Health IT Pulse

Sep 6 2011   12:18PM GMT

Final rule clarifies e-prescribing incentive program, sort of

Beastwood Profile: Beastwood

EHR incentive program

The Centers for Medicare and Medicaid Services has released its update to the final rule for the e-prescribing incentive program, which offers financial incentives to eligible professionals who demonstrate that they are using e-prescribing (eRx) technology and penalties (in the form of reduced Medicare Part B Physician Fee Schedule payments) to those who are not.

Though it sounds eerily similar to the Electronic Health Record (EHR) Incentive Programs, which includes provisions that require electronic prescriptions, the e-prescribing incentive program is separate. It’s also unequal, argued many, including the Government Accountability Office, when the final rule first came out in November 2010.

For starters, the two programs cover different time spans. The EHR Incentive Programs started this year, with penalties for failing to demonstrating the meaningful use of EHR applying in 2015, while the e-prescribing incentive program began in 2009, with penalties kicking in next year. The programs also define the term “eligible professional” (EP) differently; this, it should be pointed out, remains the case in the updated final rule.

Critically, the two programs also maintain different standards for “qualified” e-prescribing technology.

  • As physicians are well aware, the EHR Incentive Programs require the use of a Certified Health IT Product that can meet all the stage 1 meaningful use criteria.
  • The e-prescribing incentive program, on the other hand, requires the use of software that can do four things — generate a complete active medication list, let EPs conduct drug-drug and drug-allergy alerts, provide data on lower-cost alternatives, and provide data on formulary medications — while adhering to the standards of the separate Medicare Part D e-prescribing incentive program.

This was the sticky wicket for the GAO and others. CMS acknowledged as much in its final rule: “Stakeholders claim that the requirements under both programs are administratively confusing, cumbersome, and unnecessarily duplicative.”

The updated final rule offers a bit of clarity. “We believe that the electronic prescribing capabilities of

ertified EHR [t]echnology are sufficiently similar in nature (and in fact, would more than likely be capable of performing all of the required functionalities) and would be appropriate for purposes of the eRx Incentive Program,” CMS wrote.

Why do the two programs not fully align their e-prescribing technology requirements? Not all of the Medicare Part D e-prescribing incentive program requirements apply to meaningful use, CMS said.

It therefore remains entirely possible that an eligible professional would need to have two separate EHR systems up and running in order to avoid being penalized for not using e-prescribing technology. This lack of cohesion means that incentive programs designed to encourage technology adoption in an industry that desperately needs it may actually have the opposite effect.

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