e-Prescribing—the electronic transmission of a medication prescription from the point-of-care to the pharmacy, using either electronic health record (EHR) technology or standalone e-prescribing software—is a key tool for every optometry practice. The Centers for Medicare and Medicaid Services (CMS) define a qualified e-prescribing system as one that1
- Electronically transmits prescriptions
- Provides warnings about potential allergic reactions
- Provides information about generic medication alternatives
In an increasing number of states, e-prescribing is required for providers who prescribe controlled substances; some states now require providers to use e-prescribing for all prescriptions. e-Prescribing of controlled substances (EPCS) will soon be required for all providers who are prescribing controlled substances covered by Medicare Advantage or Medicare Part D.2-4
EPCS regulations have been put in place to help control the growing epidemic of opioid misuse, abuse, and diversion. One goal of EPCS has been to make it easier to identify patients who might be “doctor shopping.”5 However, e-prescribing’s benefits reach far beyond regulating controlled substance prescriptions.
In this article, we will look at five ways e-prescribing can help your optometry practice to run more smoothly, efficiently, and safely, helping you to provide better care for your patients.
1. Improve patient safety
Perhaps the most important reason to add e-prescribing to your optometry practice workflow is that it allows you to treat your patients more safely.6
Thousands of patients are hospitalized every year due to medication errors and medication-related problems.7 e-Prescribing helps keep patients safer by eliminating the majority of prescription errors. When pharmacists don’t have to decipher handwritten prescriptions, your office will receive fewer calls from the pharmacy for clarifications. Mistakes will also become less likely, so fewer prescriptions will be filled incorrectly.2, 8-10
e-Prescribing helps prevent other types of errors, as well. The e-prescribing application generates a list of the patient’s active medications and then provides warnings for1, 6, 8, 9, 11
- Possible drug-drug interactions
- Possible drug-allergy interactions
- Duplicate therapy alerts
- Potential dosage problems
With increased accuracy and context-specific warnings, e-prescribing enables you to deliver medications to your patients in an efficient and safer manner while increasing patient safety.
2. Write and deliver prescriptions more conveniently
The second reason to add e-prescribing to your workflow is that it will allow you to operate your optometry practice more smoothly and efficiently.6
With e-prescribing, you can write and submit secure, regulatory-compliant, digitally signed electronic prescriptions from any desktop computer, laptop computer, or mobile device.9, 11 e-Prescribing eliminates time you and your office staff have to spend on the phone with the pharmacy for prescription clarifications or to set up refills.9-11
e-Prescribing also allows you to handle Prior Authorizations (PAs) more smoothly and effectively. e-Prescribing gives you immediate access to a patient’s pharmacy benefit formulary information, so you know if a PA will be required while the patient is still at the point-of-care. Then e-prescribing enables you to submit PA forms electronically, from within your e-prescribing workflow, avoiding paper, fax, and phone authorization requests. You can also respond immediately to electronic PA requests when initiated by the pharmacy after an insurance claim rejection.9
By enabling electronic PAs, e-prescribing reduces wait times for insurance approvals, plus lets you and your staff spend less time on the phone discussing PAs with pharmacies and insurance companies.11
3. Improve medication adherence rates
Another benefit e-prescribing brings to your optometry practice is that it’s a research-backed method for improving your patients’ rates of medication adherence.6
Taking medication as prescribed is important for controlling both chronic and temporary conditions. However, a study from the U.S. Food and Drug Administration (FDA) reported that 25% of new prescriptions are never filled or picked up by patients.9 Another study showed that patients fail to take their prescription medications as prescribed at least 50% of the time.12
On the other hand, medication adherence is clearly correlated with improved patient outcomes.13 For instance, researchers in one study found that glaucoma patients who consistently took their prescribed glaucoma medications were less likely to experience glaucoma-induced vision loss.14
There are numerous reasons patients fail to take their medications, such as:9, 12
- Economic—the prescription costs too much
- Clinical—the patient doesn’t fully understand the medication, its purpose, or its side effects
- Behavioral—the patient doesn’t fully understand how to take the medication or forgets to take it
e-Prescribing can help overcome many of these obstacles. First, e-prescribing provides access to information about whether specific medications are covered under a patient’s formulary, helping you to prevent potential cost issues. If a medication is not covered for the patient, you are able to view and discuss alternatives while the patient is still at the point-of-care. You also have access to the patient’s out-of-pocket cost for each medication, allowing you to discuss costs and possible alternatives before the patient is possibly confronted by a high price tag at the pharmacy.9
Second, studies show that engaging patients at the right time with medication adherence support can reduce prescription abandonment by up to 20%. e-Prescribing can also provide you with educational materials to help you help your patient understand their prescribed medication, its importance, and how to take it.9
