Local, State, Federal

CCHIT Approves Criteria
ACR Offers RBM Standards

CCHIT Approves Criteria

It took more than 200 volunteers, but it came on time, as promised. The Certification Commission for Healthcare Information Technology (CCHIT) recently announced its approval of the final 2009-2010 criteria for certification of Ambulatory (office-based), Inpatient (hospital-based), and Emergency Department electronic health records (EHR), and for its stand-alone Electronic Prescribing certification. Furthermore, the Commission also approved updated criteria for the Ambulatory add-on options in Child Health and Cardiovascular Medicine.

“We will be offering these certification criteria promptly to the Federal HIT Policy and Standards Committees, along with data from our 4 years of experience certifying health IT, as the Committees race to meet their tight deadlines,” said Mark Leavitt, MD, PhD, Commission chair.

To help the public understand the new policies, CCHIT has issued a concise companion guide, outlining the criteria relating to the characteristics of a qualified EHR as described in the American Recovery and Reinvestment Act (ARRA).  

As stated by the guide, the definition of a qualified electronic health record is:

1. an electronic record of health-related information on an individual that A) includes patient demographic and clinical health information, such as medical history and problem lists; and B) has the capacity to provide clinical decision support, to support physician order entry, to capture and query information relevant to health care quality, and to exchange electronic health information with, and integrate such information from, other sources.

The document also went on to point out that “many criteria support more than one of the qualifications. Furthermore, the ARRA qualifications are not an exhaustive list of required capabilities; for example, they do not mention technical security features essential to protection of health information privacy. Accordingly, we include additional supporting categories to accommodate these other essential functions of an EHR.”

CCHIT said its Certification Handbook, which describes the policies of its certification programs, will be significantly revised to incorporate the expanded applicability of EHR certification under ARRA. The Commission explained that changes will include a more comprehensive verification of successful implementation and use of commercial products. It will also account for piloting a new program to inspect and certify EHR technologies-in-use that will accommodate a wider variety of development and deployment models. The Commission has formed a subcommittee to research usability measurement.

Addressing the opening date for vendor applications to achieve 2009-2010 certification, Leavitt said, “According to the recently released Program Implementation Plan for ONC [Office of the National Coordinator for HIT], their Draft Rule—which includes standards and certification criteria—must be submitted to HHS by August 26. We will defer launch of our 2009-2010 inspection programs until we have reviewed that material, in order to ensure conformance of this program to ARRA incentive requirements.”  

To read the entire “Concise Guide to CCHIT Certification Criteria,” visit www.cchit.org.

—Elaine Sanchez

ACR Offers RBM Standards

While radiology benefit management (RBM) companies may not be the most efficient way for the business side of radiology to be handled, they are a fact of life. In order to eliminate the obstacles and headaches caused by these companies, which are contracted by payors and managed care organizations to handle billing and control costs associated with radiologic services, the American College of Radiology and the Radiology Business Management Association (RBMA) have developed a set of RBM guidelines.

The guidelines are pragmatic and straightforward, designed to make billing and care-related interactions more consistent. Christopher Ullrich, MD, FACR, chair of the ACR Managed Care Commission, likened the goal of the RBM guidelines to those that were designed to smooth out the problems caused by the rise of health maintenance organizations in the 1980s.

Among the guidelines are a number covering preapproval of procedures. The guidelines stipulate that once permission for tests is granted, the RBM can’t refuse to pay for them after the fact. Another problem with RBMs is that they support very delimited, catchall CPT codes. The guidelines recommend that a “family” of codes that reflect the complexity of radiology procedures be developed.

Ullrich noted that the RBM system can be extremely disruptive to the patient-doctor relationship, because the radiologist has to spend an inordinate amount of time—in some cases up to 20 minutes—getting a test preapproved. On average, only 70% of tests are preapproved by RBMs and cover only outpatient settings.

The guidelines also recommend that the RBMs comply to all federal and state guidelines covering radiology-specific procedures and tests. The guidelines also advocate that the RBM decision makers be medically trained and qualified personnel.

Clearly, the guidelines are designed to fix a system that is not efficient. Ullrich said that the system at Massachusetts General Hospital reflects the kind of ideal that he’d like to see implemented someday. The system, which is enterprise-wide, is integrated with the patient’s electronic record, and grades a selected test on a number of criteria. Even if a test is graded low based on the patient’s profile, the physician can still order it. Over time, the physician builds up a profile that can be used to track and measure rate of consumption. “It’s a more positive approach. You refine and learn in a nonpunitive way,” said Ullrich.

While the Massachusetts General system seems to be an ideal, the reality is that many payors have gone the RBM route and this is the environment many radiologists find themselves in. The guidelines are designed to address this. “We want to be as efficient and honest in our business practices as possible,” said Ullrich, who lays the blame for many of the RBM companies’ problems at the feet of poor computer interfaces and not “evil” insurers that are out to “get” radiologists.

Ullrich hopes that the guidelines will open a line of dialogue between radiologists and payors. Prior to the release of the guidelines to the public, the ACR made the plans available to payors as a courtesy. The response, according to Ullrich, was “positive.”

The full text of the American College of Radiology RBM guidelines is available at: www.acr.org/SecondaryMainMenuCategories/~

—C.A. Wolski