Accelerating e-Prescribing

BCBS Massachusetts Creates Incentives for e-Prescribing

Blue Cross and Blue Shield of Masschusetts -- the state's largest health insurer -- has established a bonus incentive program for physicians to use e-prescribing.  Health insurers say that electronic prescribing "can reduce medication errors, complications from drug interactions and drug allergies and overall pharmacy costs," according to the Boston Globe. John Fallon, chief physician executive of BCBS, in a statement said, "Our incentive programs are designed to reward doctors for taking steps to improve the quality of outcomes for patients, and e-prescribing has certainly proven to increase the quality of care."

The swift adoption of e-prescribing technology faces several barriers, including the costs of implementing such systems. BCBS said it will pay an undisclosed amount to help some physicians cover software licensing fees for the technology. Medicare is scheduled to being its physician bonus program on January 1, 2009.

CHT Hosts Louisiana Event with Gov. Bobby Jindal: HIT Investment Necessary

CHT hosted an event on October 22 which featured CHT Founder Newt Gingrich and Louisiana Governor Bobby Jindal which focused on improving Louisiana's health and healthcare systems. Both Speaker Gingrich and Gov. Jindal provided opening remarks at the event which was titled, "Creating a 21st Century Intelligent Health System in Louisiana."  The program also featured a series of three panels. The first panel focused on “Designing an Effective and Efficient Health Delivery System in Louisiana.” The second panel was on, “Achieving Optimal Health and Wellness for a Productive Louisiana.” The final panel of the day was, “A Community Approach to Managing Diabetes and Obesity.”

The Baton Rouge Advocate reports that both Speaker Gingrich and Gov. Jindal (R) discussed the importance of advancing technology in healthcare. Speaker Gingrich called on the federal government provide incentives for healthcare providers to be completely electronic by December 2012. He believes the government should subsidize electronic health record adoption.

Gov. Jindal told reporters that he also supports government action to boost the transition to EHRs. Jindal's health care delivery reform plan includes a better use of technology.

WSJ: Can Technology Really Change Healthcare?

In an article recently published in the Wall Street Journal entitled, “Prescription for Change,” Professor Amar Gupta of the University of Arizona makes the case that health care has historically managed to avoid the information technology revolution. However, he believes that it won't be able to dodge the technology wave for much longer.

 

The entire health-care industry ― from physicians and pharmacies to large hospitals and ambulatory surical centers ― are about to undergo a revolution driven by information technology. “While hospitals and other care providers have long been quick to adopt breakthrough technology in medical devices, procedures and treatments, far less attention has focused on innovations in networking and communications,” Professor Gupta contends.

 

Concerns such as breaches in security and patient privacy are often cited as barriers to the widespread adoption of health information technology (HIT). However, security will “eventually meet the expectations of the health-care industry, just as has happened in other sectors, like banking.”

And when it does, according to Professor Gupta, powerful IT networks crisscrossing the globe will change the way much of health care is delivered: “Outsourcing and offshoring of medical and non-medical services will increase, providing more efficient health care at the most cost-effective rates; systems integrations will allow more medical records to be transferred swiftly and securely; efforts to monitor the safety of medicines will gain global access to data; and professionals and patients will find authoritative and up-to-date information on every specialty online.”

 

The WSJ article indicates that in the future, there will be three overlapping modes of delivering healthcare services: 1) services performed in person by humans, 2) services that can be performed by people at a remote location, and 3) services performed by computers without direct human involvement. Offshore outsourcing in combination with a 24-hour work cycle will be appropriate when certain conditions are met ― mainly, if the information involved in the task can be digitized, and if workers at different sites can do their jobs independently from one another.

 

There will be plenty of challenges, barriers and obstacles as healthcare institutions and networks reach across borders and encounter different laws as well as technical standards. In the meantime, healthcare organizations that don’t join in the coming changes will incur higher costs and less integration. The WSJ believes this will make them less competitive in the global healthcare marketplace.

CHT Member Zix Corporation Announces New e-Prescribing Partnership

Zix Corporation, a member of the Center for Health Transformation and one of the largest providers of e-prescribing technology services, and Aetna, one of the largest integrated health insurance carriers, announced a three-year e-prescribing agreement for northern New Jersey. Under the agreement, certain primary care physicians in northern New Jersey will be eligible to receive, at no charge, an e-prescribing device and associated connectivity services. E-prescribing devices provide physicians with access to health plan formulary and drug interaction information, and electronically submit prescriptions to the patient’s preferred pharmacy, helping to reduce prescribing errors, and saving members the time of having to drop off hand-written prescriptions at the pharmacy.

This new contract follows an existing and successful relationship between ZixCorp and Aetna that began with an e-prescribing pilot program in 2005 in New Jersey, followed by New York and Connecticut in 2007.