Over the past several years, optometrists who serve patients covered by Medicare have had to switch from a predefined reimbursement system to payments adjusted by the Quality Payment Program (QPP). QPP is a quality incentive program created by the Centers for Medicare and Medicaid Services. This system shifts reimbursement away from fee-for-service healthcare to payment based on the quality and cost-efficiency of the patient’s care.15
QPP has two avenues for participation:
- Merit-Based Incentive Payment System (MIPS)
- Alternative Payment Models (APMs)
APMs have very specific eligibility criteria; most optometrists, if eligible to participate in QPP, participate via the MIPS route.16
You are not required to participate in MIPS if:16
- It’s your first year as a Medicare provider
- Or you do not meet the MIPS low volume threshold, which requires practitioners to meet all three of the following criteria during the two different twelve-month periods during which CMS evaluates your eligibility:*
- Billing more than $90,000 in Medicare Part B allowable charges
- Seeing more than 200 unique Medicare Part B patients
- Performing more than 200 Medicare professional services
If you are eligible for MIPS, it’s important to participate in order to achieve the highest score possible. Depending on their composite score, participating providers will receive payment adjustments for their Medicare reimbursements. Adjustments can be positive, negative, or neutral—that is, no payment adjustment.
If your practice does meet the low volume threshold for MIPS but fails to report data, you will receive the maximum negative payment adjustment, or a 9% penalty on all Medicare reimbursements received in the applicable year. In addition, every MIPS score is included in a publicly released report from CMS, making your MIPS score an important component of your practice’s public reputation.17
e-Prescribing has an important role in increasing your MIPS final score. Your MIPS score is based on points earned in four categories:15-17
- Improvement Activities
- Promoting Interoperability
Points in these four categories are used to determine your overall composite MIPS score, a number ranging from 0-100.15-17
e-Prescribing is one of the key objectives required to earn points for the Promoting Interoperability category. In addition, your practice can earn “bonus points” in this category under the e-prescribing objectives. You can do so by querying your state’s Prescription Drug Monitoring Program (PDMP) when e-prescribing controlled substances. This step, while optional, can earn your practice an additional ten bonus points toward Promoting Interoperability.18, 19
To count toward the Promoting Interoperability score, e-prescribing must be performed with certified e-prescribing technology. That is, the e-prescribing technology must meet the criteria of the 2015 Edition Cures Update for certified electronic health record technology.20 Not all e-prescribing programs satisfy these certification requirements, but Veradigm ePrescribe™is one of those specifically certified to meet the criteria in this update.3
5. Ensure compliance with EPCS regulations
Numerous states have issued mandates requiring providers to use e-prescribing when prescribing controlled substances. Electronic prescribing of controlled substances, or EPCS, is the process of electronically delivering prescriptions for regulated medications directly to the pharmacy. The Drug Enforcement Agency (DEA) passed a regulation making EPCS legal in 2010 if providers used a certified system. By 2015, all fifty states had updated their regulations to legalize EPCS.21
At first EPCS was not widely adopted except in areas where it was required. As a result, more and more states have been mandating EPCS—twenty-eight states as of October, 2021, while several others have set future implementation dates for EPCS mandates.22
It’s important to know your state’s requirements for prescribing controlled substances, as the precise requirements for EPCS vary from state to state. Some states require EPCS only for opioids; others require it for all schedule II or schedule II and III drugs; others require it for all controlled substances. Some states require e-prescribing for all prescriptions, both those for controlled and those for non-controlled substances.22, 23
However, even if your state has not yet mandated EPCS, the federal government passed the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act (SUPPORT Act) in 2018. This Act, passed in response to the nation’s opioid crisis, created a requirement for controlled substances covered under Medicare Part D or Medicare Advantage Prescription Drug Plans to be submitted electronically beginning January 1, 2021. Due to the COVID-19 national health emergency, the Centers for Medicare and Medicaid Services (CMS) initially postponed enforcement of penalties for noncompliance, but noncompliance penalties will be enforced beginning January 1, 2022. All Medicare Advantage and Medicare Part D prescribers in all states are subject to this requirement and must comply.24-26
It’s also important to note that compliance with EPCS regulations requires the use of certified e-prescribing software, such as Veradigm ePrescribe.11 Veradigm ePrescribe not only helps you comply with current e-prescribing and EPCS regulations. It will also help ensure new regulations don’t take you by surprise. With automated updates, ePrescribe enables you to stay current with continually evolving regulatory requirements without any disruption to your workflow.27
e-Prescribing to improve your optometry practice
Certified e-prescribing software such as Veradigm ePrescribe will allow you to stay on top of new prescribing requirements while simultaneously saving your practice time and energy. Even more important, it will help you provide safer, higher quality care for your patients.
