Home Forums Discussions General Discussion E-Prescription Networks to Merge

The nation's two electronic prescription networks plan to announce today that they are merging in an effort to encourage the adoption of their technology by doctors and patients.

Alexandria-based SureScripts and St. Paul, Minn.-based RxHub are extensions of different parts of the pharmaceutical industry. SureScripts is owned by retail and independent pharmacies; RxHub is owned by three major drug benefit managers, which are also mail-order pharmacies. The companies say they hope the broader use of the technology will cut down on costs and medical mistakes

http://www.washingtonpost.com/wp-dyn/content/article/2008/06/30/AR2008063002072.html

E-prescribing is a powerful concept with two big problems, one insurmountable.

One is the fact that the e-prescribing process is currently slow and painful. This can be probably be overcome, in time, with better UI technology, but currently it is a logjam, and busy doctors can't afford the delay.

The bigger issue relates to loss of physician autonomy. The diversion of all prescribing through a single electronic clearing-house will obviously allow the people controlling the system a great deal of control over how physicians practice medicine.

They will be much more able to analyze our prescribing habits and penalize the ones they don't like -- stopping us in our tracks with instant pop-ups, emails and phone calls when we prescribe in a manner that displeases them.

This is inescapable. This power may not be used much, if at all, AT FIRST. But, we will have a choker chain around our neck, ready for a correcting jerk when somebody wants to bad enough.

You all know the famous saying about how controlling doctors is like herding cats? E-prescribing is a cat-herding device. Mark my words.

Here, Here, Brian well said. And I'm sure the honest and honorable people at UHC won't use the writing of more expensive but possibly better drugs in some weird hard to understand, doctor rating system. Penalized for doing the right thing, Gotta love it. And what about my favorite part of all this, large centralized systems lead to ease of privacy violations and hacking. And who else will be allowed to see and use this data, not the employer who is behind the self paid, administrator based plan now will they?

Cat Herding, uh??? Meow....

And as far as I and many others are concerned, these "E" Rx systems really make life easier and less expensive on these folks, the Pharmacys. So I don't want to hear about us providers having to have to pay a dime for another new monthly, forever and ever "taximeter" that we have to pay for just to make everyone else's life easier, cheaper, better. I like the model of the lab interfaces here at AC. Sure it cost money to activate the interface, but who did this interface help most? The lab we hooked up with... So who picked up the tab for it? The lab did. So when all these "E Rx" places care to pay us to pay Jon and offer the great support that Quest has given us then and only then will our office willing sign up for such a thing....

HockeyRef, I have heard enough of doctors whining, for lack of a better word, about who controls what.

Insurance and Drug companies are successful at legislation because they lobby and pay lobbyists.

Where is the lobby for the doctors?

They have never seemed to understand that with "free" you give up control. So the drug company will "pay for this" the drug company will "pay for that;" what is missing is if someone else is paying for it, you lose control...over time, Docs have lost more and more control because they came to want "free," when they should have demanded a seat at the table.

Finally getting legislation passed, requires money...you have to pay to play. I'm not saying that is how it SHOULD BE, but that is how it is!

George,
But in this model they want to the docs to pay for the right to lose their control. Like in a dictatorship we are going to arrest and pop you in prison and while we're at it we are going to charge you and your family for the services. Now that is just insane....

Still...where is the lobby for the Doctors? If you want to change the game, you have to get in the game!

"Our" organizations (AMA, etc) do not represent the PCPs best interests.

We "aren't allowed" to unionize.

The insurors have all the cards. They control all the money. We control our services, but when it comes right down to it, we feel like it is immoral not to provide our services if the patient can't pay. They have us over an emotional barrel, and they know it.

Now, there is this constant tension as the insurors (including the government) keep testing the limits of what they can make the "rich doctors" pay for, and how they can force us to behave.

It is a battle played out in Congress, within our organizations (who represent subspecialists by and large), and in the realms of public relations.

While we try to practice medicine full-time and get ourselves paid part-time, the payors have full-time people thinking of nothing but how to withhold payment, and cut costs without causing their organization too much P.R. trouble.

The short-term solution is for solo physicians to join multi-specialty groups that can afford to pay more and more and more for the resources that allow them to comply with the burden placed on them by insurors.

I have looked ahead and declared checkmate for the insurors in not too many moves. I am ready to resign the game.

Let the government and the insurance companies make the regulations as complex as they want. They can make the hurdles as high as they want! They can set up as many hoops as they can find!

If I don't take your money, you can't tell me what to do.

Whether that means cash-only, Medicare non-participation, concierge practice or on-site clinic, dropping out of the system will eventually be the only logical option for the solo physician.

IMP Brian, IMP!

Hey I am not going to "Count My Chickens" here before they hatch, but I am going to attempt to do something radical here with one insurance carrier I consider to be at least some what ethical. I know not where it is going to lead, but my basic position will be based on the things I learned from IMP Camp.

I will not Jinx it by saying anymore, but I need lots of good group Karma and support here... Wish me luck and thanks for your kind thoughts. I will report back here when things have started to play out, probably on a thread of it's own...