Under this new agreement, over 1000 physicians are eligible for participation and Aetna estimates that 40,000 members in northern New Jersey could benefit from this program.

"E-prescribing allows us to provide doctors with access to timely information, allowing real-time decision support to occur at the point of care, such as formulary information and potential adverse drug interactions that ultimately help doctors lower a member’s out of pocket costs and promote patient safety," said Thomas Howe, MD, Aetna medical director, northern New Jersey. "Increasing and supporting physician use of new administrative technologies will bring universal, proven benefits to everyone in the health care system, and we are pleased that this relationship with ZixCorp helps bring this technology to our network providers in Northern New Jersey."

CHT Members Form Strategic Partnership: MedIpact and SureScripts-RxHub Advance e-Prescribing

Two cutting-edge members of the Center for Health Transformation (CHT), MedImpact and SureScripts-RxHub, have created a new partnership. The two have recently launched an electronic prescribing platform that will securely connect physicians with e-prescribing tools which will provide critical data sources for member eligibility, formulary and drug history information.

The Institute of Medicine (IOM) reported that more than 1.5 million Americans are injured every year by medication errors. In the same report, the IOM recommended that all prescriptions be written and received electronically by the year 2010.

As members of the Center for Health Transformation (CHT), MedImpact and SureScripts-RxHub collaborated with CHT over the past year in the development of a white paper that communicates the benefits of e-prescribing to the health care industry. Newt Gingrich, founder of the Center for Health Transformation, congratulated MedImpact and SureScripts-RxHub for developing a flexible e-prescribing solution that will be delivered to its clients, “With the Centers for Medicare and Medicaid Services estimating that e-prescribing could eliminate as many as two million harmful drug errors every year, this is a very important step that can save lives as well as money for countless Americans.”

“MedImpact will continue to help SureScripts-RxHub advance electronic prescribing which reduces the human error that can lead to harmful drug interactions,” said Dale Brown, senior vice president for MedImpact. “In addition, SureScripts-RxHub’s technology platform provides flexibility for our clients and important capabilities for electronic health records such as a master patient index for more than 200 million Americans. MedImpact will leverage and enhance these capabilities for the benefit of our clients who wish to provide this service and for the benefit of the patients they serve.”

As a clinical utility for the health care industry, SureScripts-RxHub enables physicians to have a single point of contact for connectivity to PBM data sources. The company certifies technology vendors and PBMs on its infrastructure, enabling the delivery of patient pharmacy eligibility, formulary and medication history information directly to physicians at the point of care.

“SureScripts-RxHub welcomes MedImpact as a PBM with a strong commitment to improving patient care through advancements in health information technology. MedImpact serves more than 30 million members nationwide, and brings a unique perspective that will strengthen and promote the e-prescribing experience for payors and for patients,” said JP Little, Co-CEO at SureScripts-RxHub.

CMS Creates a Dedicated Web Page to New Medicare Physician e-Prescribing Incentive

According to the Centers for Medicare & Medicaid Services (CMS), the agency recently added a new E-Prescribing Incentive Program section page to the Physician Quality Reporting Initiative page of the CMS website.

CMS reports that the new section page will provide information about the E-Prescribing Incentive Program.  In the downloads portion of the new section page, CMS has already posted an Introduction to E-Prescribing Incentive Program Fact Sheet that describes the Medicare Improvements for Patients and Providers Act of 2008 provisions for the E-Prescribing Incentive Program. CMS reports that additional information, including how to qualify for the E-Prescribing incentive for the 2009 reporting year, will be posted in the near future.

CHT White Paper on e-Prescribing

The Center for Health Transformation recently released a unique white paper on electronic prescribing that presents a comprehensive look at the technology, its benefits in saving lives and saving money, and how to overcome the barriers to its widespread adoption. The Center brought together a broad coalition of member organizations to author this work, from physicians and hospitals, to health insurers, pharmacy benefit managers and technology leaders.

The paper provides policymakers and industry leaders a comprehensive look at the benefits of e-prescribing, supporting the Institute of Medicine’s recommendation for all prescriptions to be written electronically by 2010. The paper includes experiences, perspectives and analyses that conclude that e-prescribing is an intelligent, efficient technology that improves patient safety and saves money by eliminating the inefficiencies of a paper-based system.

“Health information technology and the use of electronic prescribing is the one issue that everyone in healthcare can agree upon,” said Speaker Newt Gingrich. “The breadth of the organizations that contributed to and actively support this report clearly demonstrates the unanimity.”

The foreword was written jointly by Speaker Gingrich and US Senator John Kerry, a strong proponent of e-prescribing and HIT.  “Healthcare in America needs to move out of the dark ages and into the 21st century,” said Senator Kerry. “With technology like e-prescribing we will undoubtedly save lives, improve quality and lower costs. This paper makes an important contribution to the debate.”

