Eligible individual physicians and group practices will have more time and greater flexibility in meeting new electronic prescribing
standards under a proposed rule issued May 26 by the Centers for Medicare and Medicaid Services (CMS).
APA joined the AMA in commending the federal agency for its efforts to clarify the requirements of the Electronic Prescribing
(eRx) Incentive Program and address previously voiced concerns about physicians' ability to comply with the new regulations
in the originally mandated time frame.
The Medicare Improvements for Patients and Providers Act, which was implemented in 2009, requires that the new eRx procedures
be implemented by June 30. Those meeting the electronicprescribing requirements are eligible for a 1 percent Medicare payment
bonus in 2012, while those failing to meet the deadline will incur a 1 percent reduction in Medicare payments in 2012, increasing
to 2 percent in 2014. The proposed rule would extend the deadline for compliance with the act to October 1, as well as offer
additional hardship exemptions. Currently, the only valid exemptions from the eRx program's 2012 payment adjustments are for
professionals practicing in rural areas with limited access to high-speed Internet connections or in locations with a limited
number of pharmacies capable of receiving electronic prescriptions. CMS proposes four new hardship exemption categories in
the revised rule:
Physicians who register to participate in the Medicare or Medicaid Electronic Health Record (EHR) Incentive Programs and adopt
certified EHR technology. These alternative electronic-prescribing programs are similar to the eRx program, and the proposed rule was introduced in
part to "reduce redundant, inconsistent, or overlapping regulatory requirements."
Physicians who are unable to prescribe electronically due to local, state, or federal laws or regulations. APA Medical Director and CEO James H. Scully Jr., M.D., noted in his comments to CMS that states such as New York and Ohio
have regulations prohibiting physicians from electronically prescribing controlled substances. These laws would result in
some physicians' incurring financial penalties under the federal eRx program while in the process of complying with state
Physicians who have limited prescribing activity. Scully noted that this exemption would apply to psychiatrists who primarily conduct outpatient psychotherapy and rarely prescribe
medication for their patients.
Physicians lacking sufficient opportunities to prescribe electronically due to patient interactions deemed ineligible for
consideration under the program. As an example of this exemption, Scully cited a physician who regularly bills Medicare for medication-management visits in
an inpatient setting, as opposed to in the outpatient setting specifically addressed in the eRx rule.