Proposed Medicare Physician Pay Rule Would Amend eRx, EHR Incentive Programs

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The proposed 2010 Medicare Physician Fee Schedule rule released July 1 by the Centers for Medicare & Medicaid Services includes changes to two health information technology incentive programs that are associated with Medicare physician payments—electronic prescribing and electronic health records.

For 2012 through 2014, the proposed physician payment rule would maintain some changes CMS recently proposed for the 2011 Electronic Prescribing Incentive program that would expand exemptions to physicians so they would not incur penalties in 2012 (see previous article).

The proposed physician payment rule would also amend the electronic prescribing incentive program to:

• allow eligible professionals to use either a qualified electronic prescribing system or a certified EHR technology;

• adopt criteria for the 2012 and 2013 incentives that parallel those for the 2011 incentive, and criteria for the 2013 and 2014 payment adjustments that parallel those for the 2012 payment adjustment;

• modify the way the electronic prescribing measure is reported for purposes of the 2013 and 2014 payment adjustment by eliminating the requirement that the measure may only be reported during an instance indicated in the denominator of the electronic prescribing measure; and

• provide “significant hardship” exemption categories for professionals who practice in a rural area with limited high speed internet access, practice in an area with limited available pharmacies for electronic prescribing, are unable to electronically prescribe due to local, state, or federal law, or prescribe fewer than 100 prescriptions during a six-month, payment adjustment reporting period.

The June 1 proposed rule from CMS that would expand the exemptions for the e-prescribing incentive program came in response to suggestions that CMS expand the circumstances in which compliance would result in significant hardship, as well as provider requests to better align the e-prescribing incentive program with the Medicare and Medicaid electronic health record incentive programs.

The physician payment proposal is scheduled to be published in the July 19 Federal Register, and comments will be accepted until Aug. 30.

Clinical Quality Measurement Through CMS Portal

The proposed physician payment rule also outlined possible methods for the reporting of clinical quality measures in order to demonstrate “meaningful use” of certified electronic health record technology.

Eligible providers and hospitals now have the option to participate in a Physician Quality Reporting System—Medicare EHR Incentive Pilot. According to the proposed rule, providers could report CQMs through either of two methods—by using a Physician Quality Reporting System qualified EHR data submission vendor to submit calculated results from the EP's certified EHR to CMS on the EP's behalf or by submitting CQM data directly from a certified EHR to CMS via a secure portal.

CMS stated that for the Medicare EHR Incentive Program, beginning in the 2012 payment year, eligible professionals, eligible hospitals, and critical access hospitals are required to electronically submit clinical quality measure results as calculated by certified EHR technology.

CMS will accept comments on these proposals until Aug. 30, and plans to respond to them in a final rule by Nov. 1.

Telehealth for Smoking Cessation

In the proposed physician payment rule, CMS also proposed to expand the list of Medicare services that can be furnished through telehealth to include smoking cessation services.

Additionally, the rule would change the way additional services are added to the telehealth list that would focus on the clinical benefit of making the service available through telehealth.

According to the proposed rule, this change would affect services proposed for the telehealth list in 2013.

The proposed rule (docket CMS-1524-P) can be found at Fact sheets are available at and at