Many radiologists in private practice may want to take a wait-and-see approach to meaningful use, despite missing out on the federal financial incentives for adopting electronic health records.
An interested crowd attended Meaningful Use: Experience from Private Radiology Practices, Tuesday afternoon at RSNA 2013 in Chicago. Moderator J. Raymond Geis, M.D., with Advanced Medical Imaging Consultants, Fort Collins, Colo., said his practice is holding off on EHR adoption until 2019 under the hardship exemption extended to certain types of practices. It will miss out on all the incentive payments, but it wont have its Medicare payments docked until 2020. Plus, says Geis, it can wait until consolidation of both EHR vendors and the provider industry provide it with more obvious and less risky choices.
Geiss practice serves two large health care systems, both of which are buying up multiple primary care practices. Eventually, he expects the majority of the practices patients to be cared for by one of the systems, and at that point, it can piggyback on that providers EHR. They will have done all the work and we wont have the capital expense of purchasing the EHR, Geis says. And if the primary care doctor has entered smoking history, I can say its my information, and I dont have to change our workflow to ask people about smoking. Thats going to make our life much easier.
At least 90 percent of radiologists at East Brunswick, N.J.-based University Radiology have attested to meaningful use so far, said CIO Alberto Goldszal, who presented his practices experiences with the meaningful use program. The practice was selected by CMS for a meaningful use audit, and while it eventually passed, Goldszal had to explain several times how the eligible patients had been determined. A mismatch between the patients and the total Medicare charges confused the auditors.
Goldszal agreed with Geis that complying with meaningful use guidelines will become easier for radiologists as primary care physicians gain the ability to share certain information. Radiologists will be able to borrow such information as allergies, problem lists, and immunization history. Because radiologists are rarely the first specialty to see the patient, all those measures should come to them electronically as part of the summary of care, he said.
Alan Kaye of Advanced Radiology Consultants, Bridgeport, Conn., described his practices participation in meaningful use. Of 31 radiologists, only two didnt do enough outpatient work to qualify for the program, and in 2011 the practice chose a radiology information system that had been certified for meaningful use. It collected its first incentive payment in January 2012, one of the first radiology practices to do so.
Kaye believes Stages 2 and 3 of the meaningful use program may help seal the deal for radiologists, even though the program remains geared toward primary care physicians, because of the requirements for electronic ordering. If radiologists cant receive orders electronically, primary care providers may be reluctant to make referrals to them.
This is just the beginning of a long-range program thats going to facilitate and mandate an exchange of information thats much more robust than we have now, he said.
Adoption was challenging: the practice had to create new fields in its RIS, develop a patient portal, and retrain its staff and even its patients, who had to become accustomed to their radiologists inquiring about their smoking history. Currently the portal is registering 3,500 new patients and seeing 6,700 patient sign-ons per month.
James Whitfill, M.D., of Scottsdale (Ariz.) Health Partners, said meaningful use has been an expensive journey and he is reserving judgment on its ultimate cost. His practice did a time and motion study and determined that it will cost an additional $160,000 a year in labor to collect the extra data required. In the maintenance phase, I think people will look at the financial impact and start to say that the 1% Medicare hit may not be so bad.
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