E-Prescribing

1. E-Prescribing Shannon Vogel Director, Health Information Technology

2. CME The TMA designates this educational activity for a maximum of 1 AMA PRA Category 1 creditTM. Physicians should only claim credit commensurate with the extent of their participation in this activity. This activity has been designated as 1 hour of ethics and/or professional responsibility education.

3. CME Course Objectives Upon completion of this activity, participants should be able to: • Describe how e-prescribing can improve patient safety by reducing medication errors.  • Discuss the state and federal landscape of e-prescribing including legal barriers. • Summarize what is needed for participation in the e-prescribing component of the Physician Quality Reporting Initiative (PQRI) developed by the Centers for Medicare & Medicaid Services.

4. CME Please fill out your CME form! White copy – TMA Yellow copy – Keep for your records Please fill out evaluation form – anonymously!

5. Agenda • E-Prescribing background and landscape • Medicare e-Prescribing incentive and penalty • E-Prescribing benefits • E-Prescribing barriers • HIT and the ARRA (Stimulus Package)

6. E-Prescribing Defined When a physician uses a computer or hand-held device with software that allows them to: • With a patient’s consent, electronically access information regarding a patient’s drug benefit coverage and medication history. • Electronically transmit the prescription to the patient’s choice of pharmacy. • When the patient runs out of refills, their pharmacy can also electronically send a renewal request to the physician’s office for approval.

7. Rx Rx SureScripts does not develop, sell, or endorse software:It “Certifies” software to connect to pharmacies. E-Prescribing Defined What the Physician Needs: What the Pharmacy Needs: SureScripts provides the behind-the-scenes network that makes the two-way electronic exchange of prescription information possible Electronic Prescribing Software A high-speed Internet connection Pharmacy management software An Internet or Intranet connection

8. E-Prescribing Getting Started • Choose stand-alone e-prescription software or a full electronic health record (EHR) system with e-prescribing functionality. • Choose an e-prescribing software vendor which will allow you to connect to the electronic prescribing network (hub or gateway for transmissions). • Install a high-speed internet connection in your practice. • Purchase necessary hardware. (I.e. Desktop computers, laptops, tablets, PDAs, etc..)

9. E-Prescribing Background • SureScripts formed in 2001 by pharmacy associations the nation’s 57,000 retail pharmacies, by three largest PBMs and provides access to patient records which provides pharmacy benefit and medication history.

10. E-Prescribing Background • SureScripts is a utility, not a software vendor • Chain pharmacies pay for the network through transaction fees • SureScripts certifies e-prescribing programs: • Stand-alone e-prescribing, and • E-prescribing integrated with EMR software

11. E-Prescribing Background SureScripts certifies based on the following criteria: • Prescription Benefit • Eligibility/formulary • Reporting • Prescription History (pharmacy and payer) • Prescription Routing • New prescription (retail and mail-order pharmacy) • Prescription renewal (retail and mail-order pharmacy)

12. E-Prescribing Background • Surescript’s Certification - www.surescripts.com/certified

13. EHR vs. Stand Alone eRx

14. Medicare E-Prescribing Incentive • The Medicare E-Prescribing Incentive Program is a voluntary program. • This initiative is a modified version of Medicare’s Physician Quality Reporting System (PQRS – formerly PQRI) Measure 125. • A physician does not need to participate in PQRS to participate in the e-prescribing incentive program • Cannot receive Medicare EHR incentive and e-prescribing incentive in same year (Medicaid EHR and e-prescribing okay).

15. Medicare E-Prescribing Incentive • The Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) created an e-prescribing reporting incentive that pays successful electronic prescribers who report 25 successful claims during the 2012 calendar year. • Incentive is 1% of Medicare Part B allowable charges.

16. Medicare E-Prescribing Incentive • TMA recommends physicians use “Claims-Based” Reporting in 2011 • Claims-Based Reporting:If electronic prescription is generated, on the claim form, report G-code G8553 • Other reporting options: • Registry-based reporting using a “CMS-selected” registry to submit 2011 data to CMS. • EHR-based reporting using a “CMS-selected” electronic health record product, submitting 2011 data to CMS. This is not to be confused with certified EHR products for the EHR incentive program.

17. Medicare E-Prescribing Incentive • The incentive is declining and will end in 2013. • Penalty started this year and increases until 2014. Currently penalties do not end.

18. Medicare E-Prescribing Incentive E-prescribing • 2009 - 2010 – 2 percent bonus; • 2011 – 1 percent bonus; • 2012 – 1 percent bonus; • 2013 - 0.5 percent bonus. No e-prescribing • 2012 – 1 percent penalty • 2013 – 1.5 percent penalty • 2014 and beyond – 2 percent penalty

19. Medicare E-Prescribing Incentive • To qualify for the incentive, a physician must use a qualified e-prescribing system. • This can be a stand-alone system, or one integrated with an electronic medical record system.

20. Medicare E-Prescribing Incentive • A qualified e-prescribing system must be able to: • generate a complete active medication list incorporating electronic data from applicable pharmacies and benefit managers; • select medications; • print prescriptions; • electronically transmit prescriptions;

21. Medicare E-Prescribing Incentive Qualified system continued: • conduct safety alerts (written or audible signals that warn prescribers of possible undesirable or unsafe situations, including potentially inappropriate doses or routes of administration of a drug, drug-drug interactions, allergies, or warnings and cautions); • provide information on lower cost, therapeutically appropriate alternatives; • provide information on formulary medications; and • electronically receive authorization requirements from the patient’s drug plan.

22. Medicare E-Prescribing Incentive • You must report an e-prescribing measure on at least 25 of Medicare Part B claims for services furnished during the 2012 reporting period. • At least 10% of your total Medicare Part B PFS allowed charges for the 2012 reporting period must be for services listed in the e-prescribing measure’s denominator.

