Accelerating e-Prescribing

Allscripts CEO Discusses Obama's Commitment to HIT and e-prescribing

Glen Tullman, CEO of Allscripts, recently said the need to cut costs and reduce the risk of medical errors has spurred more physicians and hospitals to switch to computer-based health records systems. According to Mr. Tullman, Allscripts, the largest U.S. provider of software to physicians, has seen a fivefold increase in the number of physicians who are using electronic prescribing technology. Mr. Tullman added that this "dramatic acceleration" in the switch to EHRs might reduce the need for $50 billion in public financing under Obama's proposal for the growth of health IT.

"I think (President-elect Obama) is absolutely committed to using information technology as a key part of his platform," Mr. Tullman added. He said it might be difficult to amass such a large amount of funding as part of another economic stimulus package. Mr. Tullman suggested that federal spending in the future be combined with physicians' use of EHR systems that could be developed as loans "to ensure doctors have some skin in the game."

Mr. Tullman said, "I see information technology doing for health care what it's done for every other industry and that is taking costs out and putting more quality in." He believes that the Obama administration "sees electronic prescriptions as not just an efficiency issue, but as a public safety issue."  Mr. Tullman said, "President-elect Obama has been very clear ... that he is going to aggressively promote electronic health records, and he's a strong believer in electronic prescribing."

More Details on the Economic Stimulus Package

According to the Associated Press, aides to President-elect Barack Obama have told lawmakers that a two-year economic stimulus package they plan to consider in January 2009 could cost as much as $850 billion, rather than the $600 billion currently under consideration.

The Los Angeles Times reports that the economic stimulus package "could shape the course of Obama's presidency" and "help lift the economy out of recession, giving him the space to enact his ambitious energy, education and health care plans."  Lawmakers and lobbyists in Washington have said that the package "would let states and localities, rather than the federal government, decide how to spend the bulk of the money" to avoid the "more time-consuming practice of loading the measure with thousands of ... earmarks."

Under the package, states likely would receive as much as $100 billion in additional federal Medicaid funds. President-elect Obama also has indicated that the package would include funds for health care information technology efforts, such as the expansion and implementation of electronic health records, in an effort to decrease costs and reduce medical errors. According to the Wall Street Journal, expansion of EHRs "has seemed the low-hanging fruit of health reform, largely because everyone agrees going digital will improve care." According to the Journal, physicians "have been reluctant to invest $40,000 to $60,000 on an electronic record system that may not be interoperable with other systems, especially when much of the savings goes to insurers and other payers."

HIT to be included in Economic Stimulus Package

US Sen. Max Baucus (D-Mont.) reiterated his intent to include health information technology legislation in a larger bill, backed by President-elect Barack Obama, meant to help stimulate the economy.  Talking to reporters, Sen. Baucus said that the Senate would include a proposal of about $50 million to wire hospitals and physician offices with electronic health records and other digital components meant to improve care and generally make the delivery system more efficient.

When asked why such a proposal would be included in an economic stimulus bill that includes decidedly nontechnical projects such as roads and infrastructure improvement, Sen. Baucus — who chairs the influential Senate Finance Committee — said “because we have to make a start.”

But the senator also said there are strategic reasons too. The cost for many of the proposed health reform initiatives, including health IT, is great, he said. Shifting some of those costs to a bill seen by Congress as “must-pass” legislation means that a broader health reform package, due later next year, won’t be as expensive as if it included the measures, he said.

Additionally, Baucus said he would push to include a short-term extension to the State Children’s Health Insurance Program and a temporary increase of federal dollars to Medicaid as part of the economic package. “There is a lot to do, (and) so little time to do it,” he said.

