MIPPA Rules

Another source of confusion among physicians looking to e-prescribe controlled substances is that rules differ in two federal incentive programs. The 2008 Medicare Improvements for Patients and Providers Act (MIPPA) provides small financial incentives through 2013 to Medicare participants who write at least 10 percent of prescriptions electronically. Penalties for sticking with paper begin in 2012, though the Centers for Medicare and Medicaid Services (www.cms.gov) calculated the 1 percent deduction to Part B charges next year based on prescribing habits in the first half of 2011.

Stage 1 standards for “meaningful use” of electronic health records, which covers the first two years of a provider’s participation in the EHR incentive program, require physicians to e-prescribe at least 75% of the time. Under both meaningful use and MIPPA, physicians can exclude from their calculations prescriptions for controlled substances if—like nearly all prescribers in the US right now—they have not obtained software certified for EPCS or if the pharmacy is unable to accept an e-prescription, controlled or otherwise. But Joseph H. Schneider, MD, MBA, the chief medical information officer at Baylor Health Care System (www.baylorhealth.com) in Dallas and chair-elect of the American Academy of Pediatrics (www.aap.org) Council on Clinical Information Technology, says the exemptions are different in each program. “All with good intentions, the original e-prescribing program was constructed independently of the meaningful use program,” Schneider says. There may be little desire on the part of physicians to explore EPCS because such scripts don’t count toward incentives this year anyway, notes Medical Group Management Association (www.mgma.com) health IT consultant Cynthia L. Dunn, RN.