Centers for Medicare & Medicaid Services asks for feedback on its implementation of e-prescribing.
The Centers for Medicare & Medicaid Services (CMS) are looking for clinician feedback, as well as comments from insurance officials and the general public, regarding obstacles they may be facing in the electronic submission of prescription opioids. These are covered by Medicare’s Part D pharmacy benefit. The Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) of 2018 made the electronic submission process law in order to deter fraud. The act also allows CMS to be somewhat lenient in its enforcement of rules regarding electronic prescribing of controlled substances (EPCS).
Although the electronic submission practice accelerated during COVID-19 and the broader use of telehealth, the agency is concerned that those in the health field may still not be prepared to make the transition. A 2019 report of nationwide prescribing data found “97% of US pharmacies were capable of processing electronic prescriptions for controlled substances but only 49% of prescribers could electronically prescribe these substances,” CMS wrote.
The Trump Administration has taken efforts to eliminate barriers that may limit beneficiary access to telehealth services. Initially, at the start of the pandemic, the Department of Health and Human Services (HHS) Office of Civil Rights announced that it would “exercise enforcement discretion and waive penalties for HIPAA violations against health care providers that serve patients in good faith through everyday communications technologies, such as FaceTime or Skype, during the emergency.” Following this announcement, CMS indicated it would pay for telephone evaluation, routine wellness visits, and behavioral health services. The agency has temporarily expanded the types of health care providers that can offer telehealth to ensure patient needs are met while offices are closed. It has also widened the types of settings in which telemedicine can be performed, including nursing homes and long-term care facilities. Because of the swift transition to virtual care, CMS has adjusted its coverage rates to mirror the costs of in-person visits.
Prior to the coronavirus outbreak, CMS’s Fostering Innovation Strategic Initiative was instituted to as a strategy to improve patients’ access to emerging technologies. Electronic transmission of “controlled substance prescription drug events rose from 26.6% in 2018 to 37.3% in 2019,” CMS reported. Analyzing 2020 data thus far, that has increased to 51.5%.
Specific questions being asked are as follows:
“What types of challenges might discourage clinicians from incorporating electronic prescribing into their normal workflows? How could CMS structure its policy to remove roadblocks to effective adoption of electronic prescribing for controlled substances?;
What level of compliance with EPCS would be appropriate to require before levying any penalties for noncompliance and why? Should CMS, for example, consider adopting a percentage-of-prescribers threshold that a practice must meet to be considered compliant with EPCS requirements? Should the agency instead consider specifying a number or percentage of a practice’s patients?
What time period (or periods) should CMS use to evaluate compliance (for example, quarterly, semi-annually, annually) and how should the agency communicate information on performance to the prescriber to drive improvement?”
Adjustments based on feedback may be made accordingly.