The letter comments on CMS’ proposed rules for the Medicare Part B physician fee schedule for 2011 (Goedert, Health Data Management, 8/25).

E Prescription, EHR Incentives

The e-prescribing program — implemented in 2009 — offers a 1% bonus payment beginning in 2011 for physicians or group practices that are deemed to be “successful electronic prescribers” under the Medicare Improvements for Patients and Providers Act of 2008.

In 2012, the program will begin penalizing health care providers who do not qualify as successful e-prescribers (Modern Healthcare, 8/25).

According to the letter, there is “significant overlap” between the 2011 Medicare e-prescribing initiative and the EHR “meaningful use” incentive program included in the federal stimulus package. The letter states that health care providers might have difficulty discerning whether they have qualified for the incentive payments.

The group suggested that CMS quickly report whether a health care provider qualifies for either program (Health Data Management, 8/25).

MGMA also said that health care providers who meet meaningful use requirements should not be subject to penalties through the e-prescription program (Modern Healthcare, 8/25).

Quality Reporting Site

In its letter, MGMA also commented on proposed changes to CMS’ Physician Quality Reporting Initiative.

The group urged CMS to continue claims-based PQRI reporting and to refrain from listing health care providers who unsuccessfully participate in PQRI on its Physician Compare website (Health Data Management, 8/25).

Source     :      http://www.ihealthbeat.org/articles/2010/8/26/mgma-seeks-revisions-to-eprescribing-ehr-incentive-pay-policies.aspx

Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, which finances and delivers healthcare services to 1.7 million people across upstate New York, conducted the report.

The report estimates that 18 percent, or 3.8 million, prescriptions are still telephoned or faxed and 65 percent, or 13.7 million, prescriptions are handwritten or printed on paper. Estimates were based on an FLRx (the pharmacy benefit management division of Excellus Health Plan, Inc.,) review of a sample of claims submitted for new and renewed prescriptions from January 2010 through March 2010.

With manual and verbal handoffs still predominant, medical errors are more likely to occur, the report suggests. According to the nonprofit Institute for Safe Medication Practices, handwritten prescriptions and drugs with similar names are among the most risky conditions associated with medication use.

The report finds that more than two million adverse drug events could be avoided in New York state if all physicians in the region made the switch to E Prescription.

“Handwritten prescriptions can lead to errors that can potentially put patients at risk and also waste time and precious healthcare dollars,” said Joel Owerbach, PharmD, vice-president and chief pharmacy officer for Excellus BCBS.

The report finds that e-prescribing’s ability to alert prescribers to money-saving opportunities with generic or other lower-cost alternatives to prescription drugs has the potential to save healthcare dollars.

“If e-prescribing alerts raised the generic fill rate by just one percent, healthcare spending in upstate New York could be reduced by more than $64 million a year,” Owerbach said.

“Based on numerous national studies, our analysis of upstate data shows that e-prescribing holds the potential to annually prevent 35 deaths, 160 permanent disabilities, 400 hospitalizations and 3,000 physician office visits,” he added. “Right now, about 17 percent of prescriptions are sent electronically, but we’re on the verge of seeing explosive growth that will save lives, time and money.”

Earlier this year, when Alexandria, Va.-based Surescripts released its 2009 National Progress Report on E-Prescribing, its CEO and President Harry Totonis, said the past year had been the “tipping point” for e-prescribing. He noted that one of the top drivers to e-prescribing growth were the federal incentives for adopting information technology in a meaningful way.

On Tuesday the Centers for Medicaid & Medicaid Services and Office of the National Coordinator released the final rules for achieving meaningful use. More flexibility for meeting requirements were built into the final rules, including the lowering of e-prescribing requirements for eligible professionals from 75 percent of prescriptions transmitted electronically to 40 percent. The final rule also included the adoption of the National Council for Prescription Drug Programs’s (NCPDP) SCRIPT Standard for the secure, electronic transmission of prescriptions and prescription-related information.

