Medicare in January 2009 will begin offering a 2% payment bonus to physicians who use electronic prescribing, the Washington Post reports. Physicians who use e-prescribing for about half of all eligible prescriptions -- a method currently used for only 2% of prescriptions -- will receive the bonus.

E-prescribing, in which doctors transmit prescriptions directly to pharmacies through a computer, helps minimize the risk of adverse drug events related to illegible handwriting, such as allergies and interactions with other drugs, because the computer checks all prescriptions against a patient's record and alerts doctors to any potential concerns. About 1.5 million preventable drug reactions occur among the more than 3.52 billion prescriptions written annually in the U.S., according to the Institute of Medicine. E-prescribing software also provides reminders for refill requests if patients have not visited their doctor in a certain amount of time.

Acting CMS Administrator Kerry Weems also said, "A lot of prescriptions end up on the dresser," but with e-prescribing "the physician can check on patient compliance." The incentive program could cost Medicare as much as $240 million next year, according to federal actuarial data. In 2010, Medicare will decrease the bonus to 1%. In 2011, physicians who do not use e-prescribing will be charged financial penalties. Weems said, "This is the proverbial carrot and stick."

Averse to Change
Despite the incentives, "it may be difficult to convince doctors to ditch their prescription pads," the Post reports. According to Janet Marchibroda, CEO of eHealth Initiative, the "key barrier to getting to electronic prescribing is financing." Physicians can obtain some Web-based platforms at no cost, but others -- those that combine e-prescribing with full electronic health records -- cost tens of thousands of dollars.

A CareFirst BlueCross BlueShield e-prescribing pilot project in Maryland launched three years ago has found that 350 of 500 physicians outfitted with no-cost hand-held devices, software and training for e-prescribing still are participating in the program. Of the remaining 150 physicians, some began using more complex e-prescribing software, but many returned to traditional hand-written prescriptions, according to the Post. Pete Stoessel, a CareFirst administrator involved in the pilot, said, "Providers are creatures of habit; they have processes they are used to," adding, "They are very, very averse to change" (Connolly, Washington Post, 11/25).