The Future of Meaningful Use and Beyond
At the 98th meeting of the Radiological Society of North America in Chicago on Nov. 26, 2012, Keith J. Dreyer, DO, PhD, vice chairman of radiology at Massachusetts General Hospital in Boston and associate professor of radiology at Harvard Medical School, discussed the future of imaging informatics in the face of meaningful use.nnCMS’ meaningful use program is one of the ways the federal government is focusing on quality, safety and access with healthcare, said Dr. Dreyer. By urging providers to use certified electronic health record technology, the federal government is hoping that safety and quality of healthcare will increase while the cost of healthcare will decrease. According to Dr. Dreyer, physicians and radiologists need incentives to have a patient-centric focus in their healthcare decisions and that is what meaningful use is — an incentive.nnDr. Dreyer pointed out that more than 50 percent of physicians and 80 percent of hospitals have enrolled in the meaningful use program, with payments passing $7 billion, from when meaningful use legislation as part of the HITECH Act was first passed in February 2009 to when the most recent regulations — stage 2 of meaningful use — were released.nn”What does this mean for radiologists? Well, nearly all radiologists are eligible for the program. In 2011, 32 percent of radiologists said they planned to participate, and in 2012, that percentage has doubled,” said Dr. Dreyer. “While meaningful use can be a challenge for radiologists, there are various exclusions and temporary exemptions available. The thing to remember is that the stages of meaningful use are important.”nnThe stage 2 regulations for meaningful use have two specific objectives for imaging:n
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- Image ordering measure: Physicians have to use certified electronic health record technology to order more than 30 percent of imaging exams.
- Image results measure: Physicians have to use CEHRT to receive more than 10 percent of imaging results.
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nDr. Dreyer concluded his presentation by commenting on the futures state of radiology and healthcare in general. “There are four metrics that I see as being important: productivity, profitability, performance and presence. The future of healthcare technology will hinge mostly on performance and presence. [Going forward], quality and relevance can drastically increase,” said Dr. Dreyer. “Productivity may take a hit for a while, and if you hinge your profits to productivity, you may see decreases. However, if profits are tied to quality and performance metrics, there will be better outcomes in the long run.”nnSource: www.beckershospitalreview.com; Kathleen Roney; November 28, 2012.nn
nna coordinated team can deliver a consistent experience, regardless of where this patient experience begins and ends. A clinic can either take the opportunity to define its own reputation through its approach to patient engagement or have its reputanntion determined by its patients, who will talk to each other about what should have happened and why and why.nnAccessibility of electronic health information is already changing the nature of the patient-clinic interaction. We all know of the reputations of the clinics in our neighborhoods that have evolved over time. And these reputations I’m referring to have had little to do with their online or “digital” reputation. The experiences that patients and clinic staff have shared over the years (perhaps even generations) that have established these reputations are those that have occurred between people in the face-to-face interactions in the clinic. However, as the patient experience continues to grow in terms of population health outcomes and the individual’s day-to-day experience, it is an important time for physicians and their staff to recognize how to participate in the culture of care that is defined by the brand that is the physician as well as the clinic as a whole.nnJust as the accessibility of health information continues to expand from the patient’s personal history to general educational material in digital form, so too is the nature of the interaction between patient and clinic expanding. Now we are seeing the convergence of those longstanding reputations built upon one-on-one encounters and digital reputation established by connecting with patients in convenient formats and online.nnThis evolution demands a new level of reception in the clinic, one requiring a sustained and fully engaged dialogue among the entire clinic staff. The conversation about traditional and digital patient experiences is one that represents a great opportunity to accept the gratitude of each patient. Whether it’s an unconditional “thank you” or even one that is qualified with a comment or concern for future encounters, this is the reputation of the clinic as a whole and each individual physician. What’s more, because this patient experience is happening in so many ways well beyond the walls of the exam room, a fully engaged staff members will find themselves contributing to this reputation more every day.nnWhereas in the past the patient experience was defined by the coveted clinic appointment, what happens before and subsequent to that encounter has now become equally important in terms of the reputation of the clinic and physician. The challenge is to keep in mind within conversations about and interactions related to EHR and health IT that this converged clinic reputation is driven by a well-defined patient experience supported by a fully engaged clinic staff.nnSource: www.ehrintelligence.com; Robert Green, November 20, 2012.
