Medicare e-prescribing still too rigid

More and more physicians are implementing electronic prescribing technology in their offices, and many of them are glad they did. But those who have not yet made the transition to the paperless side of drug ordering have good reasons for it. For many of them, unique practice conditions and outside influences beyond their control make the move impractical or even impossible at this time, regardless of any incentives they may face.

That's why the Centers for Medicare & Medicaid Services did the right thing when it expanded the list of exemptions to Medicare's e-prescribing incentive program and gave physicians more time to claim a significant hardship waiver from the program's mandates. Those waivers mean that many physicians will not be penalized unfairly just because they did not have an adequate opportunity during the first six months of 2011 to write at least 10 electronic prescriptions.

The exemptions will benefit physicians who could not implement standalone e-prescribing systems because they already had in place -- or were installing -- electronic medical records systems in their offices. It will help those who could not issue paperless orders for their patients because they prescribe mainly narcotics or similar medications in states that still require traditional prescriptions for those drugs. And it will help those who simply didn't order enough medications or see enough patients during eligible visits earlier this year.

Individual physicians now have until Nov. 1 to request a hardship waiver online.

Group practices have until the same date to send a waiver request letter to CMS. Those doctors whose requests are granted will avoid seeing all of their Medicare payments cut by 1% next year.

While physicians no doubt appreciate that CMS has shown some flexibility on e-prescribing, many worry that the program is still too rigid, given the practice environments in which doctors work. After all, not every physician who didn't e-prescribe will qualify for a significant hardship waiver, but that doesn't mean those doctors don't support the technology modernizations that the incentive program is designed to encourage. The agency was not willing to acknowledge that many of these physicians needed more time, declining a request from organized medicine for another e-prescribing reporting period for practices that missed the small window this year.

And the clock keeps ticking. The Nov. 1 exemption deadline is right around the corner, and so, too, is another key date for the e-prescribing program. Jan. 1, 2012, starts yet another six-month reporting period during which CMS will require at least 10 more e-prescriptions under the threat of another Medicare penalty. Many physicians will face the same barriers to e-prescribing that they did this year, but the stakes will be going up -- doctors who don't meet the 2012 minimum and don't receive an exemption will sustain a 1.5% Medicare pay cut in 2013.

The lawmakers who set up these incentives did not intend them to operate this way. Even though Congress authorized the program's mandates to start in 2012, CMS jumped the gun, making the administrative decision to base that year's penalty on doctors' activities from a full year earlier. But as for the doctors who not only are early adopters but also were able to go above and beyond the minimum, sending at least 15 e-prescriptions during 2011? They won't see their 1% Medicare bonus until closer to 2013, by which time their less fortunate colleagues will have sustained reduced pay for months.

Organized medicine argues that basing the program years' penalties on previous years' activity violates congressional intent, and that more mechanisms must be put in place to help doctors avoid pay cuts, such as an appeals process for those denied waivers. More than 100 state and specialty medical societies have stated those strong beliefs to CMS. It's time for the agency to realize the wisdom of that united message.