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Coming to a Hospital Near You: E-prescribe

Coming to a Hospital Near You: E-prescribe

Will hospitalists and hospital medicine groups get to participate in the Centers for Medicare and Medicaid e-prescribe program?

Jettie Eddleman, BSN, RN, Quality Initiatives Program Director North Texas Specialty Physicians (NTSP), Fort Worth, Texas

Dr. Hospitalist responds: According to a December 2007 study by SureScripts, only 6% of U.S. physicians prescribe medications electronically. Medicare would like more physicians to electronically prescribe prescriptions because “e-prescribing is more efficient and convenient for consumers, improves the quality of care, lowers administrative costs, and its widespread use would eliminate thousands of medication errors every year.”

Medicare is not the only organization encouraging e-prescribing. Blue Cross Blue Shield of Massachusetts (BCBSMA) recently announced e-prescribing will be required for any physician to participate in any of the BCBSMA physician incentive programs, effective January, 2011. To speed the adoption of e-prescribing, Medicare will provide financial incentives to physicians who e-prescribe. Starting in this year, Medicare will pay a 2% bonus to physicians who prescribe under Part D. This incentive bonus will decrease to 1% in 2011 and 0.5% in 2013. Starting in 2012, physicians who are not e-prescribing will lose 1% of their Medicare payment. This penalty will increase to 1.5% in 2013 and 2% in 2014. In other words, you can e-prescribe sooner or later, but hospital medicine groups will increase revenue if they start sooner.

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E-prescribing is, however, not without barriers. For example, the Drug Enforcement Agency (DEA) presently prohibits e-prescription of controlled substances. Medicare is working with the DEA to address this issue. In the meantime, providers who implement e-prescription will need to continue a separate system for prescription of controlled substances.

Some physicians have electronic medical record (EMR) systems, which send prescriptions to pharmacies via facsimile machines. For clarification, this is not considered e-prescribing. In fact, under Medicare statute, most EMR-faxed prescriptions no longer are allowed for Part D. As the plan currently stands, this incentive is tied to specific Current Procedural Terminology (CPT) codes, used primarily by primary care providers and not by hospitalists. Unless the hospitalists in your group also provide outpatient care, it is unlikely any will be able to participate in this Medicare e-prescribing incentive plan.

Test Results Post-Discharge

Some of my patients have laboratory test results pending at the time of discharge from the hospital. Most of my patients do not have a routine outpatient provider. At the time of discharge, I always set them up with outpatient follow-up with a new primary care provider, but I have no way of knowing if the patients are showing up at their appointments. My concern is if they don’t show up, they won’t know about their test results. Is this something I need to address? If so, how do you suggest I go about doing it?

Z. Taylor, Durant, Okla.

Dr. Hospitalist responds: This definitely is an issue that needs to be addressed. It is not only a quality of care issue, but also potentially a medical/legal issue. Transitions in care are risky for patients because these are periods with increased risk for medical error. For example, this is why the Joint Commission mandates medication reconciliation each time a patient sees a provider.

When patients are discharged from the hospital, which provider is responsible for notifying the patient of pending laboratory test results? Is it the primary care provider (PCP) or the hospitalist? As you described in your question, what if the patient does not have a regular PCP? Does the responsibility then rest with the hospitalist who discharged the patient? One could argue the physician who ordered the test is responsible. What if the hospitalist who ordered the test is not the same hospitalist who discharged the patient? It would seem under that circumstance, the hospitalist who discharged the patient bears more responsibility than the hospitalist who ordered the study.

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