AMA Says ePrescribing Program Penalizes Docs

Aggressive timetable may decrease Medicare patients' access to healthcare, says American Medical Association, which calls for delays.
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The American Medical Association has criticized the Centers for Medicare and Medicaid Services (CMS) for its handling of the electronic prescribing (eRx) incentive and penalty program, and is calling for the agency to add a new eRx reporting period in 2012, extend the deadline for applying for exemptions, and apply penalties in 2013 instead of 2012.

AMA's letter was sent Monday to CMS administrator Donald Berwick, and was written in response to CMS' proposed guidelines to modify the 2011 electronic prescribing incentive and 2012 eRx penalty program.

"While we appreciate CMS' steps to modify these programs, we are concerned that more changes are needed, including establishing an additional eRx reporting period in 2012 and not applying penalties until 2013; otherwise, a significant number of physicians and other eligible professionals (EPs) will be unfairly penalized starting on January 1, 2012," the letter stated.

To address this problem, the AMA, along with more than 90 state and specialty medical societies, said CMS should add new exemption categories for physicians who are unable to adopt and use a qualified eRx system.

AMA is proposing several exemption categories, including situations in which:

-- The physician is registered to participate in the Medicare or Medicaid EHR incentive program and has adopted certified EHR technology.

-- The physician is unable to e-prescribe due to local, state, or federal law or regulation.

-- The physician infrequently prescribes (e.g., prescribed fewer than 10 prescriptions between January 1 and June 30, 2011).

-- There are insufficient opportunities to report the eRx measure due to program limitations (e.g., a surgeon who e-prescribes but does not frequently use the service codes allowed under the program).

The organization said it recommends that in the final rule, CMS clearly state that physicians must apply for at least one exemption, but are allowed to apply for more than one exemption, in order to avoid the 2012 eRx penalty. The AMA also recommended that CMS maintain these exemption categories through 2014, which marks the end of the eRx penalty program.

Under the Medicare eRx program, physicians and group practices that are eligible for eRx incentives, but choose not to participate or do not successfully participate in the eRx program, will be faced with a levy against them that will amount to a 1% Medicare payment reduction based on the total Medicare Part B allowed charges. The reduction will be 1.5% in 2013 and 2% in 2014.

To apply for an exemption, physicians must submit their applications by October 1, 2011, another point of contention for the AMA, which suggests that CMS extend the deadline to December 2011. The organization also said there should be no penalties applied until 2013, instead of 2012.

The AMA is also asking that CMS exempt older physicians who are currently receiving or will be eligible for social security benefits by 2014.

"It will be economically burdensome for physicians who intend to retire in the next several years to install and use an eRx system. We are also concerned that many of these physicians may decide to close their Medicare fee-for-service panels or opt out of Medicare to avoid penalties during the end stage of their clinical careers, which would adversely affect access to care for our nation's elderly and disabled," the letter states.

Find out how health IT leaders are dealing with the industry's pain points, from allowing unfettered patient data access to sharing electronic records. Also in the new, all-digital issue of InformationWeek Healthcare: There needs to be better e-communication between technologists and clinicians. Download the issue now. (Free registration required.)