American College of Physicians: Internal Medicine — Doctors for Adults ®

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?


Blogger Bonhoeffer Bug said...

I would take it. I have tried for 4 years to get EMR at our clinic, from owners, hospital, free, etc, without success.

July 22, 2008 at 12:46 AM  
Blogger Marcy Zwelling-Aamot MD FACEP said...

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

July 22, 2008 at 2:38 AM  
Blogger Salvatore Volpe MD FAAP FACP CHCQM said...

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.

July 22, 2008 at 9:20 AM  
Anonymous Anonymous said...

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.

July 23, 2008 at 6:00 PM  
Anonymous James W Sawyer MD said...

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?

August 5, 2008 at 2:29 PM  
Anonymous Anonymous said...

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?

August 5, 2008 at 2:53 PM  
Anonymous Neil Kirschner, Ph.D. said...

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.

August 5, 2008 at 3:54 PM  
Anonymous Joan St. Onge, M.D. , F.A.C.P. said...

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

Also, remember to vote!-only 6 days left!

October 29, 2008 at 8:57 PM  
Blogger Ryan DuBosar said...

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

October 30, 2008 at 9:50 AM  
Blogger Ryan DuBosar said...

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.

October 31, 2008 at 8:24 AM  
Anonymous Nirav Patel MD said...

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...

December 24, 2008 at 4:33 PM  
Blogger Ryan DuBosar said...

It's now an issue that physicians are stuck with, for better or worse. The article we ran in September's issue ( still holds true, and e-prescribing's benefits are being repeated as a trusim in national discussions on health care reform.

January 5, 2009 at 9:36 AM  
Anonymous James Morgan - Puritan Financial Advisor said...

But the vast majority of docotrs don't e-prescribe today, with only about 2% of all prescriptions getting to the pharmacy electronically.

September 2, 2010 at 8:40 AM  

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Members of the American College of Physicians contribute posts from their own sites to ACP Internistand 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.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Iowa City, IA, with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

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.

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
Mike Aref, MD, PhD, FACP, 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.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

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.

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.

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, FACP, 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.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

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.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

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.

Peter A. Lipson, MD
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.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

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.

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.

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