ACR survey: Non-cooperative hospitals discourage MU participation

Why do most radiologists choose not to participate in the Medicare/Medicaid EHR Incentive program? According to a recent survey of radiologists taken by the American College of Radiology (ACR) government relations department, hospital and practice issues outside of a radiologist’s control is the greatest barrier to his or her participation in the Meaningful Use program.

“I think the most important takeaway from the survey was that more than half of noncompliant radiologists indicated they wanted to participate in the program but were prevented by barriers outside their control—mostly hospital administration, practice management, or IT/vendor issues,” said Michael Peters, ACR director of regulatory and legislative affairs.  “We have heard for several years that certain hospitals—particularly the smaller community hospitals with stressed resources—are not facilitating MU compliance by their onsite physicians in the eligible professional version of the program.  It is hard, if not impossible, to comply if your workplace doesn’t provide the requisite certified software, patient data, and support.”

The ACR carried out an informal, voluntary three-question survey in order to better understand the reasons behind radiologists’ decisions whether or not to participate in Meaningful Use. The ACR received 107 responses from 68 radiologists who have not participated in the program and 39 who had participated at least one year.

Those who haven’t participated in the program were asked to identify the major reason behind their decision. The results:

• 37% encountered hospital/practice issues outside their control
• 28% did not believe the participation requirements added value to the practice of radiology
• 12% encountered IT/vendor problems outside their control
• 12% had never heard of the program
• 7% encountered cost restrictions
• 3.5% did not want to participate due to unspecified reasons

This means that more than half (56%) were dissuaded from participation because of barriers outside of their control— hospital facility/practice decisions, IT/vendor issues or prohibitive costs.

ACR also asked those non-participating physicians to identify what needs to change in order for them to begin participating in the future:

• 34.5% indicated the program must offer more compliance options or be more specialty-centric
• 33% need hospital administration and/or practice management to be more helpful
• 13% need more education, guidance, or consultation
• 11% indicated the requirements must be less complex
• 5.5% need certified software to integrate better with their practice IT infrastructure
• 3.5% need certified software to be less expensive or free

Radiologists who participated in at least one year of MU, and planned to continue participating, were also asked to identify all of the drivers/benefits behind their decision:

• 70% were motivated by the incentive payments 
• 70% wanted to avoid negative payment adjustments for nonparticipation
• 37% were required to participate by their hospital/facility and/or practice
• 33% wanted to improve their connectivity with referring providers and/or patients
• 18.5% wanted access to previously inaccessible, but helpful, patient data
• 18.5% were readying for involvement in alternative payment models/delivery systems
• 11% supported standardization of HIT

“It’s fair to say that financial incentives helped drive MU participation between 2011 and 2014 in radiology and elsewhere; and I suspect the Medicare payment penalties will drive future participation as well,” said Peters. “On the flip side of that, however, our survey suggests that nonparticipation is (more than half of the time) decided for the radiologist by external factors.  Therefore, most nonparticipating radiologists were apparently not given an opportunity to participate by their workplace, regardless of financial considerations.”

According to Peters, the ACR plans to use the results of the survey to supplement its ongoing legislative and regulatory efforts.

“All in all, I think the survey supports ACR’s advocacy activities specific to this program over the years,” Peters said. “Simply put, CMS must add more flexibility for those who can participate, and establish a fair way out for those who don’t have the option to participate.”