Audio CD and written materials of AIS's audioconference on December 1, 2005

The E-Prescribing 'Safe Harbors' and Their Impact on Business Strategies

On October 11, CMS and the HHS Office of Inspector General (OIG) proposed new exceptions to the Stark physician self-referral law and additional anti-kickback “safe harbors” that allow Medicare Advantage (MA) plans, Prescription Drug Plans (PDPs), hospitals and group practices to provide physicians, pharmacies and pharmacists with the technology and training for e-prescribing. But the proposed exceptions have strict conditions on who may provide, who may receive and what may be provided. Some incentives would be allowed, and others would not. With HHS's first round of e-prescribing standards taking effect January 1, health plans, PBMs, hospitals and physician groups need to know what they will be permitted to do and how to use the exceptions and safe harbors in an e-prescribing business strategy.

Sponsored by Atlantic Information Services, Inc., publisher of Managed Care Week, Medicare Advantage News, Drug Benefit News, A Guide to the Medicare Drug Benefit and A Guide to Complying With Stark Physician Self-Referral Rules.

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The 2003 Medicare reform law charged HHS with establishing standards for the e-prescribing of Part D drugs covered under the new Medicare drug benefit that takes effect January 1, 2006, and to promulgate Stark exceptions and anti-kickback safe harbors to protect health care entities that want to provide necessary incentives to make an e-prescribing program work. HHS now has finalized a set of "foundation" standards, and beginning January 1, Part D plan sponsors must use these standards when electronically transmitting prescriptions. But to achieve the e-prescribing goals of patient safety, quality of care, and cost savings, health plans, PBMs and hospitals must convince physicians and other health care professionals to make the technological leap.

One of the biggest barriers to e-prescribing is cost, and the proposed exceptions would allow certain health care entities to give physicians and others the technology and training they need to participate in e-prescribing without running afoul of the Stark and anti-kickback laws. But the proposed exceptions are complicated, with lots of potential for fraud and abuse. If an organization does not understand their intricacies, the mistakes could cause significant problems.

E-prescribing creates terrific new business opportunities for health plans, PBMs, and hospitals, but to take advantage of them, you must understand how the proposed exceptions expand — and limit — these opportunities.

Listen in as two experts in this field discuss how to design and create effective e-prescribing business strategies that take advantage of the exceptions and safe harbors. First, you'll get a practical, understandable summary of the proposed protections, with a sharp focus on the legal paths and pitfalls they create. You'll learn about:

Then you'll hear a detailed case study of how a major health plan is integrating these new protections into its e-prescribing strategy and business plans, including:

 

Speakers

DANIEL MELVIN, Esq. is a partner in the law firm of McDermott Will & Emery LLP, in the firm's Chicago office. As a member of the Health Department, Mr. Melvin's practice is focused on regulatory compliance and payment issues for the health care industry, including hospitals, health systems, medical device manufacturers, group practices and freestanding imaging facilities. He has substantial experience counseling clients on fraud and abuse, physician self-referral, and Medicare reimbursement and compliance issues, as well as modeling of clinical joint ventures and other collaborative arrangements involving physicians.

MIHIR H. PATEL, Pharm. D., leads Horizon Blue Cross Blue Shield of New Jersey's e-prescribing initiative and associated research projects as the clinical project manager. He has been working on the current project since its inception. He works closely with Horizon's e-prescribing business partners and researchers to ensure an efficient implementation and to drive adoption of the technology to over 1,000 New Jersey physicians. Dr. Patel is also a member of the BCBSA e-prescribing work group and has presented on the topic to various audiences. Dr. Patel also is directly involved in the implementation of Part D programs to support Horizon's MA-PD and PDP product offerings in Region 4.

Moderator: Francie Fernald, JD, executive editor of AIS's A Guide to the Medicare Drug Benefit and A Guide to Complying with Stark Physician Self-Referral Rules

 

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Written Materials