Radiologists have had varied success with becoming meaningful users of electronic health records. Results with initiatives depend on a variety of factors, but economics have in many cases affected the results.
“We’re not a meaningful user; in fact, I’m embarrassed about that,” says Keith D. Hentel, MD, associate professor of clinical radiology at Weill Cornell Medical College and executive vice chairman in the department of radiology at New York-Presbyterian Hospital-Weill Cornell Medical Center.
“There was a lot of enthusiasm at the start of the [MU] program in 2011, and it would have meant $2.5 million in incentive funds for us,” Hentel said during an educational session at the annual meeting of the Radiological Society of North America on Tuesday, December 1. “But we failed to become meaningful users.”
There were several reasons why the effort was scuttled, but Hentel contends the economics just couldn’t support the amount of effort. “It was a poor return on investment,” he said during the session, entitled “Meaningful Use for Radiology: Pros and Cons.” “It would have increased revenue by about 7 percent, and the amount of effort it would have taken to achieve meaningful use would have far exceeded 7 percent.
Meaningful use can be a mixed bag for radiologists, and changes in the program that lie ahead may influence what radiology groups decide to do, says James Whitfill, MD, chief medical officer for Scottsdale Health Partners and president of Lumetis LLC, a consulting firm. Scottsdale decided to participate in the MU program, but costs were substantial.
“For radiology, you have to consider the total cost of ownership,” Whitfill says. “We had to buy an EHR that had nothing to do with what our main line of business is. That was a fairly large financial outlay, and our costs to maintain it run about $250,000 annually.”
Scottsdale belongs to an ACO, and that obviates the need for it to participate in the meaningful use program, Whitfill says. With MU incentives declining over time, “we’re considering the idea of sunsetting our EHR system,” he adds.
Much will depend on the eventual final form of the merit-based incentive payment system (MIPS), a new approach to physician payment that is under development to replace the controversial Sustainable Growth Rate formula, which had been in place to limit growth in physician payments. The intent of MIPS is to base reimbursement on value, not the volume of services; meaningful use of electronic health records systems will be one component of the reimbursement formula, which also will factor in quality measures, efficiency gains and clinical process improvement.
MIPS is expected to go into effect in 2019 and it will reward performance improvements while penalizing laggards. Incentives can grow to 27 percent over standard Medicare payment in 2022, while penalties will grow to 9 percent of standard Medicare payment by that year.
The yet-to-be designed system impacts current decisions about how vigorously to pursue meaningful use, panelists at the session said. A question from the audience, from a manager of a small practice wondering about whether to start participating in the MU program this year, met with a substantially negative response from presenters. They advised him to begin the planning to prepare for MIPS in 2019.
The meaningful use program has been a disappointment to Whitfill. “At most of the organizations I’ve seen, it’s really just a ‘check the box’ kind of thing,” he says. “Audits of the program have the same focus. There’s a lot of meeting the letter of the law, but I don’t think that, from a radiology perspective, this has made a huge difference in the quality of care provided to patients. But MIPS will be a seismic change in reimbursement for us.”
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