E-Prescribing Update


About this time last year, I wrote about electronic prescribing and the incentives that had been put in place to encourage adoption. Apparently, most of you were unimpressed; a year later e-prescribing use has increased only marginally.

The Centers for Medicare and Medicaid Services thought it could turn the tide in 2009 by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn’t do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.

Dr. Joseph S. Eastern

In 2010, CMS made it much easier to collect the incentive with minimum e-prescribing effort: If you could show that you were using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you got a 2% bonus on every Medicare Part B claim you filed over the entire year. They also replaced myriad confusing "G" codes with a single one, G8553.

If none of these incentives has swayed you, 2011 might be the year you are finally persuaded: CMS has not sweetened the deal. In fact, the bonus is reduced to 1% this year. But 2011 is the last year you can avoid going electronic without generating a penalty.

In 2012, physicians filing at least the minimum 25 Medicare claims will receive a 1% bonus, but those not doing so will incur a 1% penalty. In 2013, the incentive drops to 0.5%, and the penalty increases to 1.5%. In 2014, and beyond, there will be no incentive, but the penalty will rise to 2% and remain there.

To be clear (and I have been asked about this more than once), faxing a prescription to a pharmacy is not e-prescribing, which, by definition, is computer-to-computer (paperless) communication of prescriptions. Many electronic medical record users are under the erroneous impression that they are e-prescribing via their EMR, when the EMR is simply generating faxes that arrive, on paper, in the pharmacy’s fax machine. That is not considered e-prescribing by CMS, and it does not qualify for the incentive program.

A coalition of insurance and technology companies called the National ePrescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology that qualifies for the program to physicians nationwide. NEPSI members include Allscripts, Surescripts, and NaviMedix, as well as Google, Dell, Cisco Systems, Fujitsu, Microsoft, Sprint Nextel, Aetna, Horizon Blue Cross Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)

Thanks to the efforts of NEPSI and others, e-prescribing is now easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions.

Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate bona fide e-prescribing into many electronic health record systems, or set it up as a separate, stand-alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection and a database of patients.

Keep in mind that this will not be a complete transition; once you’re set up, you cannot throw away your paper prescription pads. Besides the 30% of pharmacies not yet equipped for e-prescribing, the Drug Enforcement Administration strongly discourages sending controlled substance prescriptions electronically. (The DEA has, however, relaxed its rules somewhat on this issue in the past year.)

You can learn more about NEPSI, and sign up for their free, online-based prescribing software at

A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, is offered by a nonprofit foundation called eHealth Initiative.

Details of the CMS incentive program are available from CMS.

Whether or not a mere 1% incentive impresses you, you’ll need to sign up this year or next to avoid a penalty; and with the free NEPSI program and only 25 e-prescriptions required to qualify, you will expend a minimum of cost and inconvenience in giving it a try.

Dr. Eastern practices dermatology and dermatologic surgery in Belleville, N.J.

Recommended Reading

Ambulance Transport Speeds Time to Catheterization in Suspected STEMI
MDedge Cardiology
Congress Addresses Fraud in Medicare System
MDedge Cardiology
Community Based Care Transitions Program
MDedge Cardiology
Dems Join Republicans to Fight Appointed Payment Board
MDedge Cardiology
Strong Physician Role Seen in DTC Genetic Tests
MDedge Cardiology