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Highlights

Congress established two CMS-administered programs--the Electronic Prescribing Program and the Electronic Health Records (EHR) Program--that provide incentive payments to eligible Medicare providers who adopt and use health information technology, and penalties for those who do not. The Medicare Improvements for Patients and Providers Act of 2008 required GAO to report on the Electronic Prescribing Program. To do so, GAO examined how CMS determines which providers receive incentive payments and avoid penalties from that program and how many providers received incentive payments in 2009. Also, GAO was asked to examine how the requirements of the two programs compare. GAO reviewed relevant laws and regulations, interviewed CMS officials, and analyzed CMS data on incentive payments made for 2009, which were the most recent data available for a full year.

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Recommendations

Recommendations for Executive Action

Agency Affected Recommendation Status
Centers for Medicare and Medicaid Services To help improve the effectiveness of the Electronic Prescribing and EHR Programs to encourage the adoption of health information technologies among Medicare providers, the Administrator of CMS should encourage physicians and other health care providers in the Electronic Prescribing Program to adopt certified electronic prescribing technology.
Closed - Implemented
CMS has taken action that addresses the intent of our recommendation. Specifically, it expanded the definition of a "qualified electronic prescribing system" to include certified EHR technology. The agency noted the technical requirements under both the Electronic Prescribing and Medicare EHR Programs are similar and that this change will align the requirements in both programs. Furthermore, it noted that the change may potentially reduce unnecessary investment in multiple technologies to meet both programs' requirements. In proposing this change, CMS noted that this change is to address inconsistencies between the Electronic Prescribing Program and the EHR Program which GAO identified in its report.
Centers for Medicare and Medicaid Services To help improve the effectiveness of the Electronic Prescribing and EHR Programs to encourage the adoption of health information technologies among Medicare providers, the Administrator of CMS should expedite efforts to remove the overlap in reporting requirements for physicians who may be eligible for incentive payments or subject to penalties under both the Electronic Prescribing and EHR Programs by, for example, aligning the reporting requirements so that successfully qualifying for incentive payments or for avoiding penalties under the EHR Program would likewise result in meeting the requirements for the Electronic Prescribing Program.
Closed - Implemented
CMS has taken actions that address the intent of our recommendation. For example, CMS expanded the categories that providers could claim to exempt themselves from penalties from the Electronic Prescribing Program in 2012 to include providers who register to participate in the Medicare or Medicaid EHR Programs and adopt certified EHR technology. Thus, CMS removed the need for providers to report electronic prescribing data to both programs during 2011. Additionally, CMS modified the reporting requirements so that providers will now be able to submit electronic prescribing data using EHR systems to obtain incentive payments in 2012 and 2013 and also to avoid penalties from the Electronic Prescribing Program in 2013 and 2014. Previously, providers could submit electronic prescribing data to obtain incentive payments in 2010 and 2011 but could not use this mechanism to exempt themselves from penalties in 2012.
Centers for Medicare and Medicaid Services To help improve the effectiveness of the Electronic Prescribing and EHR Programs to encourage the adoption of health information technologies among Medicare providers, the Administrator of CMS should identify factors that helped or hindered implementation of the Electronic Prescribing Program to help support the ongoing implementation of the EHR Program. CMS could include consideration of such factors in the integration plan that the agency is required to develop by January 1, 2012.
Closed - Implemented
CMS has taken action that addresses the intent of our recommendation. Specifically, CMS stated that it made changes to the Electronic Prescribing Program that took into consideration factors that had helped or hindered implementation of that program. For example, CMS expanded the categories that providers could claim to exempt themselves from penalties from the Electronic Prescribing Program in 2012 to include providers who register to participate in the Medicare or Medicaid EHR Programs and adopt certified EHR technology. CMS stated that it made this change to support and encourage eligible professionals to actively take steps to become meaningful users of certified EHR technology and to remove the burden that some providers might have faced if they had to adopt two systems?one to participate in the Electronic Prescribing Program and another to participate in the EHR Program.
Centers for Medicare and Medicaid Services To help ensure that Electronic Prescribing Program resources are used appropriately, the Administrator of CMS should develop a risk-based strategy to audit a sample of providers who received incentive payments from the Electronic Prescribing Program to help ensure that providers who receive incentive payments meet that program's requirements. A risk-based strategy could, for example, focus on those providers who received larger incentive payments.
Closed - Not Implemented
In written responses to GAO regarding open recommendations received in June 2014, CMS stated that although it had awarded a contract that would have incorporated information from the Electronic Prescribing Program into its validation and sampling efforts, various delays will not enable these activities to take place. In addition, since incentive payments for the Electronic Prescribing Program are not available to providers after 2013, the agency has no plans to focus efforts on this program.

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