If only the wrath of Hurricane Isabel could be blamed for the delay of compromise on provider provisions in the congressional Medicare bill negotiations. Alas, it cannot.
Partisan standoffs over details in the prescription drug benefit package and the question of future competition between Medicare and private plans are the culprits pushing issues dear to physicians' hearts even further from resolution.
After two months of talks among staff, the only issues agreed to by the entire conference committee were some rural healthcare improvements, provision of a temporary drug discount card and an incomplete structure for electronic prescribing.
The House and Senate conferees, who last met Sept. 9, made no headway on critical language for the e-Rx plans. Whether health insurers "must" or "may" require prescriptions to be written and transmitted electronically was left for another day, as were details on who will develop the standard for electronic prescribing and by what deadline.
These are serious sticking points for the AMA, the American College of Physicians and about 50 other medical organizations who sent an Aug. 26 letter detailing their concerns to conference Chairman Rep. William Thomas (R-Calif.).
The physician associations recommend that the conferees reject language in the House bill that would mandate Medicare officials to establish electronic prescribing standards by Jan. 1, 2006, and instead accept modified Senate language, which would allow physicians to choose whether to adopt such technology.
Medical Group Management Association lobbyist Paul Speidell summarizes the core complaint. "MGMA recognizes the potential for improvements that e-prescribing technologies offer--patient safety and quality are clearly very important," Speidell says. "That said, forcing physician practices into mandatory e-prescribing programs in the very short timelines outlined is probably ill-advised. A voluntary approach that allows people to test programs and get up to speed is better."
Allan Weinstein, M.D., chairman and CEO of InstantDx, an electronic-prescription company based in Gaithersburg, Md., says the debate in Congress is succumbing to what he calls "myths" associated with computerized prescribing-namely that it is expensive and the technology is slow and untested.
For four years, with his product called OnCallData, Weinstein says doctors have been prescribing medications over any Internet-enabled device for $39.95 a month. He says the goal of electronic prescribing should be to get the doctor and pharmacist off the phone so they can save time, counsel patients and prevent potential medication errors.
Weinstein argues that this essential cause is diluted in the Medicare bill by the inclusion of provisions regarding medication history and formulary compliance that are supported by pharmaceutical benefits managers and health plans.
He agrees a total medical history, when it is available and complete, would be valuable and that formulary information could be added, but he says the "logical progression" would be to put electronic prescribing in place first.
"The greater good is for Congress to stay focused on what's right for patients," Weinstein says. "We don't want to take it to the point where the doctor loses control of decisionmaking, where he is not communicating his wishes to the pharmacy or the health plan is telling the doctor what to order."
ACP has laid out its own guiding principles for developing electronic prescribing standards that would ensure physician involvement. ACP President Munsey Wheby, M.D., says the group is part of several private-sector initiatives "to design, test and encourage the use of effective, patient-centered e-Rx technologies and systems."
Weinstein argues that e-Rx is uncomplicated and that efficient, secure systems already exist.
"We need to focus attention toward what we can do today and do well, which is send accurate prescriptions quickly and inexpensively to the pharmacy," he says.