Accelerating e-Prescribing

Stimulus Focuses on Incentives

According to Allscripts, when President Barack Obama signed the American Recovery & Reinvestment Act on Feb. 17, he not only helped to stimulate the lagging U.S. economy. He also paved the way to providing every physician in America an affordable means to enter the digital era of medicine.

The health IT component of the legislation - the Hitech Act - appropriates $19 billion to encourage health care organizations to adopt what are referred to as electronic health records (EHR) and establish regional health-information exchange networks (HIE), all while ensuring that the systems safeguard critical patient data.

The act represents an enormous opportunity for health care providers. After decades of slow but steady progress toward converting our paper-based record system into an electronic one, we are taking a monumental leap forward. The Congressional Budget Office predicts 90 percent of physicians and 70 percent of hospitals will be using a comprehensive, robust EHR in a few years. As a result, the country will save billions of dollars on the provision of health care, and our citizens will receive better-informed care from a coordinated network of providers. 

But just what does the new law mean for physician groups? How can you take advantage of the billions in new funding that will be available as early as 2011? And what will happen if you fail to seize the opportunity presented by the new law?

The Hitech Act can be broken into two sections - one providing $2 billion immediately to the Department of Health and Human Services (HHS) and its subagency, the Office of the National Coordinator for Health IT (ONCHIT); and a second that sets aside $17 billion for health care providers who can demonstrate their use of a certified EHR.

There are $17 billion in incentive payments to physicians and hospitals. The government is focused on two primary goals in this legislation: first, moving physicians who have been slow to adopt EHRs to a computerized environment; and second, ensuring that patient data no longer sits in silos but instead is actively exchanged between providers to ensure that patients receive informed care.  The majority of the funds within the Hitech Act are for payments that will reward physicians and hospitals for effectively using a robust, connected EHR system. There is a program designed for those that see a large volume of Medicaid patients and another for those that accept Medicare.  There are two separate incentive programs for physicians: one provided by Medicare and another by Medicaid. 

• Medicaid: If more than 30 percent of a physician's patients pay with Medicaid (20 percent for pediatricians), then they are eligible for payments of up to $64,000 over five years. The incentives will be calculated through a formula that factors in the exact Medicaid mix of their patients, as well as amounts ranging from $25,000 in the first year to $10,000 in subsequent years. Additionally, nurse practitioners and nurse midwives are eligible for the same incentives.

• Medicare: Physicians who do not have a large Medicaid volume but do accept Medicare can earn up to $44,000 over the five years. Additionally, physicians operating in a "provider shortage area" will be eligible for an incremental increase of 10 percent, though those delivering care entirely in a hospital environment, such as anesthesiologists, pathologists and ED physicians, are not eligible for any incentives.

• Fee reductions: Providers who do not demonstrate meaningful use of an EHR by the end of 2014 will see a decrease of 1 percent in their 2015 fee schedules from Medicare. An additional decrease will be affected in 2016 and 2017, down to a total of 97 percent of the regular fee schedule. The secretary of HHS can reduce the fee schedule even further, by a maximum of 5 percent beginning in 2018, if the nationwide EHR adoption rate remains below 75 percent.

The secretary of HHS is required by the act to review all existing standards and determine the initial set of standards that will apply to the "meaningful use" criteria. All of this must be completed before the end of 2009.   To gain the maximum amount of Medicare and Medicaid incentives, physician groups must have a qualifying records system in place by 2011. Bottom line: If you want to be at the front of the line to collect those incentive payments and move your practice onto the electronic health care highway, the time to start driving is now.

e-Prescribing Key to Federal Savings

Government Health IT reports that the stimulus law’s incentives for providers to adopt health information technology will double the rate of e-prescribing and result in a $22 billion reduction in drug and medical costs in the next decade. The Pharmaceutical Care Management Association commissioned a study by Visante, a consulting firm, which indicates that the e-prescribing savings alone will more than pay for the $19 billion in adoption incentives and other health IT promotion activities required under the stimulus law.

By 2014, more than three-quarters of prescribers will be using e-prescribing, the researchers said. That is double the number anticipated after passage of the Medicare Improvements for Patients and Providers Act of 2008, which includes incentives to encourage Medicare providers to adopt e-prescribing.

Today, fewer than 15 percent of prescribers use e-prescribing, according to Visante’s report.

