Electronic prescribing Medicare bonus in '09

March 1, 2009

Physicians can receive a 2% bonus for e-prescribing and participating in the Physician's Quality Reporting Initiative, adding up to a potential 4% bonus to participating doctors in 2009. This year, program participation is not mandatory, but in 2012, physicians will be penalized –1% for not e-prescribing.

Key Points

Atlanta-Electronic prescribing (e-prescribing) can be both beneficial and profitable for a practice, despite the bumps along the way that may occur when becoming familiar with the system. That is why a panel of American Academy of Ophthalmology (AAO) representatives and members presented "Introduction to e-prescribing: Improving the safety and efficiency of medication management" at the American Academy of Ophthalmic Executives meeting.

Cherie McNett, director of health policy for the AAO, described e-prescribing as "a physician's use of real-time, patient-specific clinical and economic information for conformed patients to prescribe the most medically appropriate and cost-effective prescription at the point of care and to transmit the prescription electronically to the patient's pharmacy of choice."

The system includes access to the patients' medication history, what you have prescribed for them, as well as what other providers have prescribed for them. You also should have access to the patient's formulary and pharmacy information.

The e-prescribing incentive was first started because, according to the Institute of Medicine, 7,000 deaths occur in the United States due to medication errors, and 3 billion prescriptions are written annually in this country.

"Errors are embedded in the prescribing program for a lot of simple reasons. We all know doctors are infamous for having illegible handwriting," McNett said.

In December 2006, the Tax Relief and Health Care Act was passed, and Congress initiated the Physician's Quality Reporting Initiative (PQRI) system, which began last year with a 1.5% bonus. The act also required that, for 2008, the program include structural measures in place for reporting electronic medical records (EMR) or e-prescribing.

Where it is now

"Ninety-five percent of the nation's retail pharmacies are using certified software today," said Kate Berry, senior vice president of business development, SureScripts Rx Hub, and executive director of the Center for Improving Medication Management (CIMM), Alexandria, VA. "So, about 75% to 80% of the pharmacies nationwide are enabled on the network and are able to receive e-prescriptions today and send renewal requests electronically as well. The gap in the pharmacy readiness is really around the independent pharmacies."

More than 100 e-prescribing and EMR systems that currently are certified, and many options are available for physicians to get started with e-prescribing.

"We have [more than] 62,000 active e-prescribers on the network today," Berry said. "This is something that has basically been tripling every year for the last 4 years. The growth is really starting to pick up, especially because of this Medicare e-prescribing bonus."

Getting certified

Berry said a certification process is in place to ensure that all of the exchange of medication information electronically across all of the stakeholders is happening in a standards-based way, based on the National Council for Prescription Drug Programs Scripts Standard for Ambulatory prescribing.

"[SureScripts Rx Hub] is a company that provides the behind-the-scenes infrastructure to enable e-prescribing," Berry said. "It was brought together by the pharmacy industry, the major pharmacy associations, as well as the major payers and pharmacy benefit managers (PBMs). SureScripts Rx Hub certifies and connects all of the pharmacies to a single infrastructure and certifies and connects all of the payers and PBMs to the infrastructure."

Berry said that the CIMM also would certify and connect the various technology providers that offer e-prescribing and EMR.

When Congress passed the Medicare Improvements for Patients and Providers Act in July, it separated the e-prescribing incentive program from the PQRI program. As of Jan. 1, a 2% bonus is given for both e-prescribing and PQRI, adding up to a potential 4% bonus to participating physicians.

In 2011 and 2012, the e-prescribing bonus will be reduced to 1%, and in 2013 it will be reduced to 0.5%. Although in 2009 program participation is not mandatory, starting in 2012, physicians will be penalized –1% for not e-prescribing, McNett said.

"[The Centers for Medicare and Medicaid Services] has not yet determined at what point prior to 2012 they are going to have that e-prescribing system," McNett said. "Even though the penalty doesn't start until 2012, they may say that you had to have had a system by 2011."

To learn about coding and reporting for e-prescribing, visit the AAO's Web site at http://www.aao.org/e-rx/. Those who are not AAO members can go to http://www.cms.hhs.gov/partnerships/downloads/11399.pdf, where Medicare has posted guidelines for e-prescribing.

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