23. Medicare E-Prescribing Incentive Bill under one of the following denominator codes (CPT or HCPCS): • 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, G0101, G0108, G0109

24. Medicare E-Prescribing Incentive • Physicians do not need to sign up to participate. • Submission of e-prescribing G-codes indicates participation. • Report G-code G8553 on more than 25 claims in which patient encounter took place.

25. Medicare E-Prescribing Incentive • Participants will receive their incentive payments around the fall of 2013 for the 2012 reporting year.  • Feedback reports will be available around the same time.  • No interim reports are available during the reporting year. 

26. Medicare E-Prescribing Penalty • A 1-percent penalty will be assessed on all 2012/2013 Medicare Part B claims unless physicians: • Submit an e-prescription at least 10 times and report via claim form using the e-prescribing G-code G8553 at least 10 times by June 30, 2011/2012. • Physicians reporting the G-code at least 25 times by December 31, 2012 will prevent 2014 penalties (and receive the 1-percent incentive).

27. Medicare E-Prescribing Penalty Physicians are automatically exempt from eRx penalty if: • Physician submitted fewer than 100 denominator eligible claims to Medicare between Jan. 1 to June 30, 2012; .

28. Medicare E-Prescribing Penalty Physician is automatically exempt from eRx penalty if at least 10 percent of physician’s denominator codes do not consist of codes listed below: 90801, 90802, 90804, 90805, 90806, 90807, 90808, 90809, 92002, 92004, 92012, 92014, 96150, 96151, 96152, 99201, 99202, 99203, 99204, 99205, 99211, 99212, 99213, 99214, 99215, 99241, 99242, 99243, 99244, 99245, G0101, G0108, G0109

29. Medicare E-Prescribing Penalty There are claimed exemptions. Deadline passed for 2012. Claim them if needed by June 30, 2013. • Physician is in a rural area without sufficient high-speed Internet access. • Physician is in an area without sufficient available pharmacies for electronic prescribing. • Physician is unable to e-prescribe due to state or federal laws (controlled substances). • Physician infrequently prescribes (fewer than 100 total prescriptions in 6-month period).

30. E-Prescribing Landscape 2009

31. E-Prescribing Landscape 2009 Prescribers: The number of e-prescribers grew from 74,000 in 2008 to 156,000 in 2009 - representing about 25 percent of all office-based prescribers.

32. Physicians Using eRx

33. Connected Pharmacies

34. E-Prescribing Landscape Texas vs. National Growth

35. Why E-Prescribe? Physician Satisfaction. The physician benefits include: • More time taking care of patients • Fewer distracting pharmacy call-backs • Higher quality care • Satisfied patients

36. Why E-prescribe? Patient Satisfaction. The patient: • gets a “right first time” prescription. • doesn’t have to wait in the physician’s office while prescriptions are written. • doesn’t have to wait in the pharmacy. • doesn’t have to wait on hold to request refills from the office.

37. Why E-Prescribe? • E-Prescribing offers a powerful tool for safely and efficiently managing medications. • Illegibility from hand-written prescriptions is eliminated, decreasing risk of medication errors and liability risk.

40. Why E-Prescribe? • Warning and alert systems available at point of care. • Clinical decision support systems can check for: • Drug-drug interactions • Drug-allergy interactions • Correct dosing

41. Why E-prescribe? • Access to patient’s medication history • Access to patient’s specific formulary • Access to patient’s fill history (sometimes!) Helps improve patient compliance.

42. Why E-prescribe? • Automates the prescription renewal and authorization process • More time on front-end with data entry. • Savings realized on renewals and prescription management going forward.

43. Barriers to E-Prescribing • DEA does now allow controlled substances to be sent electronically, however, the mechanisms are still not in place to allow. Must still use triplicate form. • In many practices this can represent 15 to 20% of prescriptions. • SB 594 (2011) allows alignment of State rules with Federal rules for e-prescribing of Schedule II controlled substances.

44. Prescription Access Texas (PAT) • DPS launched a secure online prescription monitoring program – PAT – in June (2012) • Provides controlled substance dispensing history for the past 12 months • For additional information, visit the DPS web site: http://www.txdps.state.tx.us/RegulatoryServices/prescription_program/

45. Barriers to E-Prescribing • E-prescribing volume low. Many times pharmacy staff are not appropriately trained for e-prescribing. • Before going live, communicate your intentions to pharmacies in your area.

46. Barriers to E-Prescribing Utilize patient/pharmacy notification cards (available for download on SureScripts Web site: www.surescripts.com To Our Patients: Our practice is committed to the safety, security and accuracy of your prescription. That’s why we’ve sent your prescription(s) electronically to your pharmacy using a secure network. Please show your pharmacist this card to ensure he or she is aware your prescription has been sent electronically, and has been received by the pharmacy computer or fax. Thank you! Dear Pharmacist: My prescription(s) has been sent to your computer electronically, not by fax or phone. If your pharmacy is enabled for electronic prescribing, please check your computer system for my prescription. If not, please check your fax machine. Thank you

47. Barriers to E-Prescribing Pharmacy policies are inconsistent. • Some pharmacy chains may not accept a Schedule 3 or 4 e-prescription. • Some pharmacies may require a “wet signature” versus a digital signature (PIN).

48. Barriers to E-Prescribing Inconsistent messaging (field mapping) • Your e-prescribing program may have a comment field that allows you to give specific information regarding the patient or prescription. • The pharmacy software may not have a comment field, and therefore the comment is not visible to pharmacy staff.

49. E-Prescribing Resources • TMA Affiliated with SureScripts’ Get Connected Campaign. • Allows you to determine e-prescribing return on investment • Access it through this TMA web page: www.GetRxConnected.com/TMA