E-Prescribing
Shannon Vogel
Director, Health Information Technology
CME
The TMA designates this educational activity
for a maximum of 1 AMA PRA Category 1
creditTM. Physicians should only claim credit
commensurate with the extent of their
participation in this activity. This activity has
been designated as 1 hour of ethics and/or
professional responsibility education.
CME Course Objectives
Upon completion of this activity, participants should be
able to:
1. Describe how e-prescribing can improve patient
safety by reducing medication errors.
2. Discuss the state and federal landscape of eprescribing including legal barriers.
3. Summarize what is needed for participation in the
e-prescribing component of the Physician Quality
Reporting Initiative (PQRI) developed by the
Centers for Medicare & Medicaid Services.
CME
Please fill out your CME form!
White copy – TMA
Yellow copy – Keep for your records
Please fill out evaluation form – anonymously!
Agenda
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E-Prescribing background and landscape
Medicare e-Prescribing incentive and penalty
E-Prescribing benefits
E-Prescribing barriers
HIT and the ARRA (Stimulus Package)
E-Prescribing Defined
When a physician uses a computer or hand-held device with software
that allows them to:
1. With a patient’s consent, electronically access information
regarding a patient’s drug benefit coverage and medication
history.
2. Electronically transmit the prescription to the patient’s choice of
pharmacy.
3. When the patient runs out of refills, their pharmacy can also
electronically send a renewal request to the physician’s office for
approval.
SureScripts does not develop, sell, or endorse software:
It E-Prescribing
“Certifies” software to connectDefined
to pharmacies.
Rx
Rx
What the Physician Needs:
1.
Electronic Prescribing
Software
2.
A high-speed Internet
connection
What the Pharmacy Needs:
SureScripts provides
the behind-thescenes network that
makes the two-way
electronic exchange
of prescription
information possible
1.
Pharmacy
management software
2.
An Internet or Intranet
connection
E-Prescribing Getting Started
1. Choose stand-alone e-prescription software or a full electronic
health record (EHR) system with e-prescribing functionality.
2. Choose an e-prescribing software vendor which will allow you to
connect to the electronic prescribing network (hub or gateway for
transmissions).
3. Install a high-speed internet connection in your practice.
4. Purchase necessary hardware. (I.e. Desktop computers, laptops,
tablets, PDAs, etc..)
E-Prescribing Background
• SureScripts formed in 2001 by pharmacy associations
the nation’s 57,000 retail pharmacies, by three largest
PBMs and provides access to patient records which
provides pharmacy benefit and medication history.
E-Prescribing Background
• SureScripts is a utility, not a software vendor
• Chain pharmacies pay for the network through
transaction fees
• SureScripts certifies e-prescribing programs:
• Stand-alone e-prescribing, and
• E-prescribing integrated with EMR software
E-Prescribing Background
SureScripts certifies based on the following criteria:
• Prescription Benefit
• Eligibility/formulary
• Reporting
• Prescription History (pharmacy and payer)
• Prescription Routing
• New prescription (retail and mail-order pharmacy)
• Prescription renewal (retail and mail-order pharmacy)
E-Prescribing Background
• Surescript’s Certification - www.surescripts.com/certified
EHR vs. Stand Alone eRx
Medicare E-Prescribing Incentive
• The Medicare E-Prescribing Incentive Program is a
voluntary program.
• This initiative is a modified version of Medicare’s
Physician Quality Reporting System (PQRS –
formerly PQRI) Measure 125.
• A physician does not need to participate in PQRS to
participate in the e-prescribing incentive program
• Cannot receive Medicare EHR incentive and eprescribing incentive in same year (Medicaid EHR
and e-prescribing okay).
Medicare E-Prescribing Incentive
• The Medicare Improvements for Patients and
Providers Act of 2008 (MIPPA) created an eprescribing reporting incentive that pays successful
electronic prescribers who report 25 successful
claims during the 2012 calendar year.
• Incentive is 1% of Medicare Part B allowable
charges.
Medicare E-Prescribing Incentive
• TMA recommends physicians use “ClaimsBased” Reporting in 2011
• Claims-Based Reporting:
If electronic prescription is generated, on the
claim form, report G-code G8553
• Other reporting options:
• Registry-based reporting using a “CMS-selected” registry to submit
2011 data to CMS.
• EHR-based reporting using a “CMS-selected” electronic health record
product, submitting 2011 data to CMS. This is not to be confused with
certified EHR products for the EHR incentive program.
Medicare E-Prescribing Incentive
• The incentive is declining and will end in 2013.
• Penalty started this year and increases until 2014.
Currently penalties do not end.
Medicare E-Prescribing Incentive
E-prescribing
• 2009 - 2010 – 2 percent bonus;
• 2011 – 1 percent bonus;
• 2012 – 1 percent bonus;
• 2013 - 0.5 percent bonus.
