The ARRA (American Recovery and Reinvestment Act) and the HITECH (Health Information Technology for Economic and Clinical Health) act were signed on 2/17/2009. The healthcare provisions of the ARRA established the MU (Meaningful Use) EHR (Electronic Health Record) ) Program and the HITECH defined the role of the Office of the National Coordinator (ONC) and laid out the incentives with timing.
Overall, the goal is to have healthcare professionals and hospitals using EHR to reduce cost and improve care by 2015. This is to be accomplished in three phases: Stage 1 – Data Capture and Sharing; Stage 2 – Clinical Decision Support; and Stage 3 – Improved Outcomes.
As signed, the ARRA/HITECH did not effect most radiologists. Hospital outpatients were part of the Eligible Hospital (EH) based population and not the Eligible Professional (EP) based population. The original focus was on family practice and internal medical physicians as reflected in the MU criteria.
Since the HITECH act dictated the time line and tied it to funding, the ONC got to work and published the Stage 1 MU draft criteria on 1/12/2010. Then, on 4/15/2010, the Continuing Extension Act 2010 was signed. A key provision for Radiology was that the hospital outpatients were shifted from the hospital base to the physician base. This change moved approximately 90% of radiologists to Eligible Professionals. This group is eligible to receive incentive payments for achieving MU and also eligible for penalties for not achieving MU.
Unfortunately, the final rule for the Stage 1 MU criteria was issued in July of 2010 just two months after radiologists became “eligible”. Most radiologists were not aware of the change then and many are not aware of it now. The intent of the Extension Act was to include hospital based internists and family practitioners. Adding radiologists and other specialties was an unintended consequence – one that has not been addressed either with an exclusion or with MU criteria that reflect radiology practice.
The impact of moving radiologists to EP’s over a year after the original acts is significant. Radiology not only lost a year of planning but was not included in the hospital plans which could help to achieve MU. In addition, most hospitals are in the midst of implementing EHR’s to accomplish MU as EH’s and do not have the resources to help out radiology at this time.
The Medicare EHR Incentive Program remains on a fast track for healthcare. The 2015 deadline remains unchanged even though Stage 2 reporting now appears to be delayed from 2013 to 2014. Also unchanged, despite extensive lobbying by radiology groups such as, the ACR and RSNA, is any effort to recognize the difference in practices of radiologists and other specialities.
Specialty physicians may be addressed in Stage 3. There is a sub committee of the HIT’s MU Workgroup said to be looking at MU criteria for the specialties. Hopefully images will be included to the EHR.
All in all, an unfortunate series of events for radiologists who were included late in the EHR Incentive process under criteria written for the majority of physicians.