ODs net $2 million in Medicare eRx incentives

May 24, 2012

The Medicare Electronic-Prescribing (eRx) Incentive Program issued bonus payments totaling $2,304,808.70 to optometrists during its second year, according to the U.S. Centers for Medicare & Medicaid Services (CMS).

Optometrists who qualified for payments through the program during 2010 received an average of $2,462.40.

Incentive payments to optometrists ranged from $96.99 to $23,277.04. The mean payment was $1,859.56.

In all, some 936 optometrists earned eRx bonuses during the program’s second year.

The Medicare eRx Incentive Program offers bonus payments to health care practitioners who issue pharmaceutical prescriptions electronically at least 25 times over the course of a calendar year and report their e-prescribing through special registries or on Medicare claims using a special billing code (G8553).

Medicare e-prescribing bonus payments are based on a percentage of the practitioner’s total Medicare allowed charges for the year. The eRx bonus for 2010, as during 2009, was set at 2 percent.

To participate in the program, a practitioner must install an eRx software system certified for use in the program.

The system can be freestanding or part of an electronic health records package. Practitioners are not required to register for the program.

About one in every 10 (9.9 percent) of the 31,106 optometrists who saw Medicare patients during 2010 – some 3,084 practitioners – took part in the Medicare eRx incentive program by submitting the eRx billing code at least once during the year.

That was about the same rate of participation as during the program’s first year.

However, only about a third (30.4 percent) of the optometrists who took part in the eRx incentive program during 2010 qualified for bonuses, compared with 56.3 percent (1,562 practitioners) during the first year of the program.

The CMS’ 2010 Experience Report for the PQRS and eRx programs, released last month, does not specifically explain why.

However the report shows that the average eRx bonus issued for an optometrist nearly doubled to $2,462.40 in 2010 from $1,265.87 in 2009, and total payments to optometrists increased more than $300,000 to $2,304,808.70 in 2010 from $1,973,493.

That suggests a smaller number of optometric practices with large Medicare patient bases were more successful in pursuing eRx bonuses during the program’s second year, according to the AOA Health Information Technology (HIT) Subcommittee.

Optometrists are exempt from Medicare payment reductions that will be imposed beginning this year on practitioners who fail to e-prescribe, the AOA Advocacy Group notes.

Nevertheless, AOA HIT Subcommittee Chair Philip Gross, O.D., believes virtually all optometric practices should be e-prescribing and pursuing bonuses through either the Medicare eRx incentive program or federal EHR incentive programs.

The typical optometrist who sees Medicare patients could qualify for a bonus of $609 by meeting the eRx program criteria, according to the CMS reports.

“E-prescribing is an excellent way to introduce digital health information technology in a practice,” Dr. Gross said. “Electronic prescribing is required as part of the ‘meaningful use’ criteria that must be met to qualify for the very substantial payments that can be obtained through the Medicare EHR Incentive Program.”

“More importantly, electronic prescribing will be increasingly expected of all health care practices over the coming years. Optometric practices must e-prescribe to remain an integral part of the nation’s health care system,” Dr. Gross said.

While optometrists have in many respects been early leaders in e-prescribing (ranking sixth in the number of participating practitioners during the first year of the Medicare eRx program) other health care professions are rapidly adopting the technology.

Across all health care professions who serve Medicare patients, 16.2 percent of practitioners took part in the eRx incentive program in 2010. Among ophthalmologists, the participation rate was 33 percent.

As part of its “Navigating Meaningful Use, Quality Reporting, and e-Prescribing with Electronic Health Records (EHRs)” continuing education program, the AOA HIT Subcommittee will offer its “Physician Quality Reporting System (PQRS) and e-Prescribing Made Easy” course at Optometry’s Meeting® and about 20 state optometric association meetings this year to help optometrists implement e-prescribing in their practices.

“Physician Quality Reporting System (PQRS) and e-Prescribing Made Easy” explains how EHR systems can facilitate participation on the Medicare PQRS or other quality reporting programs.

The CMS complete PQRS/eRx 2010 Experience Report can be accessed online at http://tinyurl.com/cngnxnp.

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