Bonus payments, no penalties make learning easier

Beginning this year, AAOS members who e-prescribe can potentially earn a 2 percent bonus payment from the Centers for Medicare & Medicaid Services (CMS), in addition to any Physician Quality Reporting Initiative (PQRI) bonus. The e-prescribing bonus drops to 1 percent in 2011 and 2012, and to 0.5 percent in 2013.

After that, the penalties kick in. Beginning in 2012, Medicare payments will be reduced by 1 percent to physicians who do not e-prescribe; by 2014, the penalty will be a 2 percent reduction in payments.

No registration is required for the program and you can begin reporting for the bonus at anytime in 2009. If you start today, you’ll need to report any of three e-prescribing G-codes 75 per­cent of the time during the calen­dar year. If you wait until July 1 to start, you’ll need to report the e-prescribing codes 100 percent of the time.

Are you eligible?
If you bill according to the Medicare Physician Fee Schedule (PFS), you are eligible to participate. The Tax Relief Health Care Act of 2006 and the Medicare Improvements for Patients and Providers Act of 2008 define “eligible professionals.” Services payable under fee schedules or methodologies other than the PFS are not included in the program. For example, suppliers of durable medical equipment (DME) are not eligible because DME is not paid under the PFS.

Reporting and system requirements
Once you’ve decided to participate and you have a qualified stand-alone e-prescribing system or a full electronic medical record (EMR) system with e-prescribing functionality, it’s as easy as 1-2-3 to report and qualify for the bonus.

1. Determine the eligibility of the patient encounter. At least 10 percent of your Medicare Part B covered services must be made up of codes that appear in the denominator of the e-prescribing measure. A list of these codes, as well as the e-prescribing G-codes, can be found on the CMS Web site (http://www.cms.hhs.gov/ERXincentive).
2. Document the encounter using one of the following G-codes on the claim you submit for the Medicare patient. G8443—All prescriptions were generated by a qualified e-prescribing system. G8445—No prescriptions were generated. G8446—Some or all of the prescriptions were printed or phoned in because of state or federal law regulation or patient request; because the pharmacy system was unable to receive the electronic transmission; or because the prescription was for a narcotic or other controlled substance.
3. Repeat steps 1 and 2 for at least 75 percent of the Medicare Part B patients you see during the reporting year (100 percent if you start reporting on July 1).

If you are not sure whether your e-prescribing system qualifies for the program, check the GetRxConnected Program (http://www.getrxconnected.org/), operated by SureScripts. You can get a free, personalized assessment that identifies whether or not your EMR is certified to connect to pharmacies electronically. If your system is certified, the report provides details on how to request an electronic connection to pharmacies through your vendor. The program also has a technology guide that offers advice and resources designed to help establish e-prescribing in your practice.

If you’re interested in a stand-alone e-prescribing system, the National ePrescribing Patient Safety Initiative (http://www.nationalerx.com) offers a free, secure, Web-based e-prescribing software program (based on Allscripts ePrescribe) to all medication prescribers.

What’s it worth to you?
A small group practice earning $300,000 in net Medicare revenue per year could earn $6,000 for reporting in 2009 (based on the 2 percent incentive). In addition, the practice can earn an extra 2 percent incentive payment (another $6,000) for reporting PQRI measures. (The generated revenue for a practice will vary by size.)

E-prescribing can also save money for your practice. According to a 2004 study by the Medical Group Management Association, administrative complexity and inefficiency related to managing phone-based prescription refill requests costs the average practice roughly $10,000 per year for each full-time physician on staff. And that figure does not take into consideration the time spent managing fax-based requests.

What about controlled substances?
Although the Drug Enforcement Agency has issued proposed regulations for e-prescribing controlled substances, the regulations have not been finalized. You can, however, report your handwritten prescriptions for narcotics or controlled substance under the e-prescribing quality measure by using G8446.

Toya M. Sledd, MPH, MBA, is the clinical quality improvement coordinator in the AAOS medical affairs department. She can be reached at sledd@aaos.org