The paper was written collaboratively by Center members, including: Allscripts; American Hospital Association; American Medical Group Association; Availity; Blue Cross Blue Shield Association; Covisint; Chrysler LLC; HCA – Hospital Corporation of America; Healthvision; InterComponentWare (ICW); MedImpact Healthcare Systems, Inc.; Microsoft; MinuteClinic; Misys; Pharmaceutical Care Management Association; RxHub, LLC; Sanford Health; SureScripts; UnitedHealthcare; WellPoint, Inc.; and Zix Corporation.

The entire white paper can be downloaded by clicking here.

Sec. Leavitt Lays Out Cost-Benefit Analysis of E-Prescribing Bonuses

   Before a huge audience of physicians, pharmacists, health plan representatives, HIT and e-prescribing vendors in Boston, Health and Human Services Secretary (HHS) (right) and CMS acting administrator Kerry Weems set forth a case to encourage physicians to accelerate plans to implement e-prescribing solutions. The first-year Medicare bonus for e-prescribing could be enough to pay for the software, and that's not counting the efficiency savings, according to HHS officials. 

“Our Nation’s health care system is undergoing a major transformation thanks to health information technology advancements like e-prescribing,” said Health and Human Services Secretary (HHS) Mike Leavitt. “From the smallest rural communities to the largest metropolitan areas, e-prescribing is streamlining the prescription process for patients, providers, health plans, and pharmacies. Today’s National E‑prescribing Conference (in Boston) is a vital step in overcoming e-prescribing barriers and sharing both best practices and insights to accelerate adoption.” 

"There's a lot of money on the table," said HHS Secretary Michael Leavitt, who likened the bonuses to the toasters that banks gave away years ago to encourage customers to use ATM machines.

If every physician met the requirements of the program, the total outlay could approach $1 billion for 2009 alone, according to CMS. The average primary-care doctor who e-prescribes, though, may receive only $2,000 to $3,000 of that.

Still, speakers at the CMS e-prescribing conference said that even such a modest amount would go a long way toward paying for the necessary software. Plus, they said, doctors could easily recoup their investment through cost savings possible with the technology.

The e-prescribing incentive program was created by the federal Medicare Improvements for Patients and Providers Act of 2008. Under MIPPA, doctors who e-prescribe for Medicare patients in 2009 and 2010 will receive a 2% bonus based on their total Medicare revenue. CHT continues to be a strong advocate for creating bonuses for physicians who utilize e-prescribing.

The bonus decreases to 1% in 2011 and 2012, 0.5% in 2013, and then disappears.

Doctors who don't e-prescribe by 2012 will suffer a 1% pay cut that year, a 1.5% cut in 2013, and a 2% cut every year thereafter.

In other words, the carrot is temporary, but the stick is permanent.

CMS and DEA Review Comments

According to Government Health IT, the Health and Human Services Department and the Drug Enforcement Administration are reviewing the feedback they have received on DEA’s proposed rule on e-prescribing for controlled substances, but the final rule might not emerge this year.

DEA published the proposed rule earlier this year, which would impose controversial security requirements for e-prescribing of controlled substances. A public comment period expired Sept. 25. Groups representing physicians, pharmacies and health information technology vendors have expressed concern that the rule as currently written could impede adoption of e-prescribing.

Kerry Weems, acting administrator of HHS’ Centers for Medicare and Medicaid Services, said DEA and HHS are reviewing the comments. Speaking at CMS’ National E-Prescribing Conference in Boston this week, Weems said the goal is to address DEA’s concerns while creating a rule that doesn’t provide a barrier to e-prescribing.

Jodi Daniel, director of the Office of Policy and Research in the Office of the National Coordinator for Health IT, said the final rule might not be on DEA’s to-do list for this calendar year. The presidential election could also push action into next year.

Medicare Incentive: Faxed Prescriptions Don't Qualify for Bonuses

According to CMS, prescriptions must be sent directly from a medical practice's computer to the pharmacy's computer in order to qualify for the 2% bonus promised by Medicare for e-prescribing.

This warning was written in boldface at the CMS conference on e-prescribing in Boston. CMS organized the meeting to educate physicians on how to reap the financial rewards for e-prescribing authorized by the federal Medicare Improvements for Patients and Providers Act of 2008.

Under MIPPA, doctors who e-prescribe for Medicare patients in 2009 and 2010 will receive a 2% percent bonus based on their total Medicare revenue, with smaller bonuses in succeeding years and penalties kicking in for doctors who don't e-prescribe beginning in 2012.

The key to qualifying for the bonuses -- and avoiding the penalties -- is having an e-prescribing system that meets the definition set out under CMS's Physician Quality Reporting Initiative. Under PQRI, an e-prescribing system must transmit a script electronically to the pharmacy via a technology called electronic data interchange, or EDI. It's the same technology used in online banking.