Accelerating e-Prescribing

Daschle Supports Expansion of HIT

According to Government Health IT, by designating former US Senator Tom Daschle as his secretary of health and human services, President-elect Barack Obama has chosen a strong advocate of expanding health information technology as one part of a comprehensive health reform program.

In Senator Daschle’s book, “Critical: What We Can Do About the Health Care Crisis,” which was published in early 2008, he states, “we are years, if not decades, behind European nations in harnessing health care information technology’s potential.” It calls for removing much health care policy-making from the political arena but states that at the same time the executive branch of the federal government should promote creation of an IT infrastructure for health information.

Both President-elect Obama and Senator Daschle are on record as favoring more health IT, and President-elect Obama supplied an endorsement of the book, saying that it “brings fresh thinking to this problem.”

Although not considered a health care leader during his 26 years in Congress, Senator Daschle did serve on the Senate Finance Committee, which had funding and policy jurisdiction over Medicare and Medicaid.

Since his election loss in 2004, Senator Daschle has worked as a consultant on the health care team of a Washington law firm, Alston and Bird. He also has served on the board of the Mayo Clinic in Minnesota, which is known for its extensive use of health IT.

The Healthcare Information Management Systems Society was among those applauding the news of his pending nomination to the HHS post. “HIMSS believes Sen. Daschle understands the critical health care issues and how IT can be leveraged to improve the quality, safety and efficiency of care,” the society said in a statement.

Praise also came from former Speaker of the House Newt Gingrich, a Republican and founder of a think tank, the Center for Health Transformation. Gingrich, a passionate advocate of health IT, said in a statement, “Given the current state of health care in America and the opportunity for real progress in Washington next year, President-elect Obama has chosen a proven leader. Senator Daschle has long been committed to reforming health care so that all Americans can get quality, effective care.”

News reports said Daschle not only will head up HHS, but also will have a White House post as health policy chief. Health reform backers said the selection of someone regarded as a heavy-hitter in Washington and his willingness to take the job indicate that Obama will indeed make health care reform a priority for his administration.

CMS Reverses Opinion on Faxed e-Prescriptions

According to Health Data Management, the final rule published by CMS setting the Medicare Part B physician fee schedule for 2009 reverses an earlier CMS decision to prohibit the use of computer-generated faxes of prescriptions for Medicare patients to pharmacies.  The decision to prohibit the use of faxes by CMS was aimed at encouraging the use of "true" electronic prescribing systems. However, public comments convinced federal officials that the health care industry was not yet ready for the transition.

Under the new rule, published Wednesday in the Federal Register, health care providers will be allowed to continue the use of computer-generated faxes until 2012. The new compliance date is designed to complement Medicare's payment incentive program for e-prescribing. The incentive program will begin in 2009, and health care providers will face reduced payments for not e-prescribing beginning in 2012.

Ten Questions to Ask Your HIT Vendor

CCHIT Certified status is the first thing for which to look when you’re selecting an EHR. But it’s also important to remember that it’s only the first step in the selection process.

Here are some other important questions to ask EHR vendors when you’re in the midst of selecting a product for your practice:

1. Tell me about your company. How long have you been in business? How many employees do you have doing development and offering technical service?
2. How many physician practices do you serve? What size are they? May I speak with a few of them?
3. How do you license your product—for a term or perpetually, by physician or user?
4. What are your maintenance or support fees? Do they cover product upgrades?
5. What are your service policies and guarantees?
6. In addition to what I can expect from CCHIT Certified interoperability, what will I pay for other desired interfaces to products or sources of information?
7. Are there third-party costs for modules or components bundled with your product? Will I need to buy some third-party products independently to make your product perform as demonstrated?
8. Tell me about your implementation and training services. What do they cost? How long will it take until my practice is successfully up and running using your product?
9. Are you willing to put these terms in a sales agreement?
10. What are your plans for staying up-to-date with CCHIT’s certification requirements?

CMS Demonstration Project Seeks Physician Participation

Primary care physicians in 12 select areas may be selected by The Centers for Medicare and Medicaid Services (CMS) to receive additional Medicare dollars under a new five-year project using certified electronic health records (EHR) systems. Each physician participant could receive up to $58,000, with a limit of $290,000 per practice, over the life of the project.

Four areas in the country, including: (1) Pittsburgh, (2) Maryland and Washington, (3) Louisiana, and (4) South Dakota, Iowa, and Minnesota, have been selected by CMS for Phase I of the “Electronic Health Records Demonstration” project. Phase II of the project launches next fall in eight additional states including: (1) Alabama, (2) Jacksonville, (3) Georgia; (4) Maine, (5) Oklahoma, (6) Virginia, (7) Delaware, and (8) Madison, Wisconsin.

