Feds Push E-Prescribing With Medicare Bonuses


For a copy of “A Clinician's Guide to Electronic Prescribing”' visit www.ehealthinitiative.org

BOSTON—“E-prescribing saves lives, it saves money, and it's time we implement it,” according to Health and Human Services Secretary Mike Leavitt. Streamlining the bloated health care system “is an economic imperative for our country. We have to get down to making the system better, and [e-prescribing] is one piece of a large puzzle,” he stressed at a conference on e-prescribing sponsored by the Centers for Medicare and Medicaid Services.

After acknowledging that “change is hard,” especially change that requires substantial time and money, Secretary Leavitt assured attendees that the benefits of implementing an electronic prescribing system would quickly exceed the costs, thanks in large part to the incentive program provided by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

Under MIPPA, physicians who use a qualified e-prescribing system for their Medicare patients will be eligible to receive a bonus of 2% of their Medicare revenue in 2009 and 2010. The bonus amount will decrease to 1% of total Medicare revenue in 2011 and 2012, and to 0.5% in 2013. Beginning in 2014, physicians who are not prescribing electronically will see their Medicare payments reduced by as much as 2%.

From the government's perspective, the business case for e-prescribing is a “no-brainer,” according to acting CMS administrator Kerry Weems, as widespread implementation of the technology could save Medicare $13 million-$146 million between 2009 and 2013. The savings, he said, will be achieved through averted medication errors and the substitution of less-expensive prescription drug alternatives. Specifically, “errors associated with illegible handwriting are eliminated and those linked to oral miscommunications are substantially reduced because the process is automated,” he said.

Additionally, e-prescribing software provides secure electronic access to each patient's prescription history and automatically alerts physicians to dangerous drug interactions and allergies, thereby minimizing the potential for both.

E-prescribing also promises advantages that will have a positive impact on physician bottom line, Mr. Weems said. Automating the prescribing process reduces time spent on phone calls and faxes to pharmacies, speeds the prescription renewal request and authorization process, increases medication compliance, improves formulary adherence, allows greater prescriber mobility, and improves drug surveillance.

Together with the promised bonuses (and future penalties) for e-prescribing, the argument in favor of technology is gaining steam. “With MIPPA, Congress has helped us solve the business equation side of e-prescribing,” he said.

Without question, the financial incentives improve the case for converting from traditional to electronic prescribing, Mr. Weems said, noting that the average e-prescribing primary care doctor stands to collect between $2,000 and $3,000 in bonuses in 2009 and the cost of an e-prescribing system ranges from $2,500 to $3,000.

The psychological obstacles, on the other hand, may be tougher to knock down, according to Secretary Leavitt. “There's always going to be resistance to change, and in this case, some of it is well thought out: 'I've got training costs; there's likely to be a productivity dip; do I really want my business to go through this?' Those are the kinds of things that are part of any sort of business process change, and such change doesn't happen overnight,” he said.

To help facilitate the change, the eHealth Initiative, in collaboration with the American Medical Association, the American Academy of Family Physicians, the Medical Group Management Association, and the Center for Improving Medication Management has published “A Clinician's Guide to Electronic Prescribing,” which offers practical information on planning, selecting, and implementing an e-prescribing system.

The guide “is an invaluable resource that provides substantial detail not only on how to get started but what challenges to expect and how to overcome them,” said Dr. Steven E. Waldren, director of the AAFP's Center for Health Information Technology.”

Other challenges hindering widespread adoption of e-prescribing, according to the guide, include workflow changes, continued need for improved connectivity and technology, state regulatory restrictions (such as the New York State Medicaid requirement that the “dispense as written” instruction be handwritten), and the need for reconciled medication histories.

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Transitioning to E-Prescribing: Careful Planning Can Smooth the Way

Moving from paper prescribing to electronic prescribing can dramatically improve the workflow in a busy practice setting, but the transition can be difficult, according to AAFP's Dr. Waldren.

Technology-averse staff may resist the new processes; productivity may temporarily dip as users become accustomed to the new system; and frustrations may mount as a result of the inevitable impact on established roles and responsibilities, he said at the conference.

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