Revise unfair e-prescription policy, doctors say

A rule set for Jan. 1, 2011, unjustly bases 2012 penalties on physicians' electronic prescribing in 2011, the AMA and others in organized medicine contend.

By Chris Silva — Posted Dec. 20, 2010

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The American Medical Association and more than 100 other state and specialty medical societies are urging the Dept. of Health and Human Services to revise a Medicare e-prescribing policy that slaps doctors with a financial penalty in 2012 if they don't meet specified e-prescribing criteria during the first six months of 2011.

The medical organizations are dismayed with a new regulation from the Centers for Medicare & Medicaid Services that uses e-prescribing activity during the first six months of 2011 as the basis for imposing penalties in 2012. In addition, the government would look at the entire 2011 calendar year to determine the 2013 penalties physicians would pay.

"We strongly oppose basing the 2012 and 2013 e-prescribing penalties on e-prescribing activity that occurs during 2011," states the letter, which the American College of Physicians, the American College of Surgeons, the American Academy of Family Physicians and the Medical Group Management Assn. also signed. "At the very minimum, CMS should extend the reporting period so that physicians have more time to comply."

Physician practices need to meet certain e-prescribing criteria during at least 10 office visits between Jan. 1 and June 30, 2011, according to the final rule. Physicians who don't must pay the government a penalty equal to 1% of all of their Part B earnings in 2012.

AMA leaders believe the penalty is unjustified, and they want CMS to change it. "The last-minute decision to require e-prescribing in 2011 will force physicians to spend additional financial and administrative resources to purchase e-prescribing software that most of them will end up discarding when they transition to a complete EHR system," said AMA Secretary Steven J. Stack, MD.

The law that created the Medicare e-prescribing program -- the Medicare Improvements for Patients and Providers Act of 2008 -- clearly supports delaying penalties against physicians who do not e-prescribe until 2012, Dr. Stack said.

Compounding the issue further is that the law prohibits physicians from receiving incentives from both the Medicare e-prescribing and the meaningful use program for electronic medical records. The AMA and other physician organizations believe the new e-prescribing regulations are duplicative because the EMR incentive program already contains an e-prescribing component.

Consequently, many physicians who decided to forgo purchasing an e-prescribing tool in favor of an EMR system could be left trying to catch up to e-prescribing requirements in early 2011.

"Unreasonable policy"

"This unreasonable policy leaves many physicians with little choice but to purchase and use a stand-alone e-prescribing program during the initial months of 2011 just to avoid penalties," Dr. Stack said. "HHS must take action now to align the e-prescribing and [EMR] incentive programs in order to alleviate confusion and reduce financial and administrative burdens on physician practices working to adopt health IT."

Tom Landholt, MD, a family physician in Springfield, Mo., said the meaningful use regulations makes the e-prescribing incentive program meaningless. "The bottom line is to get physicians to adopt an EMR, and that makes it easier to use e-prescribing than not," said Dr. Landholt, who has used an EMR for 15 years.

"So no further incentive is needed just for e-prescribing. The fact that these two policies are in conflict and creating a burden on physicians shows both a lack of understanding of how and why clinics adopt technology and a failure to review these incentives comprehensively."

The physician organizations accuse CMS of significantly changing its policy "at the eleventh hour" through the November publication of its 2011 final fee schedule rule.

The physician organizations state in the letter that although they oppose basing the 2012 and 2013 e-prescribing penalties on activity that occurs in 2011, at the very minimum they want to see two immediate actions. First, physicians want CMS to extend the reporting period so it includes the first 10 months of 2011. Second, doctors want CMS to add more exception categories consistent with recommendations made when the proposed rule came out this summer. For example, physicians who attest to meaningful use in 2011 or 2012 should be exempt from penalties associated with the program.

Assn. of American Medical Colleges leaders believe additional time is needed.

"We have to educate the physician community, because this is really news to them," said Ivy Baer, director and regulatory counsel at AAMC. "Physicians had thought that reporting for meaningful use was enough."

CMS said not to expect an immediate response, because such correspondence needs to funnel through the appropriate agency before an official response can be delivered.

