Several weeks ago we authored a blog entitled, “The eRx Incentive Program – A lot of stick not too much carrot”. The essence of the blog was that the Medicare eRx, “quality initiative was poorly aligned with other government programs, especially ones that are intentioned to reward early adopters of EHR technologies.”

Let’s recap the government eRx program – from our prior blog

The eRx program for 2011 will pay a meager 1% of their Medicare Part B PFS covered professional services. Contrast that amount with the EHR incentive program, up to $18,000, and it is clear that providers should be focused on the EHR incentives and not the eRx program.

Incentives and Penalties for the eRx Program by Year
Year Incentive Penalty
2011 1% 0%
2012 1% -1%
2013 0.5% -1.5%
2014 +0% 2%
  1. The government sponsors an eRx incentive program (1% in 2011)
  2. The government sponsors an EHR incentive program (up to 18k in 2011)
  3. If you are in the EHR program you cannot qualify for the eRx incentive
  4. Meaningful Use EHR users can be penalized 1% in 2012 even if they e-prescribe with their certified EHR

If you planned on targeting the EHR incentive program, you still could have been penalized in the eRx program, even though the Government Meaningful Use EHR program included similar, if not stricter, e-prescribing regulations when compared to the less comprehensive eRx incentive program.

The government offered a “work around” for EHR users – who just had to remember to include special G-codes on at least 10 claims and avoid the 2012 penalty related to the eRx incentive program. Busy work, silly and time-consuming, and certainly not aligned with the government’s ultimate interest, which is accelerated adoption of comprehensive EHR products.

MediTouch® responded quickly and installed a tool that, with a single click per encounter, assisted providers in passing the proper G-code to Medicare, so they could avoid the 2012 eRx penalty.

Now that the mad rush to add G-codes to at least 10 claims is over (the January – June 2011 deadline), the government has finally seen the light of day. They have proposed a new rule, we expect will be officially adopted sometime this summer, which offers certain “waivers” to the current eRx bill. Guess what? – the policy makers back in Washington figured out what every doctor and medical association knew many months ago: the eRx incentive rule needed a dose of adjustment, especially with regard to alignment with the Meaningful Use EHR incentive.

Now with the new eRx rule, G-code or no G-code, meaningful users of EHR technology won’t be penalized by the eRx incentive program in 2012. That’s great, but way too late. The government’s relationship with the physician community is tenuous at best; let’s face it most docs do not trust the Medicare program and they are skeptical of all government programs. It took at least a year for Medicare to cure the mal-alignment between the eRx and Meaningful Use incentive programs. In the meantime it cost the government credibility, and it was expensive for providers that were trying to avoid 2012 Medicare payment penalties, because every one of those docs had to train their billing staff to add the G-codes. Now that those providers who are tracking for Meaningful Use have added those codes, they have quickly come to the realization that the entire process was an exercise in futility.

In a recent article on the front page of the AMA News, government officials have promised to do a better job of re-examining regulations that are burdensome and costly to the provider community. The AMA News reported that:

“An initial review of the rules has determined that some regulations appear to be redundant and unhelpful,” said Jack Lew, director of the White House Office of Management and Budget. “It will be asked if some of these actually benefit patients or are they a matter of bureaucratic, anachronistic rules,” Lew said.


In addition, the AMA News reported that Medicare is looking at the following potentially burdensome rules. They include:

  • Requirements to provide translators for Medicare and Medicaid patients with hearing impairments or limited English proficiency.
  • Misaligned incentive programs, such as EMR meaningful use and the physician quality reporting system.
  • Overlapping claims reviews by auditors, such as Medicare administrative contractors and recovery audit contractors.
  • Various Medicare documentation requirements.
  • The prohibition on the use of Medicare consultation codes.
  • Burdensome Medicare enrollment requirements.

The government needs to act quickly on aligning incentives and cutting through red tape as it relates to providing regulatory relief for providers. We are at the early stage of EHR adoption, and widespread EHR adoption is key to saving the Medicare program (I want to get my benefit someday). Building trust with the physician community is essential to accelerating EHR adoption, and embracing EHR technology is essential to saving money and more importantly, lives. Let’s hope this eRx issue was just a small bump on the road to EHR adoption, and not the large pothole it appeared to be just a few weeks ago.

Our team has worked diligently with providers in an attempt to build trust in the Meaningful Use program in order to facilitate EHR adoption, and these types of bureaucratic mistakes are, at the very least, counter-productive for all constituents of the healthcare delivery system. The fact that MediTouch® users have started to bank their Meaningful Use incentive dollars has worked wonders to reinforce what our team has been proclaiming for months – the government is ready and willing to make good on their Meaningful Use EHR promises.