Streamlined prescription renewal process. Increased practic

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Orthopaedic Specific Open Door Forum

• Tuesday, May 19, 2009

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Agenda

• Overview of PQRI
• Overview of E-Prescribing Incentive Program
• Peer Experience with PQRI and E-Prescribing
• Question and Answers Session

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Open Door Forum Leaders

• Sylvia W. Publ, MBA, RHIA (CMS)
• Robert H. Haralson, III, MD, MBA (AAOS)
• Toya M. Sledd, MPH, MBA (AAOS)
• Barbara Sack, MHSA, CMPE (AAOE)

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E-Prescribing Incentive Program

• Authorized by MIPPA 2008
• Implemented January 1, 2009
• Separate from and is in addition to PQRI  
• Physicians can begin reporting for 2 bonus in
  2009 2010
• Report on one of three G-codes 50 of the time on
  Medicare Part B claims (We recommend reporting
  100)

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Benefits to Participating

• Alert for drug to drug, drug to allergy and other
  patient safety checks
• Streamlined prescription renewal process
• Increased practice efficiency

• Eliminate transcription or legibility errors
• Up-to-date medication list
• Convenience to the patient

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Challenges to Participating

• Financial Cost and Return on Investment (ROI)
• Modifying Practice Workflow
• Prescribing Controlled Substances
• Hardware and Software Selection
• Pharmacy, Payer/PBM and Mail Order Connectivity

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E-Prescribing Incentive Payments

• Incentive payments are based on all Part B
  allowed charges.

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Revenue Generating

• How much can a practice earn?
• 300,000.00 (Net Medicare revenue earned)
• X 2.0 (2009 E-Rx Reporting)
• 6,000.00 (Potential Payment for
• reporting)
• This does not include the additional 2.0
  incentive payment if you participate in PQRI.

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How Can You Participate?

• No registration required
• Qualified E-Prescribing System
• At least 10 of total Medicare Part B payments
  come from a list of office based codes
  (denominator codes).
• Report at least 50 of the time during these
  eligible patient encounters using one of three
  G-codes (numerator codes)

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Qualified E-Prescribing System

• Generate a complete active medication list
• Allow physician to select medications, print
  prescriptions, transmit prescriptions
  electronically
• Provide information on lower cost,
  therapeutically appropriate alternatives (if
  available)
• Provide information on formulary medications,
  patient eligibility and authorization
  requirements (if available)
• Must comply with all Part D specifications

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Office Based Codes (Denominator Codes)
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G-Codes (Numerator Codes)

• G8443 - ALL prescriptions created during the
  encounter were generated using a qualified
  e-prescribing system.
• G8445 - NO prescriptions were generated during
  the encounter, but the eligible professional has
  access to a qualified e-prescribing system.
• G8446 - SOME or ALL the prescriptions generated
  during the encounter were printed or phoned in
  because of state or federal law or regulation or
  patient request, because the pharmacy system was
  unable to receive the electronic transmission, or
  because the physician prescribed a narcotic or
  other controlled substance to the patient.

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Determining Percentage of Total Medicare Charges

• Eligibility Calculation
• Charges from Codes in the eRx measure
  denominator  X 100  () of Total Medicare
  Charges
• Total Medical Part B Allowed Charges
• Example
• Charges from Codes in the eRx measure
  denominator (office based codes) 186,663
• Total Medical Part B Allowed Charges 797,705
• 186,663  X 100 23.4 
• 797,705
• The Medicare Part B charges for the codes in the
  denominator of the measure makes up 23.4 of your
  total Medicare Part B allowed charges, which
  means that physician is eligible and can
  participate.

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What About Prescribing for Controlled Substances?

• DEA has authority through the Controlled
  Substances Act over e-prescribing of controlled
  substances, and currently does not allow it.
• Physicians can still report on the e-prescribing
  quality measure by using G-code, G8446.

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E-Prescribing Scenario 1

• A 66-year old male presents to Dr. Bones's office
  for medical care

Returning Patient (99213) Patient has swelling
in the left knee. Dr. Bones discuss current
medications and e-prescribes anti-inflammatory
medication. Dr. Bones Reports G8443
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E-Prescribing Scenario 2

• A 28-year old male presents to Dr. Bones's office
  for medical care

New Patient Encounter (99203) Patient has a
sprain in right wrist, no fractures. Dr. Bones
advise Patient to put ice on wrist and take
Tylenol (Acetaminophen). No Rx generated. Dr.
Bones Reports G8445
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E-Prescribing Scenario 3

• A 51-year old female presents to Dr. Bones's
  office for medical care

Returning Patient with new problem
(99214) Patient complains of persistent pain and
inflammation in the left hip. Dr. Bones
e-prescribes an anti-inflammatory medication and
provides a written prescription at the request of
the patient for pain medication. Dr. Bones
Reports G8446
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How To Report on Your Claim
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What Happens If You Dont Participate?

• Physicians can expect to see these reductions in
  their total allowed Medicare Part B charges.

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Available Resources

• AAOS (www.aaos.org/research/committee/evidence/qua
  lityinitiatives.asp)
• CMS Website (http//www.cms.hhs.gov/ERXincentive)
  and (http//www.cms.hhs.gov/pqri/)
• AMA E-Prescribing Learning Center
• (http//www.ama-assn.org/ama/pub/erx/home.sh
  tml)
• Get Connected (www.getrxconnected.org)
• National ePrescribing Patient Safety Initiative
  (http//www.nationalerx.com/)
• SureScripts (http//www.surescripts.com/certified)
  
• CCHIT (http//www.cchit.org/)

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Important Contacts

• Toya M. Sledd, MPH, MBA
• Clinical Quality Improvement Coordinator, AAOS
• sledd_at_aaos.org
• Robert H. Haralson, III, MD, MBA
• Medical Director, AAOS
• haralson_at_aaos.org
• Barbara Sack, MHSA, CMPE
• Executive Director, Midwest Orthopaedics, PA
• bsack_at_midwest-orthopaedics.com

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Thank You! Questions?