Wednesday, July 16, 2008
Amid Medicare debate comes mandatory e-prescribing
Included in this week's passage of Medicare payment updates was a carrot-and-stick mandate that doctors electronically prescribe drugs. Starting next year, physicians who do e-prescribe will recoup 2% of their entire Medicare billing component, which some back-of-the envelope math shows could average $4,000. By 2012, though, those who don't e-prescribe face penalties starting at 1% in 2012 and rising to 2% by 2014.
Prescription volume is expected to grow to 4.1 billion by 2010, according to a report by the eHealth Initiative. But the vast majority of docotrs don't e-prescribe today, with only about 2% of all prescriptions getting to the pharmacy electronically.
Doctors don't have good options when trying to adopt e-prescribing systems. Free systems are out there, but these have come and gone in the past decade, with the companies often going out of business. ACP recommends against standalone e-prescribing systems, saying the real benefits come from functions available to fully functioning electronic health records. But such systems cost tens of thousands of dollars per physician to implement, and setting up systems set back doctors for months, as article in Annals of Internal Medicine and ACP Internist point out.
One option that may become popular is hospitals that offer Web-based systems to doctors. The federal government has specifically exempted hospitals from Stark II kickback regulations when they offer EHRs. The systems can be Web-based, requiring no extra hardware or software, and hospitals can then extend tech support to users.
Has your hospital contacted you? Would you accept an offer if it came?
posted by Ryan DuBosar at
2:00 PM
Contact ACP Internist
Send comments to ACP Internist staff at acpinternist@acponline.org.
Previous Posts
- Drugs going to the dogs
- Is there a web cam in your future?
- Medical News of the Obvious
- A new day for mental health parity
- The long arm of your chromosomes and the law
- Yeah, yeah, I need to lose weight. But how?
- Unveiling the secrets of a long life
- Medical News of the Obvious
- Watermelon can have Viagra-like effects
- Drug news
Blog log
Members of the American College of Physicians contribute posts from their own sites to ACP Internist and ACP Hospitalist. Contributors include:
Albert Fuchs, MD
Albert Fuchs, MD, FACP,
graduated from the University of California, Los Angeles School of
Medicine, where he also did his internal medicine training.
Certified by the American Board of Internal Medicine, Dr. Fuchs
spent three years as a full-time faculty member at UCLA School of
Medicine before opening his private practice in Beverly Hills in
2000.
David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned
authority on nutrition, weight management, and the prevention of
chronic disease, and an internationally recognized leader in
integrative medicine and patient-centered care.
DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about
health topics for patients and health professionals.
Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more
than a decade and is an Associate Professor of Medicine at an
academic medical center on the East Coast. His time is split
between teaching medical students and residents, and caring for
patients.
Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science,
medicine, health and healing in the 21st century.
FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the
Internal Medicine Residency and Assistant Dean of Scholarship &
Discovery at the Pritzker School of Medicine for the University of
Chicago. Her education and research focus is on resident duty
hours, patient handoffs, medical professionalism, and quality of
hospital care. She is also an academic hospitalist.
Glass
Hospital
John H. Schumann, MD, FACP, provides transparency on the workings
of medical practice and the complexities of hospital care,
illuminates the emotional and cognitive aspects of caregiving and
decision-making from the perspective of an active primary care
physician, and offers behind-the-scenes portraits of hospital
sanctums and the people who inhabit them.
Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the
University of North Carolina School of Medicine, and the Program
Director for the GI & Hepatology Fellowship Program. He
specializes in diseases of the esophagus, with a strong interest in
the diagnosis and treatment of patients who have
difficult-to-manage esophageal problems such as refractory GERD,
heartburn, and chest pain.
I'm dok
ACP Member Mike Aref, MD, PhD, ACP Member, is an academic
hospitalist with an interest in basic and clinical science and
education, with interests in noninvasive monitoring and diagnostic
testing using novel bedside imaging modalities, diagnostic
reasoning, medical informatics, new medical education modalities,
pre-code/code management, palliative care, patient-physician
communication, quality improvement, and quantitative biomedical
imaging.
Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.
KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites
for influential health commentary.
MD
Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of
medical practice, including controversies in the doctor-patient
relationship, medical ethics and measuring medical quality. When
he's not writing, he's performing colonoscopies.
Medical
Lessons
Elaine Schattner, MD, ACP Member, shares her ideas on education,
ethics in medicine, health care news and culture. Her views on
medicine are informed by her past experiences in caring for
patients, as a researcher in cancer immunology, and as a patient
who's had breast cancer.
Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a
small community hospital in Connecticut. His blog is a series of
musings on medicine, medical care, the health care system and
medical ethics, in no particular order.
Reflections
of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being
a doctor in a community hospital in Atlanta.
Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in
education, social media and networking, practice management and
evidence-based medicine tools, personal information and knowledge
management.
White Coat Underground
Peter A. Lipson, MD, ACP Member, is a practicing internist and
teaching physician in Southeast Michigan. The blog, which has been
around in various forms since 2007, offers musings on the
intersection of science, medicine, and culture.
ACP Internist and ACP Hospitalist also contribute to and draw upon content from Get Better Health, a network created by Val Jones, MD, to support and promote health care professional bloggers, provide insightful and trustworthy health commentary, and help to inform health policy makers about the clinician's point of view on health care reform, science, research and patient care.