Paul

By the way Gee I agree with you that docs especially PCP's need to get it together and take a unified stand. One without the turncoats of the Major Medical Societies and the AMA.

BIG FYI: I was just reading that healthcare blog. If any of you think for a moment that the AMA has even a lick of concern about you PCP's and other office visit based type pratices like Endo's and the like, think again and then never again. The RUC, that is the committee that makes up the values behind the RVU's that value or in your case De-value your work, is stacked the the hilt. It turns out that 25 of the 29 members on the RUC are specialists. So let's see, a frational proportion of 4/29 to 25/29. Gee that sounds about as fair and balanced as FOX Noise political reporting.

And you thought I was just making this stuff up about these RVU's and the like. It is not just the carriers or the government that is attempting to screw primaries, it is as much if not more because of traitors from within you own ranks. And then these same specialists as I have spoken to before that then take over your IPA's and PO's to make sure that you have contracts that are like Nancy's with one of the majors, 125% of present day Medicare for office visits and other E&M codes, 135% of present day Medicare for procedural codes. I kid you not and I have heard the same from other organization or other docs bitching across the country. So they are then doubling the insult and slap in your face with the land grab while you guys barely scrap by on the table scraps...

Well, I received permission to be long winded from HockeyRef on another blog so I'm going to use it again

While all the corporate antics are concerning to me, I prefer eprescribing. In my state, most scripts have to go on tamper proof scripts. According to CMS, the faxing of scripts loses HIPAA compliance at the end of this year. Without eprescribing, that could be a nightmare.

I have chosen to keep my lists on the free NEPSI site. I find it safer for me and the patient. I can track refills much better. My nurse has access to the site so she can do refills that I authorize. All refills go through me first. We don't waste time faxing back and forth. In rural Missouri, pharmacists sometimes completely switch the drug I order to one they have been incentivized to sell. This way, I also get access to exactly what it is they fill. I have not had that problem since using erx.

When I signed up for AC I was told that eprescribing would become "free" with Version 4. I am waiting excitedly for that because I do not want to pay for something that is free.

I do agree that Allscripts is just using this as a ploy because we will all have to pay for it one way or another some day. The customer service is inconsistent. There are some really helpful folks and some who have literally told me that since this is a free service, I really don't have a right to an opinion.

Medicine marches on as does time. I'm just trying to find the tools that help me deliver the best, safest care I can to my patients.

Well, that's one way to force strapped business to BUY another tool to do something they already do just fine. Legislate the current method to be unacceptable.

Wait, Hockey--did you just possess my brain and make me write that?!

"It's the Nepsi generation, comin' at ya, comin' strong, go and grab yourself a Nepsi...." Sorry I couldn't resist.

Vickie,
I'm not sure I ever heard of this NEPSI, could you tell us all a little bit more about it???

Thanks,
Paul

Just did a quick google and went to their home page. One frightening thing about all this is so many of their sponsors are some of the largest and most offensive players in the Cartel side of this business. Do they get to plug into the any and all of this data so as to track our docs, patients, Rx writing habits, use against you guys for the "Ratings System" and a ton of other nasty garbage???

Hey Brian have you herded any cats lately??? Buck me man...

National electronic prescribing and patient safety initiative

agreed, some big players

Here's the link folks...

http://www.nationalerx.com/?gclid=CO3rlcu6oZQCFQdxHgodf2vUtg

Happy, happy, joy, joy....

Sponsored by BC/BS, Aetna, Quest among others....it's FREE. FREE, yet Docs complain they don't have control.

Yes, FREE! like a free spy camera in my television set, that I can't turn off!

Right now, only Medicare part D requires EMRs to e-prescribe in 2009, while they're getting the kinks worked out of it, but everybody will end up using it, and this will end up as a gizmo that will:

• Stop you from prescribing things before you even get started.
• Analyze your prescribing patterns and take corrective action automatically.
• Be mandatory!

Zieg Heil!!! Schullllltzzzzz!!!!

Now everybody wistle Hogan's Hero's with me....

Another cat herding device Brian???

When I signed up for this last month, I was told that the the ePrescribing software provided by NEPSI for our "free" use only applied if we used it independently of AC. If I wanted it integrated with AC it would cost us $20 a month in addition to a $295 set up fee. Is that correct?

What a crock! If they can afford it to be free as a standalone,why do they need $20/month annuity to use it with an EMR. I'll give them set-up fee. But the $20 seems like Ross Perot's "Great Bit Sucking Sound."

What we all need to do is to boycott the eprescribing initiative en masse so that politicians hear us loud and clear- that this is a stupid law, a costly workflow killer, fueled by lobbyist bribing of our representatives in the House and Senate.

At Sermo, one recent poll showed that 60% of physicians refused to participate in eprescribing... I hope that 80% or more will eventually!

60% not too bad. So far the cat herding is not working too well. Did ya hear that Brian??? I love that phrase... We are certainly in no rush to sign on for another taxi meter service that only really serves the big chain drug stores and the carriers we are attempting to break free of....