Orthopaedic Specific Open Door Forum

Tuesday, May 19, 2009

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)

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 (We recommend reporting 100%)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

Calendar Year Incentive amount2009-2010 2.0%2011-2012 1.0%2013 0.5%2014 and beyond 0%

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

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Revenue GeneratingHow 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 listGenerate a complete active medication list

• Allow physician to select medications, print prescriptions, Allow physician to select medications, print prescriptions, transmit prescriptions electronicallytransmit prescriptions electronically

• Provide information on lower cost, therapeutically Provide information on lower cost, therapeutically appropriate alternatives (if available)appropriate alternatives (if available)

• Provide information on formulary medications, patient Provide information on formulary medications, patient eligibility and authorization requirements (if available)eligibility and authorization requirements (if available)

• Must comply with all Part D specificationsMust comply with all Part D specifications

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Office Based Codes (Denominator Codes)

Service/Procedure CPT/HCPCS Code

New Patient 99201, 99202, 99203, 99204, 99205

Established Patient 99211, 99212, 99213, 99214, 99215

Consultations 99241, 99242, 99243, 99244, 99245

Screening and Diabetic Training G0101, G0108, G0109

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G-Codes (Numerator Codes)

• G8443 - ALL prescriptions created during the encounter were generated - ALL prescriptions created during the encounter were generated using a qualified e-prescribing system. using a qualified e-prescribing system.

• G8445 - NO prescriptions were generated during the encounter, but the - NO prescriptions were generated during the encounter, but the eligible professional has access to a qualified e-prescribing system. eligible professional has access to a qualified e-prescribing system.

• G8446 - SOME or ALL the prescriptions generated during the encounter - SOME or ALL the prescriptions generated during the encounter were printed or phoned in because of state or federal law or regulation or 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 patient request, because the pharmacy system was unable to receive the electronic transmission, or because the physician prescribed a narcotic or electronic transmission, or because the physician prescribed a narcotic or other controlled substance to the patient. 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 ChargesTotal 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 DEA has authority through the Controlled Substances Act over e-prescribing of Substances Act over e-prescribing of controlled substances, and currently does not controlled substances, and currently does not allow it. allow it.

• Physicians can still report on the e-prescribing Physicians can still report on the e-prescribing quality measure by using G-code, G8446.quality measure by using G-code, G8446.

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E-Prescribing Scenario #1A 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 #2A 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 #3A 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 Don’t Participate?

Calendar Year Penalty2012 -1.0%2013 -1.5%2014 and beyond -2.0%

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

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Available Resources• AAOS (www.aaos.org/research/committee/evidence/qualityinitiatives.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.shtml)

• 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, AAOSsledd@aaos.org

• Robert H. Haralson, III, MD, MBAMedical Director, AAOSharalson@aaos.org

• Barbara Sack, MHSA, CMPEExecutive Director, Midwest Orthopaedics, PAbsack@midwest-orthopaedics.com

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Thank You! Questions?

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