“The final rules will help clinicians achieve better and more effective patient care,” said Lee Ann Stember, president of NCPDP. “We are very pleased with the final rule as it relates to e-prescribing and using the NCPDP SCRIPT Standard to achieve meaningful use.”

The Pharmaceutical Care Management Association (PCMA) President and CEO Mark Merritt said that while they applauded the final rule as a step forward they said they hoped regulators “will do more down the road to ensure that the full safety and savings benefits of e-prescribing are realized on behalf of America’s patients. We believe, for example, that providers who receive HITECH payments should perform ‘e-prescribing safety checks’ to prevent dangerous medication errors, and think that certified EHR products should support – and providers should use – all the safety and savings components of   E Prescription as defined in Medicare Part D.”

Source   :    http://www.healthcareitnews.com/news/erx-rate-ny-state-see-explosive-growth-0

The report also concluded that the percentage of physicians across the U.S. who use the technology doubled from 2008 to 2009,  the Rochester Democrat and Chronicle reports.

Benefits of E-Prescribing Systems

E-prescribing systems transmit prescriptions from the health care provider directly to pharmacies.

The report found that use of the systems by every upstate New York physician would prevent two million adverse reactions or events annually, including:

• 35 deaths;
• 160 permanent disabilities;
• 400 hospitalizations; and
• 3,000 physician consultations.

In addition, the report found that greater use of the technology overall would:

• Increase the use of more cost-efficient drugs;
• Provide greater security;
• Limit “doctor shopping” and illegal prescription practices;
• Boost efficiency for physicians, patients and pharmacies; and
• Save money for insurers (Matthews, Rochester Democrat and Chronicle, 7/15).

Predicted Increase in Use

On an annual basis, 3.6 million new and renewed prescriptions are handled regionally using the technology. That number is likely to grow as the systems become more affordable and as government incentives to spur the use of health IT take effect, the report predicted.

Source  :  http://www.ihealthbeat.org/articles/2010/7/16/report-on-eprescribing-in-new-york-predicts-growth-in-technology.aspx

Surescripts operates the nation’s largest e-prescription network and supports a rapidly expanding ecosystem of healthcare organizations nationwide. Surescripts was founded on the principles of neutrality, transparency, interoperability, education, collaboration and quality. Surescripts’ e-prescribing services allow physicians to electronically send prescriptions from their offices to any of 52,000 retail pharmacies and six of the largest mail-order pharmacies. In addition, Surescripts provides physicians with electronic access to their patients’ prescription benefit and prescription history, which helps to improve safety and enables doctors to prescribe medications with the lowest out-of-pocket cost to the patient. Beginning Jan. 1, 2010, Surescripts reduced what pharmacies, pharmacy vendors and pharmacy benefit managers pay for e-prescribing.

“Our decision to lower prices fulfills a public promise made when legacy SureScripts and RxHub were founded,” said Harry Totonis, president and CEO of Surescripts. “Three things have enabled us to keep this promise: Surescripts’ ongoing commitment to its own operational efficiency; the economies of scale resulting from the merger; and Surescripts’ success in working with healthcare organizations across the country to create and meet the growing demand for e-prescribing.

“And stay tuned — we are not done yet. With this price reduction, we are focused on the opportunity to connect even more physicians, pharmacies, payers and patients. As we add more participants to the network, this will continue to drive down the cost of e-prescribing, as our efficiency, scale and economics improve. As this occurs, we will again pass those savings along to the industry.”

“The widespread adoption of e-prescribing is clearly the right thing for all of us to support,” said Stanton McComb, president of McKesson Pharmacy Systems. “In these times, we are especially sensitive to the economic pressures that our customers are under. We recognize that most everyone wants to support e-prescribing, but there is a real cost to doing so for pharmacies. MPS felt that it was important to support and extend Surescripts’ price reductions as quickly as possible to our software customers to support this advancement in pharmacy care and also support our customers economically.”

