Medicare, as of Jan. 1, 2009, was to prohibit the use of computer-generated faxes to transmit prescriptions and refill requests, except in instances of temporary network transmission failures. Many electronic prescription systems don't actually send an electronic prescription or refill request to a pharmacy, but generate a fax. The new policy was designed to move vendors to build--and physicians to use--"true" electronic prescribing systems.
The proposal did not mandate electronic prescribing. Rather, it sought to eliminate computer-generated faxes from e-prescribing systems that physicians were using.
Comments on the proposal, however, convinced policymakers that the industry is not yet ready to transition from computerized faxes to true electronic transmissions to pharmacies.
“One national drug store chain estimates that it produces approximately 150,000 computer-generated facsimile prescription refill requests every day,” according to the proposed rule.
Consequently, CMS now proposes to permit computer-generated faxes “when the prescriber is incapable of receiving electronic transmissions using the NCPDP SCRIPT standard,” according to the proposed rule. The agency will periodically revisit the issue and is seeking comments on what constitutes an adequate time to transition to the electronic standards.
On the issue of remote diabetes self-management training, CMS reviewed numerous studies and concluded that there is no compelling evidence that individual or group diabetes training done via telehealth “is an adequate substitute for the face-to-face encounter between the practitioner and the patient.”
CMS also turned down a request for Medicare reimbursement of critical care specialists using telehealth technology to remotely consult with on-site clinicians.
“The acuity of a critical care patient is significantly greater than the acuity generally associated with patients receiving the E/M services approved for telehealth,” according to the proposed rule. “Because of the acuity of critically ill patients, we do not consider critical care services similar to any services on the current list of Medicare telehealth services. Therefore, we believe critical care must be evaluated as a Category 2 service. Because we consider critical care services to be Category 2, we need to evaluate whether these are services for which telehealth can be an adequate substitute for a face-to-face encounter. We have no evidence suggesting that the use of telehealth could be a reasonable surrogate for the face-to-face delivery of this type of care. As such, we do not propose to add critical care services to the list of approved telehealth services.”
CMS did, however, propose to create specific payment codes for 15-, 25- and 35-minute inpatient follow-up consultations done via telehealth.
The agency also announced it will publish “when available” electronic specifications for the proposed 2009 Physician Quality Reporting Initiative pay-for-performance measures collected via electronic health records systems.
“The posting of the electronic specifications for any particular measure prior to publication of the final rule does not signify that the measure will be necessarily selected for the 2009 PQRI measure set, nor that the EHR-based data submission will be accepted for that measure even if it may otherwise be included in the 2009 PQRI,” according to the proposed rule. “However, by posting the specifications, we seek to allow sufficient time for EHR vendors to adapt their products to support EHR-based capture and submission of data for these measures prior to the start of any 2009 PQRI reporting periods.”
Full text of the rule, published July 7 in the Federal Register, is available at gpoaccess.gov/fr/index.html.
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