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ePrescribing and PQRI: Are You Leaving Money on the Table?

As the time approaches when potential financial incentives for the widespread use of electronic medical records (EMR) finally kick in, there is increasing excitement and anxiety among medical practices. Unfortunately, there is also a lot of confusion.

What is the difference between the financial incentives from the Stimulus Bill and bonuses from ePrescribing or those from PQRI (Physicians Quality Reporting Initiative)?

And what do you need to do to qualify for and then claim these incentives and/or bonuses?

Meaningful Use Incentives. Healthcare providers are eligible for certain incentives if they can demonstrate “meaningful use” of EMR, which is based on a set of goals and objectives spelled out in a matrix that is being developed by the Department of Health and Human Services, with input from various government and industry work groups. At this time, some of these goals and objectives are more clearly defined than others. But the first of these will not go into effect until 2011.

Medical practices must demonstrate a certain level of adoption and proficiency within these categories of objectives in order to qualify for the federal incentives, which can range from about $2000 to $18,000 per provider within a given year (depending on the year of adoption). There is also a maximum of $44,000 per provider over about five years. Providers who do not adopt EMR within the specified time-line will not only fail to qualify for incentives but will also face eventual financial penalties in the form of reimbursement cuts.

ePrescribing. Also known as eRx, this is “the electronic generation, transmission, and filling of a medicinal prescription using either an EMR or practice management system or a web interface system”. This is facilitated by the Surescripts/RxHub electronic prescribing network, which links the prescriber to a most retail pharmacies. If a provider is using an EMR system, the process automatically checks for such things as drug allergies, drug-drug interactions, and formulary issues. Enhancements to the system will allow for two-way communication between provider and pharmacy so patients in your office can be told when their prescriptions will be ready for pick-up.

In 2008, eRx was actually part of the PQRI program (see below). In 2009, this was spun off from PQRI resulting in a separate bonus for eRx reporting. In 2010, providers who use eRx at least 25 times can earn a bonus worth 2% of their allowable professional Medicare charges – all providers within a practice must meet this threshold to qualify. In 2011, however, ePrescribing will be folded into the meaningful use standards and providers will need to eRx at least 80% of their patients to qualify for the bonus. Beginning in 2012, there will be increasing financial penalties for those providers who do not participate.

PQRI Incentives. The Physician Quality Reporting Initiative (PQRI) gave physicians their first exposure to what was informally called P4P or “pay-for-performance”. Specific objectives were listed for certain diagnosis codes and providers could initially earn a 1.5% bonus. This year it will increase to 2%, after which it will probably decrease and then, as with eRx, become part of the meaningful use criteria.

What all of this means is that this year practices can still earn a 4% bonus of allowable Medicare charges for professional services. And that is no small potatoes for any practice, regardless of its size. So, why are most practices still not participating? Many practices have complained about technical problems with the program as well as trouble getting information about whether or not they met the threshold for their bonus payment.

We have been using a program developed by Protodrone LLC called PQRI Toolset that audits practice billing before it is sent, in order to verify qualification for both PQRI and eRx incentives. For 2009, we hit a reporting threshold of 99.7% for PQRI, and our bonus was the highest of any other practice that reported PQRI measures for our specialty. For more information on the PQRI Toolset call Protodrone at 1-888-569-5593 begin_of_the_skype_highlighting              1-888-569-5593      end_of_the_skype_highlighting or go to www.pqritoolset.com (ed. note: some of our partners have a financial interest in Protodrone LLC).

[This article first appeared in the March issue of Ophthalmology Management magazine]

2 Comments

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  1. Good job to remind everyone about ePrescribing and PQRI. These two items are so so overlooked. PQRI has managed to get a bad reputation as being a cumbersome, poorly managed federal program. However,it is real money being left on the table. Having an EMR system in place, while currently not necessary for PQRI participation, can go a long ways toward simplifying the process on the provider’s end. And as you correctly point out there are additional tools that can help with the process and have the potential for a good ROI.

    • Thomas, thanks for the comment. And we have now learned that the PQRI incentives for 2010 will be assessed on a 6-month basis. So, even those practices that have procrastinated until now and think that it is too late can still qualify for the bonus for the second half of the year. But they need to get moving!

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