RSNA: MU tales from private practices

CHICAGO—The audit process for satisfying Meaningful Use (MU) in a private radiology practice is challenging, but ultimately fair, and the process can lead to a number of ancillary benefits besides the incentive payments, according to a presentation from practice representatives at the annual meeting of the Radiological Society of North America (RSNA).

There has been concern within the specialty that MU may not be suitable to radiology. Some criteria are not relevant to the workflow in radiology and the program seems geared more toward primary care. Hospital-based radiologists also are subject to the decisions of the wider enterprise. Only 14 percent of radiologists have attested for MU to date.

A more positive outlook was presented by Alan D. Kaye, MD, CEO of Advanced Radiology Consultants, which has seven private practice offices throughout Connecticut. Not only is MU suitable for radiology, he said, but it may be necessary. Imaging specialists are an information source for healthcare, and radiology can provide IT leadership to other specialties or to ACOs and hospitals. The American College of Radiology has been helpful in pushing for MU policies that are more relevant for radiologists.

Kaye also pointed to MU Stage 2 and Stage 3 as tipping points for radiology with their requirements for electronic ordering, and the fact that roughly two-thirds of office-based physicians are in the MU program.

Alberto F. Goldszal, PhD, MBA, CIO for University Radiology Group, New Brunswick, N.J., talked about his group’s experiences with the audit process earlier this year. From March to August, there was an initial request for documentation and two follow-up requests for additional information or clarification before the auditors were satisfied. He said that the group did not pass the initial review largely due to simple misunderstandings. For example, auditors asked why the group asked for exclusions for recording vital signs or immunizations, and it had to be explained that these were not relevant to the radiology services being offered by the practice. Goldszal noted that the actual auditors they interacted with changed over the course of the process.

Another speaker, James Whitfill, MD, CMIO at Southwest Diagnostic Imaging, Scottsdale, Ariz., explained that his practice initially delayed the MU process while waiting for the rules on exemptions to be finalized. Once they began to work towards satisfying the requirements, they realized it would be a challenging endeavor and patients were not used to having certain information, including data on race and ethnicity, recorded by a radiologist.

The move to MU is costly, with expensive system updates, workflow changes and administrative burdens all necessary to satisfy requirements. Whitfill could not offer an estimate of his group’s ultimate costs, but he said some groups may determine the looming 1 percent penalty in Medicare payments will be not as bad in comparison.

Kaye said his practice was ultimately successful thanks to a strong relationship with its RIS vendor, extensive planning and the commitment of an educated and motivated staff. A gap analysis determined the group could satisfy the requirements and management realized they could use the MU incentive money to fund other related projects. The patient portal is getting 4,000 log-ins per month, and the portal saw massive gains in registrations after the group began experimenting with using front desk staff to help direct patients to register for the portal, including using iPads kept on site for portal registration.

Whitfill made a connection between the patient portals required of MU and the early days of passing images via CD. While portals may be a powerful tool, he worried that patients will be overwhelmed by the different types of portals being thrown at them by different providers, similar to how radiologists have had to deal with different viewing software embedded with imaging studies on CDs.

A major benefit beside merely receiving the incentive payments was the effect on practice marketing, said Kaye. The increased collection of patient emails improved communication, and an outreach effort to boost breast cancer screening garnered 235 new mammography patients. The practice also developed a reputation for being forward-thinking and now helps administer PACS for other providers.