Medicare Compliance & Reimbursement

Congress should make electronic prescription voluntary, not mandatory, under Medicare prescription-drug legislation it's developing, a large number of physicians groups have told congressional conferees on the measure.

In an Aug. 26 letter, 48 physician organizations - including the American College of Physicians, the Medical Group Management Association, the Society of General Internal Medicine, and other specialty groups - urged conference chair Rep. Bill Thomas (R-CA) to adopt the Senate's voluntary, slower-paced approach to e-prescribing rather than the quick, mandatory shift contained in the House bill that Thomas largely authored.

Electronic prescribing "shows promise toward reducing medical errors and improving patient safety," the groups say. Nevertheless, the movement toward computerized prescribing should be slower than the House wants because "current technology is in its infancy and remains unproven."

That's a similar objection to one raised against the provision earlier this year by the National Association of Chain Drug Stores. Congress envisions a system in which real-time information passes between physicians and pharmacies during the prescribing process, but current technology likely isn't up to that challenge, according to NACDS statements on the Medicare bill.

The physician groups say they back the two bills' general call for development of uniform standards for computerized prescribing. "Creation of uniform national standards will help facilitate the dissemination" of the technology, they write.

But they argue that, since "each physician practice is unique," physicians "should have the opportunity to weigh the costs and benefits, both clinical and financial," of e-prescribing in a voluntary program. "Federally mandated electronic prescribing would place an additional costly unfunded mandate on physicians, forcing them to rush to purchase an expensive, untested technology. The ... burden would be highest on small practices."

The groups also dub "unrealistic" the House bill's call for uniform e-prescribing standards to be developed by Jan. 1, 2006, the planned implementation date for Medicare prescription-drug coverage under the legislation.

Ambulatory Practice Not Ready for Online

Setting standards may appear simple, but in fact it will be "extraordinarily complicated," in part because "broad scale electronic prescribing as envisioned in this legislation does not yet exist in the ambulatory setting."

Hospitals and large practice groups e-prescribe today, but largely using closed systems. The House envisions "two-way, interoperable, and secure external systems" that could serve individual physicians' offices equally well, but such systems "are in extremely limited use," according to the groups. "Development of a single set of standards appropriate for all health care settings, while meritorious, will be a significant undertaking."

In an Aug. 15 letter to Senate Medicare conferee Max Baucus (MT), the American College of Physicians proposed a Jan. 1, 2008, implementation date for standards, to allow for demonstration projects. ACP also told Baucus that standards should be developed by an "appropriate private-sector group," while the legislative language calls for the effort to be led by the Department of Health and Human Services. Providing resources for private-sector development and testing of standards and accommodating needs of communities without high-speed Internet access also are priorities for ACP.

Meanwhile, however, other voices are encouraging Congress to move ahead as aggressively as possible on computerized prescribing. Former House Speaker Newt Gingrich, for example, now of the American Enterprise Institute, names the e-prescribing provisions as some of the most important in the legislation. He's been urging former Hill colleagues to enact Medicare legislation that pushes the entire health-care system toward adoption of innovations like e-prescribing and integrated chronic-disease management, rather than just pasting a drug benefit onto the federal program.