eRX: from Carrots to Sticks

March 8, 2011

It's funny how healthcare IT “incentives” work with the government. They begin as carrots (bonus payments), but eventually turn into sticks (payment deductions).

It's funny how healthcare IT “incentives” work with the government. They begin as carrots (bonus payments), but eventually turn into sticks (payment deductions).

A case in point is the Electronic Prescribing (eRX) Incentive Program. Started in 2009, this voluntary program was intended to encourage providers to become e-prescribers. In 2009 and 2010, successful participants could earn a 2 percent bonus against their Medicare billings. Not bad.

However, in 2011, the carrots get smaller and a stick appears for the first time. Incentives for successful participation drop to 1 percent. Non-participants have their Medicare billings docked by 1 percent.

This trend will continue over the next couple of years: in 2012 bonuses will drop to .5 percent and penalties will increase to 1.5 percent; in 2013 no more bonuses will apply and penalties will rise to 2 percent.

The message is pretty clear: the government wants you to not only e-prescribe, but also to be an active participant in the program. Non-joiners are going to get a smaller paycheck.

The good news is that becoming an eRX Incentive Program participant is reasonably easy (assuming that you have implemented e-prescribing); no application or registration is necessary. You simply need to start reporting an e-prescribing G-code (G8553) on claims in which you have written an e-prescription for a patient. (Just so we are all on the same page; e-prescribing is defined as submitting prescriptions through the national e-prescribing network-faxes don't count.)

For this year, the requirements are pretty lax, but time sensitive; by June 30 you need to have submitted at least 10 claims with this G-code.

If you don't have an e-prescribing tool yet, it becomes a bit more challenging. Electronic health record (EHR) users who are not yet connected to the e-prescribing network, contact your vendor to get connected. There will be some software configuration, paperwork and probably some fees. In concept it is not dissimilar to getting connected to a claims clearinghouse-but it should be a lot easier.

However, depending on the EHR vendor, it could take a few weeks to be up and running. Considering that the June submission deadline is rapidly approaching, the time to act is right now.

Paper-based practices that don’t anticipate implementing an EHR before June should consider standalone e-prescribing tools. Many are relatively inexpensive, easy and quick to implement, and easy to use.

A final note: as with any good government program, there are exceptions. Providers operating in areas (typically rural) without access to high speed Internet, or in parts of the country with limited penetration of pharmacies capable of receiving e-scripts (again, typically rural) can qualify for an exemption. If this describes your situation, you will need to submit a hardship G-code (G8642 or G8643) on at least one claim before June 30, 2011.

For more information visit the eRx Incentive program on the CMS website.

Bruce Kleaveland is a paid correspondent through Intel’s sponsorship with Physicians Practice.