Feds Push to Get Physicians on Board With e-Prescribing

HHS Secretary Michael Leavitt hosted a media conference call July 21 to provide details on the federal government's latest effort to encourage physician adoption of electronic prescribing. AAFP President Jim King, M.D., of Selmer, Tenn., and CMS Acting Administrator Kerry Weems joined Leavitt on the call.

The new e-prescribing program was created by language in Section 132 of recently enacted Medicare legislation. As outlined by CMS, the program first will coax physicians and other eligible professionals into compliance by offering incentive bonuses.

Prescribers can earn a 2 percent bonus payment from Medicare in 2009 and 2010, a 1 percent bonus in 2011 and 2012, and a 0.5 percent bonus in 2013. Preliminary AAFP calculations indicate that in 2009, a 2 percent bonus could reap an individual FP close to $1,300 in additional Medicare payments.

Beginning in 2014, however, CMS will hand out penalties in the form of reduced Medicare payments to physicians and other prescribers who have not adopted e-prescribing.

Leavitt said during the call that there are "human and financial costs to illegible prescriptions." He pointed to an Institute of Medicine report (4-page PDF; About PDFs) that concluded at least 1.5 million Americans are injured each year by "adverse drug events." He said pharmacists make more than 150 million phone calls each year to clarify prescriptions.

"That's a lot of people needlessly hurt and a lot of time spent trying to sort out bad handwriting. Fortunately, we know what to do about it," said Leavitt. "We expect this (program) will have a profound effect on the adoption and use of e-prescribing."

King provided the physician perspective during the call. E-prescribing, he said, "will help our physicians take better care of their patients" by decreasing errors and providing better two-way communication. The technology enables physicians to see if patients fill prescriptions and helps physicians assess whether patients really are taking their medications.

Although he acknowledged the Academy's support for the e-prescribing incentives, King made it clear that even family physicians who embrace e-prescribing -- including himself -- encounter obstacles to using the technology (0:18-minute MP3 file; About Downloading).

King said there are pharmacies and health insurance plans that don't yet recognize e-prescriptions. These e-prescribing barriers "have to be removed before any kinds of punishment to doctors are in place -- especially when it's not their fault," he said.

The bill also contains a hardship waiver for practices that have justifiable reasons for not adopting e-prescribing. Fine-tuning of the waiver language and other details of the program will be ironed out by CMS in coming weeks via its rule-making process.

Weems said an upcoming fall conference hosted by CMS will focus on what physicians need to know to participate in the program (0:21-minute MP3 file; About Downloading), and how the e-prescribing incentives will operate within the Physicians Quality Reporting Initiative, or PQRI, reporting framework.

Family physicians are ahead of the curve when it comes to use of electronic health records, or EHRs, said King, noting that the 37 percent of members who currently use an EHR will be joined by another 13 percent of members who say they plan to implement systems by the end of the year.

"Most of the (EHR) systems are capable of doing e-prescribing," King told reporters on the call, and that bodes well for the number of FPs who likely will be able to adopt e-prescribing by Jan. 1, 2009. "Hopefully, during the next couple of years, that number will increase before the penalty phase starts," he added.