e-Prescription for Success?

The Hospitalist. 2008 September;2008(09):

September 1, 2008|The Hospitalist

CMS has taken up the e-prescribing torch. In July, the agency announced a preliminary program to promote widespread adoption of electronic prescribing.

E-prescribing is a natural goal for CMS; it has been proven to improve quality of care, reduce medication errors, increase efficiency, and lower administrative costs. Kerry Weems, the acting CMS administrator, says an all-electronic prescribing system could save Medicare as much as $156 million over five years—largely through improved quality care.

Though details on the e-prescribing plan are not yet decided, CMS has revealed that beginning in 2009 (and for the next four years) it will provide incentive payments to physicians who are “successful electronic prescribers.”

Policy Points

Arizona Proactive in e-Prescribing

Arizona has already started plans to increase the use of e-prescribing. Gov. Janet Napolitano issued an order directing state agencies to work with the Arizona Health-e Connection initiative, health plans, and providers to increase the use of electronic prescribing and other medication safety tools.

Providers: Curb Bad Behavior

The Joint Commission is warning healthcare professionals that rude language and hostile behavior pose threats to patient safety and quality of care. This issue is targeted in a new standard effective Jan. 1, 2009, which requires hospitals to establish a code of conduct that defines acceptable and inappropriate behavior, as well as a process for dealing with disruptive behavior. The standard applies to all hospital personnel.

In the Joint Commission’s field review of the standard, 57% of respondents at hospitals said they’d seen disruptive behavior, but only by certain individuals. An additional 25% said such behavior occurred in more than one or two individuals.

Find Out Your PQRI Feedback

CMS has made the 2007 PQRI Final Feedback Reports available on a secure Web site. Practices must register for access to their reports through a new CMS security system called the Individuals Authorized Access to CMS Computer Services–Provider Community (IACS-PC). Note: If you are an individual physician and have no staff who will use the system on your behalf, CMS advises you to wait until further notice to register in IACS.

Reports will include information on reporting rates, clinical performance, and incentives earned by individual professionals, with summary information on reporting success and incentives earned at the practice (Tax Identification Number) level.

Information on how to register for IACS-PC is available online at www.cms.hhs.gov/MLNMattersArticles/downloads/SE0747.pdf and www.cms.hhs.gov/MLNMattersArticles/downloads/SE0753.pdf. General information can be found at www.cms.hhs.gov/PQRI.—JJ

Details to Be Determined

The e-prescribing plan will be included in the Physician Quality Reporting Initiative (PQRI), with guidelines included in the 2009 PQRI. (How the new plan will work with the current PQRI e-prescribing measure is one of the unknown details.)

Weems says CMS will use its standard rule-making process to shape the e-prescribing plan. Therefore, details of the incentives program will not be available until this fall, when Medicare releases its final rule on the 2009 physician fee schedule. According to Weems, the 2009 fee schedule and PQRI will clarify some murkiness. “They will be specific about what constitutes e-prescribing, including the extent and reporting of what needs to be done through PQRI,” he says.

Rewards, Then Possible Punishments

Physicians can start reporting on e-prescribing Jan. 1, and those who do will reap the benefits. Patrick Conway, MD, MSc, a hospitalist, an assistant professor at Cincinnati Children’s Hospital Medical Center, and a 2007-2008 White House Fellow working in the Department of Health and Human Services (HHS), says initial discussions about promoting e-prescribing included talk of an incentive-based plan.

“It’s my opinion that, for physicians, it’s beneficial to start with a reward or carrot rather than a punishment,” he says. “And generally, CMS has approached physician programs with this method—like the PQRI.”