The dreaded “E” word: E-prescribing

By Bradley K. Reiner
Practice Management Consultant, Reiner Consulting and Associates

Did you hear the news? As if electronic medical records were not difficult enough to navigate, electronic prescribing has now been designated by Medicare as the preferred choice for getting prescriptions filled. Not only is it the preferred choice, but the government has decided to give incentives to make it easier for you to pull the trigger on this new technology. But, don’t assume it will be an easy process.

What is e-prescribing? As defined by the eHealth Initiative and the Center for Improving Medication Management, “e-prescribing means the transmission, using electronic media, of prescription or prescription-related information between a prescriber, dispenser, pharmacy benefit manager or health plan, either directly or through an intermediary, including an e-prescribing network.

“E-prescribing includes, but is not limited to, two-way transmissions between the point of care and the dispenser.”

Fortunately, when Congress stepped in to stop Medicare from decreasing payments, it also added incentives for practices to adopt e-prescribing. This could be the next big technological advancement that offers offices an easier way to fill patients’ medications while reducing or eliminating problems communicating their prescriptions to the pharmacy. Sending it directly from the office to the pharmacy will help ensure that they are filled timely and correctly. Improvements should reduce medication errors and decrease drug interactions. Anything that helps eliminate difficulties reading illegible handwriting must be positive, right?

There still are not very many practices adopting e-prescribing. Why? My recent conversation with a family physician gave me the answer. He tried a couple of the e-prescribing systems and had a miserable time getting them to work correctly. Some pharmacies are not even in the system, which eliminates the benefits of having an e-prescribing system in the first place. According to SureScripts, developed to improve the efficiency of the overall prescribing process, approximately 95 percent of chain pharmacies and 27 percent of independent pharmacies are e-prescribing capable. Unfortunately, controlled substances, which account for approximately 20 percent of prescriptions, cannot be sent electronically. Apparently they are still trying to get this changed.

The Medicare incentive program gives practices opportunities to receive bonuses for e-prescribing. For a period of five years, the government will give incentives broken down as follows:

• In 2009 and 2010, Medicare will pay a 2-percent bonus in addition to the practice’s Medicare fee for e-prescribing;
• In 2011 and 2012, the bonus will drop to 1 percent;
• In 2013, the bonus will drop to 0.5 percent, and
• If eligible practices do not e-prescribe, the legislation imposes penalties of 1 percent in 2012, 1.5 percent in 2013 and 2 percent in 2014 and beyond.

Other important points to consider as the program matures are the new Physician Quality Reporting Initiative and other Medicare reimbursements. Separate bonuses will be paid in addition to bonuses for e-prescribing. This could mean practices might receive up to a 4-percent bonus. More guidelines on this will follow.

Many practices may find that the bonuses don’t cover the costs of their e-prescribing systems. It will be important to find a system that does the job correctly and efficiently and is more timely than hand-writing prescriptions for patients to fill.

There will be exemptions on who is required to participate. These will be determined on a case-by-case basis. Obviously, if the government determines that implementation of the program causes a significant hardship for the practice or if the practice is in a rural area without Internet access, then Medicare might consider an exemption.

Some practices have been worried that you have to have an electronic medical record to e-prescribe. This is not the case. There are a few e-prescribing software programs available for practices to use that are not supported by any electronic medical record. The problem is finding the one that best fits your practice. One is offered for free through the National e-Prescribing Patient Safety Initiative. Visit the NEPSI website at www.nationalerx.com for more information. A complete listing of companies offering e-prescribing is available on the SureScripts Web site at www.surescripts.com. Most e-prescribing systems are part of an EMR rather than available as a stand-alone system so it is critical to make sure the system can support what you are trying to do. Other questions that the Web site can answer include:

• What are the recommended devices with and without EMR attached?
• What are the system requirements for implementing an e-prescribing system?
• How do you set up the connection with the pharmacy?

Costs of these systems can vary based on the bells and whistles. This tends to be one of the major problems with physicians implementing an e-prescribing system. Basic programs can easily cost over $1,000 to almost $5,000 per physician. Some of the more powerful systems can be as much as $30,000 per physician with annual fees thereafter. Grants through Medicare can assist to reduce the cost.

Keep in mind that not all pharmacies and physician practices are able to use e-prescribing tools. Patients can check to see which pharmacies and physician practices currently e-prescribe through the Learn About e-Prescriptions Web site at www.learnabouteprescriptions.com.

Another resource for learning more about e-prescribing involves a Web site the American Academy of Family Physicians and other organizations support. “GetRxConnected,” www.getrxconnected.com, discusses some of the benefits associated with e-prescribing and provides information on choosing the associated technology. This is important for those who have not yet taken steps to acquire e-prescribing technology and for those who may already be using an electronic health record or e-prescribing system but have not yet established an electronic connection to pharmacies.

One problem some practices have experienced is they think using e-prescribing software means they are electronically connected to the pharmacy, when in actuality the software generates a fax and transmits it to the pharmacy. As of Jan. 1, 2009, government plans are eliminating computer-generated fax prescriptions for Medicare and Medicaid patients. Practices would have to hand-write prescriptions if their software is incapable of generating a true electronic prescription. Anybody who is going to implement this would need to investigate these issues before purchasing a system especially if he or she sees a lot of Medicare and Medicaid patients.

If you make a decision to participate with e-prescribing, be cautious of what system you adopt. Talk to your peers or other practices currently using e-prescribe software and to see if they are having any problems. Learn from others’ mistakes and avoid additional hassles.

Electronic prescribing is the wave of the future. You can’t stop this technology, but you can do your homework and make it as painless as possible. Utilize the resources available to implement something that will work. Make the best of the transition and maybe even save some extra money along the way.

Bradley K. Reiner, formerly with Texas Medical Association, is now owner of Reiner Consulting and Associates. He can be reached by phone at (512) 858-1570 or e-mail at breiner@austin.rr.com.