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Newsletter Article


E-Prescribing, Quality Reporting Could Boost Docs Medicare Pay

By Mary Agnes Carey, CQ HealthBeat Associate Editor

October 31, 2008 -- Physicians can increase their Medicare reimbursements by an additional 4 percent next year if they prescribe drugs electronically and participate in a quality reporting initiative.

The Centers for Medicare and Medicaid Services said late Thursday that physicians who adopt and use qualified "e-prescribing" systems to electronically transmit prescriptions to pharmacies may earn an extra 2 percent in Medicare payments. Physicians who report on quality measures as part of the Physician Quality Reporting Initiative (PQRI) will receive an additional 2 percent, CMS said. All Medicare physicians are scheduled to receive a 1.1 percent payment increase next year, so doctors who participate in both the e-prescribing and PQRI programs could receive up to a 5.1 percent payment increase in 2009.

Proponents of electronic prescribing and measuring the quality of health care services say those steps are critical to improving patient care and lowering its cost. "The Institute of Medicine says more than 1.5 million Americans are injured every year by drug errors. E-prescribing lets providers know—up front—their patients' medication history and the risk of dangerous infections," acting CMS administrator Kerry Weems said in a news release.

In a statement, American Medical Association President-Elect J. James Rohack said the Medicare physician payment rule "confirms that physicians caring for seniors would have faced a harsh payment cut of 15.1 percent next year if Congress had not stepped in to replace the looming cut with a payment increase." Legislation (PL 110-275) to stop that payment cut became law in July.

Rohack also said the group is "reviewing the 1,500-page rule now to determine how it addresses AMA concerns with proposals that would exacerbate already significant administrative hassles that take physicians away from patient care."

Separately Thursday CMS issued a final rule implementing several new payment changes to the Medicare program that were also included in the Medicare legislation.

In addition to the physician payment update, the rule expands the type of services included in the initial physical Medicare beneficiaries receive when they join the program and it increases ground ambulance service payments. Changes to the way Medicare pays for oxygen services drew the ire of the American Association for Homecare, which called the new regulations "alarming and wholly inadequate."

The rule implements provisions of the Medicare bill that require an oxygen supplier that furnishes oxygen equipment during the 36-month rental period to continue to furnish the equipment after the rental period ends for "any period of medical need for the remainder of the 'reasonable useful lifetime' of the equipment," according to CMS. The American Association for Homecare expressed concern that there is no payment for oxygen supplies required to keep the patient healthy and keep the equipment working properly once that 36-month cap becomes effective. The group also said that the rule includes "no recognition of costs associated with visiting patients who require episodes of unscheduled emergency services."

The CMS rule also implements language in the Medicare bill that requires accreditation of imaging providers in order to qualify for certain Medicare payments. The measure also requires a two-year program testing the use of physician-developed criteria to determine whether imaging services for various conditions are medically appropriate.

"These provisions...are important steps toward ensuring proper utilization of medical imaging services while preserving access to diagnostic and therapeutic imaging technologies," Maureen Zilly, director for government relations for the Medical Imaging & Technology Alliance, said in a statement.

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