Medicare e-prescribing deadline stands, but exemptions are expanded

Washington -- Physicians who see Medicare patients would have more opportunities to claim a hardship exemption and avoid being penalized for failing to meet electronic prescribing requirements by a June 30 deadline under a proposal from the Centers for Medicare & Medicaid Services.

Under current rules, eligible physicians must complete at least 10 paperless drug orders using an e-prescribing system between Jan. 1 and June 30 to avoid a 1% Medicare pay cut in 2012. On May 26, the Medicare agency released a proposed rule that would give physicians a second chance to avoid the penalty. It would allow physicians who did not meet the e-prescribing requirements to report one of several hardship exemptions through a special website by Oct. 1, CMS said.

Members of organized medicine had requested that CMS expand its list of exemptions to reflect some of the compliance barriers that medical practices face. The original proposal would have exempted rural physicians with limited Internet access or doctors in areas with few pharmacies accepting electronic prescriptions -- and only if they claimed such a hardship by June 30.

Now, in addition to having more time to register hardship claims, doctors will be able to choose additional reasons for not complying:

• The physician has limited prescribing activity during the six-month time frame.
• The physician has delayed purchasing an e-prescribing system because he or she intends to participate in Medicare's electronic medical records incentive program for 2011.
• The physician lives in an area where regulations prevent e-prescribing, such as those prohibiting paperless orders for narcotics.
• The physician e-prescribes, but only for types of visits that don't count toward the 10-order minimum.

The Medicare agency has proposed developing a website where physicians would report such hardships. A physician would log on to the site, select one of the categories and submit supporting information to CMS for approval. "Then those individuals would be taken off the list," said Michael Rapp, MD, director of the CMS Quality Measurement and Health Assessment Group.

The proposed rule also will make it easier for physician practices that already utilize certified EMRs to use those systems to satisfy the e-prescribing requirements. This was another change requested by members of organized medicine, including the American Medical Association.

"Eliminating unreasonable penalties and burdensome requirements, and providing physicians with more flexibility through an exemption process, will help ensure more physicians are able to successfully participate in the e-prescribing incentive program," said AMA President Cecil B. Wilson, MD. "The AMA has continually stressed to CMS that these changes were essential and is pleased to see them become a reality in a rule that will be finalized this summer. Preventing physicians who largely prescribe controlled substances only from being hit with a cut is another key change proposed today that the AMA strongly supports."

The proposed rule is available online (link). CMS is accepting public comments until July 25.