Centers for Medicare and Medicaid Services (CMS) finalized its proposed rule on e-Prescribing last week. The final rule establishes the requirements for successful reporting of the e-prescribing measure, while also finalizing additional hardship exemptions for avoiding the 2012 e-prescribing penalty that begins on Jan. 1, 2012.

The ACC, along with the AMA and others, have had significant concerns regarding the implementation of the 2012 penalty and have urged CMS to reconsider the details and timing and to thoroughly consider the effects of this position on specialists such as cardiologists. Although the final rule does not extend the reporting time, it makes it easier for physicians to be eligible for hardship exemptions and addresses many of the concerns the ACC raised.

Under the rule, final hardship exemption categories for eligible physicians are as follows:

• Practitioners who have registered to participate in the Medicare or Medicaid EHR Incentive Program and have adopted certified EHR technology.
• Practitioners who are unable to e-prescribe due to local, state or federal law or regulation. (This proposed exemption is designed to address practitioners who primarily prescribe controlled substances.)
• Practitioners who infrequently prescribe. (For 2012, this means a practitioner must not have had the opportunity to e-prescribe at least 10 times between January and the end of June 2011.)
• Practitioners who provide services that are not included in the e-prescribing measures (e.g. does not provide office visits).
• Practitioners with practices located in rural areas without high-speed Internet access.
• Practitioners with a practice located in an area without sufficient available pharmacies for e-prescribing. (This includes natural disaster-caused disruptions.)