Wednesday, July 16, 2008
Amid Medicare debate comes mandatory e-prescribing
Included in this week's passage of Medicare payment updates was a carrot-and-stick mandate that doctors electronically prescribe drugs. Starting next year, physicians who do e-prescribe will recoup 2% of their entire Medicare billing component, which some back-of-the envelope math shows could average $4,000. By 2012, though, those who don't e-prescribe face penalties starting at 1% in 2012 and rising to 2% by 2014.
Prescription volume is expected to grow to 4.1 billion by 2010, according to a report by the eHealth Initiative. But the vast majority of docotrs don't e-prescribe today, with only about 2% of all prescriptions getting to the pharmacy electronically.
Doctors don't have good options when trying to adopt e-prescribing systems. Free systems are out there, but these have come and gone in the past decade, with the companies often going out of business. ACP recommends against standalone e-prescribing systems, saying the real benefits come from functions available to fully functioning electronic health records. But such systems cost tens of thousands of dollars per physician to implement, and setting up systems set back doctors for months, as article in Annals of Internal Medicine and ACP Internist point out.
One option that may become popular is hospitals that offer Web-based systems to doctors. The federal government has specifically exempted hospitals from Stark II kickback regulations when they offer EHRs. The systems can be Web-based, requiring no extra hardware or software, and hospitals can then extend tech support to users.
Has your hospital contacted you? Would you accept an offer if it came?
posted by Ryan DuBosar at
2:00 PM
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12 Comments:
I would take it. I have tried for 4 years to get EMR at our clinic, from owners, hospital, free, etc, without success.
This is a much larger issue than dollars. E-prescribing will require that we document a diagnosis along with each Rx pretty much eliminating off label use of meds.
More important is that we know that this data is SOLD. We compromised our patient's personal healthcare privacy for dollars.
Out patients interests must always come first.
In this case, getting the 10% "back" only leaves us with the threat of 20% cuts in 18 months.
The program needs to be fixed ... another bandaid is not now nor has it ever been the answer particularly when the patient is hemorrhaging.
Marcy Zwelling-Aamot, MD FACEP
I have been e-Prescribing for over eight years. Many "stand alone" companies have indeed come and gone over the years. The software and hardware continue to improve. My patients and I have benefited significantly.
The value of quick and easy access to drug-drug interactions cannot be under-estimated. Now add to this a reduction in phone calls for refills, formulary issues and handwriting issues. There is a good deal of uncompensated time saved by automating the process. How many of you have had to hand write 4-8 refills for patients? We now have e-Prescribing incorporated in our EHR and get the benefit of drug-disease checks.
http://ehrphrpatientportal.blogspot.com/
Our initial experience with internet based E Rx was quite clumsy but also gave our doctors an open book to everything any doctor had prescribed for the patient. While this may be useful, in several cases the other prescriptions were not disclosed to me by the patient and I felt this was a HIPAA issue. Do I have the right to see your Viagra or Adderall Rx if you don't want to tell me?? Also agree with above comment about sale of such information. Now our EMR will E RX in a more blinded way -- but you know the sale of information through the intermediary clearinghouses is still big business.
Does anyone know the details about the January 1, 2009 deadline for e prescribing for Medicare. Is it a 2% bonus of Medicare charges?, Medicare collection?, Medicare Part D prescriptions filled by e prescribing? Is it per physician? grooup? Have the details been clarified?
As a patient, I would ask what those of you who are clinicians would say in these scenarios:
1--I travel. Perhaps I'm a retiree. It's Monday and I get my pay on Friday. I want to wait to fill my script on Friday, and haven't decided where I'll be that day. I want paper. Is your staff going to give me a hard time? (My current MD's staff get upset with me when I want to schedule my own consult appointments. Wondering what they'll do with this.)
2--It's my husband's script. I have to pick it up for him (say he can't drive). On the way home from work, there's construction. It's too much hassle and I want to go to a different pharmacy. You're closed. Now what?
I could keep going here. What is your option B?
Regarding Dr. Sawyers questions, the legislation refers to payment based on "allowed charges under this part for all such covered professional services furnished by the eligible professional". The legislation also provides an option for payment to go to the provider or practice. Full details will be annouced by CMS this fall through the publication of a Final Rule with Comment.
Any further comment from medicare about the final rules? They were to come out in the fall, and it is almost November.
Joan St. Onge
stongeje1@aol.com
Also, remember to vote!-only 6 days left!
In response to Dr. St. Onge's question, our Regulatory and Insurer Affairs staff tells me that CMS has yet to publish the rules. They should be out any day now but by no later than November 15. It doesn't give much time to get the word out, but in fairness to CMS, the agency didn't have a lot of time to gear up since Congress just passed the law in July.
Ryan DuBosar, Senior Editor
ACP Internist
Just a day after following up about when the final rule will appear for e-prescribing, here's the announcement. The final rule with comment will appear in the November 19 Federal Register. You can comment up to Dec. 29. The rule takes effect Jan. 1 and another rule will appear later, responding to the comments.
For more details on the general provisions of the rule, as well as CMS’s implementation of the PQRI and e-Prescribing initiative, and MIPPA changes, see the Medicare Fact Sheets posted here.
E-prescribing has so many flaws:
From the pharmacy perspective - you will get millions of requests which the patient does not fill but they were too polite to tell the doctor what their intentions were. Waste of time...
From the physician perspective - If a particular pharmacy doesn't have the prescription you prescribed, they have to transfer the prescription to somewhere else but that may only be done once. If supply for a medication is short, the patient has to try their luck and if all else fails they call the doctor. Waste of time...
From the patients perspective - you have to go to the pharmacy you usually go to unless you tell your provider or he/she asks each time that you can find it cheaper somewhere else if you pay cash. Waste of money...
It's now an issue that physicians are stuck with, for better or worse. The article we ran in September's issue (http://www.acpinternist.org/archives/2008/09/erx.htm) still holds true, and e-prescribing's benefits are being repeated as a trusim in national discussions on health care reform.
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