e-Prescribing is Here!

February 17, 2010 in Health Care "Reform", Health Policy by RangelMD

I sent my first e-Prescriptions yesterday. I sent them to a local pharmacy using my trusty PracticeFusion EMR and it was very good. E-Prescribing is important as this not only partly automates medication prescribing but it also makes it much more efficient by incorporating this technology into an electronic medical record system thus allowing for quick recall of the patient record, review of their medications, and approve, sending, AND tracking of the e-prescriptions.

Medication refills are often a major headache for any medical office, particularly for primary care practices and especially for those that still use paper charting (i.e. 20th and 19th century medical record keeping). This is because the medication refill process is a massive time sink for office staff. A phone call from a patient or a fax or letter is received from a pharmacy requesting authorization on one or more medication refills from patients who didn’t bother to get their refills when they were seen during a prior visit (or the doctor and/or staff were too rushed to ask or keep track of needed refills).

Somehow, in between all the duties of taking care of patients who are actually in the office to be seen, scheduling visit, checking test results, giving injections, and a million other tasks, the staff must find time to pull the patient’s paper chart, review their medications, get the doctor to authorize/sign the refills, fax the refill over to the pharmacy and wait for the confirmation fax and then file it in the patient’s chart and return the chart to the racks and/or call the patient back to confirm that the refill has been done or even call the pharmacy and wait on hold for 30 minutes if required or requested.

Minimum time per medication refill has to be anywhere from 10 to 30 minutes and our office regularly gets 40 or more requests for refills each day!  You do the math. And neither Medicare/Medicaid nor any private insurances pay for all this extra work. I suppose a busy practice can hire a staff member just to manage refills and other patient calls but (yet again) this is another un-reimbursed overhead cost. Welcome to the primary care hell/treadmill.  Eventually, piles of refill requests just pile up and patients must wait days or longer for anything to happen.

I suppose that this process could be mitigated by a supper efficient staff and process overhaul. But why try and polish a turd? From patient phone call to finish, I literally spent no more than 2 minutes yesterday in front of my EMR doing my first e-Prescription and I had no idea what I was doing. The next time it will be even faster.

And beginning this year, CMS (Medicare/Medicaid) will be giving out bonuses of 2% to offices that start regularly using e-Prescribing! If anything, this will help off-set the 10% cut in reimbursements that CMS is forced to make every year by law (and needs a literal act of Congress to prevent). Of course, e-Prescribing very well may be required by CMS in the next few years and the bonus will turn into a penalty for those offices still in the 20th and 19th centuries.

Now if they can only come out with e-Prior Authorization, e-Medical Records Transfer, e-Timely and Proper Reimbursements, and e-Improved Primary Care Reimbursements.

Please share.