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Who's on board

In addition to the American Medical Association, more than 100 specialty and state medical societies signed onto a Dec. 9 letter asking for changes to the e-prescribing regulations in the 2011 Medicare physician fee rule. Among the signers:

  • Academy of Pharmaceutical Physicians and Investigators
  • Alaska State Medical Assn.
  • AMDA Dedicated to Long Term Care Medicine
  • American Academy of Dermatology Assn.
  • American Academy of Family Physicians
  • American Academy of Home Care Physicians
  • American Academy of Neurology
  • American Academy of Ophthalmology
  • American Academy of Otolaryngology--Head and Neck Surgery
  • American Academy of Pediatrics
  • American Assn. for Hand Surgery
  • American Assn. of Clinical Endocrinologists
  • American Assn. of Neurological Surgeons
  • American Assn. of Orthopaedic Surgeons
  • American College of Cardiology
  • American College of Gastroenterology
  • American College of Osteopathic Internists
  • American College of Osteopathic Surgeons
  • American College of Phlebology
  • American College of Physicians
  • American College of Preventive Medicine
  • American College of Rheumatology
  • American College of Surgeons
  • American Congress of Obstetricians and Gynecologists
  • American Gastroenterological Assn.
  • American Geriatrics Society
  • American Medical Association
  • American Osteopathic Academy of Orthopedics
  • American Osteopathic Assn.
  • American Psychiatric Assn.
  • American Society for Gastrointestinal Endoscopy
  • American Society for Radiation Oncology
  • American Society for Surgery of the Hand
  • American Society for Reproductive Medicine
  • American Society of Anesthesiologists
  • American Society of Cataract and Refractive Surgery
  • American Society of Clinical Oncology
  • American Society of Plastic Surgeons
  • American Thoracic Society
  • American Urogynecologic Society
  • American Urological Assn.
  • Arizona Medical Assn.
  • Arkansas Medical Society
  • Assn. of American Medical Colleges
  • California Medical Assn.
  • College of American Pathologists
  • Colorado Medical Society
  • Congress of Neurological Surgeons
  • Connecticut State Medical Society
  • Florida Medical Assn.
  • Hawaii Medical Assn.
  • Heart Rhythm Society
  • Idaho Medical Assn.
  • Illinois State Medical Society
  • Indiana State Medical Assn.
  • Infectious Diseases Society of America
  • Iowa Medical Society
  • Kansas Medical Society
  • Kentucky Medical Assn.
  • Joint Council of Allergy, Asthma and Immunology
  • Louisiana State Medical Society
  • Maine Medical Assn.
  • Massachusetts Medical Society
  • MedChi, The Maryland State Medical Society
  • Medical Assn. of Georgia
  • Medical Assn. of the State of Alabama
  • Medical Group Management Assn.
  • Medical Society of Delaware
  • Medical Society of New Jersey
  • Medical Society of the District of Columbia
  • Medical Society of the State of New York
  • Medical Society of Virginia
  • Michigan State Medical Society
  • Mississippi State Medical Assn.
  • Missouri State Medical Assn.
  • Montana Medical Assn.
  • Nebraska Medical Assn.
  • Nevada State Medical Assn.
  • New Hampshire Medical Society
  • New Mexico Medical Society
  • North Carolina Medical Society
  • North Dakota Medical Assn.
  • Ohio State Medical Assn.
  • Oklahoma State Medical Assn.
  • Oregon Medical Assn.
  • Pennsylvania Medical Society
  • Renal Physicians Assn.
  • Rhode Island Medical Society
  • Society for Cardiovascular Angiography and Interventions
  • Society for Vascular Surgery
  • Society of American Gastrointestinal and Endoscopic Surgeons
  • Society of Gynecologic Oncologists
  • South Carolina Medical Assn.
  • South Dakota State Medical Assn.
  • Tennessee Medical Assn.
  • Texas Medical Assn.
  • The Endocrine Society
  • The Society of Thoracic Surgeons
  • Utah Medical Assn.
  • Vermont Medical Society
  • Washington State Medical Assn.
  • West Virginia State Medical Assn.
  • Wisconsin Medical Society
  • Wyoming Medical Society

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