By Mary Mosquera

The Centers for Medicare and Medicaid  Services should reduce the duplicate requirements in its two programs that pay incentives to healthcare providers who use health information technology. It should also reconcile areas in the two programs that are similar but inconsistent to relieve some of the reporting burden for participating physicians, according to the Government Accountability Office.

CMS administers two programs, for electronic prescribing and electronic health records, which pay incentives to eligible Medicare providers who adopt and use health IT, and imposes penalties on those who do not use the digital tools after several years.

In 2009, the first year the e-prescribing program disbursed incentive payments, CMS paid out $148 million to about 8 percent of the about 600,000 Medicare providers who were eligible. From 2012 through 2014, CMS will decrease the amount of payments for claims to providers who do not establish e-prescribing, said GAO in a report published Feb. 17.

CMS will start paying incentives under the EHR program to qualifying Medicare providers this year.

Although GAO found similarities in the technology and reporting requirements for both programs, the auditor said that the requirements of the two programs are inconsistent in several areas.

The EHR program provides incentives from 2011 to 2016 and introduces penalties beginning in 2015, while the e-prescribing program provides incentives from 2009 to 2013 and provides for penalties from 2012 to 2014, when the program ends. Both programs require providers to adopt and use technology that can perform similar electronic prescribing-related activities.

However, the EHR program requires providers to adopt and use EHR systems that are certified to meet criteria which include electronic prescribing-related capabilities, while the e-prescribing program does not have a certification requirement.

“As a result, providers have no assurance that the systems they invest in will meet the electronic prescribing requirements,” said Linda Kohn, director of healthcare issues at GAO.

The two programs have established separate reporting requirements related to e-prescribing, potentially requiring physicians to report to both programs from 2011 through 2014.

Physicians who invest in certified EHR systems can be assured that in doing so they will meet the current requirements of both programs. In addition, physicians who invest in certified EHR modules integrated together to perform the electronic prescribing–related capabilities could also be assured that they meet the current requirements of the e-prescribing program.

The technology could later be integrated with other certified modules to form a complete, certified EHR system.

“This inconsistency between the programs has the potential to create uncertainty among physicians” as to what technology is most appropriate for them to invest in, Kohn said.

Physicians may choose to participate in the EHR program in 2011 because the potential incentive payment will likely be higher under that program than under the e-prescribing program in 2011. However, to avoid the penalty assessed by the e-prescribing program in 2012, CMS will require physicians to meet the e-prescribing reporting requirement in 2011, even if they elect to participate in the EHR program in 2011.

The e-prescribing reporting requirements in the EHR program are also more rigorous, with at least five reporting requirements related to e-prescribing while providers in the e-prescribing program have only one reporting requirement.

“We believe these inconsistencies may limit the programs’ effectiveness in encouraging the use of health information technologies,” Kohn said.

In response, CMS said it will identify methods for aligning the two programs in the plan it is already required to develop by Jan. 1, 2012, to integrate the reporting requirements in the EHR Program and the Physician Quality Reporting System (PQRS), CMS’s quality measures program.

However, that might be too late for physicians to avoid penalties from the e-prescribing program in 2013 since the requirements for avoiding penalties in 2013 would likely be proposed in July 2011 and finalized in November 2011. CMS said it may be able speed up its proposals for aligning the programs’ reporting requirements.

This article was originally posted at http://www.govhealthit.com/newsitem.aspx?tid=77&nid=76363