Aug 31, 2011

Greater Flexibility in e-Prescribing Means Greater Success

Patrick Conway, M.D., M.Sc.
CMS Chief Medical Officer and Director of the Center for Clinical Standards and Quality

Electronic prescribing plays a vital role in improving patient care and helping make our health care system more efficient.  With electronic prescribing, providers can better manage patient prescriptions, reducing drug interactions or other preventable prescription errors. We’ve made several changes in the newly released final rule for the 2011 Electronic Prescribing (eRx) Incentive Program that will encourage more doctors and other health care professionals to adopt this technology and give them the added flexibility to help them succeed.  In particular, the changes will better recognize those circumstances when the ability of professionals to meet the eRx requirements is limited and when the requirements clearly pose a significant hardship.

The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) required an adjustment to payments, beginning in 2012, for eligible professionals who aren’t successful electronic prescribers. After we published the 2011 Medicare Physician Fee Schedule Final Rule last fall, we heard about additional circumstances that could keep physicians and other health professionals from being successful e-prescribers. For example, some providers weren’t sure whether certified electronic health record (EHR) technology that the Medicare and Medicaid EHR Incentive Programs require is also a “qualified” electronic prescribing system as required by the Medicare eRx Incentive Program. Others providers brought up additional hardship situations that the 2011 MPFS final rule didn’t address.

Here’s how we’re addressing those additional concerns:

  • We’re modifying the 2011 electronic prescribing measure to say that a qualified electronic prescribing system for the purpose of the Medicare eRx Incentive Program includes certified EHR technology under the Medicare and Medicaid EHR Incentive Programs.
  • We’re adding four additional significant hardship exemptions that will make professionals exempt from the 2012 payment adjustment: (1) eligible professionals who register to participate in the Medicare or Medicaid EHR Incentive Program and adopt certified EHR technology; (2) eligible professionals who are unable to electronically prescribe due to local, state, or federal law or regulation; (3) eligible professionals who have limited prescribing activity; and (4) eligible professionals who have insufficient opportunities to report the e-prescribing measure due to limitations of the measure’s denominator.  The two hardship exemptions already available to professionals are (1) eligible professional or group practice practices in rural areas with limited high speed internet access; and (2) eligible professional or group practice practices in an area with limited available pharmacies for electronic prescribing.
  • We’re extending the deadline for requesting significant hardship exemptions to November 1, 2011.
  • We’re allowing providers to report significant hardship exemptions to the 2012 eRx payment adjustment via a Web-based tool for eligible professionals or via a mailed letter for group practices that are participating in the eRx group practice reporting option for 2011.

We remain committed to the many benefits that come to patients with successful electronic prescribing, and we continue to encourage health care professionals to adopt this practice.  However, we also can appreciate and acknowledge that this technology poses challenges to some providers. Changes in the final rule will help doctors and other health care providers in their efforts to become successful e-prescribers, ultimately leading to fewer errors and better care for patients.