Electronic prescribing was supposed to be standard practice by now. With all the predictions of increased efficiencies and cost savings, policymakers and health plan administrators were sure physicians would adopt the technology--but the associated costs and hassles dissuaded most.
The Centers for Medicare and Medicaid Services thought it could turn the tide last year by adding a financial incentive: a 2% bonus on Medicare Part B payments. That didn't do the trick either; accessibility and cost issues remained, and the various "G" codes that had to be added to Medicare claims to document e-prescribing were confusing and annoying.
As 2009 ended, only 10%-15% of American physicians were e-prescribing. If you're in the prehistoric majority, 2010 may be the year to reconsider: CMS has made it much easier to collect the 2% bonus with a minimum of e-prescribing effort. This year, if you can show that you are using a qualified e-prescribing program on only 25 Medicare claims over the course of the entire year, you'll get the 2% bonus on every Medicare Part B claim you file in 2010.
In addition, CMS has simplified the reporting process by eliminating all add-on codes except G8553, the one that indicates you have a qualified e-prescribing program and you used it to provide at least one prescription at the visit being billed.
Of course, CMS is hoping you won't quit after only 25 claims; they're betting you'll notice a decrease in paperwork, simplification of record keeping, fewer misspellings and handwriting misreads, and a greater awareness of contraindications and drug interactions, plus simplified access to patients' medication histories.
To address the cost and accessibility problems, a coalition of insurance and technology companies called the National e-Prescribing Patient Safety Initiative (NEPSI) has provided $100 million in funding to offer free e-prescribing technology to all doctors nationwide. NEPSI members include Allscripts, SureScripts, and NaviMedix, as well as Google, Dell, Cisco, Fujitsu, Microsoft, Sprint, Aetna, Horizon Blue Cross/Blue Shield, WellPoint, and Wolters Kluwer Health. (I have no financial interest in any company or product mentioned in this column.)
Thanks to the efforts of NEPSI and others, e-prescribing is now quick and easy for most practices to set up and use. Pharmacies have already done most of the work to make themselves compatible; about 70% of U.S. pharmacies can now handle electronic prescriptions. Setup methods vary, but the concepts and requirements for each company are generally similar. You can incorporate e-prescribing into many electronic health record systems, or set it up as a separate, stand alone system. In most cases, all you need to get started is an Internet-enabled computer with a high-speed connection, and a database of patients.
Keep in mind that this will not be a complete transition; you cannot entirely eliminate paper prescriptions from your practice. Beside the 30% of pharmacies not equipped for e-prescribing, Drug Enforcement Administration rules prohibit sending controlled substance prescriptions electronically.
A nonprofit foundation called eHealth Initiative has released an excellent guide for physicians on e-prescribing. You can find it at www.ehealthinitiative.org/ basics-what-electronic-prescribing.html. You can learn more about NEPSI, and sign up for their free, online-based prescribing software at www.nationalerx.com.
A list of other companies currently offering e-prescribing software, along with links to their respective Web sites, can be found at www.eprescribing.info/epre scribe/companylist.aspx.
Details of the CMS incentive program are available at http://www.cms.hhs.gov/ERxIncentive/. The 2% incentive will decrease to 1% in 2011 and 2012, then to 0.5% in 2013. But beginning in 2012 there will be a 1% penalty for not e-prescribing, increasing to 1.5% in 2013 and 2% in 2014 and thereafter.
Bureaucrats hope 75% of us will be prescribing electronically by 2014, 90% by 2018. And that, in turn, they claim, will save the government $22 billion over the next decade.
Maybe, maybe not. But with only 25 e-prescriptions required to collect the 2% bonus this year, it is, as outgoing AAD President David Pariser puts it, "a no-brainer" to give e-prescribing a try.