MED3OOO/Connection Newsletter - December 2008

Newsletter for Physicians and Clinical Staff

“Every Little Bit Helps"
by Paul McLeod, M.D., MED3OOO Chief Medical Executive
 
December is a very special time for those who celebrate the holiday season. It signals the end of another year of challenges and accomplishments, an opportunity for family time and reflection, a fitting transition to the New Year. Recent Decembers have also found physicians struggling with the uncertainty of Medicare fee schedules for the New Year. For the past several years, physicians have waited, the AMA has lobbied, and required eleventh hour stop gap legislation has been passed to prevent mandated cuts as a result of the flawed Sustainable Growth Rate Formula (SGRF). This year is slightly different. The final version of the 2009 Medicare Fee Schedule includes a 1.1% increase. The SGRF has not been replaced, but simply put on hold once again. 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. The 1.1% increase is not enough to make us want to go out and buy that new yacht, but at least it is not a decrease.

The interesting new twist this year is another potential 4% available to those who meet the requirements of two “bonus” initiatives. Physicians who e-prescribe can earn an additional 2% and those who meet Physician Quality Reporting Initiative (PQRI) can get another 2%. Suddenly, the available increase becomes 5.1%. Unlike in years past, however, the majority of this money is related to achieving quality measures.  The total number of PQRI quality measures will reach 153 with the addition of 52 new ones for 2009. Physicians who don't e-prescribe by 2012 will face penalties instead of bonuses. In order to qualify for the e-prescribing incentive bonus, physicians must have a system that:

• Communicates directly with the patient's pharmacy
• Provides decision support tools for choosing appropriate drugs
• Provides information on formulary and tiered formulary medications
• Generates alerts about possible adverse events, including drug-drug interactions

Software options to meet these criteria include stand alone products, as well as many EHRs. To report the e-prescribing measure, the eligible healthcare professional must report one of three G codes for each patient encounter:

1. The first to report that all prescriptions in connection with the visit billed were electronically prescribed;
2. The second G code when no prescriptions were generated during the visit; or
3. The third G code when some or all prescriptions were written or phoned in due to patient request, or to comply with state or federal law the pharmacy’s system could not receive the data electronically, or because the prescription was for a narcotic or other controlled substance.

From the paragraphs above, it is clear that “what” needs to be done is complex. A relevant question for the practicing physician is “how” to do it. The answer is systems. Electronic tracking of PQRI and electronic prescribing software become the only rational choice for those who target the additional 4%. Even more important is the message that other payers are moving in that direction. Where the government goes, the health plans will follow. This initiative is a rudimentary, interim step toward more “value based” compensation. Ultimately, patients and payers will look for outcome data to drive reimbursement. MED3OOO has products designed around these new bonuses. More importantly, we will continue to develop new products and services as the bonus parameters change toward patient satisfaction, morbidity, and functional outcomes.

The Clinical Advisory is a clinical publication from MED3OOO dedicated to informing physicians and clinical staff about tools and information to improve the quality of patient care.

Corporate Headquarters: MED3OOO, Inc., 680 Andersen Drive, Foster Plaza 10, Pittsburgh PA 15220. For more information on our clinical initiatives visit www.MED3000.com or contact Geoff Coleman at Geoff_Coleman@MED3000.com or 1-888-811-2411.