No e-prescribing
• 2012 – 1 percent penalty
• 2013 – 1.5 percent penalty
• 2014 and beyond – 2 percent penalty
Medicare E-Prescribing Incentive
• To qualify for the incentive, a physician must use a
qualified e-prescribing system.
• This can be a stand-alone system, or one integrated with an
electronic medical record system.
Medicare E-Prescribing Incentive
• A qualified e-prescribing system must be able to:
• generate a complete active medication list incorporating
electronic data from applicable pharmacies and benefit
managers;
• select medications;
• print prescriptions;
• electronically transmit prescriptions;
Medicare E-Prescribing Incentive
Qualified system continued:
• conduct safety alerts (written or audible signals that warn
prescribers of possible undesirable or unsafe situations,
including potentially inappropriate doses or routes of
administration of a drug, drug-drug interactions, allergies, or
warnings and cautions);
• provide information on lower cost, therapeutically
appropriate alternatives;
• provide information on formulary medications; and
• electronically receive authorization requirements from the
patient’s drug plan.
Medicare E-Prescribing Incentive
• You must report an e-prescribing measure on at least
25 of Medicare Part B claims for services furnished
during the 2012 reporting period.
• At least 10% of your total Medicare Part B PFS
allowed charges for the 2012 reporting period must
be for services listed in the e-prescribing measure’s
denominator.
Medicare E-Prescribing Incentive
Bill under one of the following denominator codes
(CPT or HCPCS):
• 90801, 90802, 90804, 90805, 90806, 90807, 90808,
90809, 92002, 92004, 92012, 92014, 96150, 96151,
96152, 99201, 99202, 99203, 99204, 99205, 99211,
99212, 99213, 99214, 99215, 99241, 99242, 99243,
99244, 99245, G0101, G0108, G0109
Medicare E-Prescribing Incentive
• Physicians do not need to sign up to participate.
• Submission of e-prescribing G-codes indicates
participation.
• Report G-code G8553 on more than 25 claims in
which patient encounter took place.
Medicare E-Prescribing Incentive
• Participants will receive their incentive payments
around the fall of 2013 for the 2012 reporting year.
• Feedback reports will be available around the same
time.
• No interim reports are available during the reporting
year.
Medicare E-Prescribing Penalty
• A 1-percent penalty will be assessed on all 2012/2013
Medicare Part B claims unless physicians:
• Submit an e-prescription at least 10 times and report via
claim form using the e-prescribing G-code G8553 at least 10
times by June 30, 2011/2012.
• Physicians reporting the G-code at least 25 times by
December 31, 2012 will prevent 2014 penalties (and receive
the 1-percent incentive).
Medicare E-Prescribing Penalty
Physicians are automatically exempt from eRx penalty
if:
• Physician submitted fewer than 100 denominator eligible
claims to Medicare between Jan. 1 to June 30, 2012; .
Medicare E-Prescribing Penalty
Physician is automatically exempt from eRx penalty
if at least 10 percent of physician’s denominator
codes do not consist of codes listed below:
90801, 90802, 90804, 90805, 90806, 90807, 90808,
90809, 92002, 92004, 92012, 92014, 96150, 96151,
96152, 99201, 99202, 99203, 99204, 99205, 99211,
99212, 99213, 99214, 99215, 99241, 99242, 99243,
99244, 99245, G0101, G0108, G0109
Medicare E-Prescribing Penalty
There are claimed exemptions. Deadline passed for
2012. Claim them if needed by June 30, 2013.
• Physician is in a rural area without sufficient high-speed
Internet access.
• Physician is in an area without sufficient available
pharmacies for electronic prescribing.
• Physician is unable to e-prescribe due to state or federal
laws (controlled substances).
• Physician infrequently prescribes (fewer than 100 total
prescriptions in 6-month period).
E-Prescribing Landscape
2009
E-Prescribing Landscape
Active Prescribers: Quarterly Growth
120,000
2006
2007
2008
2009
100,000
80,000
60,000
40,000
20,000
0
Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1
Source: Surescripts and The 2008 National Progress on E-Prescribing (www.surescripts.com/report)
Prescribers: The number of e-prescribers grew from 74,000 in 2008 to 156,000
in 2009 - representing about 25 percent of all office-based prescribers.
Physicians Using eRx
Connected Pharmacies
E-Prescribing Landscape
Texas vs. National Growth
3000000
40000000
35000000
2500000
30000000
2000000
25000000
1500000
20000000
15000000
1000000
10000000
500000
5000000
0
0
Q1-07
Q2-07
Q3-07
Q4-07
Texas
Q1-08
Q2-08
National Trend
Q3-08
Q4-08
Q1-09
Why E-Prescribe?