Veradigm ePrescribe is used by more than 140,000 prescribers for hundreds of millions of transactions every year.11 Click here if you would like to learn more about how ePrescribe can help you run your practice more smoothly and effectively.
*The easiest way to determine if your practice is eligible for MIPS or exempt, either because it’s your first year as a Medicare provider or because you fail to meet all three low-volume criteria, is to visit https://qpp.cms.gov/participation-lookup and enter your National Provider Identification number (NPI) in the lookup window. This will generate a report containing your MIPS status.16
- What is E-Prescribing? E-Prescribing in EHRs. iTrust. Updated September 22, 2021. Accessed September 24, 2021, https://www.itrust.io/what-is-e-prescribing-e-prescribing-in-ehrs/.
- American Psychiatric Association. e-Prescribing (eRx). American Psychiatric Association. Accessed June 14, 2021, https://www.psychiatry.org/psychiatrists/practice/practice-management/health-information-technology/e-prescribing.
- Jameson H. Don’t Panic Over Mandated E-Prescribing of Controlled Substances Laws. Academy of General Dentistry. Updated August 10, 2020. Accessed August 18, 2021, https://www.agd.org/publications-and-news/newsroom/newsroom-list/2020/08/10/don-t-panic-over-mandated-e-prescribing-of-controlled-substances-laws.
- CMS Delays Federal EPCS Compliance Enforcement To 2022. RXNT. Updated February 17, 2021. Accessed August 9, 2021, https://www.rxnt.com/cms-delays-epcs-compliance-enforcement-to-2022/.
- COE Briefing: Mandating PDMP participation by medical providers: current status and experience in selected states, Revision 1. February 2014. Accessed August 6, 2021. https://www.ojp.gov/pdffiles1/bja/247134.pdf.
- e-Prescribing benefits. Practice Fusion. Accessed August 18, 2021, https://www.practicefusion.com/e-prescribing/benefits/.
- Carter H. New electronic prescriptions to also reduce medication-related hospital admissions. Optometry Australia. Updated July 31, 2020. Accessed September 24, 2021, https://www.optometry.org.au/patient_care_management/new-electronic-prescriptions-to-also-reduce-medication-related-hospital-admissions/.
- Pence NA, Gulledge M. A Brief Primer to Electronic Prescribing (eRx). Review of Optometric Business. Updated April 2, 2011. Accessed September 24, 2021, https://www.reviewob.com/a-brief-primer-to-electronic-prescribing-erx/.
- Rai N. Benefits of E-Prescribing and Medication Adherence Tools for Eye Care. First Insight. Updated August 5, 2020. Accessed September 24, 2021, https://www.first-insight.com/blog/benefits-electronic-prescribing-medication-adherence-tools/.
- Mullarkey C. The Pulse on e-Prescribing in Optometry. Review of Optometry. Updated June 13, 2013. Accessed September 24, 2021, https://www.reviewofoptometry.com/article/the-pulse-on-e-prescribing-in-optometry.
