The Centers for Medicare and Medicaid Services (CMS) has proposed giving physicians additional "hardship" exemptions that will prevent them from being penalized by Medicare for not prescribing electronically this year. The only catch is that the proposed rule won't be finalized until sometime after July 25, when the comment period ends. With a deadline for obtaining an exemption set for Oct. 1, doctors will have roughly two months to apply for an exemption.
Under CMS' current regulations for its e-prescribing incentive program, which started paying bonuses to doctors in 2009, physicians who do not e-prescribe face a 1 percent reduction in their Medicare payments in 2012. To avoid that penalty, they must show they ordered at least 10 prescriptions on an e-prescribing system between January 1 and June 30 of this year.
The original rules specified that a physician could request a hardship exemptionby June 30 if he or she practiced in a rural area with limited Internet access, or in an area where few pharmacies accepted online prescriptions. Under the proposed rule, a doctor could also qualify for an exemption if he or she:
- Has limited prescribing activity during the six-month time frame;
- Lives in an area where regulations prevent e-prescribing, such as state laws against e-prescribing of controlled substances;
- Prescribes electronically only for types of patient visits that do not count toward the 10-order requirement;
- Delays the purchase of an e-prescribing system because of plans to participate in the federal incentive program for the Meaningful Use of electronic health records.
In addition, CMS would redefine an electronic prescribing system to include e-prescribing modules of EHRs certified for Meaningful Use. It's not surprising that this wasn't included in the original rule, because the e-prescribing program began prior to the passing of the HITECH Act that established Meaningful Use incentives. But it's somewhat mystifying that this glitch wasn't fixed before now.