For those of you wondering whether the cost associated with implementing an e-prescribing software as early as calendar year 2009 outweighs the incentive payment offered under the 2009 Electronic Prescribing Incentive Program, a financial breakdown will be the most useful tool in the decision making process.
While we can agree that e-prescribing will enable prescription of the most medically appropriate and cost effective therapy by offering an exchange of information that includes a patient's medication history, insurance coverage information, drug interaction information, allergy alerts and so forth, the costs associated with incorporating an e-prescribing software may be an unreasonable financial burden for some providers.
Data currently available estimates that a standalone e-prescribing system can range from $50/month to $100/month, per physician (not per practice). To qualify for the incentives, the standalone system must meet the certification criteria established by the Certification Commission for Healthcare Information Technology through its Electronic Prescribing Work Group. In addition to qualifying for incentives, certification will also ensure that standalone systems are interoperable with any future technology that a practice decides to adopt.
As an alternative, the more sophisticated electronic health records (“EHR”) systems available on the market offer an electronic prescription submission function. However, it may be too early for providers to commit to any particular EHR software because a national certification system for EHR software it yet to be named, and only providers using nationally certified EHR systems will be eligible for the financial incentives offered under the HITECH Act. And for those of you that have not begun testing the EHR systems available in your area, they generally have a purchase price of $25,000 to $45,000 per physician, or a lease price of $250/month to $500/month per physician.
On the incentive side, eligible professionals who are determined to be “successful prescribers,” as outlined on the Electronic Prescribing Incentive Fact Sheet (PDF) may earn an incentive payment equal to 2.0% of the total estimated allowed charges for all covered professional services for reporting year 2009-2010. Centers for Medicare & Medicaid Services (“CMS”) anticipates that the first e-prescribing incentive payments, for reporting year 2009-2010, will be paid as a lump sum in mid-2010.
It is important to note that being deemed a “successful e-prescribers” is no easy task. One e-prescribing measure must be reported in at least 50% of the cases where the measure is applicable during the reporting period, and where at least 10% of the providers Medicare Part B covered services are made up of CPT codes that appear in denominator of e-prescribing measures. The denominator codes are comprised mostly of office visits, consults, psychiatric evaluations, and generally center around diagnosis based visits rather than the course of treatment.
Therefore, the decision of whether to incorporate an e-prescribing software will likely hinge on the size of the providers practice, and whether a 2% incentive payment will result in a return equal to the amount spent on implementing the e-prescribing software into the practice. Providers that currently have billing software with a mechanism for reporting the number of certain procedure codes that were billed during a specific period of time can easily estimate what their 2% incentive return will amount to.
