Sunday, February 8, 2009

Evaluating Medical Records: "patientkeeper" (2)

By federal law [Medicare Improvements for Patients and Providers Act (MIPPA)], starting 1/1/09, pysicians writing prescriptions for their Medicare patients can increase their reimbursement by 2%, for the next 2 years. In 2011, this gets reduced to 1%. In 2012, it is 0%. In 2013, it is -1%. In 2014, it is -2%. This was meant to be an incentive to use "e-prescriptions" followed by a disincentive for those who resist change. It sounds wonderful and the idea does have advantages. However, every coin has two sides. I'll cover some of the disadvantages later.

Imagine that at your doctor visits, your physician could use his electronic medical record (EMR) to produce and send a prescription to the pharmacies of your choice. Furthermore, he or she would be able right there to tell you if the prescription is covered on your insurances' drug plan. You'd still have to wait at the pharmacy for them to fill the prescription, but at least you know it got there.

Reality checks: 1) A lot of patients change their minds as to which pharmacy they want to use, which means more phone calls and that the prescriptions would have to be re-sent; 2) MIPPA only applies to regular Medicare, not HMO Medicare nor any other insurance company; 3) the cost of the computers and software are to be borne by the physician's office. They are ongoing, by contract; 4) So when would be the break even point be? Assume that reimbursements remain level, not decline as has been debated in Congress. What percent of the practice is regular Medicare? How much in the end does this extra reimbursement come to? 5) What percent of insurances have their formularies online and accessible for an e-prescription program like this? 6) Is the program certified by Medicare for this program?

In summary, the idea sounds good and simple, but in reality, there are many problems and hidden costs. That's it for this post. I'll be reporting my evaluation of an e-prescribing program soon. I've got to careful. I've received some pointed and foul-worded comments from at least one person who takes strong issue with my comments.

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