Medicare E-Prescribing Exemptions Are Expanding

On May 26th, CMS released a proposed rule that would give physicians another way to avoid a 1% cut in Medicare payments in 2012 if they have failed to complete at least 10 paperless drug orders using an e-prescribing system in the first half of 2011.

While the original E-prescribing rule made exemptions for rural physicians with limited Internet access or doctors in areas with few pharmacies accepting electronic prescriptions (and only if the exemption was claimed before June 30, 2011), the proposed rule includes recognizing the following hardships:

• Physicians who have limited prescribing activity
• Physicians who have delayed purchasing an e-prescribing system because they intend to participate in the Medicare electronic medical record incentive program in 2011
• Physicians who live in an area where regulations prevent e-prescribing, including prohibition of paperless orders for narcotics
• Physicians who e-prescribe, but only for types of visits that do not count towards the 10-order minimum necessary to avoid the mandated reduction in Medicare payments

The CMS proposal  includes the plan to develop a website where physicians would report such hardships.  In addition to having multiple ways to register their hardship, the proposal would allow more time for physicians to indicate the reason(s) they were unable to e-prescribe, by setting a new deadline of October 1, 2011. Additionally, the proposed rule will make it easier for practices that already utilize certified EMRs to use those systems to satisfy the e-prescribing requirements.  

CMS is accepting public comments on this proposal until July 25th.  The entire proposed rule can be found here:   (www.ofr.gov/ofrupload/ofrdata/2011-13463_pi.pdf).

Administration Offers New Path for ACOs

The Centers for Medicare & Medicaid Services on Tuesday announced three new ideas to drive interest among healthcare providers for forming an accountable care organization.  The initiatives will be run by the newly created Center for Medicare and Medicaid Innovation, which is a byproduct of the Affordable Care Act.  

The new "Pioneer" ACO would allow existing integrated-care organizations that have already begun coordinating care for patients to pocket more of the expected savings an ACO offers.  The plan allows providers to move more rapidly from a shared savings payment model to a population-based payment model consistent with, but separate from the Medicare Shared Savings Program.  CMS estimates the Pioneer model could save Medicare up to $430 million over three years by better managing care and eliminating duplication. Organizations interested in applying to the Pioneer ACO Model must submit a letter of intent on or before June 10, 2011.  To apply, go to: http://innovations.cms.gov/wp-content/uploads/2011/05/Pioneer-ACO-Letter-of-Intent.pdf.  Applications must be received on or before July 18, 2011. 

For less mature health systems, CMS is considering an "Advance Payment" initiative that would provide additional up-front funding to providers to support the formation of new ACOs.  The program would test whether and how pre-paying providers could increase participation in the Medicare Shared Savings Progarm.  Providers would be expected to use the funds (an advance on the shared savings they are expecting) to make the infrastructure and staff investments crucial to successfully coordinating and improving care for patients.  The agency is requesting comments on this idea by June 17th. To comment, go to http://www.regulations.gov./

CMS has also announced free learning sessions on ACOs for providers interested in learning more about how to coordinate patient care through ACOs.  Four on-site learning sessions will be held in 2011.  The plenary session will be made available to all interested organizations through a web-cast and all materials from the sessions will be publicly available.  Individuals wishing to attend the June Accelerated Development Learning Session in person may register at https://acoregister.rti.org. Registration is on a first come, first served basis.


For additional information, go to: 
http://www.cms.gov/apps/media/press/release.asp?Counter=3957&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date

A Proposed Five Year Overhaul for Medicare

Three of the nation's largest physician groups told Congress on Thursday that Medicare needs to overhaul the way it pays for care.  The American Medical Association, along with the American Academy of Family Physicians and the American College of Surgeons testified before the House Energy and Commerce Health subpanel about proposals to replace the Sustainable Growth Rate (SGR) formula, which if left intact, will require a 29.5% cut to Medicare payment rates beginning on January 1, 2012.

Pointing out that the current formula "cannot pay for thought, analysis, deduction, discussion and persuasion and the value that comes from managing the care of the whole person, as well as the care that comes from avoiding unnecessary care" all three presenters advocated for repeal the SGR formula this year.

Each agreed that Congress should put in place a five-year transition period during which different payment models can be tested.  A new system that transitions to a new generation of payment models designed to reward physicians and hospitals for keeping patients healthy, managing chronic conditions in a way that avoids hospitalizations and delivering high quality care with efficient use of resources was one suggestion made to Congress.

Another was to create a system of separate service category growth rates that recognizes the unique nature of the various types of services that physicians provide to their patients, while allowing for increased payments for areas experience workforce shortages.  A third suggestion was to offer primary-care physicians a 2 percent higher payment update than others during the transition period.

Committee Chairman Fred Upton has previously indicated that the committee is committed to working together with physician organizations to implement a permanent, sustainable solution this year that lessens taxpayers’ burden and ensures providers have the resources they need to provide quality care to patients.