eRx Progress Report

Previously I have referenced Daniel Pink’s bestseller Drive. In his book, Pink suggests that classic carrot-and-stick incentive programs work well for menial tasks, but often create the wrong response when the task at hand is complex. With respect to the three CMS incentive programs frequently discussed within this blog, the eRx program is the one that seems to fall in the “menial task” bucket. Based on available data, most would consider the eRx program a resounding success. Surescripts recently published its annual progress report and today I would like to share some of the highlights with you.

 

By the numbers

 

The Surescripts report can be downloaded here with the provision of an email address. Among the remarkable statistics available in this year’s report:

• 58% (317,000) of all office-based providers actively e-prescribe.
• 36% (570 million) of prescriptions dispensed are now routed electronically.
• 82% of active e-prescribers used EHRs for e-prescribing (as opposed to stand-alone e-prescribing software).
• Prescription benefit and medication history was available for over 66% of the U.S. population.

The most striking stat above is the physician adoption rate. In 2008, eRx was a PQRI individual measure. That year 1 out of 10 physicians were e-prescribers. In 2009, CMS created the stand-alone eRx incentive program and 1 out of 4 physicians became e-prescribers. In 2010, participation in the eRx incentive program was substantially simplified and 1 out of 3 physicians were e-prescribers. Last year witnessed the arrival of the CMS EHR incentive program (meaningful use) as well as the eRx penalty adjustment reporting period and more than half of the physicians in this country were e-prescribers in 2011.

 

First fill rates

 

The benefits of eRx have been well delineated and include the following:

• Mitigating the handwriting legibility issues that plague paper scripts
• The provision of decision support at the point of care (albeit with the burden of alert fatigue)
• The benefits of real-time formulary data at the time of script creation

Previously I have mentioned another interesting benefit, which Surescripts reiterates in this report. Patients are actually more likely to pick up their medications from the pharmacy when the script is sent electronically instead of sent by paper, fax or telephone.

 

 

So called “first fill medication adherence” is 76.5% when the scripts are sent electronically vs. 69.5% when the script makes its way to the pharmacy by another route (paper, phone or fax). Stated another way, 23.5% of the scripts you send electronically are abandoned by the patient vs. 30.5% of those sent by another route. While this is simply a correlation and should not imply causation, the finding is hard to ignore.

 

Impact on nephrology

 

Nephrologists have been among the early adopters of eRx, in large part related to the striking incentives paid in 2009 and 2010. That trend will surely continue as the penalty phase of the CMS eRx program matures. Also looming on the horizon is the approaching incorporation of renal-related oral medications within the bundle for the ESRD population. Finally, ONC has proposed raising the eRx target for Stage 2 to 65% of all permissible scripts created during the reporting period. In combination, these factors suggest continued growth in eRx adoption rates by nephrologists in the years ahead.

 

What’s been your experience with eRx? Join the conversation by sharing your comment below.