“Surescripts’ overall efforts — which go well beyond operating a network and certifying software vendors — have helped create unprecedented demand for e-prescribing,” said Bruce Roberts, RPh, National Community Pharmacists Association (NCPA) executive vice president and CEO. “Today, nearly 25 percent of all U.S. office-based physicians, nurse practitioners, and physician assistants are now e-prescribing. That accounts for more than 150,000 prescribers nationwide — more than double the number from one year ago. For community pharmacies, this growth not only lowers the cost of e-prescribing, but begins to realize the gains in efficiency that we all envisioned from the beginning.”

Building The Network, Creating a Market for Paperless Prescriptions

In 2001, the nation’s retail pharmacies and leading pharmacy benefit managers embarked on a shared vision — to create a national network to facilitate the secure transmission of prescription information between prescribers, pharmacies and health plans.

Today, PBMs and health plans providing prescription drug coverage for two-thirds of all Americans are active users of The Nation’s E-Prescription Network. Together with 85 percent of all retail pharmacies and the nation’s leading mail-order pharmacies, they have created the first and only network to allow an entire segment of the nation’s healthcare system — the $254 billion prescription care segment — to electronically share clinical health information on a nationwide basis. However, these organizations have gone far beyond building and electronically linking to a network.

With an eye toward safer, more efficient and lower-cost prescribing, these organizations have worked closely with the state governments, medical associations, technology vendors and various non-governmental organizations focused on standards, health IT adoption, quality, privacy and security to create a sustainable market for e-prescribing. As a result, more than 150,000 (nearly 25 percent) of all U.S. office-based physicians, nurse practitioners, and physician assistants use more than 200 types of e-prescribing and electronic medical record (EMR) systems to e-prescribe today.

Above article publish on http://www.fiercehealthcare.com/press-releases/surescripts-announces-significant-price-reduction-e-prescribing

According to the analysis, the European market for e-prescription systems, including integrated and stand-alone e-prescription systems, was worth $95.4 million in 2008 and should reach $449.7 million by 2015.

“Having experienced tremendous growth in the United States, e-prescription is on course to be accepted by the healthcare system in Europe,” notes Frost & Sullivan Research Analyst Jayapradha T. E. “With an increase in the acceptance of integrated healthcare solutions, government initiatives and the need to reduce medical errors caused by paper prescriptions, the e-prescription market is expected to carve a niche for itself in the global healthcare arena.”

The drive to ensure greater mobility for patients and health professionals has resulted in attempts to modernize healthcare IT systems, which requires the effective integration of economic, organizational and clinical information across the healthcare spectrum.

“The drive towards enhanced healthcare mobility, reduced costs and improved efficiency, paralleled by an emphasis on patient safety and service quality, is having a direct positive impact on the e-prescription systems market in Europe,” Jayapradha said.

According to the Jayapradha, prescriber resistance to e-prescription technology still needs to be overcome. In addition, there is a dearth of empirical evidence demonstrating the advantages of e-prescription. Prescribers also seem to believe that they need a substantial amount of training to use e-prescription technology—training that will take up a considerable amount of their time.

“Good change management and stakeholder engagement are vital to overcoming the reluctance of health professionals to shift from paper-based to electronic-based prescriptions,” Jayapradha noted. “There is also a need for more empirical data through research to prove the benefits reaped by existing users of e-prescription.”

Above article publish on http://www.healthimaging.com/index.php?option=com_articles&view=article&id=18824:e-prescribing-gains-momentum-in-europe

Eighteen percent of prescriptions are not being sent electronically while e-prescribing is being used by one in four prescribers, according according to Surescripts, located in Alexandra, Va. Growth was seen in the use of prescription benefit, prescription history and prescription routing that support the e-prescribing process as well as in adoption by prescribers, payors and pharmacies between 2008 and 2009, the company said.