The Centers for Medicare & Medicaid Services (CMS) issued a final rule with comment period on November 1, 2012 for Medicare’s payments for physician fees for 2013. It includes a new policy to pay a patient’s physician or practitioner to coordinate the patient’s care in the 30 days following a hospital or skilled nursing facility stay. Recognizing the work of community physicians and practitioners in treating a patient following discharge from a hospital or nursing facility will ensure better continuity of care for these patients and help reduce patient readmissions. The changes in care coordination payment and other changes in the rule are expected to increase payment to family practitioners by seven percent—and other primary care practitioners between three and five percent—if Congress averts the statutorily required reduction in Medicare’s physician fee schedule.n(
The Centers for Medicare and Medicaid Services (CMS) has released updated reference grids for Stage 1 and 
The International Classification of Diseases, Tenth Revision (ICD-10), comprises two sets of codes, one for documenting diagnoses (ICD-10-CM) and the other for documenting procedures (ICD-10-PCS). Compared to ICD-9, these codes are more extensive and more numerous. ICD-10-CM codes number close to 68,000 and contain 3–7 characters compared to ICD-9-CM total more than 14,000 3–5 digit codes. Similarly, ICD-10-PCS comprise 7 characters and approximate nearly 87,000 compared to 4,000 ICD-9-CM codes of 3–4 numbers in length.nnGiven the size and scale of ICD-10, the new code set will demand more from hospital staff, not just coders. Unless physicians improve their methods of documenting clinical encounters with patients, they and their hospitals could find themselves in dire financial straits:nnEssentially what’s going to happen is physicians are going to have to have more specific documentation in order to meet medical necessity so that they can even be paid and in order to be able to make sure they’re getting the most appropriate reimbursement when they do get paid, both for the physicians and the hospitals. When a physician is treating a patient in the hospital, you have two patients: one to the physician and one to the hospital. They both are dependent on better documentation with ICD-10.nnTo avoid loss in revenue and uncertainty in productivity, experts recommend that hospitals pay special attention to their clinical documentation as well as the templates used by physicians in their electronic health record (EHR) systems.nnIn this second installment of ICD-10 Best Practices, we address how hospitals undertake an important health information technology project necessary to ensure a smooth transition to ICD-10: identifying and making improvements to EHR templates.nnModifying EHR templates for ICD-10nThe most successful ICD-10 implementations begin with an assessing of current procedures and systems. Considering that ICD-10 demands more information than ICD-9, hospital leadership must first identify where physicians presently fall short in capturing data necessary for ICD-10.nnThose tasked with updating EHR templates need strike the right balance so as to avoid stimulation overload for physicians using the system:nnICD-10 has a lot of detail that you can collect that’s informational only, and it allows you to assign a more specific code. However, that code is not based on or will not lead you to a change in the way a physician manages that patient, and it won’t have an impact financially. Your alerts have to be focused on those areas where you’re improving documentation because it’s going to improve payment or capture of severity of illness and risk of mortality.nnThe real challenge is identifying what’s necessary versus what’s superfluous. And this extends to the details physicians will now have to capture. By and large, many parts of ICD-9 carry over to ICD-10; however, the level of specificity changes greatly:nnMost of things that you have to document for ICD-9 to improve reimbursement are going to still hold true with ICD-10. But there are some additional things in ICD-10 and the problem is that they’re buried. It’s not easy to identify where the shift in payment is going to come from based on all the specificity that we have available, and that’s why you need to have the assessment to really drill down and identify. You take that information to improve the templates you have because some of it is not intuitive. You wouldn’t think that adding this little is going to have a financial impact, but it does.nnWhile the modifications to the EHR templates represent a significant undertaking, they are only successful if preceded by a thorough assessment of ICD-10 and its requirements on physicians and hospitals.nnSource: www.ehrintelligence.com; Kyle Murphy, PhD; October 30. 2012.
few months ago, we paired with Novitas Solutions, INC. as our new Medicare Administrative Contractor (MAC). Effective October 29, 2012, Novitas Solutions, Inc. will begin handling all fee-for-service claims processing for the Part A providers.nnIn order to facilitate a smooth Part A JH transition, please take note of the following important dates:nnEDI Claims Submissionn
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