Physician Satisfaction. The physician benefits include:
•
•
•
•
More time taking care of patients
Fewer distracting pharmacy call-backs
Higher quality care
Satisfied patients
Why E-prescribe?
Patient Satisfaction. The patient:
• gets a “right first time” prescription.
• doesn’t have to wait in the physician’s office while
prescriptions are written.
• doesn’t have to wait in the pharmacy.
• doesn’t have to wait on hold to request refills from
the office.
Why E-Prescribe?
• E-Prescribing offers a powerful tool for safely and
efficiently managing medications.
• Illegibility from hand-written prescriptions is
eliminated, decreasing risk of medication errors and
liability risk.
Why E-Prescribe?
• Warning and alert systems available at point of care.
• Clinical decision support systems can check for:
• Drug-drug interactions
• Drug-allergy interactions
• Correct dosing
Why E-prescribe?
• Access to patient’s medication history
• Access to patient’s specific formulary
• Access to patient’s fill history (sometimes!)
Helps improve patient compliance.
Why E-prescribe?
• Automates the prescription renewal and authorization
process
• More time on front-end with data entry.
• Savings realized on renewals and prescription
management going forward.
Barriers to E-Prescribing
• DEA does now allow controlled substances to be sent
electronically, however, the mechanisms are still not
in place to allow. Must still use triplicate form.
• In many practices this can represent 15 to 20% of
prescriptions.
• SB 594 (2011) allows alignment of State rules with
Federal rules for e-prescribing of Schedule II
controlled substances.
Prescription Access Texas (PAT)
• DPS launched a secure online prescription
monitoring program – PAT – in June (2012)
• Provides controlled substance dispensing history for
the past 12 months
• For additional information, visit the DPS web site:
http://www.txdps.state.tx.us/RegulatoryServices/prescription_program/
Barriers to E-Prescribing
• E-prescribing volume low. Many times pharmacy
staff are not appropriately trained for e-prescribing.
• Before going live, communicate your intentions to
pharmacies in your area.
Barriers to E-Prescribing
Utilize patient/pharmacy notification cards (available
for download on SureScripts Web site:
www.surescripts.com
To Our Patients:
Our practice is committed to the safety,
security and accuracy of your prescription.
That’s why we’ve sent your prescription(s)
electronically to your pharmacy using a
secure network.
Please show your pharmacist this card to
ensure he or she is aware your prescription
has been sent electronically, and has
been received by the pharmacy computer
or fax. Thank you!
Dear Pharmacist:
My prescription(s) has been sent
to your computer electronically,
not by fax or phone.
If your pharmacy is enabled for
electronic prescribing, please
check your computer system for
my prescription. If not, please
check your fax machine.
Thank you
Barriers to E-Prescribing
Pharmacy policies are inconsistent.
• Some pharmacy chains may not accept a Schedule 3
or 4 e-prescription.
• Some pharmacies may require a “wet signature”
versus a digital signature (PIN).
Barriers to E-Prescribing
Inconsistent messaging (field mapping)
• Your e-prescribing program may have a comment
field that allows you to give specific information
regarding the patient or prescription.
• The pharmacy software may not have a comment
field, and therefore the comment is not visible to
pharmacy staff.
E-Prescribing Resources
• TMA Affiliated with SureScripts’ Get Connected
Campaign.
• Allows you to determine e-prescribing return on
investment
• Access it through this TMA web page:
www.GetRxConnected.com/TMA
E-prescribing resources
www.texmed.org/HIT (choose e-prescribing from top menu)
www.surescripts.com
www.learnabouteprescriptions.com
Searchable database to see which physicians and pharmacies
participate in e-prescribing
www.cms.hhs.gov/ERXIncentive/
http://nationalerx.com/ (Free ePrescribing software)
HIT and the ARRA
• President Obama signed into law the American
Recovery and Reinvestment Act of 2009 (ARRA)
• Provisions for nationwide HIT infrastructure
HIT and the ARRA
• Incentives through Medicare and Medicaid for the
meaningful use of EHRs
• Meaningful use means meeting 20 of 25 criteria to be
eligible for incentive payments.
HIT and the ARRA
There will be milestone payments to physicians that
demonstrate meaningful use.
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Must be certified EMR
Must have e-prescribing capability
Must be able to exchange health information
Must be able to extract quality reports
HIT and the ARRA
2011
2014
2015
$4,000
$2,000
-
$44,000
$18,000 $12,000 $8,000
$4,000
$2,000
$44,000
2013
$15,000 $12,000 $8,000
$4,000
$39,000
2014
$12,000 $8,000
$4,000
$24,000
-
-
Year of eligibility
2011
2013
$18,000 $12,000 $8,000
2012
2015
2012
-
-
-
-
-
2016
Total
Paid
Last payment year is 2016!
