Revise unfair e-prescribing penalty

The AMA and others in organized medicine say doctors need more time to comply with a CMS regulation that levies charges for not prescribing electronically.

Posted Jan. 24, 2011.

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Physicians have been encouraged to switch from paper records to electronic systems in their offices, and the push seems to be working. In 2010, 50.7% of office-based doctors used some type of electronic medical records system -- more than twice the adoption rate through 2005, says a December 2010 survey by the Centers for Disease Control and Prevention's National Center for Health Statistics.

The federal government, which strongly supports EMRs, has touted bonuses to physicians who go electronic. A new survey shows just how interested the health care community is in such financial motivation. Forty-one percent of office-based physicians and four in five hospitals plan to take advantage of federal incentive payments for adoption and meaningful use of full-featured, certified EMRs, according to the survey, issued Jan. 13 by the Office of the National Coordinator for Health Information Technology.

Another inducement is from the Medicare electronic prescribing incentive program, created by the Medicare Improvements for Patients and Providers Act of 2008 and started Jan. 1, 2009. The five-year program provided a payment to eligible physicians equal to 2% of their total Medicare payments for the year in 2010. The amount is 1% in 2011 and 2012, then will dip to 0.5% in 2013.

While that is a positive step, there also are penalties for those who do not adopt e-prescribing systems. A new regulation, which took effect Jan. 1, says eligible practices should meet e-prescribing criteria in at least 10 Medicare office visits between Jan. 1 and June 30. If they don't, they will pay the government a penalty equal to 1% of their Part B earnings in 2012. The entire 2011 calendar year will determine punishment for 2013.

The American Medical Association and 103 state and specialty medical societies have raised concerns about the penalty and are fighting to revise the policy. In a Dec. 9, 2010, letter to Dept. of Health and Human Services Secretary Kathleen Sebelius, they take issue with the timing. They say the Centers for Medicare & Medicaid Services had indicated that eligible physicians would not be able to get incentives from both the Medicare e-prescribing and Medicare EMR incentive programs simultaneously. Therefore, doctors should choose to take part in only one of these programs, the letter says.

Many doctors who have not yet purchased an e-prescribing or a limited EMR system have decided to forgo the e-prescribing incentives and invest in a comprehensive EMR, the organizations say. But CMS changed its policy at the eleventh hour with the November 2010 publication of its 2011 final fee schedule rule, the letter states. The sudden change doesn't allow enough time to educate doctors on the need to take part in the 2011 e-prescribing incentive program to avoid penalties in 2012 and 2013.

The major last-minute policy change will compel doctors to spend additional time and money to implement and use e-prescribing software and applications that most will discard when they move to a complete EMR.

The AMA and the organizations strongly oppose basing the 2012 and 2013 e-prescribing penalties on activity that occurs during 2011. At the very least, they say, CMS should extend the reporting period from June 30 to Oct. 31 -- an extra four months -- to avoid penalties. In addition, the agency should add more exception categories for health professionals, allowing physicians who meet meaningful use criteria in 2011 or 2012 to be exempt from e-prescribing penalties.

The decision to move forward with an EMR can be complicated and costly. Physicians who took the time to make a prudent choice should not be penalized or forced into a wasteful, short-term solution.

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