- ePrescribe–Automate and Empower Your Prescribing Success. Veradigm. Accessed June 15, 2021, https://veradigm.com/eprescribe/.
- Why You Need to Take Your Medications as Prescribed or Instructed. U.S. Food & Drug Administration (FDA). Updated February 16, 2016. Accessed September 24, 2021, https://www.fda.gov/drugs/special-features/why-you-need-take-your-medications-prescribed-or-instructed.
- Sabaté E. Adherence to Long-Term Therapies: Evidence for action. 2003:194. 2003. Accessed August 23, 2021. http://apps.who.int/iris/bitstream/handle/10665/42682/9241545992.pdf?sequence=1.
- Prescription Drug Monitoring Program Training and Technical Assistance Center Mandatory PDMP Enrollment. Accessed September 25, 2021. https://www.pdmpassist.org/pdf/Mandatory_Enrollment_Conditions.pdf.
- Sheth N, French DD, Tanna AP. Merit-Based Incentive Payment System Scores in Opthalmology and Optometry. Opthalmology. September 11, 2020;128(5):793-795. doi:https://doi.org/10.1016/j.ophtha.2020.09.015.
- Wroten C. Key elements to know about MIPS in 2020. Optometry Times Journal. 12(5):30-31.
- What Eye Care Providers Need to Know About MIPS Scoring. EyeCare Leaders. Accessed September 25, 2021, https://eyecareleaders.com/what-eye-care-providers-need-to-know-about-mips-scoring/.
- Quality Insights. 2021 Promoting Interoperability (PI) Measures for MIPS. QPP-040821. https://qppsupport.org/CMSPages/GetFile.aspx?guid=8c116796-38ed-4fab-909e-c75e9867edd4.
- Merit-Based Incentive Payment System (MIPS) 2020 Measures and Activities for Optometrists. 2020. https://qpp-cm-prod-content.s3.amazonaws.com/uploads/1065/2020%20MIPS%20Optometry%20Specialty%20Guide.pdf.
- e-Prescribing - MIPS PI Measures for 2021 Reporting. MD interactive. Accessed August 23, 2021, https://mdinteractive.com/mips_pi_measures/e-prescribing-mips-pi-measures-for-2021-reporting.
- Opioid Epidemic & Health IT. The Office of the National Coordinator for Health Information Technology. Updated December 18, 2019. Accessed September 16, 2021, https://www.healthit.gov/playbook/opioid-epidemic-and-health-it/.
- State PDMP Profiles and Contacts. Prescription Drug Monitoring Program Training and Technical Assistance Center. Updated July 7, 2021. Accessed August 19, 2021, https://www.pdmpassist.org/State.
- HIMSS Electronic Health Record Association. Prescription Drug Monitoring Program State-by-State Landscape: State Mandates.5. Accessed August 24, 2021. https://www.ehra.org/sites/ehra.org/files/EHRA%20PDMP%20-%20EPCS%20-%20State%20Landscape%20June%202018.pdf.
- Centers for Medicare & Medicaid Services (CMS). Medicare Program: Electronic Prescribing of Controlled Substances; Request for Information (RFI). Federal Register: The Daily Journal of the United States Government. Updated August 4, 2020. Accessed September 16, 2021, https://www.federalregister.gov/documents/2020/08/04/2020-16897/medicare-program-electronic-prescribing-of-controlled-substances-request-for-information-rfi.
- Electronic Prescribing of Controlled Substances (EPCS) among Office-Based Physicians, 2017. HealthIT.gov. Updated September 2019. Accessed September 16, 2021, https://www.healthit.gov/data/data-briefs/electronic-prescribing-controlled-substances-epcs-among-office-based-physicians.
- The SUPPORT for Patients and Communities Act (P.L.115-271): Medicare Provisions. In: Service CR, editor. R45449. January 2, 2019 ed2019.
- Veradigm ePrescribe Integrated–Your Ideal Solution for Advanced, “Plug-and-Play” e-Prescribing. Veradigm. Updated 2021. Accessed August 26, 2021, https://veradigm.com/eprescribe-software/.