David May, MD, PhD, FACC, senior physician and founder of Cardiovascular
Specialists, PA, in Coppell, Texas, president of the Texas Chapter of the ACC
and a member of the Board of Governors’ Steering Committee.
Like a Sergio Leone western, e-prescribing
(e-Rx) has been viewed by many as a dark and foreboding landscape in which physicians
must have a broad, sweeping view of the electronic health care vista
alternating with intimate, close-up reflections on each patient encounter. In
reality, e-Rx accomplishes neither of these things perfectly. It is, however, here to stay.
The concept of e-Rx is quite simple. The ability to submit an accurate, understandable,
legible prescription without typographical mistakes from the point of care to
the pharmacy is a vitally important part of any safe health care system. Because of how important it is, the development
and facilitation of the e-Rx process is one of the key elements in the overall
plan for the further advancement of the electronic health infrastructure for
Section 132 of the Medicare Improvements
for Patients and Providers Act of 2008 provides the guidelines for the
incentive program we now define as the e-Prescribing Incentive Program. It was
implemented in 2009 as a stand-alone program in addition to the Physician
Quality Reporting System (PQRS). Providers who wished to participate in the
e-Rx program could but did not have to participate in the PQRS incentive
Two years post-implementation, where does
the program stand? Let’s review the good, the bad and the ugly.
The electronic submission of a prescription from the
point of care to the pharmacy reduces errors by providing accurate, dose-correct
prescriptions without illegible handwriting in a timely fashion. It benefits providers and pharmacies by
allowing 24-hour submission and its asynchronous communication eliminates the
“phone tag” delay associated with telephone submission and the twisted, often
illegible faxed-in prescription. For
patients, medicines are available in a timely and expeditious fashion with
accurate tracking available. In my
private practice, we’ve seen fewer mistakes in prescriptions, faster turnaround
time in the pharmacy, and incentive payments in 2009 and 2010 of 2% of our Medicare
Part B professional reimbursement through the e-Prescribing Program.
The implementation of e-Rx submission requires providers to alter their normal
work flow and develop additional skills. In addition, the enhancing and maintaining staff training is mandatory. For example, in
my practice, the nurses are responsible for making sure the prescriptions make
it to the right pharmacy for the patient. We had to devote a lot of resources
to training to make sure this happens for every prescription. With a little
creativity though, we were able to make this a more enjoyable experience by
implementing the training as a game.
In addition, e-Rx requires great attention
to detail, in that if your Internet access is not reliable, electronic
submission can be problematic. Due diligence is necessary to be certain that
submission has “gone through” successfully, and this is a departure from
handing a patient a prescription and being done with it.
Like the PQRS incentive program, e-Rx incentive “carrot” is rapidly changing to
an incentive “stick.” The 2012 payment adjustment reporting
period is Jan. 1 to June 30, 2011. Practices that have not submitted 10 e-Rx
submissions per provider by June 30, 2011, will be penalized 1% of their
Medicare professional fee reimbursement for 2012. In addition, registry
submission of the e-Rx information is not allowed for this time frame. The e-Rx information must be submitted by
claim with the appropriate G code and evaluation and management code.
The E-Prescribing Program may not be
perfect, but unlike a Sergio Leone
western, it’s a reality. In order to avoid a one percent (1%) decrease in the
covered professional Medicare reimbursement for 2012, you must be e-prescribing
before June 30 of this year. See www.cardiosource.org/HealthIT
for more resources to get started.