On March 7, 2012, the proposed rule¹ governing stage 2 of the CMS incentive program for electronic health records (EHRs) and the 2014 EHR certification criteria² were published to generally favorable reviews from organized radiology. Mike Peters, director of legislative and regulatory affairs for the ACR®, explains why the ACR has spent so much time monitoring the program and why the proposed rule for stage 2 represents a significant improvement in the program for radiologists who intend to participate.
RBJ: I understand that the Health Information Technology for Economic and Clinical Health (HITECH) Act and its meaningful-use regulations have kept you very much occupied. How much time are you spending on this?
Peters: As far as the EHR incentive program goes, we have been following this issue very closely since late 2008, when the HITECH language was first tacked onto the stimulus package. We’ve actually monitored just about every federal initiative, meeting, and event pertinent to this issue over the past three years. I can’t think of any physician association of any specialty, including the AMA, that has spent as much time as the ACR has on this issue.
The Office of the National Coordinator (ONC) for Health IT has two extremely active federal advisory committees, with various workgroups and tiger teams under them. It takes a lot of time to follow all of that. We’ve always followed this program under the assumption that somewhere between 50% and 70% of our membership might be eligible, based on the original statute and the CMS stage 1 proposed rule. When the Continuing Extension Act of 2010 removed outpatient hospital settings from the statutory definition of the hospital-based professional, we estimated that almost all of our remaining physician members would be eligible for the program.
Our ACR IT and Informatics Committee has been leading us on this issue, chaired by Khan Siddiqui, MD, and Keith Dreyer, DO. Between them, they’ve volunteered hundreds of hours.
RBJ: How many practices are you aware of that attested to meaningful use in year one? Do you have a sense of how many might try to attest this year?
Peters: There’s no way to know how many people are actively pursuing compliance. What we have right now are the attestation statistics from CMS. As of February, CMS showed that 269 diagnostic radiologists had successfully attested and received dollars; 29 interventionalists, 86 radiation oncologists, and seven nuclear-medicine physicians received meaningful-use dollars, as well.
When CMS and the ONC talk about statistics associated with the program, they often trump up registration numbers, but that’s a pretty meaningless measure for judging success. You have to look at Medicare attestation statistics, which actually show that the rates are pretty low, across the physician community as a whole.
RBJ: What will practices forfeit if they start later than 2012?
Peters: The CMS notice of proposed rulemaking did not propose any changes to the incentive amounts or to the payment adjustments that begin in the penalty phase. All of that is prescribed by Congress in the statute, so CMS doesn’t have any wiggle room there. If people start after 2012, they are looking at reduced incentives, over time.
You can begin your first EHR reporting period in 2012 and still get the same amount of incentives over five consecutive compliance years as you would have if you had started last year. In 2013, the incentive amounts go down; then, 2015 is the beginning of the payment-adjustment (or penalty) phase.
The way CMS is proposing it, if you’re not compliant by July 3, 2014, you will get the 2015 payment adjustment. As the rule is proposed, you would have to complete your attestation no later than October 1 2014—which is about three months earlier than many people expected, based on the attestation deadlines in the existing regulations.
RBJ: The ACR’s initial response to the proposed rules for stage 2 seems positive; some of the accommodations requested were included. What were they?
Peters: I would say we are cautiously optimistic about the content of the proposed rules, but we expect many changes—some positive and some negative—before the final rules are promulgated, later in 2012. We have a pretty big platform of requests that we’ve been pushing for in regulations from both CMS and the ONC. I would say that almost all of our requests were addressed, to some degree.
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