The report tracked the status of e-prescribing adoption, use in the U.S. and measures the growth of e-prescribing across a number of categories. Included in Surescripts analysis were:

• Prescription Benefit Information: The number of electronic requests for prescription benefit information went from 79 million in 2008 to 303 million in 2009.
• Prescription History Information: The number of prescription histories delivered to prescribers grew more than five-fold, from 16 million in 2008 to 81 million in 2009.
• Prescriptions: By the end of 2009, approximately 18 percent of eligible prescriptions were prescribed electronically compared with just 6.6 percent at the end of 2008. The number of prescriptions routed electronically grew from 68 million in 2008 to 191 million in 2009.
• Prescribers: The number of prescribers routing prescriptions electronically grew from 74,000 at the end of 2008 to 156,000 by the end of 2009, representing 25 percent of all office-based prescribers.
• Pharmacies: At the end of 2009, approximately 85 percent of community pharmacies and six of the largest mail-order pharmacies in the U.S. were able to receive prescriptions electronically.

Drivers of e-prescribing in 2009 included government incentives through programs such as the Medicare Improvements for Patients and Providers Act and Health IT for Economic and Clinical Health Act, according to Surescripts. Additional drivers included the broadening of certification programs by Certification Commission for Health IT, increased adoption by large clinics and health system, government and nongovernmental organization education and awareness programs and state-and-regional-level initiatives.

To support the continued growth of e-prescribing, Surescripts recommended supporting the development of regional health information exchanges, promoting more focus on the utilization of e-prescribing technology, encouraging the Drug Enforcement Administration to finalize rules permitting the electronic transmission of prescriptions for controlled substance and advocating for the improvement in the maintaining of prescriber and pharmacy directories.

Above article publish on

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“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 under the Medicare improvements for Patients and Providers Act of 2008.

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 work flow 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.

Above article published on
http://www.entrepreneur.com/tradejournals/article/190946289_1.html

By Ed Edelson

HealthDay Reporter

An electronic prescribing system that tells doctors which drugs are the least expensive can save millions a year, a new study finds.

“One of the challenges physicians face is that they don’t know which drugs are preferred or not preferred,” said Dr. Michael A. Fischer, an assistant professor of medicine at Harvard Medical School and lead author of a report in the Dec. 8/22 issue of the Archives of Internal Medicine . “The insurance companies involved in the study provided that information by a color code — green for drugs that were preferred, red for drugs that were not preferred.”

The study of 17.4 million prescriptions filled by more than 1.5 million patients of nearly 1,200 Massachusetts physicians found that use of the least expensive drugs — classified as “tier 1″ for the study, such as those available generically — increased by 3.3 percent when e-prescribing was used. Use of more expensive “tier 2″ preferred brand-name drugs decreased by 1.9 percent, and use of “tier 3″ non-preferred brand-name drugs decreased by 1.5 percent.

The result was an estimated savings of 70 cents per patient a month — not much per individual, but it added up to $845,000 a year for every 100,000 people filling prescriptions.

And those savings were possible when just 20 percent of the doctors who had access to e-prescribing used it. “The potential savings increase with more availability and use of e-prescribing; for complete e-prescribing use, the projected savings are $3.91 million per 100,000 patients per year,” the report said.

The U.S. government is pushing hard to increase electronic prescribing. Medicare is offering a 2 percent bonus over its regular fees for physicians using such a system in 2009 and 2010. The bonus will be 1 percent for 2011 and 2012, and 0.5 percent for 2013.

A number of different electronic prescribing systems are available, but many doctors have been reluctant to use them. Establishing a system can cost an estimated $3,000, with maintenance costs estimated at $80 to $400 a month. A study earlier this year found that only 17 percent of U.S. doctors have embraced electronic medical record systems.

The system used in the new study was established by two large insurance companies, which provided doctors in private practice with free wireless devices and access to a Web portal that color-coded drugs according by co-payment.

“Nothing in the system forces the doctor to make a choice of drugs,” said Fischer, who is also an internist at Brigham and Women’s Hospital in Boston. “But just color-coding, without forcing them to do anything, led to a movement to lower-cost drugs.”

The e-prescription system is growing rapidly, said Kate Berry, senior vice president for business development at SureScripts-RxHub, a company formed in the recent merger of two former competitors. The company is an electronic middle man, maintaining a master index of patients of a large number of physicians, and matching requests for their prescriptions with offers from participating pharmacies.

