Congress scramble to put together a Medicare bill that includes a rollback of cuts to physician reimbursement and other provider desires got a little more complicated last week when lawmakers threw an electronic-prescribing measure into the mix.
While its uncertain what will be in the final bill, which Senate Finance Committee Chairman Max Baucus (D-Mont.) says wont be finished until after the Senates Memorial Day recess from May 23 to June 2, its likely that some sort of e-prescribing mandate will remain in the legislation, based on Baucus long-time interest in health IT, plus additional pressuring from the Bush administration to include such a measure.
Its inevitable that Medicare will eventually link payments to e-prescribing, HHS Secretary Mike Leavitt said at a symposium last week. I believe that very soon were going to have to tell participating Medicare providers that if they intend to use a system other than e-prescribing, we wont be able to compensate them at the highest level, he said.
Substantial support for e-prescribing exists in both parties in Congress, Leavitt said.
His push for e-prescribing is indicative of a larger health IT agenda within HHS to improve patient safety. Just last week, he and other HHS officials launched a series of initiatives to advance patient care through IT channels, making Part D claims available to federal agencies and academic researchers so they can better track adverse drug events. In particular, the FDA will be using the claims data to pilot test its Sentinel Initiative, a new electronic system that will enable the agency to query a vast array of health information databases to more effectively identify post-market adverse events.
We are moving from reactive dependence on voluntary reporting of safety concerns to proactive surveillance of medical products on the market, Leavitt said.
If an e-prescribing mandate ever does become law, however, some physicians would not likely be happy about it. Certain industry groups such as the Pharmaceutical Care Management Association have been pushing for a mandate, but medical groups want industrywide e-prescribing standardsand some incentives for physicians to adopt the technologyin place first before such a mandate takes effect.
Clinical information technology, which includes e-prescribing, is a useful tool to improve quality of care, said Glen Stream, medical director for clinical information services with the Rockwood Clinic, a multispecialty group in Spokane, Wash.
The concern physicians have is Congress wants to make e-prescribing mandatory, but theyre not providing any funds for physicians to operate these e-prescribing measures, Stream said. Another problem with this plan is theres no mandate for the pharmacies to be prepared to receive e-prescribing or communicate electronically with physicians, he said.
Even if the system is free, theres significant costs to a physician practice to train staff to use the system, Stream said. And while its possible to have a free-standing e-prescribing component, this tool works more efficiently in combination with an electronic health record, he said.
E-prescribing may be one of the few provisions that survive in a bill that has yet to be formally introduced, and has been delayed by partisan infighting among Senate Finance Committee members over how to pay for the bill, whose price tag could go up to $20 billion.
At deadline, it appeared that Republicans and Democrats on the Senate Finance Committee were proceeding with their own separate bills.
Republican Senate sources said the GOP had presented Baucus with a good-faith offer that included $10 billion in Medicare Advantage cuts ($30 billion over 10 years) and about $3 billion in beneficiary improvements, in addition to provisions to crack down on marketing abuses in Medicare Advantage. The Bush administration, however, has made it clear it doesnt want to use Medicare Advantage as the bills chief financial vehicle.
Despite that offer, Baucus in a statement last week announced that bipartisan negotiations had broken down, and in the interest of time, he would be spending Memorial Day recess crafting legislation with his Democratic colleagues to issue another physician pay fix before the July 1 cut goes into effect.
Its understandable that the chairman is moving forward on his own proposal but its also disappointing that there is not yet a bipartisan plan, Sen. Chuck Grassley (R-Iowa), the finance panels ranking member, said in response to Baucus plan to proceed without the GOP.