Saturday, February 8, 2014

E-Prescribing and Physician Assistants

E-Prescribing and Physician Assistants

Legal in 48 states, e-prescribing is a herald that medicine is continually evolving. Your state approval is one of many milestones required to achieve electronic prescribing of controlled substances (EPCS). Pharmacies and EHR (electronic heath record) software companies are fully aware of the challenges they must overcome to meet the requirements of the Drug Enforcement Administration's Interim Final Rule (IFR). When each of these aforementioned systems receives a DEA audit, a company named Surescripts certifies and connects the pharmacy with the prescriber application through a national health information network. This allows a provider to review prescription history, to send off non-controlled medications electronically to a patient's pharmacy, and many other quick and easy functions all through their very own EHR!

Fig 1. Surescripts logo. 

From Ethics and Professionalism: A Guide for the Physician Assistant, authors Blessing and Cassidy describe prescribing and dispensing capabilities of a Texas PA: A PA is allowed to prescribe or sign a prescription drug order if given the order to do so under a licensed physician. A PA in Texas has authority to prescribe Schedules III-V and non-controlled medications (sometimes referred to as legend drugs). If a PA wishes to prescribe controlled medications, they must register with the DEA (Drug Enforcement Administration) and DPS (Department of Public Safety). Unfortunately, organizations like TAPA (Texas Academy of Physician Assistants) must continue fighting for our rights to prescribe medications of all classes, including Schedule II.

According to the American Academy of Physician Assistants, "'Carrying out a prescription drug order means to complete a Rx presigned by the delegating physician or the signing of a prescription by a PA designated by the physician as a delegated prescriber by providing the patient’s name and address; drug to be dispensed; directions to patient; number of refills; name, address and phone of physician and PA; and PA identification number. Controlled substance prescriptions or refills are limited to 90 days and refills must be authorized after consultation with a supervising physician. A prescription for controlled medications for a child under 2 years of age requires consultation with supervising physician. A PA may request, receive, and sign for pharmaceutical samples and distribute samples in setting where PA authorized to prescribe."

Now that you know a little bit about e-prescribing and what Schedules PAs are able to prescribe, let's talk about some benefits you and your patients will experience by your use of e-prescribing.

Benefits of E-Prescribing

  • More Accurate Prescriptions - you can confirm prescription benefit information prior to sending an e-prescription; no need for a pharmacist to verify this anymore!
  • Improved patient safety - you can check for harmful drug interactions by reviewing patient medication history at the point of care (with patient consent, of course!) 
    • No handwriting = no misinterpretation for the pharmacist! 
  • Lower healthcare costs - prescribers can choose medications preferred by the patient's healthcare plan, medications that meet therapeutic guidelines, and medications that are cost effective. 
  • Over 64,000+ pharmacies nationwide currently participate in e-prescribing, and if they don't already, they'll more than likely agree to join if it means cooperation from you! Click here to see a map showing the % of pharmacies allowed to e-prescribe controlled substances

E-prescribing of Controlled Substances 

So, why can't I e-prescribe Schedule II, III, IV, V medications?
If you live in Texas, you're probably wondering why you can't e-prescribe Schedule II-V medications, when you're allowed to e-prescribe non-controlled substances. This is the case in most states. Most providers begin to get upset about this issue when they are first introduced to e-prescribing. They feel as though someone "should've thought of this!" Well, good news doc! They did! Only, the government said, "no way, Jose!"

Texas law requires that Schedule II medications such as Codeine, Hydrocodone, and Morphine (high potential for abuse drugs) are prescribed on state issued triple copy prescription forms. Providers keep one copy, pharmacists keep another, and the last copy is sent to the Department of Public Safety (DPS). DPS uses this information to monitor providers prescription practices, pharmacies dispensing activities and individuals purchasing patterns. DPS reports evidence of illegal use to the appropriate law enforcement office.

Schedule III-V are still required to be printed out from your EHR software and apply a "wet signature." If this is not possible, they must be handwritten and MUST BE signed.

Find out what your state's regulatory status is like for class II-V here.

Why is E-Prescribing So Useful?

The Health Information Technology for Economic and Clinical Health (HITECH) Act is a key component of the American Recovery and Reinvestment Act of 2009 (ARRA). Under the Act, eligible prescribers can receive incentive payments by meeting qualitative and quantitative standards for the 'meaningful use' of a certified EMR (electronic medical record), which began in 2011. The Act also makes provisions for incentive payments to support the acquisition and use of certified EMR technology for prescribers who see high volumes of Medicaid patients (AKA PHYSICIAN ASSISTANTS), and makes federal matching funds available for some state Medicaid plans for programs that encourage adoption and use of EMR technology. E-prescribing is a key component of 'meaningful use'.

Medicare Improvements for Patients and Providers Act (MIPPA) went into effect January 1, 2009. Prescribers who use a qualified e-prescribing system to prepare and send electronic prescriptions as defined by MIPPA are eligible to receive higher levels of reimbursement under Medicare through 2013, with a maximum reimbursement rate of 2% available in 2009 and 2010. Prescribers who do not start to send e-prescriptions by 2012 will suffer a penalty on their Medicare reimbursements starting at 1 percent.

So, in summary. Get your EHR together, learn how to use it, because e-prescribing is going to help you make money, it's going to help your patients have a better experience seeing you, and at the end of the day, you won't be suffering from any penalties from NOT participating. So don't be THAT physician assistant who doesn't catch on to the EMR/EHR wave and e-prescribing. 

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