The current plan’s outlines indicates that in 2009 and 2010, physicians who successfully report on e-prescribing will receive an incentive payment of up to 2% of their total Medicare allowed charges, matching the maximum bonus they can earn under the regular PQRI. Payment will be additive, so a physician can earn up to 4% (2% for PQRI and 2% for e-prescribing.)
The e-prescribing incentive will drop to 1% in 2011 and 2012, and to 0.5% incentive payment in 2013. After 2013, the carrot is replaced with a stick, and those who do not use e-prescribing will suffer a reduction in payment.
CMS estimates the cost of adopting e-prescribing will be approximately $3,000 per individual prescriber. This includes equipment, training, and program maintenance. That can add up to a sizeable expense—particularly for small groups. For that reason, the agency promises a built-in hardship exemption for small practices and others who prove they cannot afford to adopt e-prescribing.
Also, some funding is available: Dr. Conway says CMS has a financial-incentive program for electronic health records, many of which include e-prescribing. “The CMS Electronic Health Records Demonstration is a $150 million program that will provide funds to 1,200 physician practices to adopt this technology,” he says. “They’re currently recruiting practices.” Details on the demonstration are available at www.cms.hhs.gov/DemoProjectsEvalRpts/.
—Patrick Conway, MD, MSc
Will Hospitalists Participate?
Until details of the e-prescribing program are published, no one can say whether the plan will encompass hospitalists. However, Dr. Conway says, “I think this plan is conceptually relevant to hospitalists: It’s possible that hospitalists will be able to participate in the current plan. We don’t know yet. But CMS will continue to push forward on initiatives that increase quality and decrease costs, including e-prescribing. They’ll support electronic health records, whether this particular initiative applies to hospitals or not.”
Even if it turns out hospital medicine groups can’t reap incentive payments from the new plan, Dr. Conway hopes they still will adopt the technology. “Computerized physician order entry (CPOE) and e-prescribing have the potential to decrease errors and increase the quality of care,” he says. “Therefore, I would encourage hospitals and hospitalists to implement electronic health records with computerized order entry and e-prescribing when possible.”
He says the real benefit to hospitals seeking to improve quality and reduce error is not the electronic transmission of prescriptions to the pharmacy, but CPOE. “Most evidence of increased quality is around computerized physician order entry, which includes decision support at the time of the order,” he points out. “One could argue that you could have an incentive for hospitals that utilize CPOE, but I have no idea if CMS will pursue that.”
On Oct. 6-7 CMS will host a conference on the complete e-prescribing plan for pharmacists and physicians in Boston. For details, check the CMS site at www.cms.hhs.gov/eprescribing or www.cms.hhs.gov/pqri.
Dr. Conway thinks the meeting is a good next step for CMS. “I believe it’s very important to engage frontline providers and stakeholders, so the concept of holding a conference to ensure the design of the program is understood, and to get buy-in from the people participating, is a wise choice,” he says.
In the next few months, physicians likely will be inundated with information on e-prescribing processes under the CMS plan. Stay abreast of the latest information through the CMS Web site and, if it turns out, hospitalists can actively participate in the plan, through the SHM Web site at www.hospitalmedicine.org. TH