Pharmaceutical interests are moving ahead with a private-sector effort to supplant the stalled and controversial government plan to tag physicians and other drug prescribers with a national identification number.
"We expect to have an initial data file up by this summer," says Ben Loy, senior vice president of industry relations for National Health Information Network, a Fort Worth, Texas-based data processing firm that is developing and financing the ID project for the National Council for Prescription Drug Programs.
The NCPDP, based in Scottsdale, Ariz., creates data transmission standards for its members in the prescription drug industry.
With the HIPAA-mandated National Provider Identifier held up because Congress stopped funding it in 1999, NCPDP officials say they hope to create their own prescriber ID system. Called HCIdea, the system will assign ID numbers to at least 1.5 million U.S. individuals with prescribing authority, including physician assistants, nurse practitioners, dentists, optometrists and other nonphysicians.
NCPDP officials also say they may pursue a contract to build and maintain a substantial part of the NPI for HHS.
"There are obviously discussions going on," says Renee Branson, the NCPDP marketing director overseeing the project. She says the NCPDP is exploring the possibility of offering its database to the Centers for Medicare and Medicaid Services as a component of the NPI program. If CMS were to seek a private-sector contractor to maintain the NPI, as it now does for its Medicare Unique Physician Identification Number (UPIN), "we would take a look at it," Branson says.
CMS pays $1 million annually to National Heritage Insurance Co., a subsidiary of Plano, Texas-based EDS, for UPIN maintenance. Of that sum, the AMA receives $100,000 as a subcontractor for access to its Physician Masterfile, a CMS spokesperson says.
But Philip Scott, senior vice president for healthcare relations and development at the NCPDP, says a goal of the planned, not-for-profit ID venture is to generate revenue to hold down NCPDP membership dues, possibly precluding involvement with the government.
"We don't necessarily want it to become the NPI," Scott says. If that happened, the proprietary numbering would move to the public domain, "and then we're right back where we started, trying to look for another source of revenue," he says.
Scott would not discuss revenue projections for the prescriber ID plan.
HCIdea culminates a decade-long push by NCPDP members--whose ranks include drug companies, pharmacies and pharmacy benefits managers--to standardize prescriber identification.
The prescriber ID effort might prove lucrative to data miners and vastly improve the accuracy of physician detailing by drug companies, thus Loy says his firm should quickly recoup its $2 million loan to the NCPDP for the project. But practitioners, who would not be informed they've been tagged, will be rankled, some physician leaders say.
"The risk of abuse and improper use of that information is extremely high, and I would consider it akin to compromising the privacy of patients," says Pano Yeracaris, M.D., CMO of two community health centers in Dorchester, Mass. "It would be fantastic for me to have one number to use for all my insurance claims, but I think it should be done by a (government) agency."
Efforts by the NCPDP to create the database without physician knowledge could taint initiatives to broaden the use of electronic medical records and transactions, says Jack Lewin, M.D., CEO of the California Medical Association.
"Physicians don't want to read about something that's happening with their data without their knowledge," he says. "This kind of thing is what's preventing a lot of people from going digital."
Currently, drug firms "don't know whether I write a prescription or if one of smy two nurse practitioners writes it, and I don't want them to know," says Scott Yates, M.D., an internist, e-prescribing consultant and medical director of North Texas Medical Group in The Colony, Texas. "I don't want them marketing to my NPs and I don't want them marketing to my residents."
HCIdea and the NPI are meant to be more comprehensive than the UPIN, which excludes non-Medicare and non-Medicaid providers, government physicians, medical interns, residents and foreign physicians employed by other UPIN registrants.
A UPIN can be assigned to a practice rather than to an individual, and physicians in multiple practices may have more than one number. Also, prescriptions written by residents and physician extenders currently are linked to supervising physicians or practices. HCIdea will allow data miners to trace prescriptions directly to residents and interns.
"We're going after the midlevel practitioners," Branson confirms.
"We've had requests for groups and facilities, but right now we're trying to solve the members' problem of identifying who's writing prescriptions."