CMS believes that the project will be a major step toward implementing a secure EHR system by 2014 that will reduce medical errors, decrease adverse drug events and lessen redundant tests. Additionally, CMS hopes that the demonstration project will change the way that health care information is managed by providing for diagnoses and treatment of serious illnesses with comprehensive information available at the touch of a screen.

CMS will provide financial bonuses for as many as 1,200 selected primary care physician practices nationwide that use certified EHRs. Payments will be made to those physicians who improve their quality of care as measured by their performance on specific CMS clinical quality measures.

The core incentive payments will be based on the practice’s performance regarding the treatment of diabetes mellitus (eight measures), congestive heart failure (seven measures), coronary artery disease (six measures) and five measures relating to preventive care of chronic conditions.

Enhanced bonuses also will be available based on the extent to which a physician’s EHR system positively impacts specific patient care processes, such as improved clinical documentation and efficient ordering of lab tests and prescriptions. Physicians are not required to obtain an informed consent from their patients for the project, but CMS urges physicians to notify their Medicare patients about their participation in the demonstration. No information about specific physicians, practices or beneficiaries will be publicly reported.

The project is generally limited to primary care physicians and small primary care practices. Eligible practices must have at least 50 fee-for-service Medicare beneficiaries. 

CMS also requires that the practice must be able to identify the physicians in the practice by Tax ID number and Medicare Provider ID number and/or individual NPI. Participation of physicians within the practice is voluntary. Practices that include primary care providers as well as other specialists may participate if they meet other criteria. Advance practice nurses and physician assistants who provide primary care services are eligible.

Practices need not have an EHR in place to apply for the demonstration project, but by the end of the second year, the practice will be required to have a Certification Commission for Healthcare Information Technology (CCHIT)-certified EHR, and must use it for the four CMS clinical quality measures.

CMS will recruit up to 200 physician practices to participate in each of the awarded 12 communities. However, since the demonstration is being conducted as a research project, half of those practices will be designated as the control group and will not receive bonuses even if they use certified EHR systems. Those in the control group will only receive a small fee for completing an annual survey on their EHR status. No one in the control group will be required to use an EHR system, but CMS wants to see how this group progresses without incentives.

There are no upfront payments from CMS for the purchase or implementation of an EHR system. Physician payments will be determined by a practice’s score on an Office Systems Survey that tracks the level of EHR implementation and the specific EHR functions used by each participating practice to support the delivery of care.

Year one requires the physician/practice to adopt a CCHIT-certified EHR system, while year two requires use of the CCHIT-certified EHR system to report clinical quality measures. During years three through five, payments will be based on the physicians’ actual performance on the CMS clinical quality measures.

Participants may earn a maximum of $5,000 per physician or $25,000 per practice in year one. Payments in year two can be $8,000 per physician or $40,000 per practice, while payments in years three through five may reach $15,000 per physician or $75,000 per practice. Enhanced bonuses are available each year based on the way the practice has used the CCHIT-certified EHR to change and to improve the way it operates.

Details of Medicare Incentive Program Revealed

The 2009 Medicare Physician Fee Schedule final rule includes details of the Medicare bonus payments for physicians who electronically prescribe in 2009. Beginning January 1, 2009, physicians could earn an incentive payment of 2.0% of their total allowable Medicare charges.

The Medicare bonus payments for electronic prescribing were created to avoid a proposed deep cut scheduled for physician payments in 2009. Under the Medicare bill approved by Congress, bonus payments for electronic prescribing will ultimately be ratcheted back through 2013 and payments under the Medicare program will be cut beginning in 2011 for physicians who fail to electronically prescribe.

The Centers for Medicare and Medicaid Services (CMS) described the capabilities required of a qualified e-prescribing system as:

• enabling the physician to communicate with the patient’s pharmacy;
• helping the physician identify appropriate drugs and provide information on lower cost alternatives for the patient;
• providing information on formulary and tiered formulary medications; and
• generating alerts about possible adverse events, such as improper dosing, drug-to-drug interactions, or allergy concerns.

PCMA Supports Final Rule on Medicare Physician Incentive

The Pharmaceutical Care Management Association (PCMA) issued the following statement on the final Medicare electronic prescribing rule recently released by the Centers for Medicare & Medicaid Services (CMS). The final rule rewards physicians and other eligible professionals who adopt this life-saving technology with bonus payments starting in 2009. According to a statement released by PCMA, “Securing full physician adoption of e-prescribing as soon as possible is critical to improving safety, savings, and quality in our health care system. PCMA applauds the final rule from CMS which establishes an important framework in providing sufficient reimbursements for physicians to adopt e-prescribing and maintaining uniform standards that have been accepted by all stakeholders.”   PCMA is the national association representing America's pharmacy benefit managers (PBMs), which administer prescription drug plans for more than 210 million Americans with health coverage.