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CMS Proposal Aims To Help Clinicians Avoid E-Prescribing Penalties


Earlier this month, CMS released adjustments to its electronic prescribing program that aim to make it easier for health care providers to avoid penalties if they do not meet certain criteria for electronically transmitting Medicare beneficiaries’ prescriptions to pharmacies, Medscape reports.


Background

The Medicare Improvements for Patients and Providers Act established Medicare incentive payments for physicians who e-prescribe with approved software.


The e-prescribing program started paying out incentives in 2009, and Medicare providers who do not e-prescribe are scheduled to face penalties beginning in 2012.


In May, CMS issued a proposed rule that would allow certain physicians to claim exemptions from requirements in the e-prescribing incentive program. The proposed rule also would extend the deadline for physicians to claim such exemptions (iHealthBeat, 5/27). The comment period on the proposed rule ends July 25.


New Proposal Details

Under the newly proposed adjustments to the e-prescribing program, clinicians who fail to earn e-prescribing bonuses in 2011 could avoid penalties in 2013 if they submit 10 or more e-prescriptions during the first half of 2012. In addition, clinicians could avoid penalties in 2014 if they receive a bonus payment in 2012 or if they report at least 10 e-prescriptions during the first half of 2013.


The new proposal also would apply two of the four exemptions from the 2012 penalty to 2013 and 2014. The two exemptions are:

  • The inability to e-prescribe because of geographic restrictions; and
  • Submitting fewer than 100 prescriptions in a six-month reporting period.

CMS is accepting comments on the newly proposed adjustments until Aug. 30 (Lowes, Medscape, 7/19).

More info….

New CMS Proposed Rule Would Modify E-Rx Incentive Program

On Thursday, CMS issued a proposed rule that would let certain physicians claim additional exemptions from requirements in the electronic prescribing incentive program, American Medical News reports (Fiegl, American Medical News,5/26).  

Background

The Medicare Improvements for Patients and Providers Act established Medicare incentive payments for physicians who e-prescribe with approved software (iHealthBeat, 5/12). The e-prescribing program started paying out incentives in 2009, and Medicare providers who do not e-prescribe would face penalties beginning in 2012 (iHealthBeat, 3/18). Payment reductions would increase in following years (Norman, CQ HealthBeat, 5/26).   Existing CMS rules require eligible physicians to complete at least 10 drug orders using an e-prescribing system between Jan. 1 and June 30 to avoid a 1% decrease in Medicare payments next year. The rules provide exemptions for rural physicians with limited Internet access or for physicians located where few pharmacies accept e-prescriptions. Physicians have to claim such a hardship waiver by June 30.  

Changes Under Proposed Rule

Under the proposed rule, the deadline for physicians to claim exemptions would be extended from June 30 to Oct. 1 (American Medical News, 5/26). The proposed rule also aims to let health care providers who have not adopted e-prescribing systems claim additional exemptions to avoid potential Medicare pay cuts (CQ HealthBeat, 5/26).   The possible reasons for an exemption are:
  • Having limited prescribing activity during the six-month time frame;
  • Living in an area where regulations prevent e-prescribing;
  • E-prescribing only for types of patient visits that do not count toward the 10-order requirement; and
  • Delaying the purchase of an e-prescribing system because of plans to participate in the incentive program for the meaningful use of electronic health records.
  Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHRs can qualify for Medicaid and Medicare incentive payments (American Medical News, 5/26).   In addition, the proposed rule would expand the definition of a qualified e-prescribing system. Under the rule, EHRs certified to meet meaningful use rules would be deemed to qualify for the e-prescribing incentive program (Goedert, Health Data Management, 5/27).   CMS will publish the proposed rule in the Federal Register on June 1 and will accept public comments on the rule until July 25 (CMS release, 5/26). More info….

Medicare Distributes $75M in Meaningful Use Incentive Payments


On Thursday, CMS announced that the agency has issued the first round of incentive payments under the Medicare portion of the meaningful use program. According to CMS, a total of $75 million was given out to more than 300 health care providers. HealthLeaders Media reports (Tocknell, HealthLeaders Media, 5/27).


Background

On April 18, CMS launched the attestation period for the Medicare portion of the meaningful use program. Under the 2009 economic stimulus package, health care providers who demonstrate meaningful use of certified EHR systems can qualify for Medicaid and Medicare incentive payments (iHealthBeat, 5/19).


Medicaid already has begun issuing EHR incentive payments through state-based programs (Conn, Modern Healthcare, 5/27).


Payment Details

The first round of Medicare payments was given to eligible health care providers who signed up within the first two weeks that payments were available and who successfully attested to meeting Stage 1 requirements. Health care providers who received payments also complied with the program requirements for the 90-day reporting period (HealthLeaders Media, 5/27).


According to AHA News, the initial round of incentive payments shows that the program is off to a relatively slow start. CMS estimates more than 42,600 eligible physicians and hospitals have registered for the Medicare and Medicaid incentive programs, and roughly 485,000 could be eligible to participate, according to AHA News (AHA News, 5/26).


A list of health care providers who received Medicare meaningful use payments is available on a CMS website (Modern Healthcare, 5/27). The amounts of the specific payments were not revealed.


Medicare incentive payments will be made continuously on a monthly basis (HealthLeaders Media, 5/27).

More info….

Upgrading E-Prescribing Systems Can Reduce Rx Errors, Pose Challenges


Transitioning to new electronic prescribing systems can reduce medication errors but present challenges for physicians, according to a study published in the Journal of General Internal Medicine, Healthcare IT News reports.


The study received funding support from the Agency for Healthcare Research and Quality (Merrill, Healthcare IT News, 5/26). For the study, researchers at Weill Cornell Medical College in New York evaluated e-prescribing among 17 physicians at an ambulatory clinic between February 2008 and August 2009.


  • Related to the clinic’s old system;
  • 12 weeks after the clinic implemented the new system; and
  • One year after the new system’s implementation.
  • Curbing Medication Errors

  • 557 e-prescribing errors under the old system;
  • 338 e-prescribing errors 12 weeks after implementation of the new system; and
  • 191 e-prescribing errors one year after implementation (Robeznieks, Modern Physician, 5/26).

Researchers noted that the overall rate of e-prescription errors dropped from 36% to 12% one year after the implementation of the new system. In addition, the rate of improper abbreviations fell from 24% to 6% one year after implementation.


However, researchers identified a temporary spike in the rate of non-abbreviation errors following the implementation of a new e-prescribing system. They found that non-abbreviation errors rose from 9% to about 18% 12 weeks after implementation, but declined to the baseline level one year after implementation (Healthcare IT News, 5/26).


Challenges for Physicians

Researchers also surveyed 15 of the physicians and found that 40% said they were not satisfied with the new e-prescribing system. In addition, 60% of the surveyed group said alerts in the new system were not useful and two-thirds said the new system slowed down prescription orders and refills.


Only about one-third of the surveyed group said they thought the new system was safer than the previous one (Modern Physician, 5/26). Researchers noted that transitioning new e-prescribing systems can create difficulties for physicians, but said their study demonstrates that such transitions are important for reducing medication errors (Healthcare IT News, 5/26).

More info….

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