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Will Medicare Bonus Jump-Start Electronic Prescribing?

HealthDay News -- Wresting old-fashioned prescription pads from the hands of the nation's prescribers remains a formidable challenge, but U.S. Medicare officials are hoping a new program provides the incentive -- literally -- to get more clinicians to give electronic prescribing a whirl.

In a final rule describing the initiative, the Centers for Medicare & Medicaid Services said it believes the incentive program will provide the "tipping point" needed to move the entire industry toward widespread e-prescribing adoption.

But it's anyone's guess whether physicians will forge ahead in great numbers next year or wait and see how the initiative plays out.

"It's hard to say what the uptake will be," said Janet Marchibroda, chief executive officer of the Washington, D.C.-based eHealth Initiative and its foundation. "I suspect there are a lot of doctors who don't know about it yet." Major medical societies, including ACP, are working hard to educate member physicians, she added.

Beginning in 2009, eligible professionals who use e-prescribing for at least 50 percent of their Medicare patient needs may earn a bonus payment of 2 percent of Medicare Part B-allowed charges for the calendar year. The financial incentive continues in 2010 before dropping to 1 percent in 2011 and 2012 and 0.5 percent in 2013.

Clinicians who don't e-prescribe, except in hardship cases, will incur payment reductions of 1 percent in 2012, 1.5 percent in 2013 and 2 percent in 2014 and beyond.

In 2007, only about 2 percent of the 1.47 billion new prescriptions and renewals eligible for electronic routing were transmitted electronically, according to a recent report issued by the eHealth Initiative Foundation, in cooperation with ACP and others.

Financial barriers, including the cost of acquiring the necessary computer hardware and software and uncertainty about the potential return-on-investment, are a particular challenge, especially for small practices, the report noted.

To participate in the Medicare initiative, prescribers must use a "qualified" e-prescribing system, meaning that it performs four basic functions:

  • Generates a medication list
  • Selects medications, prints prescriptions, transmits them electronically and conducts safety checks
  • Provides information on lower-cost alternatives
  • Provides information on formulary medications, patient eligibility and authorization requirements from a patient's drug plan

But doctors needn't invest in a full-blown electronic health record (EHR) system to e-prescribe, said Mark Gorden, eHealth Initiative's director of policy.

Another major obstacle is getting physicians to integrate the e-prescribing technology into their practices, Marchibroda said. While financial incentives will help, "we really need more mechanisms in the U.S. to help small physician practices migrate from paper to electronic systems, and we haven't figured that out yet," she said.

Physician Associates LLC, a multispecialty physicians' group serving Central Florida, just inked a $2 million deal with Allscripts for an EHR with e-prescribing capabilities. Nearly all of the practice's 80 physicians will be e-prescribing by the end of 2010, said Chris Jordan, the practice's chief information officer.

About 30 of them have already been e-prescribing for the past year in a nationwide pilot project using PocketScript PDAs, and that experience has captivated the majority. "Once they tried it and got hooked on it, there was no turning back," Jordan said.

He even convinced a highly respected but "technology-illiterate" internal medicine physician with a large number of older and chronically ill patients to try it. After about three months of "moaning and groaning," the doctor realized that he could see every medication a patient was taking and could renew those prescriptions with one click, Jordan explained.

While Medicare's incentive is "icing on the cake," it isn't driving Physician Associates' decision to e-prescribe, Jordan conceded. The doctors "already know (they) want it and they've convinced the guys who don't have it that this is why it's so good," he said.

December 15, 2008
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