The revelation that 85% of radiologists are considered nonhospital-based physicians—and are considered, therefore, to be eligible for American Recovery and Reinvestment Act (ARRA) stimulus funds—has sparked something of a gold-rush mentality in the imaging industry. Medicare-participating radiologists who are not hospital based (providing at least 90% of their services in inpatient or emergency-department settings) are permitted to participate in the program, which could yield incentives of up to $44,000 for each radiologist over five years. With stage 1 of the ARRA’s Health Information Technology for Economic and Clinical Health provisions kicking off in 2011, how should practices prepare to demonstrate meaningful use of their certified IT systems?
Depending on your current IT system’s vendors, it might already be too late to attempt to qualify in 2011, according to Alberto Goldszal, MBA, PhD, CIO of University Radiology, East Brunswick, New Jersey. “The vendor that is your electronic health record (EHR) provider—in our case, it’s the RIS provider—must be certified per the Office of the National Coordinator (ONC),” he says. “If you’re not using a certified EHR, you’ll have to start implementing one right away, and I’m not sure you have time to take advantage of all the incentives as early as 2011. If your vendor has been certified already or is in the process of being certified—and the list is being updated all the time—I feel optimistic about the ability to prove meaningful use.” The
list of ONC-certified EHRs and EHR modules is updated continuously.
He also warns that even if a product you’re using has been ONC certified, “most of the information systems pass because the manufacturers have introduced new features and functionality to their latest versions—but that may not be the version you have. They may need to upgrade you, and that can be complex,” he says.
Selling the NeedAlthough University Radiology did not need to make any additional capital expenditures to get its IT systems up to snuff for demonstrating meaningful use, the internal effort to capture and maintain the patient data that form the basis of the majority of stage 1 requirements translates into a significant investment of time—and therefore, money, Goldszal notes. Even assembling the multidisciplinary team needed to develop a plan for the coming year can be a time-consuming (and thus, costly) endeavor, he says. “It’s a considerable investment in terms of internal effort, but we think it is a good use of our time,” he says.
Naturally, he adds, some peers were initially skeptical as to whether the effort was worth it—a situation in which many practice CIOs pushing for participation in the program might find themselves, given the increasingly tough business environment faced by radiology practices.
Goldszal says, however, that the benefits of participation far outweigh the drawbacks—an argument to which his partners were amenable.
“Of course people are skeptical—it’s grunt work, collecting data and analyzing,” he says, “but there is a clear payoff. The business as a whole will benefit.” Benefits aren’t limited to the incentive payoffs, which one hopes will offset the time investment involved; instead, Goldszal says, practices should focus on how they can use their newly proven capabilities to improve operations and quality of care.
“People tend to think, ‘We’re the best practice.’ Over the years, we have perfected systems, people, and processes, so we think we’re as good as the top providers out there,” he says. “When you see these other measures that you hadn’t even thought of yet, you see how we really stand to benefit from this. It’s yet to be proven that the collection of these data will yield better outcomes for patients directly, but it’s a good first step.”
Taking the LeapGoldszal recommends that radiology groups with eligible EHR modules begin by educating themselves on the process, using resources such as the ACR® summary of the final stage 1 requirements or online communities like radiologymu.org, where radiologists can share their experiences with one another. “It may sound overwhelming at first, but then you get used to the concept of what needs to be done and you can plan your work,” he says. “Early in 2011 is when we’ll begin implementing our plan, and of course, we need some things done ahead of time.”
Engaging a broad range of stakeholders, like University Radiology’s multidisciplinary team, can help guide practices in determining which of the menu measures they’d like to focus on for the first year—and how best to integrate these measures into their workflow. “Now that you’re capturing these multiple data points on every patient, you need to incorporate that into your database and also your workflow,” Goldszal notes.
He adds that front-desk and business-office employees should not be excluded from this process. “It’s very important that you talk not only with the radiologists, but with the technologists and the front-desk people,” he says. “You may decide on a menu measure and how to report on it, and from your perspective, it may work well, but from someone else’s, it may be difficult. It’s important to have good representation from within your practice—everyone has to be heard in terms of what he or she can do.”
In addition, Goldszal notes, a modification to the stage 1 requirements that came through following the comment period makes reporting easier for practices than it would have been: “The reporting for the first year will be via attestation, which does simplify the logistics. There is very good flexibility in the latest version of the language that has made this feasible without a major impact on day-to-day operations,” he says.
Goldszal is optimistic that radiology groups like his can profit, in both the short and long terms, from the program. “We consider this a top priority that warrants people’s time and energy,” he says. “There are few bright spots out there, in terms of radiology business. We are committed to these efforts because there is a clear payoff to the practice, and ultimately, to generating better patient outcomes.”
Cat Vasko is editor of Radinformatics.com.