Medicare E-Prescribing Bonus Payment Program Due for 2009 Launch

Section 132 of the AOA-backed Medicare Improvements for Patients and Providers Act (MIPPA) of 2008 (H.R. 6331) authorizes the Centers for Medicare & Medicaid Services (CMS) to pay a bonus to physicians for successful electronic prescribing (e-prescribing) beginning in 2009. The American Optometric Association has provided e-prescribing educational materials to members and will supply more information - when it becomes available - about the requirements to receive a bonus payment.

CMS has not issued details about the implementation and requirements for the bonus program. CMS has scheduled a conference October 6-7 in Boston to educate physicians about the provision. Details about the conference and registration information are available here.

Recently, AOA partnered with the GetRXConnected program to assist members with implementing e-prescribing. See the Health Information Technology web page for guidance on e-prescribing, including a factsheet.

In 2009 and 2010, physicians who successfully e-prescribe may receive a bonus payment of 2 percent of their overall Medicare reimbursement much as physicians who successfully report measures (one of which addresses e-prescribing) in the Physician Quality Reporting Initiative (PQRI) may receive a 1.5 percent bonus in 2007 and 2008. The PQRI bonus for 2009 has been increased to 2 percent. Optometrists may earn both bonuses by successfully e-prescribing and reporting other PQRI measures. To learn more about PQRI please visit the AOA PQRI page.

In 2011, however, the reward for e-prescribing will begin to phase out, while a penalty for not e-prescribing begins in 2012. The e-prescribing bonus payment will be 1 percent in 2011 and 2012, and 0.5 percent in 2013. The penalty for not e-prescribing will be a reduction in Medicare reimbursement by 1 percent in 2012, 1.5 percent in 2013, and 2 percent in 2014.

Doctors who e-prescribe infrequently or who can demonstrate a hardship adopting e-prescribing might not be eligible for the bonus payments or penalties.

According to CMS, Medicare beneficiaries experience as many as 530,000 adverse drug events every year due in part to negative interactions with other medication or lack of information about a patient's medical history. The e-prescribing initiative has been predicted to save Medicare $156 million by avoiding adverse drug events.

Congress already requires Part D drug plans to support e-prescribing and CMS has developed four e-prescribing standards: formulary and benefits, medication history, fill status, and National Provider Identifier (NPI). See http://www.cms.hhs.gov/EPrescribing

CMS has also included an e-prescribing measure to be voluntarily reported in PQRI in 2008. To qualify to report PQRI Measure 125, the provider's e-prescribing system must generate a complete active medication list, select medications, print prescriptions, electronically transmit prescriptions, and conduct safety checks. It must also provide information about the availability of lower cost therapeutically appropriate alternatives (if any), formulary or tiered formulary medications, patient eligibility, and authorization requirements. See http://www.cms.hhs.gov/pqri

The e-prescribing section is one of many provisions in MIPPA that will have an affect on optometrists serving Medicare beneficiaries (please see the July 31 Washington Office Report for more information).

AOA members with questions concerning the Medicare e-prescribing bonus program can contact Rodney Peele, AOA Assistant Director for Regulatory Policy and Outreach at rpeele@aoa.org or 1-800-365-2219 ext. 1348.