Interest grows in e-prescribing

As a new set of Medicare e-prescribing standards goes into effect April 1, behavioral healthcare providers’ interest in this technology seems to be at an all-time high. The combination of government incentives and the publicity surrounding the health IT provisions of the American Recovery and Reinvestment Act (ARRA) has at least put e-prescribing on most providers’ radars.

“Our company put on an [e-prescribing] webinar yesterday and had 300 attendees—many more than usual,” notes Kevin Scalia, executive vice-president of corporate development for Netsmart Technologies. “There is a huge awareness of it, and they had hundreds of questions,” adds Scalia, who also chairs the Software and Technology Vendors’ Association (SATVA), a trade organization of behavioral health and human services software vendors.

Researchers estimate that only about 5% of U.S. physicians currently e-prescribe, and adoption among behavioral health physicians likely is even lower. Yet Scalia says his company is seeing growth in this area.

“The adoption of e-prescribing was slow initially, but in the last two years the growth has been dramatic,” he explains.

CMS’s “carrot and stick” approach
To spur adoption, the Centers for Medicare and Medicaid Services (CMS) launched a Medicare incentive program in January. Providers who successfully e-prescribe in 2009 and 2010 are eligible for incentives equal to 2% of their total Medicare payments for the year. The incentive decreases to 1% in 2011 and 2012 and to 0.5% in 2013.

CMS offers a stick as well as a carrot: Prescribers who do not adopt e-prescribing will face reimbursement reductions, beginning at 1% in 2012 and increasing to 2% by 2014.

Last year, CMS adopted several e-prescribing standards that are effective April 1. When providers prescribe electronically for Medicare Part D-eligible patients, the system used must comply with several standards.

Formulary and benefits. The qualifying system must allow prescribers to communicate with Part D sponsors about drugs covered by individuals’ prescription benefit plans. Providers also can learn about lower-cost generic alternatives.

Medication history. The system must allow providers, dispensers, and sponsors to communicate about what drugs a patient is taking, including those prescribed by other providers. The goal is to cut down on the number of adverse drug events.

Fill-status notification. Providers can receive an e-mail from a pharmacy indicating whether patients have filled prescriptions.

Provider identifiers. To increase efficiency, CMS requires prescribers to use their National Provider Identifier.

Providers considering adopting e-prescribing software, either stand-alone or as part of an electronic medical record (EMR), should check with potential vendors to ensure their products meet CMS’s standards.

According to vendors and analysts, CMS’s specifications largely follow the certification system created by Surescripts, a national electronic prescription networking vendor. Surescripts has created an online chart of which features of each vendor it has certified (Note: Some EMR vendors in the behavioral health field may not appear in this list because they partner with an e-prescribing software vendor, which may be listed).

Incentives’ minimal impact
Although enthusiastic about e-prescribing’s benefits, some leaders of behavioral healthcare organizations say the Medicare incentives are unlikely to drive the field’s adoption of e-prescribing.

Even among early adopters, the Medicare incentives are not seen as crucial. Rhode Island was a pioneer in e-prescribing adoption, and Gateway Healthcare, Inc., in Pawtucket began looking at e-prescribing in late 2003. By 2006, it had 15 doctors using InstantDX’s OnCallData product. Its providers now issue 50,000 e-prescriptions a year. But the Medicare incentives will not have a huge impact, says Rich Leclerc, Gateway’s president and CEO.

“We do have some patients dually covered by Medicare and Medicaid, but it is not a big incentive for us,” he says. Yet features among the Medicare standards, such as fill-status notification, are key to how e-prescribing could improve quality of care in the field, Leclerc adds.

Gateway, which has grown to include more than 41 locations across Rhode Island, plans to use its e-prescribing system for greater medical supervision and analysis of prescribing patterns, which should lead to quality improvements beyond just greater efficiencies, Leclerc notes.

Vic Topo, MSW, president and CEO of the Center for Life Management (CLM) in Derry, New Hampshire, says that although his organization does not receive much funding from Medicare, it is important for CLM to apply for the incentives and pay attention to the new standards as it moves forward with plans to add e-prescribing to its home-grown EMR and billing system. Because his IT staff have experience building their own software, he is confident that they have the level of expertise to understand the government’s requirements for qualified systems.

Topo notes that as CLM builds a completely integrated system, it would be “foolish” not to have e-prescribing as one component. For large organizations that do receive significant Medicare funding, “reductions in payments if they don’t e-prescribe won’t bode well for them,” he points out.

DEA restrictions
Besides cost, privacy issues, and painful work-flow changes, another hindrance to e-prescribing adoption in behavioral healthcare has been the Drug Enforcement Administration’s reluctance to allow e-prescribing of controlled substances.

“DEA does not allow it for Schedule II through V drugs,” explains Chuck Klein, PhD, Netsmart's director of clinical services and InfoScriber (its e-prescribing product) operations. “In behavioral health, this is a big issue. A lot of stimulants used with children are Schedule II.”

This forces some prescribers to use a computer for half of their practice, but then turn to paper for the rest. “We don’t have a good answer for them yet,” Klein says. “It is the number-one issue besides cost.”