Problem Solvers

E-Prescribe Is Coming to HME

What should providers know and how should they prepare before transitioning to an e-prescription system?

• By Leila McNeill
• Sep 01, 2018

Since the late 1970s, physicians and pharmacies have been utilizing some form of electronic prescribing system. As computing technology has evolved and become more widely available over the decades, the number of healthcare providers and suppliers using e-prescribe has significantly increased. Today, an estimated 70 percent of physicians have transitioned to using an e-prescribe system. Despite its popularity in various segments of healthcare, the HME industry has been slow to transition to e-prescribing, but its adoption is becoming inevitable.

From suppliers to patients, e-prescribing has the potential to transform the industry through streamlining the referral cycle, eliminating the prevalence of incorrect documentation and driving efficiency. Still, transitioning to an e-prescribe system can feel like an unnecessary disruption to your current business model, or even a looming unknown. To help ease the coming transition, it’s important to know how e-prescribing works and what steps to take in preparing your business for an e-prescribing platform.

Understanding E-Prescribing

E-prescribe is an electronic delivery system that allows physicians and other medical practitioners to securely send prescriptions and other patient information to a pharmacy or another healthcare provider directly from the patient’s point-of-care. These systems can stand on their own or tie into integrated electronic medical record systems. More than just phasing out the pen and prescription pad, sophisticated e-prescribing systems can manage medical history for individual patients.

Nick Knowlton, vice president of business development at Brightree LLC., believes that HME providers will see numerous benefits by adopting e-prescription. “Providers can automate what once were manual processes, allowing them to focus on more value-added tasks.” He added, “They can also bring in the right data and documentation to correctly fill an order and ensure reimbursement, which eliminates costly rework and time spent chasing physicians.”

Benefits of e-prescribing are perhaps most evident is in the lengthy referral process. Typically, the referral cycle kicks off when a physician sends the HME a prescription or order by phone, fax and sometimes EMR. After the HME processes and generates documentation, they send it back to referral to complete the documentation on a varying timetable.

“If you think about the way that we do things in the industry, everything is done by way of fax, phone and hand delivery of documentation,” said Bill Guidetti, executive vice president for Apria Healthcare’s East Zone. “It’s really archaic and it’s rife with mistakes.” Overall, clerical errors are responsible for over 80 percent of fax orders being initially denied.

This is where e-prescribing comes in. Electronic forms, unlike paper, ensure that all necessary fields are filled in, which prevents denials resulting from incomplete or incorrect paperwork. In 2017, Medicare reported that 64.1 percent of improper payments were the result of insufficient documentation; for DME alone, the error rate was more than 46 percent.

With real-time error notifications, faulty or incomplete data is flagged before documentation is submitted while call back and fax back communication with physicians the referral time is drastically reduced. “You can go from what would take days to get an order right and take it down to hours,” Guidetti said. “I think we can do better as an industry and healthcare system to use this technology to communicate with each other and make it faster and easier.”

Making the Industry Transition

In other segments of healthcare, e-prescribe with referral management has been proven to work. Knowlton, who first worked in the EHR industry, said “I…remember the emergence of ePrescribe for medications and the evolution of capabilities to support lab orders and other post-encounter activities.” The technology, however, is not yet as mature in HME. “Key in that evolution will be the role that government agencies, payers, technology vendors and providers play. I believe this will mature rapidly, but we as an industry need to make sure that it’s done correctly.”

AAHomecare is currently undertaking a project to ensure that this transition to and integration of e-prescribing will be done correctly. Part of their project includes working with the four leading HME e-prescribing platforms: Stratice Healthcare, GoScripts, DMEhub, and Parachute Health. Kim Brummett, vice president of regulatory affairs at AAHomecare, explained, “We’re setting up demos [with the platforms] and having conversations with them to get a feel for their platforms – how they work, their differences, their similarities.”

As of yet, there is not an industry standard for e-prescribing interoperability with other current HME billing and management systems. Unlike other segments of healthcare, Knowlton explained, “Our sector of care delivery was not considered when interoperability standards were developed for the rest of the healthcare industry.” This means that HME e-prescribe platforms must provide a robust system that can support multiple existing standards from various vendors.

CMS will have a hand in setting standards for interoperability best practices. As such, the other part of AAHomecare’s research involves working closely with CMS to ensure that e-prescription standards and functionality are what works best for the industry.

Brummett says that there is not a strict timeline for transitioning the industry to e-prescribing en masse. Though she does have some suggestions for how suppliers can start to prepare their business for adoption. Suppliers can begin by educating themselves about the e-prescription platforms available to them and thinking about how it would fit into their current systems. “[The platforms] are very different in terms of functionality and integration with either EHRs or DME software, so I’d start by doing my due diligence there.”

This includes the supplier looking at things like cost of the platforms through the purview of cumulative and long-term pay-off. Each platform comes with a cost to the supplier; some may be a monthly subscription while others charge a per transaction fee. “So you have to do your analysis,” she added. “Say ‘Okay, this platform is going to cost me X per month, but at the end of the day, my current process costs me X.’”

Suppliers should also look outward and assess the current landscape of e-prescribing in their larger network. Brummett says that suppliers should take inventory of which physicians are already using e-prescription platforms and which ones. “What we’re likely to find is that depending on how adoption goes through the country that some pockets geographically will be driven by what is already there or what the prescriber community is using.”

She also suggests that suppliers open communication about e-prescribing with big referral sources to discuss how e-prescribing could work with current operations and what adjustments should be made upon the adoption of an e-prescribing platform.

“Those things I think suppliers need to be doing today. And [AAHomecare’s] goal is to continue to work with CMS on the acceptability of e-documents,” Brummett added.

Why It’s Worth It

Guidetti believes that e-prescribing will benefit all suppliers. “This is for the mass market, and it’s really critical that any healthcare entity – sub-acutes, nursing homes – go through the whole spectrum of healthcare facilities that work with the HME community, we all benefit from it.”

Beyond benefits to suppliers, e-prescribing has the potential to improve the entire DME segment of healthcare, including the patients. “We can’t claim that the industry is healthy when patients can’t get their equipment due to lack of a diagnosis code or lack of a signed document being sent the HME provider,” said Knowlton. “In an era where the referral sources are all electronic and sharing data, it’s hard to fathom the state of disconnection that has existed.”

The current state of the referral process can frustrate patients as much as suppliers when their paperwork has to be reworked by multiple points of contact from the HME supplier to the physician’s office. But more than frustration, an inefficient system can cause delays in equipment being delivered to the patient’s home, which ultimately results in an extended stay in a hospital. Once the equipment has been delivered to the home, patients can be at risk of non-compliance with proper use of the equipment because of imprecise documentation. Or, if the wrong equipment is delivered because of insufficient or incorrect documentation, the patient is put at more risk of not receiving the care they need when they need it. These are side-effects of an outdated system.

“That’s happening right now, today, every day,” Guidetti said. “And [e-prescribing] addresses those issues to streamline the process, making it better, easier, faster.”

This article originally appeared in the September 2018 issue of HME Business.