There’s been a lot in the news as of late regarding the virtues of adding on-line Rx (prescription) capabilities to your electronic medical record. Sounds like a good idea, right? But what’s the reality adding on-line prescribing capabilities to your solo practice?
To answer that question I called my EMR vendor (Eclipsys) to get a bit more information. Granted, many of these programs are new. And there are (in theory) some advantages for both patient and doctor. For instance, if I write an Rx and submit it to the pharmacy, the Rx program at the pharmacy will cross reference the script with those approved medications on the patient’s insurance formulary. Also, the program will cross reference the medication that I am prescribing against the other medications that the patient is taking, picking up any cross reactions between medications. Sounds pretty effective, eh?
Now let’s take a step into my practice. Face to face time with patients is limited due to the need to see more patients. That’s simply a fact. As reimbursement drops, you need to see more folks/day to be able to meet the overhead. The light bill, salaries and the rent keep going up while reimbursement to providers keeps going down. So what happens if I add a new module to my daily routine?
First, when I submit a script to the pharmacy, the neat functions we just alluded to above take upwards of 60 seconds to process. The database that the script has to access is vast and just simply takes time to process. Now remember, here you’re asking the top producer in the office to sit and wait a minute. 30 patients a day with a script each? That’s a half hour a day. Is on-line Rx worth that? No can do.
Next is the cost. Eclipsys charges $495/year for the module to accomplish what we’ve described above. Now let me get this straight; I’m in solo practice aka small business. I can write a script on my EMR for free. That script is type and legible. And did I say, free? So if you were in small business, what choice would you make?
Don’t get me wrong, I’m for EMR. I’m a technophile at heart. But it’s going to be a cold day before I buy into on-line Rx.
Jeffrey A. Oster, DPM
Medical Director
Myfootshop.com
The healthcare IT legislation that is attached to the economic stimulus bill currently making its way through Congress will approve $41,000 per physician of incentive payments from Medicare, if you have an EHR (including e-prescribing) and submit quality data about the care that you are providing. I am sure you know about the other 2% reimbursement bonus from Medicare that started January 1st for physicians that e-prescribe.
I understand your concerns about becoming less productive. Would the e-prescribing component make prescription re-fills easier and make up for the lost time? $495 sounds pretty steep. I am sure you don’t want to switch EHR’s, but maybe you could point out that NEPSI would be free and leverage that to get a better rate.
Comment by John Smith — January 31, 2009 @ 10:12 am
Hi John,
What is it you do for a living? Also a doc?
Right, the PQRI initiative by Medicare. I heard it got off to a bumpy start the first year but that it’s much more functional now. My EMR did promote it as a means of increasing cash flow. My impression was that it was primarily primary care oriented. Are you participating in PQRI?
The 2% incentive from Medicare would have us at a break even point at about $25,000 in Medicare reimbursement. (2% x $25,000=$500) So anything above that would have us in the black. But then the % drops. It’s 2% x two years, 1% and then plummets actually become a 2% penalty by 2013 if you don’t use e-prescriptions.
Jeff
Comment by Jeffrey Oster, DPM — February 6, 2009 @ 7:47 am