“Right now we have almost 70,000 active subscribers,” Berry said. “They are using more than a hundred different electronic medical record systems. We have added about 4,500 new active doctors in the last three months, and the level of use of those who have adopted the service is also increasing.”

The decision to use an e-prescription service is up to the doctor, Fischer said, “but patients can certainly ask their doctors if they are e-prescribing.”

Above article published on

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Under the Medicare Improvements for Patients and Providers Act (MIPPA) providers who implement e-prescription programs are eligible for incentives. Offices are looking for medical software to help them implement this program and reap the rewards.

The E-Prescription Incentive Program

In 2003 the Medicare Modernization Act (MMA) included provisions for electronic prescriptions. Growing evidence that e-prescriptions reduce medication errors and protect patient safety, as well as physician liability, has motivated many medical offices to convert over but many doctors still depend on paper prescriptions.

This in part led to the creation of the 2009 Electronic Prescribing Incentive Program that rewards providers who use e-prescriptions for their Medicare Part B claims. In 2009 a qualified e-prescriber will be eligible for a 2% incentive payment. The hope is that most or even all providers will seek out medical software that supports e-prescription and adopt that system for growing numbers of patients. The goal is not only to improve public safety but to make Medicare filing more cost effective and save money.

Qualification for the Program

The requirements for participation in the program are quite simple. The medical software used must be able to do the following, quoted directly from the measure specifications:

- Generate a complete active medication list incorporating electronic data received from applicable pharmacies and pharmacy benefit managers (PBMs) if available

- Select medications, print prescriptions, electronically transmit prescriptions, and conduct all alerts

- Provide information related to lower cost, therapeutically appropriate alternatives (if any). (The availability of an e-prescribing system to receive tiered formulary information, if available, would meet this requirement for 2009)

- Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient’s drug plan (if available)

In addition, at least 10% of a participating provider’s Medicare Part B services must be made up of specific procedure codes detailed in the measure. More information can be found at http://www.cms.hhs.gov/ERxIncentive/06_E-Prescribing_Measure.asp

What Software Is Required?

There are a number of medical software options available to providers. Many EMR systems include an option for e-prescriptions. The software used doesn’t have to be CCHIT certified which allows a number of inexpensive and free EMR systems to be considered.

The guidelines above are fairly basic and nearly any e-prescription system will satisfy them. Providers should consult with the software producers to ensure they will meet the qualifications. If so, adoption of the new medical software should be undertaken as soon as possible so the provider can start earning the e-prescription incentives.

Providers who adopt these new systems will find once they get past the learning curve, the capabilities of the EMR system will allow their offices to run more efficiently. Easy access to patient records and integration with the EMR of other providers will ultimately make patient diagnosis and treatment safer and more cost effective.

Above article published on

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Medicare is proposing a rule that would simplify reporting requirements for the Electronic Prescribing Incentive Program and the Physician Quality Reporting Initiative and set the Medicare Physician Fee Schedule for calendar year 2010.

The proposal would also add more measures for physicians to report under the PQRI pay-for-performance program, allow data submission from an electronic health record system and create a process to ease quality measure reporting for group practices.

The Centers for Medicare and Medicaid Services has also revised the reimbursement system for some payments. For example, it proposes to stop paying for “consultation” codes typically billed by specialists at a higher rate than equivalent “evaluation and management” services. In addition, CMS is proposing to remove physician-administered drugs from the definition of “physician services,” an action the American Medical Association has been calling for since 2002.

CMS published the rule July 13 in the Federal Register, and will accept public comment through Aug. 31. The final rule will be published Nov.1, and the revised physician payment system would be effective Jan. 1, 2010.

CMS is projecting a 21.5 percent rate reduction for physicians in 2010 based on current data, but the agency and Congress annually take measures to prevent or minimize reductions.

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-simplify-PQRI/ArticleStandard/Article/detail/613603?contextCategoryId=40137