E-Prescribing Adding to the Squeeze

Hoping to find some (ahem) non-viral news, I wandered over to see our old pals at Medical Economics.  They have a kinda funny slide show about wondering whether office-based physicians are using electronic prescribing for controlled substances.  

The slideshow says that one-third of docs with EHR’s are electronically prescribing the good stuff. 

“Physician practices that were larger or owned by hospitals had the highest rates of electronically prescribing controlled substances.”  Yeah, because they are being forced to, no big revelation there. 

“Physicians in practices with four or more were significantly more likely to electronically prescribe…”  Also no mystery there, bigger practices are going to get a bigger bonus from Uncle Sugar by playing his game.  Also e-prescribing rates were much higher among hospital- and HMO-owned practices.  Same reason, plus the bigger groups are going know how to mine those patient satisfaction scores.  

There was no major difference in controlled substance e-prescribing rates between rural and urban areas.  So there’s pain in the hollers and the ‘hoods, but it seems like stories on the biggest candymen have all come from the flyover areas.  Street drugs are just as available rurally as downtown, so maybe higher population density encourages more market dispersal?  I don’t know.

I think the War On Drugs (Amen and Hell Yeah!) has caused far more harm than good, but I tend to think that of every government overreaction when the media declares a health crisis.  Given the chance I’d end the DEA five minutes ago, and let any adult ingest whatever they wanted.  The WOD has been a major impetus in the growth of mandated e-prescribing, and now has given major pharmacy chains a chance to help tighten the bonds on physicians.  Some chains actually limit what they will dispense based not on applicable state law, but on corporate policy.  Government at the federal and state level, along with Big Insurance and Big Pharmacy are all shoving individual physicians into ever shrinking therapeutic windows to the point where the poor ambulance chasers will have to allege that the doc off’d the poor patient with a single 10-count prescription of 5 mg hydrocodone. 

But our last slide offers safe harboring for the new generation of conforming med techs:  “Physicians participating in CMS Innovation Models had significantly higher rates of electronic prescribing of controlled substances (EPCS) compared to physicians that did not participate in those programs.  Participants in the Patient Centered Medical Home Program had the highest rates of EPCS:  42 percent of physicians participating in this program electronically prescribed controlled substances.”

The Patient Centered Medical Home Program??!  Don’t tell me Medical Economics has lost its sense of humor.

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  6 comments for “E-Prescribing Adding to the Squeeze

  1. Kurt
    June 3, 2020 at 4:44 pm

    I absolutely refuse to prescribe narcotics electronically. In my group it was optional. We had a device called the key fob “thingie” that you push a button, get a number and it gave you a secret number you transmitted with the prescription to allow the pharmacy to fill it. The thing that jerked my chain was if I filled a narcotic prescription for one of my partners patients when on call or when they were out of town, if said patient wanted a refill, the refill request would come to my inbox instead of the patient’s primary physician’s inbox. I told the administrative staff they could take the key fob and shove it where the sun don’t shine. Fortunately I am in a state where a written prescriptions for narcotics are still allowed. What really behooves me is the insurance companies can restrict the number of narcotics that the patient can have. I recently had a patient who has a surgical back that the neurosurgeon has recommended an operation for but the patient is under cancer chemotherapy and is not advisable to operate when on chemotherapy. (Risk of failed healing.) The patient is not expected to die soon with treatment with the cancer chemotherapy therefore narcotics are the only option for the short-term treatment that that patient is going to need. This may be for a few months. With good Rx we’re getting the patient coupons to pay for some of the opioids which they will most likely be needed to be on for several months. The patient has been referred to a pain specialist to see if local injections can give some relief and be opioid sparing. BTW, I’m retiring July 1st. I am not going to maintain a license. MOC crap and licensing fees aren’t worth it.
    I’ll be free and happy.

  2. Dr. M. Brown
    June 3, 2020 at 3:07 pm

    WOD = War on Doctors

  3. Stuart
    May 31, 2020 at 11:55 am

    “Medical Economics” is a sad case. It used to be a good voice for physicians, especially those in private practice. Now, it’s been completely taken over by the EMR/PCMH/hospital corporation folks.

    Never read it any more.

  4. Steven Mussey
    May 30, 2020 at 9:19 pm

    I just got an email from the Commonwealth of Virginia reminding me that the law requiring prescriptions that contain an opioid be transmitted to a pharmacy electronically becomes effective July 1, 2020.
    I’m not getting a bonus for it. It’s simply the only way I can prescribe an opioid except for certain circumstances.
    I’m definitely not thrilled about it. The system often has glitches with certain pharmacies and can be frustrating.

  5. L. J. Sloss, M.D.
    May 30, 2020 at 6:14 pm

    When you see sheep being lined up and marched all in the same direction, it is usually to the slaughterhouse.
    At least when we were salmon heading upstream to spawn, it was not 100% fishermen and grizzly bears.
    LJSlossMD, Retired 2019

  6. Benjamin Van Raalte
    May 30, 2020 at 4:10 pm

    The pharmacies are limiting because they got shakedown…. I mean…. sued by the trial attorneys on behalf of the states saying that it was their fault for not controlling the number of narcotics given out. So because of that they now have a policy of limiting the number of pills so they can’t be extorted….. I mean appropriately redressed again

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