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
"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
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.
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.
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
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
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. ▪