The Centers for Medicare and Medicaid Services on May 26 proposed modifying the rules for e-prescribing so more physicians could claim exemptions from the criteria and therefore avoid being penalized in 2012.
In a conference call with reporters, agency officials said the change-up in the e-prescribing program was in response to indications from providers and professional societies that many prescribers might not be able to meet the requirements of the current incentive program.
"Today’s rule demonstrates that CMS is willing to work cooperatively with the medical professional community to encourage participation in electronic prescribing," Dr. Patrick Conway, chief medical officer at CMS and director of the agency’s Office of Clinical Standards and Quality, said in a statement.
"These proposed changes will continue to encourage adoption of electronic prescribing while acknowledging circumstances that may keep health professionals from realizing the full potential of these systems right away," he said.
Under the current incentive program, which was established in the Medicare Improvements for Patients and Providers Act of 2008, eligible prescribers were due to get a 1% bonus payment for 2011 and 2012 and a 0.5% bonus in 2013. For prescribers who did not meet the criteria, there would be a penalty imposed in 2012. The penalty would escalate in 2013 and 2014.
The final Medicare Physician Fee Schedule for 2011 contains exceptions to the criteria, along with two hardship exemptions. Eligible professional practices are exempt if they are in a rural area without high-speed internet access or an area without enough available pharmacies for electronic prescribing.
The proposed rule would modify the criteria. For instance, prescribers who use certified electronic health records can now claim this as a "qualified" e-prescribing system. This move was designed to more closely align the e-prescribing program with the program that offers incentives for meaningful use of electronic health records.
In addition, the proposed rule would create four additional hardship exemption categories. Eligible professionals would have to demonstrate that they have:
- registered to participate in the Medicare or Medicaid EHR incentive program and have adopted certified EHR technology.
- an inability to electronically prescribe due to local, state, or federal law (this primarily applies to prescribing of narcotics).
- very limited prescribing activity.
- insufficient opportunities to report the electronic prescribing measure due to limitations on the measure’s denominator.
Prescribers also would be granted an extension of the deadline, until Oct. 1, 2011, to apply for the hardship exemption.
CMS officials said that this proposal is not the final word. "This is the proposed rule, so we’re looking for additional comments from stakeholders," Dr. Conway said during the briefing.
The comment period closes July 26. According to Dr. Michael Rapp, director of quality measurement at CMS, who also spoke to reporters, it will probably take until at least August to have a final rule published.