Federal officials are urging physicians to begin electronic
prescribing as soon as possible now that Congress has authorized bonus
payments for the successful use of the technology.
Under the recently enacted Medicare Improvements for Patients and
Providers Act (H.R. 6331)--the same law that eliminated the 10.6%
Medicare physician pay cut--Congress also outlined plans to ramp up
e-prescribing beginning next year. Under the law, bonus payments will
gradually decrease and eventually physicians will be penalized if they
don't transmit prescriptions electronically.
"We expect this will have a profound effect on the adoption
and use of e-prescribing," Health and Human Services Secretary Mike
Leavitt said during a press conference to explain the details of the new
initiative.
The widespread use of e-prescribing will create benefits for
patients and the health system as a whole by allowing for real-time
cross-checking for drug-drug interactions and providing automatic error
screening of prescriptions, Mr. Leavitt said.
It also is expected to save money. Medicare could save up to $156
million over a 5-year period by avoiding adverse drug events, according
to the Centers for Medicare and Medicaid Services.
The incentive payments will be awarded through the Physician
Quality Reporting Initiative, Medicare's voluntary program that
provides incentives to physicians who successfully report on certain
quality measures. CMS of ficials have developed measures specific to
e-prescribing and will be releasing guidance on how they define the
routine use of e-prescribing. They also plan to host a conference on the
technical details of the plan this fall.
The e-prescribing bonuses will be in addition to the current
bonuses.
In 2009 and 2010, physicians who successfully report on
e-prescribing measures will be eligible to earn 2% of total allowed
Medicare charges. In 2011 and 2012, the incentive payment will drop to
1% and then to 0.5% in 2013.
Beginning in 2012, eligible physicians who do not e-prescribe will
see their total allowed Medicare charges cut by 1% with: hat amount
increasing to 2% by 2014, acording to the provisions of H.R. 6331.
The law grants an exemption for those providers for whom the
requirement would be a "significant hardship," such as a
physician who is practicing in a rural area that does not have
sufficient Internet access.
CMS officials already have laid the groundwork for the increased
use of eprescribing by issuing standards around the trans mission of
electronic prescriptions, Mr. Leavitt said. With the authorizaion of
bonus payments, the government will be able ease some of the costs of
adopting e-prescribing technology.
According to CMS estimates, the average the cost of acquiring and
setting up an e-prescribing system is about $3,000 per prescriber, with
ongoing maintenance costs of $80-$400 per month.
Dr. James King, a family physician in Selmer, Tenn., and president
of the American Academy of Family Physicians, estimated that he spent
about $10,000 to implement an e-prescribing system in his practice. But,
even with the technology in place, he is able to e-prescribe only some
of the time. For example, not all pharmacies in his area are able to
receive electronic prescriptions, he can't prescribe some narcotic
drugs electronically, and he cannot prescribe medications electronically
across state lines for his patients who live in Mississippi.
That's why Dr. King said he is pleased that Congress chose to
proceed first with payment incentives, so that policy makers have time
to remove some of these barriers.
He urged physicians to adopt the technology. In addition to
improving quality and safety for patients, it allows the physicians to
engage in more "two-way communication," he said. For example,
e-prescriptions generally allow physicians access to information about
whether the patient has filled the prescription. And e-prescribing
should improve efficiency, allowing physicians to devote more time to
patient care, he said.
A significant number of family physicians are likely to be ready to
begin e-prescribing in January, Dr. King said. The AAFP estimates that
about half of their members either have electronic health records (EHRs)
with e-prescribing capabilities or plan to implement them by the end of
the year.
BY MARY ELLEN SCHNEIDER
New York Bureau
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