E-prescribing systems encourage physicians to choose lower-cost drugs

A recent study published in the Archives of Internal Medicine indicates that physicians using an electronic prescribing system appear more likely to prescribe lower-cost medications thereby reducing the drug spend.  "Prescription drug costs account for a significant proportion of medical spending and have been increasing rapidly," the authors write as background information in the article. One method for encouraging use of lower-cost medications is a tiered copayment system. Employers, health insurers and PBMs identify preferred medications, such as generic drugs, and designate them "tier 1" with the lowest copayment. Moderately priced brand-name medications may be designated second-tier and assigned a higher copayment, and third-tier drugs represent the highest cost brand-name medications for which generic alternatives may or may not be available and have the highest copayment. (Arch Intern Med. 2008;168[22]:2433-2439)

"A key limitation of tiered copayment systems is prescribers' inability to keep track of differing copayment tiers across insurance plans' formularies," the authors write. Michael A. Fischer, M.D., M.S., of Brigham and Women's Hospital and Harvard Medical School, Boston, studied an electronic prescribing (e-prescribing) system designed to address this issue. In April 2004, two large Massachusetts insurers began using the system, which provided community-based practices with free wireless devices and access to a secure web portal that color-coded drugs by copayment tier. Using 18 months of data, the researchers compared the change in proportion of prescriptions for the three tiers before and after e-prescribing began, and also compared the prescription habits of clinicians using the e-prescribing system to those of controls.

Accroding to the study, between October 2003 and March 2005, more than 1.5 million patients filled 17.4 million prescriptions. After implementation of e-prescribing, tier 1 prescriptions increased by 3.3 percent and second- and third-tier prescriptions decreased accordingly among clinicians using the system. E-prescriptions of tier 1 medications increased 6.6 percent, compared with a 2.6 percent increase among prescriptions from the control group.

Among clinicians using the new system, e-prescriptions accounted for 20 percent of prescriptions. These clinicians prescribed more tier-1 medications than the control group even when not e-prescribing; however, prescriptions of lower-cost medications were most common among e-prescriptions.

Based on average medication costs for private insurers, the researchers estimate that using such an e-prescribing system at this rate could result in savings of $0.70 per patient per month, or $845,000 annually per 100,000 insured patients filling prescriptions. "The potential savings increase with more availability and use of e-prescribing; for complete e-prescribing use, the projected savings are $3.91 million per 100,000 patients per year," the authors write.

"Our results suggest that there are important economic gains achievable through the broader use of e-prescribing with formulary decision support but that merely providing e-prescribing systems to clinicians will not necessarily achieve those savings," they conclude. "Rather, prescribers need to adopt the e-prescribing systems fully for these gains to be realized. Making those changes represents an important goal for physicians, insurers and all those with a stake in the cost of prescription medications."

How to Qualify for the New Medicare 2% e-Prescribing Bonus

According to the Centers for Medicare & Medicaid Services a new guide was created to assist physicians who plan to pursue the Medicare e-prescribing incentives that start in 2009. Here's what CMS says doctors should do.

Step 1: Obtain an eligible system

Physicians must have or acquire a qualified electronic prescribing system that can:

• Generate a complete medication list with available data from pharmacies and benefit managers.
• Select medications and transmit prescriptions electronically (not via fax) following applicable federal standards, after warning the prescriber of any possible safety issues associated with the drug orders.
• Provide information on lower-cost, therapeutically appropriate alternatives.
• Provide drug plan information, such as formularies, patient eligibility and authorization requirements.

Step 2: Report the appropriate measures

Starting with applicable services rendered on or after Jan. 1, 2009, physicians must report the appropriate combination of CPT codes and special G-codes on Medicare claims. For example, a doctor might bill code 99213 for a mid-level patient checkup and also report code G8443 if the visit resulted in an electronic drug order.

Code G8445 applies for visits during which no prescriptions were ordered. G8446 applies when the drug orders could not be made electronically because of pharmacy limitations, federal or state restrictions, or patient preference.

Step 3: Qualify for a bonus

Physicians must submit all claims including e-prescribing codes no later than two months after the end of 2009.

To be eligible for the bonus, the services a doctor provided that can be linked to an e-prescribing measure must make up at least 10% of his or her Medicare charges for the year. In addition, the physician must report the appropriate G-codes for at least 50% of the cases in which they apply.

If CMS determines a physician qualified, he or she will receive a 2% bonus on all 2009 Medicare pay. Bonuses will be paid in 2010.

For more information

"Medicare's Practical Guide to the E-prescribing Incentive Program" is available online in pdf (www.cms.hhs.gov/partnerships/downloads/11399.pdf).

President-elect Obama to Focus Stimulus Package on HIT

According to Newsday, President-elect Obama laid out his priorities for a "green" stimulus plan on Saturday. The package will focus on making public buildings and schools more energy efficient, modernizing health care with technology and electronic records, expanding broadband connections, and making the biggest investment in infrastructure since the 1950s.

