A necessary dose of e-prescribing flexibility

Medicare's original incentive rules would have penalized too many doctors unfairly. They needed to be changed.

Posted June 13, 2011.

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Physicians understand the potential of health information technology to help improve patient care, and doctors are willing to work with the federal government through incentive programs designed to encourage more practices to go paperless. But the government went too far when designing the punitive side of some of these incentives, tying penalties to burdensome, unfair and even unrealistic mandates on many of the practices that are trying to work toward the same goals.

That's why the Centers for Medicare & Medicaid Services made the right move in adjusting its Medicare electronic prescribing incentive program to correct several key shortfalls in the original plan. The program offers a 1% bonus next year to eligible practices that e-prescribe a minimum number of times in 2011, but it also will impose a 1% penalty on those that don't. Under a new proposed rule released in late May, CMS outlined a number of revisions to the details of this plan that members of organized medicine, including the American Medical Association, had insisted were sorely needed.

The changes, which are set to be finalized this summer, provide a measure of relief to physician practices that were worried about being subject to Medicare e-prescribing penalties even though they are actually early technology adopters.

Because CMS did not align the requirements for its e-prescribing program with those for its separate electronic medical records meaningful use program, some practices had to contemplate installing a stand-alone paperless drug order system -- on top of the EMR they already had -- just to be compliant. Some practices took this duplicative step earlier in the year just to be sure.

With its latest changes, the Medicare agency has confirmed that practices that already have certified EMRs can use those systems to meet the e-prescribing mandate as well. CMS recognized that in most cases, approved EMRs have the same level of functionality when it comes to sending paperless drug orders as the systems called for by the e-prescribing program.

In future reporting years, physicians who use certified EMRs will know for sure that their systems will be acceptable to the government when it comes to e-prescribing.

Better aligning the requirements of the e-prescribing and EMR programs was only one of the revisions that CMS needed to make. Many other physicians were facing Medicare penalties for practice circumstances that truly were out of their hands.

CMS initially only proposed exemptions to the e-prescribing requirements for rural physicians with limited Internet access and those living in areas where pharmacies don't accept paperless medication orders. That left too many other physicians who still would have faced a 1% penalty in 2012 simply because they had limited opportunities to prescribe electronically. Now CMS also will offer exemptions to doctors who don't prescribe enough drugs in the first place, who are barred by law from issuing enough electronic drug orders (such as under prohibitions on e-prescribing of controlled substances), or who prescribe drugs only during patient encounters that don't count under the program (such as many surgeons). Practices also will be able to avoid the penalty if they did not e-prescribe by the June deadline because they were planning instead to adopt and use EMRs in 2011 to qualify for meaningful use bonuses.

When the proposed changes are finalized, physicians not meeting the e-prescribing requirements will have until Oct. 1 to apply for one of these waivers. The agency predicts that more than 200,000 doctors and health professionals might be eligible to claim a hardship. By expanding the exemption list and the deadline to file, CMS is acknowledging that many practices will not meet the minimum this year not because they don't want to, but because they can't.

When it comes to providing needed regulatory relief to doctors, the Obama administration shouldn't stop with the changes it already has proposed. Medicare and Medicaid have a whole host of burdensome, redundant or unnecessary rules for physicians, including certain regulations pertaining to translators, claims audits, documentation and enrollment.

Now that CMS has shown it can be flexible on the e-prescribing requirements, it needs to devote its attention to these rules.

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