Published 1/1/2009
Jackie Ryan, MPA

Nuts and bolts of e-prescribing

How and why you should participate in the 2009 eRX program

On Oct. 30, 2008, the Centers for Medicare and Medicaid Services (CMS) issued a final rule implementing the new e-prescribing (eRX) incentive program that began on Jan. 1, 2009. The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) authorized a new and separate incentive program for eligible professionals who are successful e-prescribers as defined by MIPPA.

The new incentive is separate and in addition to the Physicians Quality Reporting Initiative (PQRI). Additionally, “in the interest of patient care and safety and to encourage prescribers and dispensers to adopt e-prescribing,” CMS announced that it would extend the deadline for banning faxed prescriptions by 3 years, until Jan. 1, 2012.

Participation requirements
According to CMS, to be a successful e-prescriber and to receive an incentive payment, an eligible professional must report one eRX measure in at least 50 percent of the cases in which the measure is reportable by the eligible professional during 2009. Eligible professionals do not need to participate in PQRI to participate in the eRX incentive program. No sign up or reregistration is required, but the following two participation limitations should be used by practices to evaluate and assess their eligibility:

  • Eligible professionals must have and use a qualified eRX system.
  • At least 10 percent of eligible professionals’ Medicare Part B covered services must include Current Procedure Terminology (CPT) codes that appear in the reporting denominator of the eRX measure.

Incentive amounts
The incentive amount is based on the total allowed charges for all such physician fee schedule covered professional services furnished by the eligible professional during the reporting period (
Table 1).

The carrot switches to a stick beginning in 2012. Eligible professionals who are not successful e-prescribers by 2012 will be penalized with a reduction in the fee schedule amount payable. This means that these providers will be paid at 99 percent of covered Medicare Part B fee schedule services in 2012, at 98.5 percent in 2013 and at 98 percent in 2014 and beyond.

To learn more about the E-Prescribing Incentive Program visit www.cms.hhs.gov/pqri or www.cms.hhs.gov/EPrescribing.

Turning a no-go into a win-win
Despite the momentum to switch to eRX during the past several years, only 17 percent of all U.S. physicians were using the technology in 2007. Two frequently cited barriers to adopting eRX are workflow and usability; cost and implementation are next.

Recent published case studies and pilot projects have proven that the benefits of eRX are real; improved safety and reductions in preventable adverse drug events are the most compelling benefits (Table 2). Physicians who have implemented eRX report that they are satisfied with the practice efficiency benefits the technology offers.

The most commonly cited improved efficiencies are associated with fewer call-backs from pharmacies. Results from a 2006 Surescripts project confirm that 90 percent of physicians noted improvements in care efficiency, and the time spent in managing refill requests and pharmacy call-backs was cut by more than half. Additionally, 57 percent of physicians who participated in the Health Alliance Plan (Henry Ford Medical Group) pilot project believe that time spent by support staff on these issues also dropped.

Best practices
Everyday, more eRX product options are available to choose from. They include stand-alone products to complete systems based on electronic medical records and information networks. The eHealth Initiative Foundation, in collaboration with several other national medical associations, has developed a series of practical guides designed to educate patients, providers, and payors about eRX and the steps involved in its adoption and implementation. The free Clinician’s Guide to Electronic Prescribing is available for download at

The growing body of knowledge on implementing eRX has identified several best practices. The Healthcare Information Management Systems Society Web site (www.himss.org) includes several resources that can help walk your practice through the steps necessary to overcome barriers to adoption and ensure success.

Physician acceptance is key
Current e-prescribers list several critical success factors for implementation. An enthusiastic physician champion to promote adoption has been identified as the cornerstone for success.

Electronic prescribing holds great promise as a solution to a national problem and is here to stay. A wide range of legislative and regulatory changes at both state and federal levels support its implementation, and published reports of pilot programs and eRX initiatives demonstrate that benefits from using e-prescribing exceed expectations.

Although implementing any new technology can be disruptive, a committed physician leader can help minimize the disruption and ensure maximum success. Careful planning that includes outlining specific selection criteria will enable your practice to choose software and hardware with robust functionality that will improve workflow.

For more information
Visit the AAOS online Practice Management Center (
www.aaos.org/pracman) to review the e-prescribing fact sheet and a best practice resource guide.

Jackie Ryan, MPA, is a practice management program coordinator in the AAOS practice management group. She can be reached at ryan@aaos.org

Test your knowledge…take the E-Prescribing Quick Quiz

  1. To participate in the 2009 E-Prescribing Incentive Program, an eligible professional must participate in the Physicians Quality Reporting Initiative. True or False
  2. For reporting years 2009–2010, a successful e-prescriber can earn a 2.0 percent incentive payment based on all of the allowed charges for Medicare Part B covered services. True or False
  3. The E-Prescribing Incentive Program calls for a 1.0 percent reduction in Medicare payments beginning in 2012 for those eligible professionals who are not successful e-prescribers. True or False
  4. A Clinicians Guide to Electronic Prescribing provides guidance on the steps to take and the pitfalls to avoid when adopting e-prescribing. True or False
  5. A Surescripts pilot project in 2006 demonstrated greater than a 50 percent reduction in time spent on managing refill requests and pharmacy call backs with e-prescribing. True or False

Answers: 1) False, 2) True, 3) True, 4) True, 5) True

Read the first article in this series...