What is the news? Top

On July 15th, 2008, the U.S. Congress was successful in overriding President Bush’s veto and has passed into law, HR 6331, the Medicare Improvements for Patients and Providers Act of 2008. Just hours after Bush vetoed the legislation, the Senate voted 70-26 to overturn him, following the House of Representatives, which voted 383-41 to override.

What are the benefits of this bill for physicians? Top

This measure prevents physician’s proposed 10.6 percent cut in their reimbursement rates when treating Medicare patients. As a result of the new law, the mid-year 2008 Medicare Physician Fee Schedule (MPFS) rate reduction of -10.6 percent is retroactively replaced with fee schedule rates in effect from January - June, 2008, which reflected a 0.5 percent update from 2007 rates. In addition, MPFS payment rates are being revised to increase the fee schedule amounts for certain mental health services.

Additionally, Section 132 of the law also provides financial incentives for physicians to adopt electronic prescribing, or "e-prescribing", and requires adoption by 2011.

For a copy of the complete law, visit: H.R. 6331

Why is it so significant? Top

This is significant because it is the first time that the Federal Government - the biggest purchaser of healthcare in the market through Medicare/Medicaid - will use their leverage in the market to help drive the use of technology.

Through Medicare/Medicaid, the government pays roughly 40 percent of the $2.2 trillion annual bill for healthcare in the U.S. HHS Secretary Mike Leavitt predicts that Medicare could avoid up to $156 million over five years in costs from adverse drug effects by getting physicians to adopt electronic prescribing tools.

What does it mean for electronic prescribing? Top

It’s now a law that physicians will receive incentives to electronically prescribe.

Additionally, physicians who do not use the technology would see their payments cut by 1 percent in 2011, and a maximum of up to 2 percent for 2013 and beyond. So you would lose 1 percent by not ePrescribing and gain 1 percent if you do, so the margin is 2 percent for ePrescribing in 2011 and 2012. The bill allows for some exceptions to the rule.

Source: The Medicare Improvements for Patients and Providers Act of 2008

How do I determine how much revenue my practice can earn with these incentives? Top

We have formulated the following calculation based upon input from several of our physician clients. You can extrapolate the data from here so it fits your practice model:

How does that work if I am in a large group? Top

The incremental revenue for a group is going to vary by size, but for the purposes of modeling below is an example of a 3-year ROI for a 5-physician group. The potential revenue gain is approximately $50,000. For a 100 MD group, the potential revenue gain could be over $1,000,000.

How will physician’s electronic prescribing compliance be reported to CMS? What must prescribers do to receive the reimbursement? Top

CMS has not yet made the information available. We will make this information available to you after we receive final guidelines from CMS. The terms of the incentives program will be outlined in Medicare’s final rule on the 2009 physician-fee schedule this fall.

Keep checking the www.allscripts.com and www.nationaleRx.com websites for updates.

Additionally, you can check the CMS website for updated information: www.cms.hhs.gov/EPrescribing/

What is the 2 percent based upon? Is it 2 percent in addition to our current reimbursement rate? Top

It is based from current fees and it is incremental.

Do you know if there will be a push to get all pharmacies to e-prescribe? There are still many mail order pharmacies that do not. Top

SureScripts-RxHub currently has an initiative in the pharmacy community www.getrxconnected.com. We are listed on this site and are currently working with major mail order pharmacies to get them on board. We anticipate that with the passing of this law more mail order pharmacies will be connected quickly to accommodate physicians and patients.

Do the new government actions affect Medicaid Services as well? Will providers who e-prescribe for Medicaid patients get the same 2 percent incentive and how will the incentive get paid to providers? Top

We expect other payers to follow the governments lead in supporting e-prescribing and we will continue to investigate and keep you advised of any developments.

How are these incentives applied? Top

We anticipate that these incentives will be applied as an increase in the reimbursable amount for the services covered under Medicare.

Will these incentives apply to clinics with groups of physicians or just to private practice physicians? Top

It is our understanding that any physician using electronic prescribing in an ambulatory setting will qualify for these incentives.

Will these incentives apply to hospitals and/or emergency departments that are billing for hospital employed physician services? Top

It applies to physicians, not hospitals; however, we anticipate that CMS will issue more specific guidelines in the fall for physicians seeing a patient in the hospital in an outpatient setting.

What are the exceptions to the rule for payments being cut in 2011? Top

CMS has not yet made the information available. We will make this information available to you after we receive final guidelines from CMS. The terms of the incentives program will be outlined in Medicare’s final rule on the 2009 physician-fee schedule this fall.

Will I be eligible for the incentives if my prescriptions are electronically faxed to the pharmacy via my EHR? Top

CMS has not yet made the information available. We will make this information available to you after we receive final guidelines from CMS. The terms of the incentives program will be outlined in Medicare’s final rule on the 2009 physician-fee schedule this fall.

How is the PQRI (Physician Quality Reporting Initiative) part of this incentive to e-prescribe? Top

Physicians will start getting an additional 2 percent credit for electronic prescribing under this initiative so they can expect a 4 percent pay increase in 2009 by adopting both ePrescribing and participating in PQRI.

For additional information about PQRI requirements, visit: www.cms.hhs.gov/PQRI/05_StatuteRegulationsProgramInstructions.asp#TopOfPage

If my practice adopts an EHR (Electronic Health Record) next year, can we implement electronic prescribing now before we are fully operational and transfer that data to our EHR? Top

That depends on your choice of technology vendor. For example, if you select Allscripts ePrescribe for free as part of the National ePrescribing Patient Safety Initiative (NEPSI) and wanted to transfer that data to your Allscripts EHR next year, we can seamlessly transfer that data. Check with your vendor for more information on their specific data transfer policy.

Where can I start electronically prescribing right now for free? Top

Please visit the National ePrescribing Patient Safety Initiative (NEPSI) website at www.nationaleRx.com and you can sign up today for the free application.

Will I have to pay to get my patient data imported? Top

We have several options for inputting your patient data. You can import all your patients automatically by choosing the free patient import feature or you can purchase an interface for a nominal fee.

Where can I get more information? Top

Please keep checking our websites at www.allscripts.com and www.nationalerx.com for updated information.

Additionally, you can visit the government websites at:

Medicare ePrescribing: www.cms.hhs.gov/EPrescribing/ PQRI Reporting: www.cms.hhs.gov/pqri/