Loom­ing threat

Jan. 1 brings 1% cut if erx re­quire­ments not met

Modern Healthcare - - INFORMATION EDGE - Joseph Conn

Up­front car­rots cou­pled with far-off sticks are part of the modus operandi of the fed­eral govern­ment on sev­eral of its health in­for­ma­tion tech­nol­ogy booster ini­tia­tives, and the CMS’ Elec­tronic Pre­scrib­ing In­cen­tive Pro­gram is no ex­cep­tion.

The big dif­fer­ence is that with the CMS’ 3-year-old e-pre­scrib­ing pro­gram, the sticks are no longer a dis­tant threat. They’re al­most here.

Bar­ring some last-minute re­prieve, come Jan. 1, the CMS will cut Medi­care re­im­burse­ment pay­ments by 1% for what could be thou­sands of physi­cians, group prac­tices and other pre­scrib­ing providers that have not met the CMS pro­gram’s ar­cane and shift­ing re­quire­ments. The erx pro­gram was cre­ated un­der the Medi­care Im­prove­ments for Pa­tients and Providers Act of 2008 and launched in 2009.

To say the erx pro­gram has been a fi­asco would be an ex­ag­ger­a­tion, but it has come un­der broad and per­sis­tent crit­i­cism for its com­plex­ity, rule changes and lack of har­mony with other fed­eral in­for­ma­tion tech­nol­ogy ini­tia­tives.

“I have to say it’s not one of their bet­ter-run in­cen­tive pro­grams,” says Robert Ten­nant, se­nior pol­icy ad­viser to the Med­i­cal Group Man­age­ment As­so­ci­a­tion.

In Fe­bru­ary, the Govern­ment Ac­count­abil­ity Of­fice pro­duced a 75-page re­port crit­i­ciz­ing the CMS for un­duly bur­den­ing physi­cians and other pre­scribers by re­quir­ing du­plica­tive reporting mech­a­nisms be­tween fed­eral e-pre­scrib­ing pro­grams. It specif­i­cally dinged the CMS for not es­tab­lish­ing com­mon cer­ti­fi­ca­tion meth­ods for the tech­nolo­gies those pro­grams re­quired.

Ten­nant es­ti­mates that as many as 80,000 physi­cians and other pre­scribers have filed re­quests with the CMS for ex­emp­tions from the loom­ing penal­ties, but, with only weeks to go be­fore those penal­ties kick in, Ten­nant says he’s heard of no physi­cians who have re­ceived a re­sponse from the CMS on whether their ap­pli­ca­tions were ac­cepted or de­nied. If the CMS grants waivers af­ter Jan. 1, “Medi­care will be forced to re­pro­cess the claims,” he says. “I think the penalty will catch a lot of docs.”

The CMS erx pro­gram au­tho­rized e-pre­scribers bonuses of 2% of Medi­care pay­ments for 2009 and 2010; 1% for this year and 2012; and 0.5% for 2013, when the car­rots stop.

In 2009, the pro­gram paid out $148 mil­lion to 47,500 qual­i­fied pre­scribers, ac­cord­ing to the GAO. The av­er­age pay­ment to e-pre­scribers un­der erx in 2009 was about $3,120 and the me­dian pay­ment was about $1,700.

The sticks—penal­ties with the erx pro­gram—as noted come out at 1% next year for non­com­pli­ance in 2011. They es­ca­late to 1.5% in 2013 and peak at 2% in 2014, end­ing that year.

Mean­while, the CMS’ Medi­care elec­tronic health record in­cen­tive pro­gram, which also has an e-pre­scrib­ing com­po­nent and which was cre­ated un­der the Amer­i­can Re­cov­ery and Rein­vest­ment Act of 2009, be­gan pay­ing providers this year. Penal­ties for non­com­pli­ance un­der the EHR pro­gram also cut Medi­care re­im­burse­ments, but they don’t start un­til 2015. So, penal­ties for the two pro­grams don’t over­lap, ex­cept that the statute for the EHR pro­gram


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