Physicians Not Ready to Board E-Prescribing Bandwagon

A bipartisan group of senators has introduced legislation that would require physicians to begin using electronic prescribing, often referred to as e-prescribing, under Medicare or face reimbursement cuts by 2011.

The legislation (S 2408) aims to speed up the adoption of e-prescribing, which is considered a key component in a national system of electronic health records that federal health officials have long sought.

The bill would provide start-up grants and bonuses to physicians to help overcome concerns about the financial impact of implementing the e-prescribing requirement.

“We have the technology, we have the interoperability, but not enough doctors are participating,” said Sen. John Kerry (D-Mass.), during a press conference introducing the bill.

Kerry and the bill's other supporters said widespread adoption of e-prescribing would save many lives and patient injuries that stem from illegible prescriptions. Up to 7,000 patients die and an additional 1.5 million are injured annually by medication errors, including those related to bad handwriting and poor communication between physicians and pharmacies, according to a July 2006 report from the Institute of Medicine.

Digitally transmitted prescriptions also would save the government and others who fund health care substantial amounts of money. Increased use of e-prescribing could reduce federal health expenditures by up to $29 billion over the next 10 years, according to estimates prepared for the Pharmaceutical Care Management Association.

But before those lives and costs can be saved, large numbers of physicians will need to begin using e-prescribing equipment. Electronic prescriptions only accounted for 2 percent of the nation's roughly 1.5 billion prescriptions in 2007, according to SureScripts, the operator of an e-prescription network.

The legislation would spur physician adoption of the technology by overcoming barriers to their use, including the cost.

Electronic prescription software can cost a clinician up to $25,000, which is less than the average initial cost of $30,000 and ongoing annual costs of up to $15,000 for electronic medical records, but still considerable. The legislation would provide grants of up to $2,000 to qualifying physicians and add 1 percent to their ongoing Medicare reimbursements.

Privacy Concerns Raised

In addition to cost concerns, some clinicians worry about privacy in e-prescribing, despite federal health officials' insistence that such concerns are no greater than with paper prescriptions.

Another important component of the bill would cut Medicare reimbursements for physicians who don't buy and use e-prescribing technology by 10 percent a year, beginning in 2011.

The legislation has drawn opposition from APA and other physician groups, primarily because of potential payment cuts and because it is seen as a poor tool for improving patient safety.

Efforts to require use of health information technology (HIT), such as e-prescribing, are driven by a desire to improve the quality of care and patient safety, said Lizbet Boroughs, deputy director of APA's Department of Government Relations. However, most patient-safety mandates have a serious obstacle in that they don't account for the limits psychiatrists and other physicians face in compelling treatment compliance from patients who will not stay on their medications, for instance.

The Drug Enforcement Administration's requirement that physicians use paper prescriptions for controlled substances, including many medications used to treat mental illness, remains in effect. However, members of Congress have urged a change in this policy.

AMA Finds Much to Dislike

The legislation has drawn opposition from the AMA, which supports the concept of e-prescribing but says the bill is a costly mandate on physicians and lacks adequate financial incentives. Both the low levels of current Medicare reimbursements and a planned 10 percent Medicare payment cut for doctors require action before Congress can require additional investments, like HIT, according to Edward Langston, M.D., AMA board chair.

The AMA “is deeply committed to the adoption of e-prescribing, but steps must be taken to address outstanding standardization issues and other barriers,” Langston said in a written statement. “We look forward to working with the Senate and the House to encourage adoption of e-prescribing without placing an undue burden on physicians.”

Physician opposition will be a barrier to legislation that already faces a congested congressional schedule, including the likely need for Congress to continue focusing on legislation to fund the federal government well into 2008.

However, the bill does have strong support, including a nod from Mike Leavitt, secretary of Health and Human Services, who sent a letter to Congress the week the Kerry bill was introduced that urged it to encourage physicians to e-prescribe.

Troy Trenkle, director of the Office of E-Health Standards and Services at the Centers for Medicare and Medicaid Services (CMS) testified before Congress last December that CMS has been working with the DEA in recent years to“ identify and adopt commercially scaleable solutions that will allow for the e-prescribing of controlled substances consistent with the e-prescribing of non-controlled substances.”

The pharmacy and health-insurance industries also have lobbied for incentives to accelerate e-prescribing as a strong cost-control measure.

“Widespread implementation of e-prescribing will promote beneficiary compliance with prescription drug therapies, promote patient safety, and result in greater efficiency in the delivery of pharmacy benefits,” wrote Karen Ignagni, president and CEO of America's Health Insurance Plans, in an October 2007 letter.

The text of S 2408 can be accessed at<http://thomas.loc.gov> by searching on the bill number. ▪