The American Health Information Community followed up on its initial recommendation last month with an amended request that HHS Secretary Mike Leavitt ask Congress for a legislative mandate to require physicians, pharmacies, pharmacy benefit managers and other payers to use electronic-prescribing technology.
A copy of the latest "revised" version of the recommendations from AHIC, the healthcare information technology advisory panel created by Leavitt in 2005, was posted on the HHS Web site on Tuesday.
An initial recommendation that e-prescribing be mandated for providers seeking reimbursement under Medicare was made Nov. 13 when AHIC met in Chicago during the American Medical Informatics Association annual convention.
It came after a show of frustration by AHIC member Craig Barrett, the chairman of the board of Intel Corp., which is one of the largest manufacturers of computer chips, who gestured toward acting CMS Administrator Kerry Weems and said, "You have the purchasing power. You have the control to say, these are the standards; you won't be reimbursed unless you do it this way. In the business world, this would have been a done deal 17 meetings ago. Slam dunk. Get on with it."
The AHIC vote was unanimous. Yet, the recommendation has been followed by a flurry of recent administrative and legislative efforts that point to just how hard it is to run a business that has hundreds of thousands of physicians as vendors and a procurement process that often requires majority approval by 100 senators and 435 representatives.
On Monday, Leavitt issued a statement urging Congress to add a requirement to the annual "must pass" legislative fix to the flawed Medicare Part B physician payment formula. Leavitt asked that physicians be required to adopt unspecified healthcare IT systems—not merely e-prescribing systems—to remain eligible for Medicare reimbursement.
If left unchanged, an automatic adjustment to the Part B formula would cut physician payments in 2008 by 10.1%, according to Robert Tennant, a senior policy adviser to the Medical Group Management Association. So the Leavitt plan sparked protests from the MGMA and other physician groups who saw fixing the troubled formula as a top legislative priority and any bill to address it should not be encumbered by other issues.
Wednesday, U.S. Sens. John Kerry (D-Mass.), Debbie Stabenow (D-Mich.) and John Ensign (R-Nev.) held a news conference to ballyhoo a separate piece of legislation, the Medicare Electronic Medication and Safety Protection (E-MEDS) Act of 2007, a bill they've sponsored to support e-prescribing. The Senate Judiciary Committee also scheduled hearings Wednesday on the Drug Enforcement Agency policies toward e-prescribing.
In the AHIC's revised recommendations, the panel first called for Leavitt to seek authority from Congress "to mandate e-prescribing pursuant to standards defined by the Medicare Modernization Act." The AHIC recommendations extend beyond physicians to include mandated participation by "all pharmacies and pharmacy benefit managers." The three-page document said that while pharmacies currently are not considered Part B providers and their participation under the MMA is considered voluntary, language should be included to make it mandatory. AHIC also noted that 30% of outpatient pharmacies are not enabled for e-prescribing. It also calls for requiring electronic transmission of the 11% of prescriptions that are for controlled substances, which would require lifting DEA rules that preclude electronic prescriptions for those drugs.
The AHIC recommendation said Leavitt's authority "should be specific to e-prescribing and not extend to other healthcare processes," which would seem to leave a mandate for electronic health-record systems out of the picture.
And yet, AHIC also recommends as a pre-condition to mandating e-prescribing that the federally supported Certification Commission for Healthcare Information Technology "should develop a certification process for e-prescribing systems that are: interoperable with certified EHRs; include clinical decision supports to improve safety, efficacy and efficiency; and can be extended to integrate with fully functional EHR systems, thus assuring that the e-prescribing investment is a step towards adoption of certified EHRs." The AHIC missive said that free-standing, noninteroperable e-prescribing systems "cannot take advantage of the full set of clinical information necessary to provide patient-specific decision support and will likely become replaced investments as the importance of the criteria for interoperability, extensibility and patient-safety features are recognized."
Further, the AHIC recommendations call for the CMS to launch incentive programs for both physician and pharmacy adoption of certified EHR or e-prescribing systems in early 2008 before the e-prescribing mandate is exercised.
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