16 PRACTICE TRENDS MARCH 2011 • CLINICAL NEUROLOGY NEWS States to Revamp Relicensing Requirements BY MARY ELLEN SCHNEIDER Dr. Humayun Chaudhry, president and CEO of the Officials at the ABMS have been working closely with FSMB, said that one of the goals in redesigning the re- states for years on the issue of maintenance of licen- tate medical boards are eyeing ways to overhaul licensure process is to minimize the burden on prac- sure and plan to continue to be involved as states be- the relicensure process so that it better measures ticing physicians. To that end, the FSMB implementa- gin to pilot the concept over the next several months Sa physician’s efforts to stay abreast of clinical tion group’s draft report calls on state medical boards to ensure that board-certified physicians aren’t asked to developments. to accept participation in maintenance of certification do any “double work,” Dr. Weiss said. “We’re going to Currently, while the public assumes that state licen- through the American Board of Medical Specialties, or be very active in trying to help our physician commu- sure means that a physician remains competent, that’s osteopathic continuous certification through the nity on a state-by-state basis.” just not the case, according to Richard A. Whitehouse, Officials at the FSMB are being careful to point out the executive director of the State Medical Board of that maintenance of licensure and maintenance of cer- Ohio. tification are not meant to be equivalent. While main- “There is really no measure once someone is initial- tenance of certification and osteopathic continuous ly licensed and has met the threshold requirements for certification could comply with the more robust reli- licensure,” he said. “Absent CME requirements, there’s censure requirements, board certification goes “above really nothing you can point to, to say that this person and beyond” basic licensure, Dr. Chaudhry said. is maintaining their competency.” For the hundreds of thousands of physicians who Officials involved in the redesign process, however, aren’t engaged in some type of maintenance of certi- emphasize that the new requirements won’t be a bur- fication process, the FSMB is working with states to de- den on practicing physicians and that most doctors are velop alternative pathways to demonstrate ongoing already doing enough to meet the standards under de- clinical competence. ALTON velopment. D The timeline for the new requirements is fairly long, ICK The Federation of State Medical Boards (FSMB), R Dr. Chaudhry said. The FSMB is recommending that which represents the nation’s state medical boards, has state medical boards implement the new approach in been promoting the need to make relicensure a more phases that in total could take up to 10 years. The first OURTESY robust process for several years. C step for any state medical board that plans to go forward Last spring, the organization’s House of Delegates FSMB CEO Dr. Humayun Chaudhry (right) discusses with maintenance of licensure is to spend the first year approved a framework that lays out what the mainte- the Maintenance of Licensure initiative with Frances educating physicians, the public, and lawmakers about nance of licensure process would look like in general. Cain, Director of the FSMB’s Post-Licensure what is planned and why. And each of the three com- And over the past few months, an implementation Assessment System. ponents of the process should take another 2-3 years group made up of physicians and medical board offi- to implement, he said. cials has been filling in the details. American Osteopathic Association, as substantially “The vast majority of physicians are already doing The expectation is that new maintenance of licensure meeting the requirements for maintenance of licen- things to stay up to date,” Dr. Chaudhry said. “In that requirements will involve three major components: a sure. “That’s a big advance because a significant plu- sense, [maintenance of licensure] is simply a means by reflective self-assessment that calls for physicians to rality of physicians are involved in those programs,” which those physicians can demonstrate what it is that complete a certain number of accredited continuing Dr. Chaudhry said. they are doing.” medical education courses; an assessment of knowledge More than 300,000 physicians are engaged in mainte- Mr. Whitehouse, who also serves on the FSMB’s im- and skills, which could be a formal exam; and some nance of certification through the various boards of the plementation group on maintenance of licensure, measurement of performance in practice, in which American Board of Medical Specialties, and that num- agrees that the process will not be onerous for physi- physicians would compare their practice data to those ber increases by about 50,000 physicians each year, ac- cians who are making an effort to keep their clinical for peers and to national benchmarks. cording to Dr. Kevin B. Weiss, ABMS president and CEO. skills current. ■ Start E-Prescribing Now to Avoid Medicare Penalty in 2012 BY SUSAN LONDON The 2010 criteria require that health care providers The list of patient encounters considered eligible for report e-prescribing for at least 25 eligible patient en- e-prescribing is “pretty comprehensive,” including all FROM THE ANNUAL MEETING OF THE AMERICAN COLLEGE OF CHEST PHYSICIANS counters (which can include multiple encounters for a outpatient office visits (those having 992xx codes), single patient) and that Medicare account for at least home health visits, nursing home visits, and psychi- VANCOUVER, B.C. – The Centers for Medicare and 10% of the provider’s payer mix. atric care visits, he said. However, inpatient visits are Medicaid Services is currently offering providers a The bonus returned to providers for 2010 was 2% of not eligible. bonus for e-prescribing (electronically transmitting the total Medicare Part B Physician Fee Schedule al- A noteworthy caveat is that providers will not be able prescriptions to pharmacies). But providers will be hit lowed charges for services for the entire year; it is 1% to earn both the e-prescribing bonus and another bonus with a penalty if they don’t get on board soon with this in 2011 and 2012, but only 0.5% in 2013. for implementing the electronic health records that the practice. The e-prescribing system used CMS is offering, because e-pre- “They are really promoting this,” Michael K. must meet certain criteria – for ex- ‘E-prescribe at scribing is among the 15 core McCormick, a practice administrator at the DuPage ample, it must generate complete least 10 times in measures of electronic health Medical Group in Winfield, Ill., said at the meeting. lists of all medications a patient is the first 6 months record implementation. But by transitioning from a bonus to a penalty over taking; provide information re- of 2011 so you Put another way, “there is no several years, “they are giving you time to get going lated to any lower-cost, thera- won’t be double-dipping” in 2011, Mr. Mc- on it.” peutically appropriate drugs; and, penalized in Cormick said. “So if you are go- The Medicare Electronic Prescribing (eRx) Incentive most notably, transmit prescrip- 2012.’ ing to go for that [electronic Program, which began in 2009 and runs through 2013, tions to pharmacies electronical- health record] bonus, which is a provides bonus payments for e-prescribing when eligi- ly. MR. MCCORMICK lot more money – $44,000 per bility criteria are met, with bonus percentages being re- Faxing of the prescription does provider paid over 5 years – you duced over the span of the program, said Mr. not count, even if a computer system autogenerates the can’t put in for the eRx bonus as well.” McCormick, a registered respiratory therapist. fax, Mr. McCormick cautioned. The prescription “must Providers who are exempt from the penalty are But the CMS will start financially penalizing basically go from your computer to the pharmacy’s those who generate fewer than 100 claims with eligi- providers who do not begin e-prescribing in 2011. The computer, not through a fax.” ble e-prescribing patient codes, those for whom less penalty for failing to e-prescribe will be 1%, 1.5%, and To obtain the bonus, providers can report their use than 10% of patient encounters are eligible (e.g., hos- 2% of all Medicare Part B charges in 2012, 2013, and of e-prescribing in any of three ways. “Probably the eas- pital-based physicians), and those in rural areas with 2014, respectively. iest way to get started is the claims-based reporting,” limited Internet service or a limited number of phar- The bottom line is to “e-prescribe at least 10 times he said, which entails simply adding the G8553 code to macies that can receive prescriptions electronically. in the first 6 months of 2011 so you won’t be penalized the other codes. Alternately, providers can use registry- The rules of the eRx Incentive Program, which in 2012,” Mr. McCormick recommended. “You really based reporting or electronic health record–based re- change annually, are online at www.cms.gov/erxIn- need to start doing this in 2011.” porting. centive. ■.