The Academy spelled out its support of CMS' decision to add further significant hardship exemption categories to the agency's proposed changes to its electronic prescribing, or eRx, incentive program(www.regulations.gov) in a July 18 letter(3 page PDF) to CMS Administrator Donald Berwick, M.D. The agency needs to be realistic, however, when deciding how much time physicians will have to apply for the exemptions, said the AAFP.
AAFP Board Chair Lori Heim, M.D., of Vass, N.C., said the Academy appreciates CMS' recognition of the need for further hardship categories "as a way to further minimize the number of physicians and group practices that are inappropriately subjected to the 2012 electronic prescribing penalty."
But Heim took issue with CMS' suggestion that physicians could submit their hardship requests within five business days after the effective date of the final rule.
- The AAFP supports CMS' proposal for additional hardship waivers to protect physicians from penalties related to the agency's electronic prescribing incentive program.
- Physicians need a minimum of 30 days from the time the proposed rule is adopted to prepare and submit a waiver request.
- The Academy strongly agrees with CMS' recommendation that physicians who register to participate in the Medicare or Medicaid electronic health record incentive programs be exempted.
- CMS should encourage mail-order pharmacies to embrace electronic prescribing.
"The AAFP believes five business days is significantly too short a time frame," said Heim, calling it "unrealistic" to expect physicians to interpret the rule, make an informed decision and then apply online for hardship waivers that quickly.
Heim urged CMS to allow physicians a minimum of 30 business days to apply for hardship exemptions.
Heim made note of the additional proposed hardship categories, which include physicians who
- are unable to e-prescribe because of local, state or federal regulations;
- generally experience limited prescribing activity, or
- have insufficient opportunity to meet the eRx measure reporting requirements because they are not based in a typical practice setting that would trigger use of the required CPT codes.
In addition, the Academy strongly agreed with CMS' proposed hardship exemption for physicians who register to participate in the Medicare or Medicaid Electronic Health Record, or EHR, Incentive Programs and who adopt certified EHR technology no later than Oct. 1, 2011. Those programs were "not constructed to penalize physicians that attempt participation in 2012," said Heim.
In her letter, Heim also urged CMS to qualify the phrase "area with limited pharmacies" that is used in the agency's proposal. She pointed out that patients -- not their physicians -- select the pharmacy to which prescriptions will be sent. "This decision falls outside of the prescribing physician's control," said Heim.
In addition, "CMS should not impose any new administrative burdens that require a physician practice to manage or collect data on pharmacies used by their patients," she noted.
Moreover, Heim told Berwick, family physicians have reported to the Academy that some mail-order pharmacies do not accept electronic prescriptions, and she asked CMS to encourage such pharmacies to embrace the technology.