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IT'S VERY EASY NOW TO TAKE AN IMAGE FROM AN MR OR CT AND STORE IT IN A PACS SYSTEM; AND NEARLY EVERYBODY CAN ALSO STORE IMAGES NOW IN THE EMR. BUT WHAT NEARLY NO ONE CAN DO IS SEND THAT IMAGE ACROSS TO ANOTHER ENTERPRISE. -KEITH DREYER, M.D.
In addition, Dreyer and his colleagues at Mass General and Partners HealthCare have implemented and have been enhancing “technology that loads a CD from another organization and transmits the images into our PACS and then into our EMR. We call that cross-enterprise image import,” he says, and notes that his organization is already able to exchange diagnostic images through that technology without the use of CDs. As that technology improves over time, he emphasizes, patient care organizations will finally move out of the current situation, in which imaging departments find themselves drowning in CDs, some of them in non-compatible formats, from other organizations, and sending out many thousands a year themselves. (Mass General alone produces 200,000 CDs a year for other organizations, Dreyer notes.)
REIMBURSEMENT ISSUES COMPLICATE EVERYTHING
On the policy and reimbursement front, numerous diverse trends are affecting radiologists in different ways. On the one hand, the Office of the National Coordinator for Health IT (ONC) confirmed last year that radiologists are considered eligible providers under both the Medicare and Medicaid HITECH programs; under the Medicare stimulus program, a physician cannot provide more than 90 percent of their Medicare-covered services in the inpatient or emergency room settings. But there are still some complications around achieving the meaningful use requirements, and it is not entirely certain that the Stage 2 requirements will clarify things for radiologists. Still, the ACR has been urging radiologists to participate in MU/HITECH.
More broadly, however, Medicare physician reimbursement overall may pose more serious issues for radiologists, particularly if the “super-committee” created in the U.S. Congress to work out remaining unresolved issues from the bipartisan agreement this summer over lifting the federal debt ceiling cannot resolve certain questions. Some federal policy analysts are predicting major provider payment cuts under Medicare, with specialists the most vulnerable. In addition, the ongoing lack of resolution around the continuing delay in implementing the sustainable growth rate (SGR) formula for Medicare physician payments (with an average 29.5-percent pay cut looming next year), is adding uncertainty to the mix.
I WOULD BET THAT NO MORE THAN 25 PERCENT OF CIOs REALIZE THAT RADIOLOGISTS ARE GOING TO BE ELIGIBLE PROVIDERS, SO CIOs NEED TO GET RADIOLOGISTS INVOLVED IN THE CONVERSATION. -KEITH DREYER, M.D.
“I don't disagree with you that radiology may get hit,” Dreyer says of the cluster of physician reimbursement issues; “and there are a lot of advocacy efforts involved around that, because you could end up decreasing imaging, but increasing costs elsewhere. But regardless of what happens from a reimbursement standpoint, the challenge for radiologists around MU is very simple, because the 25 main requirements don't really apply to what we do, and don't really speak to the necessary technology necessary for improving patient care within our specialty,” he adds.
Given all this uncertainty around reimbursement, which likely will strongly influence how radiologists respond to the meaningful use imperative, Dreyer urges CIOs to “get educated. I would bet that no more than 25 percent of CIOs realize that radiologists are going to be eligible providers, so CIOs need to get radiologists involved in the conversation,” he says. They need to start looking at enterprise visualization tools [formerly referred to as “enterprise image distribution tools”] and cross-enterprise image-sharing,” as tools that can appeal to radiologists as they begin to transition to the emerging world of image management. And on the other side of the ledge, CIOs should look into clinical decision support for image-ordering, for ordering/referring physicians.
And then there is the work towards creating health information exchanges (HIEs), which will most certainly involve radiologists at some point, in every organization.
In the end, Dreyer says, CIOs and other healthcare IT leaders need to look at the imaging informatics world as one key piece of the overall clinical informatics puzzle. With technological, policy, and industry changes all creating shifts in the landscape, radiologists and imaging informatics will, he concludes, become more and more a part of the broader conversation going forward.
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