As a national patient advocacy organization serving those affected by Ankylosing Spondylitis and other Related Diseases, it behooves us to help protect our constituents' ability to access the appropriate and necessary medical care to improve their quality of life and to allow them to remain productive members of society. That is why it is so important for patient advocacy groups to take action toward protecting the rights of patients as implementation of Health Information Technology (HIT) advances.
HIT includes Electronic Prescribing (eRx or e-prescribing), Electronic Health Records (EHR), claims processing and other mechanisms to capture and move electronic health data. In 2009, the Medicare Improvements for Patients and Providers Act of 2008 authorized the Centers for Medicare & Medicaid Services to pay bonuses to physicians for successful e-prescribing. In 2009 and 2010, physicians who successfully used e-prescribing received a bonus payment of 2% of their overall Medicare reimbursement. The bonus for 2011 and 2012 will be 1% and 0.5% for 2013. To ensure adoption of this HIT initiative, the penalty for NOT e-prescribing begins in 2012 with a reduction in overall Medicare reimbursement of 1%, 1.5% in 2013 and 2% in 2014.
HIT could radically reduce both spending and mistakes in the US healthcare system by reducing duplicative tests or lowering the number of prescription drug errors due to poor handwriting. However, there is also potential for abuse of the HIT system by insurers. Health insurers already use protocols such as prior-authorizations and step-therapy or fail first to delay or deny care, and those protocols are having a significant impact on patient access to their physicians recommended treatment of care. In fact, the American Medical Association released a membership survey on preauthorization which found that more than half (58%) of physicians already experience difficulty obtaining approval from insurers on 20% or more of preauthorization requests for medication. Unregulated HIT platforms would make this much easier for insurance companies to implement these types of protocols that would only worsen the delay or denial of patient care and physician autonomy.
As the country transitions to this new HIT platform, the passage of HIT legislation needs to be a top priority for all states. This new legislation needs to focus on protecting physicians and patients with the following provisions:
- QUALITY OF CARE FIRST – Patients' and Physicians' needs should drive the design of eRx tools that will be used at the point of care
- PRIVACY – Patient privacy must be protected
- STANDARDS – eRx systems must be secure and able to prevent unauthorized use of the system
- CINICAL DECISIONS – eRx should support access to data for better clinical decision making, including alerts to adverse events and access to up-to-date formulary information
- Information provided should be fair and balanced
- System messages should not interfere with prescribing process
- OPEN & NEUTRAL PLATFORM – eRx programs should be provided through a neutral and open platform
- It should NOT be designed to advance the commercial interests of any particular participant (e.g., Pharmacy Benefit Managers, Insurance Co, Pharmaceutical Co, Pharmacy, etc)
- Physicians should be able to prescribe any medication available in the United States using the eRx system without barriers preventing transmission of a prescription to any pharmacy
- ELECTRONIC PRIOR AUTHORIZATION – eRx should facilitate electronic approval of health plan restrictions for needed medical services and products, minimizing administrative hassles to seeking the most appropriate care for a patient
- ACCURACY OF INFORMATION – All messages transmitted to physicians and/or their staffs through eRx systems must be sourced, accurate, and fact based
- FRAUD – eRx should facilitate efforts to eliminate fraudulent prescriptions
Spondylitis Association of America (SAA) Position
Regardless of the individual state initiative, it is imperative that laws support the HIT infrastructure that PROTECTS patients and physicians and their access to health care. The Spondylitis Association of America strongly supports any state legislation that would secure any of the above provisions that protect these essential patient and physician access to healthcare rights.
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