Eligible physicians practicing in a health professional shortage
area (HPSA) receive a10% increase on incentive payments.
HIT and the ARRA
• Incentive payments based on 75% of Medicare
allowable charges
• In order to qualify for the maximum payment of
$18,000 in the first year, a physician must bill
Medicare a minimum of $24,000.
HIT and the ARRA
• Eligible physicians (non-hospital based), with at least
30% Medicaid volume, could receive up to $63,750
over a 6 year period.
• Eligible pediatricians (non-hospital based), with at
least 20% Medicaid volume, could receive up to
$42,500 over a 6 year period.
Medicaid Incentives
• Eligible physicians with at least 30 percent Medicaid volume
could receive up to $63,750 over a six-year period.
Year 1
Adopting,
Implementing,
and upgrading
an EHR
Meaningfully
operating and
maintaining an
EHR
Year 2
Year 3
Year 4
Year 5
Year 6
$8,500
$8,500
$8,500
$8,500
$8,500
$21,250
Total possible Medicaid incentive is $63,750.
Medicaid Incentives
• Eligible pediatricians with at least 20 percent Medicaid
volume could receive up to $42,500 over a six-year period.
Year 1
Adopting,
Implementing, and
upgrading an EHR
Meaningfully
operating and
maintaining an
EHR
Year 2
Year 3
Year 4
Year 5
Year 6
$14,167
$5,667
$5,667
$5,667
$5,667
Total possible Medicaid incentive is $42,500.
$5,665
HIT and the ARRA
Penalties
Percentage
2015
1%
2016
2%
2017 and subsequent years
3%
For updated information visit the TMA Federal Stimulus
Package Resource Center on the TMA Web site:
www.texmed.org/HIT
(choose “federal stimulus package” from top menu)
Three Stages of Meaningful Use
2011
2016
2014
Stage II — Advanced
clinical processes
Stage III — Improved
outcomes
Stage I — Data
capture and
sharing
Stage 2 Final rule released 08/23/12
Stage 3 proposed by early 2014
Texas Regional Extension Centers
North Texas REC $8.8 Million
DFW Hospital Council
CentrEast REC $6.4 Million
Texas A&M HSC
Gulf Coast REC $15.7 Million
UT HSC Houston
West Texas REC 7.1 Million
Texas Tech HSC
Total Texas Funds: $38 Million
Regional Extension Centers
• Regional extension centers available to help
physicians with EHR:
• Selection
• Implementation
• Meaningful use requirements
• Meaningful use attestation
For More Information visit:
www.texmed.org/RECs or
www.txrecs.org
TMA Resources
Resource
Access
HIPAA 5010 Resource Center
www.texmed.org/5010
E-Prescribing Information
www.texmed.org/E-Prescribe
Physician Quality Reporting System
(PQRS) Information
www.texmed.org/PQRS
TMA Knowledge Center will answer or
route questions on ALL topics.
Call: (800) 880-7955
8:15 AM – 5:15 PM (CT) Mon-Fri
TMA Resources – EHRs
Resource
Access
EHR Implementation Guide (105 pages)
www.texmed.org/HIT
EHR Readiness Assessment
www.texmed.org/EHRAssess
EHR Comparison Tool
www.texmed.org/EHRTool TMA Members Only
EHR Price Guides
•
•
•
Solo physician
2-physician
10-physician
www.texmed.org/EHRTool TMA Members Only
EHR Buyer Beware: Issues to Consider
When Contracting with EHR Vendors
www.texmed.org/BuyerBeware
HIT Homepage
www.texmed.org/HIT
TMA HIT Helpline
Email: HIT@texmed.org
Call: (800) 880-5720
TMA Resources – EHR Incentives
Resource
Access
Federal Stimulus Resource Center
•
•
•
EHR Incentive Timelines
Program Comparisons
Meaningful Use Information
www.texmed.org/Stimulus
Medicare EHR Incentive Guide
•
Step-by-step registration instructions
www.texmed.org/MedicareEHR
Medicaid EHR Incentive Guide
•
Step-by-step registration instructions
www.texmed.org/MedicaidEHR
REC Resource Center
•
•
REC locator tool
Service and eligibility information
TMA HIT Helpline
www.texmed.org/REC
Email: HIT@texmed.org
Call: (800) 880-5720
TMA Practice Management Services
Current and future
services…
 Medical record audits
 Private on-site training
 Hands-on workshops
 Physician-only seminars
 On-demand webinars
 Website resources
practice.consulting@texmed.org
(800) 523-8776
www.texmed.org/doom
CONTACT INFORMATION
Shannon Vogel
Director, Health Information Technology
401 West 15th Street
Austin, Texas 78701-1680
(800) 880-1300, ext. 1411
shannon.vogel@texmed.org
www.texmed.org