Physicians Left in Tech Turmoil Over ‘Unreasonable’ E-prescribing Rules

Tech-savvy practices psyched about scoring federal dollars for EHR and e-prescription systems in 2011 may be disappointed at what they collect. 

Unless prescription penalties outlined in the Center for Medicare and Medicaid Services’ 692-page, mammoth-size 2011 Final Fee Schedule Rule published Nov. 29 are adjusted, physicians aren’t eligible to receive incentives from both the Medicare e-prescribing incentive program and the Medicare EHR incentive program simultaneously, the American Medical Association notes. What’s more, physicians who do not meet e-prescribing minimums in the first six months of 2011 will face penalties in 2012 and 2013.

The AMA, which spearheaded a letter to HHS Secretary Kathleen Sebelius signed by 103 healthcare associations lambasting the “last-minute change” in policy and asking for adjustments to the e-prescription penalty, said failing to align these high-tech programs will ultimately delay physicians’ efforts to adopt a complete EHR.

AMA said it was “disappointed” at CMS’ lack of options for physicians to use a qualified registry or EHR to report e-prescribing activity to avoid penalties. As the new rule stands, physicians who use a qualified registry or EHR will also have to submit claims with the G code to avoid a penalty.

“This unreasonable policy leaves many physicians with little choice but to purchase and use a stand-alone e-prescribing program during the initial months of 2011 just to avoid penalties,” said AMA Board Secretary Steven J. Stack, in a press release. “HHS must take action now to align the e-prescribing and EHR incentive programs in order to alleviate confusion and reduce financial and administrative burdens on physician practices working to adopt health IT.”

Steven Waldren, director of the Center for Health Information Technology, a division of the American Academy of Family Physicians, said the rule pulls the rug out from under well-meaning docs.

“A lot of our members have been figuring out what they need, and some have probably made plans relative to that, and the concern is that CMS is changing the rules mid-way through,” says Waldren. “The proposed rule more or less said ‘the penalties start in 2012,’ so that would give you all of 2011 to become an e-prescribing physician to avoid the penalty. Now they’re saying you have to do that in the next six months.”

In its letter, the AMA and its peer organizations are calling for CMS to:

• Extend the reporting period so that physicians can report the e-prescribing G-code, G8553, at least ten times for applicable Medicare office visits and services during the first ten (not six) months of 2011 (January 1, 2011-October 31, 2011) to avoid penalties in 2012; and

• Add more exception categories consistent with recommendations made by commenters in response to the proposed rule so that more physicians and other health care professionals will be eligible for an exemption from e-prescribing penalties in 2012. For example, physicians who attest to meaningful use in 2011 or 2012 should be exempt from e-prescribing penalties.
 

Surescripts reports that by the end of 2010, about 200,000 physicians, physician assistants, and nurse practitioners will be prescribing electronically. For more e-prescription data and suggestions on how your practice can benefit from rapid implementation, check out "Choosing the Right E-Prescribing Application."