The report said e-prescribing saves money by:

• Informing doctors at the point of prescribing about the cost and clinical characteristics of medication options and letting doctors choose the best and most affordable drugs, including more generic drugs.
• Giving doctors the patient’s medication history so that harmful drug interactions and duplicate prescriptions can be avoided.
• Notifying doctors of pharmacy options, including mail-order and retail drug stores, to help them hold down patients’ out-of-pocket costs.
• Transmitting the prescription to the pharmacy electronically, thereby reducing waiting times and errors associated with illegible handwriting.

Besides cutting the federal government’s costs by $22 billion, the report states that health care payers will save a total of $56.2 billion under the stimulus law, titled the American Recovery and Reinvestment Act of 2009.

Although the law’s incentives will not totally offset providers’ outlays for acquiring electronic health records, the report predicts that “pay-for-performance measures implemented by the private sector will likely provide further financial inducement for providers to adopt the technology.”

Physicians Resistent to Change

According to a survey by theAmerican College of Physician Executives (ACPE), the percentage of physicians using electronic medical records has nearly doubled in five years.  ACPE found that most physicians consider EMRs “clunky” and unresponsive to their needs.  The federal $787 billion economic stimulus includes $19 billion for health information technology, including $17 billion in physician incentives to encourage adoption of health information technology. About 1,000 members of the ACPE responded to the survey, which was a repeat of a survey conducted in 2004.

Some of the findings were:

• More than 64 percent of respondents in the 2009 survey said they used electronic medical records, up from 33 percent in 2004.

• About 44 percent said their organization uses computerized order entry, while only about 33 percent used the systems five years ago. Computerized physician order entry systems are electronic prescribing systems that intercept errors when medications are ordered.

• More than 38 percent said they use pharmaceutical bar coding, up from 20 percent in 2004.

From SureScripts-RxHub to the New surescripts

SureScripts-RxHub, which operates the country's largest national electronic prescribing network, today announced that the company will henceforth be known as Surescripts®. To mark the occasion, the new Surescripts has launched The E-Prescribing Resource Center (www.surescripts.com), where doctors, pharmacists, payers, hospitals, policymakers and software vendors can go to find the latest information and advice about e-prescribing. 

Also highlighted throughout the site are Surescripts’ re-branded services. What were once presented as seven discrete services are now three, reflecting the three steps that define e-prescribing: Prescription Benefit, Prescription History and Prescription Routing. Consistent with the promise of the merger between SureScripts and RxHub, the change is part of a larger effort aimed at simplifying e-prescribing for physicians, payers, pharmacies, technology vendors and the market at large. That same principle carries over to the network upon which those services are offered – now known as the Surescripts network. To see a demonstration of how the Surescripts network and services enable e-prescribing, please visit www.surescripts.com and click on “How Electronic Prescribing Works.”

Surescripts is the result of a 2008 merger between the country’s two leading health information networks: RxHub and SureScripts. RxHub was founded in 2001 by the nation’s three largest PBMs – CVS Caremark Corporation, Express Scripts, Inc. and Medco Health Solutions, Inc. SureScripts was also formed in 2001 by the National Association of Chain Drug Stores (NACDS) and the National Community Pharmacists Association (NCPA). Both were created with the same goal in mind – to reduce the cost and improve the safety and efficiency of a process relied on by millions of patients every day.
 
In 2008, the U.S. saw twofold growth in e-prescribing adoption and use. This continues the trend of the last three years. A review of 2006-2008 operational data from SureScripts and RxHub indicates that electronic requests for prescription information, the responses to those requests and the number of prescriptions routed electronically totaled nearly half a billion. (Note: More detailed data will be made available in the soon-to-be-released 2008 National Progress Report on E-Prescribing. Visit www.surescripts.com/report for more information.)
 
As Medicare incentives, federal stimulus funding, and new state and federal adoption initiatives take hold, the momentum behind e-prescribing is only expected to grow. However, there is a demonstrated need to support that growth with access to unbiased information and advice that allows users to realize the full benefit of the technology.
 
In the weeks and months to come, visitors to www.surescripts.com can expect to see many updates to The E-Prescribing Resource Center, including more frequent releases of state and national e-prescribing statistics and online communities for physicians and pharmacists.

President Focuses on HIT at White House Summit

At Thursday's White House summit on health care reform, President Obama said health care IT is the "low hanging fruit" on health care reform and an area in which Republicans and Democrats can find common ground. The summit was designed to launch President Obama's health care reform efforts.  According to CongressDaily, health care policy stakeholders, members of Congress and eight "everyday Americans" attended the summit.

The president said that the return on health information technology (HIT) will take several years but that the technology is necessary to overhaul an inefficient health care system. Senate Finance Committee Chair Max Baucus (D-Montana) also endorsed HIT as a way to reduce costs and align health care provider incentives.