deadlines for first year MU participants beginning in 2017. In 2017 and every year after that, any first year MU participant in the Medicare version program will have a year-long reporting period.  They will also need to avoid penalties for two years before the penalty year in question.

“This means,” the ACR reported, “if a radiologist eligible professional (EP) uses up all five possible years of significant hardship exceptions in CY 2015 though CY 2018, that radiologist EP would need to begin participating in MU in CY 2018 to avoid the 2020 payment reduction for noncompliant EPs.

“Therefore, all pre-planning for MU participation, including certified EHR technology implementation, would need to occur sometime in 2017 to gear up for January 2, 2018 start date,” the ACR suggests.

Meaningful Use Objectives

CMS is proposing eight total objectives for Stage 3: 

• protect patient health information
• electronic prescribing [eRx]
• clinical decision support (CDS)
• computerized provider order entry [CPOE]
• patient electronic access to health information
• coordination of care through patient engagement
• health information exchange (HIE)
• public health and clinical data registry reporting

According to the ACR, these objectives will be more focused than those in previous stages. Diagnostic radiologists are likely to meet the proposed exclusions for electronic prescribing, CPOE, patient electronic access to health information, and coordination of care through patient engagement. They would have to meet the measures for the other objectives—protecting patient health information, clinical decision support, HIE, and public health and clinical data reporting.

Clinical Decision Support

As for CDS, the stage 3 Meaningful Use requirements are essentially the same as stage 2. CMS has proposed a clarification and ONC’s associated 2015 Edition certification criteria should give participants more flexibility regarding what CDS is and where it can come from. Appropriate use criteria-based CDS for ordering imaging is an example of acceptable CDS.

The ACR reiterated that the proposed rules are just for public comment purposes (the public comment period began March 29) and should not be used for compliance planning or business or clinical use.