Other blogs of note:
American
Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine
publishes original clinical articles of interest to physicians in
internal medicine and its subspecialities, both in academia and
community-based practice.
Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP
Member, associate program director at New York University Medical
Center's internal medicine residency program. Faculty, residents
and students contribute case studies, mystery quizzes, news,
commentary and more.
db's Medical
Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating
medicine and the health care system.
Interact
MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so
he can create an independent, clinician-reviewed space on the
Internet for physicians to report and comment on the medical news
of the day.
PLoS
Blog
The Public Library of Science's open access materials include a
blog.
White Coat Rants
One of the most popular anonymous blogs written by an emergency
room physician.
13 Comments:
I would take it. I have tried for 4 years to get EMR at our clinic, from owners, hospital, free, etc, without success.
This is a much larger issue than dollars. E-prescribing will require that we document a diagnosis along with each Rx pretty much eliminating off label use of meds.
More important is that we know that this data is SOLD. We compromised our patient's personal healthcare privacy for dollars.
Out patients interests must always come first.
In this case, getting the 10% "back" only leaves us with the threat of 20% cuts in 18 months.
The program needs to be fixed ... another bandaid is not now nor has it ever been the answer particularly when the patient is hemorrhaging.
Marcy Zwelling-Aamot, MD FACEP
I have been e-Prescribing for over eight years. Many "stand alone" companies have indeed come and gone over the years. The software and hardware continue to improve. My patients and I have benefited significantly.
The value of quick and easy access to drug-drug interactions cannot be under-estimated. Now add to this a reduction in phone calls for refills, formulary issues and handwriting issues. There is a good deal of uncompensated time saved by automating the process. How many of you have had to hand write 4-8 refills for patients? We now have e-Prescribing incorporated in our EHR and get the benefit of drug-disease checks.
http://ehrphrpatientportal.blogspot.com/
Our initial experience with internet based E Rx was quite clumsy but also gave our doctors an open book to everything any doctor had prescribed for the patient. While this may be useful, in several cases the other prescriptions were not disclosed to me by the patient and I felt this was a HIPAA issue. Do I have the right to see your Viagra or Adderall Rx if you don't want to tell me?? Also agree with above comment about sale of such information. Now our EMR will E RX in a more blinded way -- but you know the sale of information through the intermediary clearinghouses is still big business.
Does anyone know the details about the January 1, 2009 deadline for e prescribing for Medicare. Is it a 2% bonus of Medicare charges?, Medicare collection?, Medicare Part D prescriptions filled by e prescribing? Is it per physician? grooup? Have the details been clarified?
As a patient, I would ask what those of you who are clinicians would say in these scenarios:
1--I travel. Perhaps I'm a retiree. It's Monday and I get my pay on Friday. I want to wait to fill my script on Friday, and haven't decided where I'll be that day. I want paper. Is your staff going to give me a hard time? (My current MD's staff get upset with me when I want to schedule my own consult appointments. Wondering what they'll do with this.)
2--It's my husband's script. I have to pick it up for him (say he can't drive). On the way home from work, there's construction. It's too much hassle and I want to go to a different pharmacy. You're closed. Now what?
I could keep going here. What is your option B?
Regarding Dr. Sawyers questions, the legislation refers to payment based on "allowed charges under this part for all such covered professional services furnished by the eligible professional". The legislation also provides an option for payment to go to the provider or practice. Full details will be annouced by CMS this fall through the publication of a Final Rule with Comment.
Any further comment from medicare about the final rules? They were to come out in the fall, and it is almost November.
Joan St. Onge
stongeje1@aol.com
Also, remember to vote!-only 6 days left!
In response to Dr. St. Onge's question, our Regulatory and Insurer Affairs staff tells me that CMS has yet to publish the rules. They should be out any day now but by no later than November 15. It doesn't give much time to get the word out, but in fairness to CMS, the agency didn't have a lot of time to gear up since Congress just passed the law in July.
Ryan DuBosar, Senior Editor
ACP Internist
Just a day after following up about when the final rule will appear for e-prescribing, here's the announcement. The final rule with comment will appear in the November 19 Federal Register. You can comment up to Dec. 29. The rule takes effect Jan. 1 and another rule will appear later, responding to the comments.
For more details on the general provisions of the rule, as well as CMS’s implementation of the PQRI and e-Prescribing initiative, and MIPPA changes, see the Medicare Fact Sheets posted here.
E-prescribing has so many flaws:
From the pharmacy perspective - you will get millions of requests which the patient does not fill but they were too polite to tell the doctor what their intentions were. Waste of time...
From the physician perspective - If a particular pharmacy doesn't have the prescription you prescribed, they have to transfer the prescription to somewhere else but that may only be done once. If supply for a medication is short, the patient has to try their luck and if all else fails they call the doctor. Waste of time...
From the patients perspective - you have to go to the pharmacy you usually go to unless you tell your provider or he/she asks each time that you can find it cheaper somewhere else if you pay cash. Waste of money...
It's now an issue that physicians are stuck with, for better or worse. The article we ran in September's issue (http://www.acpinternist.org/archives/2008/09/erx.htm) still holds true, and e-prescribing's benefits are being repeated as a trusim in national discussions on health care reform.
But the vast majority of docotrs don't e-prescribe today, with only about 2% of all prescriptions getting to the pharmacy electronically.
Post a Comment
Subscribe to Post Comments [Atom]
<< Home