Yet the legislation that will embody Obama's plan is very much a work in progress, with no language yet written, said Democratic aides, who hope to have a bill ready for Obama to sign soon after he is sworn in as president Jan. 20. Most congressional Democrats believe there is little likelihood Congress will act next week, and instead will wait until January to pass a stimulus bill.

President-elect Barack Obama outlined a plan to electronically link hospitals, physician offices and the patients who rely on them as part of a multipronged approach to help boost the U.S. economy. According to Health Information Technology Strategist (HITS), Obama sketched out a plan to “make sure that every doctor’s office and hospital in this country is using cutting-edge technology and electronic medical records so that we can cut red tape, prevent medical mistakes and help save billions of dollars each year.”

In Washington last week, congressional aides confirmed that health information technology is being considered as part of a larger economic stimulus package, though it’s unclear which bill would be used as the framework to such a proposal. One Senate aide said that the Wired for Healthcare Quality Act, sponsored by Sens. Edward Kennedy (D-Mass.) and Michael Enzi (R-Wyo.), could make the cut.

But other bills are likely to be in contention as well, including one passed by the House Energy and Commerce Committee earlier this year and another proposed by Rep. Pete Stark (D-Calif.), chairman of the House Ways and Means Health Subcommittee.

Appearing on "Meet the Press" on Sunday, President-elect Obama stressed the importance of acting quickly. “The key for us is making sure that we jump-start that economy in a way that doesn’t just deal with the short term, doesn’t just create jobs immediately, but also puts us on a glide path for long-term, sustainable economic growth,” he said, according to a transcript of the interview.

Comparative Effectiveness And HIT Are Essential To Healthcare Reform

Addressing the eHealth Initiative Annual Conference held in Washington, DC, Scott P. Serota, president and chief executive officer of the Blue Cross and Blue Shield Association (BCBSA), a member of the Center for Health Transformation, called on Congress and the new administration to support comparative effectiveness research and health information technology to improve healthcare quality, safety and affordability.

"We have a unique opportunity to work together to advance healthcare reform, Mr. Serota said.  "It will take all stakeholders – consumers, employers, healthcare professionals, policy makers, insurers and others – working together to forge a bold vision and a clear roadmap to achieve the kind of healthcare system we want for future generations."

He went on, "There is a growing consensus that our future healthcare system must be built on a foundation of evidence-based care.  Nearly a year ago, BCBSA rolled out the 'Pathway to Covering America,' a comprehensive plan that builds on the employer-based system to improve quality, rein-in costs and expand coverage to everyone.  One of the key tenets of our Pathway is an independent comparative effectiveness institute to encourage research on what works and put it into practice."

Examples of initiatives by Blue Cross and Blue Shield companies to improve quality and value are highlighted in "The Pathway to Covering America," which can be found on the BCBSA Web site at: www.bcbs.com/issues/uninsured/pathway-to-covering-america/. 

Study Finds Link Between EHR use, e-Prescribing and Lower Malpractice Claims

According to a study published in the Archives of Internal Medicine, physicians who are active users of electronic health records including electronic prescribing often pay lower malpractice claims. The study examined survey responses from 1,140 practicing physicians in Massachusetts during 2005, paying specific attention to demographic characteristics and the length and extent of EHR use.

According to the study, 6.1% of physicians with EHRs and 10.8% of physicians without the technology paid malpractice settlement claims in the last 10 years. After controlling for variables, the investigators found a trend favoring EHR use.

In a secondary analysis of EHR adopters, researchers found that 5.7% of more active EHR users had paid malpractice settlements, compared with 12.1% of less active users.

According to the researchers, EHRs might lower malpractice claims for several reasons. For example, EHRs facilitate access to patients' history, which could result in:

• Better adherence to clinical guidelines;
• Improved follow-up of abnormal test results; and
• Fewer diagnostic errors.

In addition, the care documentation provided by EHR systems could bolster physicians' legal defense if a malpractice claim is filed.

The study's authors noted that if future studies confirm the link between EHR use and lower malpractice payments, professional liability insurance carriers might begin offering premium discounts for practices that use EHRs, and there would be greater incentive for physicians to invest in the technology.