March 15, 2010

A number of our clients have asked about the medicare electronic prescribing (eRx) bonus, which allows qualifying physicians and certain allied health providers including nurse anesthetists to earn a second, separate bonus on top of the potential PQRI 2 percent bonus. This year, the eRx bonus is 2 percent of estimated allowable charges for Medicare patients. In 2011 and 2012, the bonus will be 1 percent, and in 2013 it will drop to 0.5 percent.

Very few, if any, anesthesiologists or even office-based pain medicine specialists will qualify for the eRx bonus because at least 10 percent of their annual Medicare allowables would need to consist of evaluation and management (E/M) services represented by the following CPT™ codes:

Be that as it may, readers may wish to know some of the basics of the eRx Incentive Program, which is now in its second year, having been enacted into law as part of the Medicare Improvements for Patients and Providers (MIPPA) legislation of 2008. The program works similarly to PQRI: eligible professionals indicate on their claims, through a special G-code (G8553), whether they use a qualified e-prescribing system. Physicians and others would have to report G8553 on at least 25 patient encounters for one of the E/M services listed by code number above.

There are two types of systems that may help an eligible professional qualify for the eRx bonus: A system for eRx only (a "stand-alone" system), or an electronic health record (EHR) system with eRx functionality. Either of these systems may be used for the incentive program, as long as they are "qualified." A qualified system must be able to do the following:

1. Generate a complete medication list that incorporates data from pharmacies and benefit managers (if available);
2. Select medications, transmit prescriptions electronically using the applicable standards, and warn the prescriber of possible undesirable or unsafe situations;
3. Provide information on lower-cost, therapeutically-appropriate alternatives (for 2010, tiered formulary information, if available, meets this requirement), and
4. Provide information on formulary or tiered formulary medications, patient eligibility, and authorization requirements received electronically from the patient's drug plan.

You should be aware that current law calls for reductions in Medicare payments for eligible professionals who are not e-prescribing by 2012. It is not clear what will happen to those, like anesthesiologists and pain physicians, for whom evaluation and management services do not amount to 10 percent of their Medicare allowables- can these professionals be penalized for not doing something that the statute makes it impossible for them to do? ASA raised this objection in its August 2009 letter to CMS commenting on the proposed Fee Schedule Rule for 2010:

ASA opposes the proposed criterion for limiting an incentive payment to successful e-prescribers, namely that the e-prescribing cases reported must constitute at least 1- percent of the total Part B allowed charges for all covered professional services furnished by the eligible professional during the reporting period.

While we recognize these provisions are imposed under the Social Security Act, ASA believes that additional encouragement and incentives are needed to facilitate the acquisition and use of e-prescribing systems. As CMS acknowledges in the proposed rule, only 12 percent of office-based prescribers are estimated to currently use e-prescribing. Some anesthesiologists specializing in pain medicine use electronic prescribing systems, but many, particularly those in smaller groups or solo practices, lack the resources to adopt such systems. With the incentive reductions slated for 2011 (1%) through 2013 (0.5%) and the payment penalties for eligible professionals who are not successful electronic prescribers slated for 2012 (1% cut) through 2014 (2.0% cut), the program will quickly eliminate any incentives to encourage adoption of this technology before it has even grown beyond its infancy. The resulting impact on patient safety and quality of care could be substantial. Thus, ASA urges CMS to work to expand and extend incentives designed to encourage additional adoption and use of e-prescribing systems.

For further information, see the recently revised "Medicare's Practical Guide to The Electronic Prescribing (eRx) Incentive Program " at  www.cms.hhs.gov/partnerships/downloads/11399-P.pdf.

The 21.2% Medicare Pay Cut Saga- Averted until October?

The Senate has yet again delayed implementation of the infamous 21.2 percent Medicare physician payment cut, this time until October 1, 2010. On Wednesday March 10th, the Senate approved the American Workers, State and Business Relief Act of 2010 (H.R. 4213) with a 62-63 vote. The bill also extends the minimum Geographic Practice Cost Indices (GPCIs) work floor of 1.000. The House of Representatives is expected to consider the bill this week.

Please keep sending us your questions and letting us know how we may best help keep you informed.

With best wishes,

Tony Mira
President and CEO

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