AR: Making sense of the MU maze

As radiology grapples with the seemingly endless details of meaningful use (MU), many questions remain. The only certainty, according to an article appearing in the February issue of Academic Radiology, is “that MU is real and will affect radiology for many years to come."

Because of this inevitability, Adeel Siddiqui, MBBS, of Beth Israel Medical Center in New York City, and colleagues wrote the article to help radiologists deal with some of the ambiguities of the MU process.

MU is divided into separate programs, with radiologists most likely qualifying under the eligible professional (EP) program through Medicare, wrote the authors. Under the EP program, providers are eligible for incentive payments if they comply during the first four years of the program. It pays to comply early because if compliance is reached by October 2012, providers are eligible for the maximum payment of $44,000, which will be paid out over five years.

Incentives are only part of the equation, however, as penalties for noncompliance will be introduced gradually after 2015, wrote the authors.

Siddiqui et al said that while MU is geared toward primary care, subspecialists are definitely included. To qualify for the EP program, as opposed to being considered hospital-based and under the eligible hospital program, just 10 percent or more of a radiologist’s total studies have to fall outside the inpatient hospital or emergency setting. This is due to a change in definitions released by the Centers for Medicare and Medicaid Services.

“We estimate that because of this rule change and the percentages of radiologists doing purely outpatient work, more than 90 percent of all radiologists will be eligible for the incentive payments,” wrote the authors.

Required MU measures are divided into two categories: a core group of 15 required items and a menu set of 10 items, of which physicians must choose five. Physicians may be eligible to exclude some of the core measures, and Siddiqui et al wrote that radiologists are likely to exclude the following:

• Use of clinical physician order entry for medication orders: Any EP who writes fewer than 100 prescriptions per year is excluded.
• Generate and transmit permissible prescriptions: Again, any EP writing fewer than 100 prescriptions per year is excluded.
• Record vital signs, height, weight, blood pressure and calculate BMI: EPs who believe these vital signs have no relevance in their scope of practice are excluded.

Radiologists must choose five of the menu set items, and the rest can be deferred, according to the authors. Deferring a menu set item can be done even if its exclusion criteria is not met, though on the other hand, radiologists also may choose to exclude an item, if they are eligible, without having to defer it.

“This distinction is important because some menu set items might move into the core set in future stages; the exclusion criteria will theoretically carry over, but EPs will no longer be able to defer the measure,” wrote the authors.

The CMS website began accepting registrations of EPs for stage 1 of MU on Jan. 3, 2011, and Siddiqui et al advised physicians go through the process even if there are no plans on meeting the incentives so departments will at least have a better understanding of MU.

“Most radiologists will initially be drawn to MU because of the incentive payments,” wrote the authors. “The more important role will be how radiologists define not only what that means for radiologists, but how radiologists want to function as a department in the future.”