Alignment of e-prescribing incentive programs a step in the right direction


Well, it isn't perfect, but the Centers for Medicare & Medicaid Services' proposed 2013 fee schedule--set to be published in the Federal Register July 30--does provide some relief for physicians trying to avoid the penalties in the electronic-prescribing (eRx) incentive program by creating two additional hardship exemptions for prescribers also participating in the Medicare and Medicaid EHR Incentive programs.

The eRx incentive program, which began in 2008, uses a combination of incentive payments and payment adjustments to encourage electronic prescribing by eligible professionals. It allows CMS to pay incentives for using e-prescribing systems to prescribe for Medicare patients. The incentives began at 2 percent of allowed charges in 2009 and 2010, dropped to 1 percent in 2011 and 2012, and dropped again to 0.5 percent in 2013.

However the penalty component of the program kicked in in 2012, assessing a pay cut of 1 percent for those who didn't successfully e-prescribe or file for an exemption, which are rather limited. The 2013 penalty for not meeting the e-prescribing requirements is 1.5 percent of a physician's Medicare Part B payments in 2012.

Unfortunately, meeting the bonus in 2012 does not wipe out the penalty; it just offsets it, and only in part. Physicians still need to meet the criteria to avoid the penalty.

What's worse: Physicians can't participate in both the e-prescribing and the Meaningful Use incentive programs at the same time. However, physicians in the Meaningful Use incentive program still can be assessed the penalty under the e-prescribing program. So physicians in the Meaningful Use program have had to undergo some duplication of efforts regarding the submission of e-prescriptions to avoid the penalty.

The two new exemptions are:

  • CMS won't penalize a physician under the e-prescribing program if the physician achieves Meaningful Use. The rationale is that the Meaningful Use incentive program's e-prescribing standards are more rigorous than those in the eRx program, and that having to submit documentation for both programs is duplicative.
  • CMS will exempt eligible professionals that show intent to be part of the EHR incentive program through registration and adoption of a certified EHR. The rationale is that there's lag time between purchasing an EHR and actually beginning to use it to e-prescribe.

"As a result of ... feedback, we believe that in certain circumstances it may be a significant hardship for eligible professionals and group practices who are participants of the EHR Incentive Program to comply with the successful electronic prescriber requirements of the eRx Incentive Program," CMS says in its proposed rule.

Of course, the proposed exemptions come with some strings attached. For instance, you can't apply for the intent exemption if you've already adopted a certified EHR or received an incentive payment under the Meaningful Use program.

The cynic in me notes that the two proposed exemptions create less work for CMS and provide further encouragement for providers to sign up for the EHR incentive program, both of which are self-serving for the agency.

Nonetheless, they do provide welcome relief for prescribers caught between two conflicting incentive programs.

CMS invites public comment on these and the other many suggestions in the proposed rule. Comments are due September 4. Please consider commenting; it's your opportunity to be heard. - Marla

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