CMS Electronic Prescribing Incentive Program

The CMS Electronic Prescribing Incentive (eRx) program has been in place since 2009 and it has allowed eligible professionals to obtain an eRx incentive payment equal to 2% of their total Medicare Part B allowed charges. However, this incentive program, much like the EHR Measures incentives, will change to a penalty program in the year 2012 for those who do not utilize an eRx program. The adoption rate for eRx has been steadily increasing and with the penalties looming in 2012, the adoption rate will most likely gain additional momentum. The penalties will be rolled out as follows:

Year	Reduction
2012	-1.0%
2013	-1.5%
2014	-2.0%
2015	-2.0%

Currently, there are numerous stand alone e-prescribing systems available for purchase, as well as those integrated with EHR software packages. The National ePrescribing Safety Initiative (NEPSI) partnered with Allscripts to make available a free standalone e-prescribing product which has about 50,000 physician users. Additionally, many hospitals and integrated delivery systems are providing e-prescribing software for their physicians as are some health plans.

As a result of the CMS EHR Meaningful Use incentive Program, many providers will decide to achieve e-prescribing compliance through implementation of an EHR system in order to qualify for the more substantial EHR incentive payments. However, for those providers who are not yet ready to convert to an EHR system, a stand alone eRx product is a viable option to get their practice headed in the right direction. However, they will still need to have a long-term plan for EHR adoption in order to avoid the penalties for future non-compliance. The penalties for not showing meaningful use of an EHR coupled with the eRx penalties (and additional PQRI penalties) would be as follows:

Year	eRX Reduction	EHR Reduction	PQRI Reduction
2012	-1.0%
2013	-1.5%
2014	-2.0%
2015	-2.0%	-1.0%	-1.5%
2016	-2.0%	-2.0%	-2.0%
2017	-2.0%	-3.0%	-2.0%
2018	-2.0%	up to 5%	-2.0%
2019	-2.0%	up to 5%	-2.0%

Much like the EHR Meaningful Use program, the eRX program requires reporting certain measures to CMS to prove that you are successfully utilizing an e-prescribing application. These measures can be reported via claims data or through a registry. Although the eRx penalties do not start until 2012, they will be based on whether or not the provider successfully participated during the first six months of 2011. However, CMS only requires that providers report on 10 encounters for the six-month period and 25 for the year. This would also qualify them for the 1% bonus in 2011.

According to Rosemarie Nelson, an MGMA consultant, a small practice can set up a stand alone eRx system for around $3,000. With MGMA estimates of annual prescribing costs at about $15,000 per provider per year, it would allow the practice to quickly recoup the initial cost of e-prescribing.