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Interesting Developments

I have been following the problem pharmacies are having with DIR (direct and indirect reimbursement). This is nothing more than a rip-off of pharmacies by the PBMs, and clawing back a portion of the patient’s co-pay is something I find an egregious act on the part of PBMs to profit at the expense of the consumer. Moreover, to leave pharmacies up in the air on the adjusted reimbursement they are going to receive is something that makes managing receivables a nightmare.

Now a word on health information exchanges (HIEs). These are pay-to-play, and it’s my take that a number of HIEs are on shaky ground financially. There are also a lot of issues with so-called interoperability, which is the cornerstone of the HIE model. For example, there are concerns with the security of protected health information as patient information floats around in an HIE. While the concept of an HIE sounds good, from what I have heard there are considerable challenges to making HIEs live up to their billing.

Then there is the meaningful use program that provides financial incentives to eligible providers, namely physicians and hospitals, to implement electronic health record (EHR) systems and then use these in a meaningful way based on the criteria established by CMS. The federal government has doled out billions of incentive payment dollars for this program so far and yet, here again these systems are falling short of expectations. EHR systems are getting mixed reviews. There is no consensus that these systems are increasing productivity. To the contrary, I have read repeatedly that they are making physicians less productive.

And just recently CMS issued an updated guidance letter to Medicaid programs to encourage the onboarding of noneligible providers such as pharmacies with financial incentives if the pharmacy systems used can help eligible providers, who opted for meaningful use dollars from Medicaid rather than Medicare, achieve the meaningful use criteria within the framework of health information exchange. One area mentioned where pharmacies can contribute is with medication reconciliation in the transition of care. The other area, where pharmacy is already contributing, is electronic prescriptions. The message I get with the meaningful use program is that CMS is finding it difficult to get users of these systems to meet all the qualifications for the incentive payments. Medicaid programs can qualify for financial assistance under the HITECH act if onboarding pharmacies, for example, can help eligible providers meet the meaningful use criteria. Be interesting to see what happens here. CT

Bill Lockwood, chairman/publisher, can be reached at