ePrescribing and LTPAC: We’re making progress with Meaningful Use

September 4th, 2013 by Rod Baird

The hurdle to achieving Meaningful Use for LTPAC physicians (and nurse practitioners under Medicaid) remains ePrescribing.

To satisfy the ePrescribing Core MU Measure, the following must occur for each Eligible Professional:

  • More than 50 percent of patients are managed using EHR technology.
  • 30 percent of patients in the EHR have at least one medication ePrescribed.
  • 40 percent of all eligible medications are ePrescribed.

The typical full-time LTPAC physician authorizes approximately 3,000 prescriptions per month, along with hundreds of other orders. None of my colleagues believe the labor involved for their practice is offset by the small annual Medicaid MU incentive available ($8,500, or approximately 24 cents per prescription).

However, if we set that problem aside, there is a second major impediment – the need for dual order entry.

  • The physician has to enter the prescription in their EHR system and send to the LTC pharmacy.
  • The physician has to copy that order and send to the facility, which is also responsible for managing that order and procuring/dispensing the medications.

Those dual-order pathways invite confusion and missed or duplicated orders. In an earlier blog post, I described a model for three-way CPOE with order entry happening at the SNF/NF. While that is our preferred strategy, my colleague from the AMDA HIT Subcommittee, Dr. Bill Russell, presented a novel LTPAC ePrescribing strategy recently.

Bill was the featured speaker at an ONC sponsored Community of Practice teleconference. This is organized by ONC’s Policy Analyst/Nurse Advisor, Elizabeth Palena Hall. Liz is the primary person responsible for encouraging the adoption of EHR and use of HIEs in the LTPAC setting.

Fortunately for us, Bill both practices in LTPAC settings and works as an advisor/consultant for ONC. He is proposing that prescriptions sent using a ”Direct” message, from the physician’s certified ePrescribing module to the nursing facility, would count towards the 40 percent objective.

According to Bill, ONC has agreed with this, and CMS appears to concur. If this proves true, we are now actually making progress towards having the MU standards adapt to the reality of LTPAC care. In itself, this isn’t a silver bullet, but it does signify that staff and ONC/CMS are trying to help.

The next step we need to take is to have staff from the CMS Survey & Certification branch begin to issue guidance to surveyors. These are the field staff members who visit nursing facilities and read medical records. They need to know to recognize a valid ePrescription in a patient’s chart.

Rod Baird

About Rod Baird

Rod Baird is the Founder and President of Geriatric Practice Management (GPM). Since 1977, he’s led provider and management organizations that deliver care to Medicare/Medicaid beneficiaries. Past programs he’s overseen include home health, personal care, hospice, rehabilitation hospitals, adult and psych daycare, alcohol/drug rehabilitation, industrial medicine and primary care practices. The Centers for Medicare and Medicaid Services (CMS) selected Baird as one of only 73 individuals to serve with its InnovationProgram. His educational background includes a Master’s Degree in Physical Chemistry from the American University, Washington, D.C.

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