Sunday, March 08, 2015
Looks Like Some Extreme Dodgyness Occurred With The 5CPA E-Prescription Initiative. A Very Interesting Audit.
This Aust. National Audit Office Audit appeared a few days ago:
Here is the link:
Here is the background on the part I was interested in: (page 111 on)
3.37 Electronic prescriptions are prescriptions that are generated electronically by prescribers and uploaded to a Prescription Exchange Service (PES). If a pharmacy subscribes to a PES, the pharmacy can download the details of a patient’s prescription from the PES instead of manually entering prescription details into the pharmacy’s database.
There are two PES providers: eRx (a wholly owned subsidiary of FRED IT, which is part ‐ owned by the Pharmacy Guild ) and MediSecure Limited (supported by the Royal Australian College of General Practitioners).
3.38 In December 2009, Health advised Ministers that a key feature of the Pharmacy Guild’s platform in negotiations for the 5CPA was the introduction of government funding for:
· a per prescription payment to pharmacies to cover the cost of processing each electronic prescription dispensed ($75.5 million); and
· software vendors to integrate a range of agreement ‐ related elements into existing dispensing software for pharmacies ($13 million).
3.39 While Ministers did not approve funding for software vendors to integrate agreement ‐ related elements into existing dispensing software, Ministers did approve $75.5 million in Government funding for a 15 cent per prescription payment to pharmacies (known as the Electronic Prescription Fee) for each PBS/RPBS prescription downloaded from a PES.
----- End Extract:
Over the next 3 years $9.12 million of EPF payments were made - however only $1.8M made it to pharmacies to cover the 15cent claims. What happened to the other $7.3M the Auditors asked?
Well a few things happened.
The Auditors noted:
“Health advised Ministers that the Pharmacy Guild had agreed that the EPF would only be paid in the following circumstances: for e-prescriptions processed and claimed for by approved suppliers, which were generated electronically by prescribers in accordance with the specifications of the National e-Health Transition Authority (NEHTA); and if NEHTA specifications changed or a Commonwealth approved individual electronic health record became available, the criteria may be reviewed.”
On the underspend we read
“The underspend was used for two purposes: to fund a communication strategy for prescribers and dispensers and thereby improve take up of the initiative, and to continue manual processing of claims by DHS ‐Medicare at the request of the Guild, whose dispensing software was not ready for full online claiming by the anticipated 30 June 2011... Market forces are a disincentive to PES [Prescription Exchange Service] interoperability with one of the two PES operators eRx, part owned by the Guild and supported by the majority of pharmacies due to its links with the Guild and FRED IT. On the other hand, Medisecure is supported by the RACGP [Royal Australian College of General Practitioners] and has a greater take up with GPs but lesser with pharmacies. Consequently there are a large number of scripts (around 80 per cent of those uploaded according to NEHTA) [National e‐Health Transition Authority], that are not being downloaded due to the PES preferences of the different clinical areas, and the failure of the two PES providers to interact and share information ... Advice from NEHTA is that, eRx has previously rejected MediSecure approaches to establish interoperability between the two providers.”
So in summary - the report says:
3.51 In summary, while the Australian Government had originally approved $75.5 million in funding for a 15 cent EPF incentive payment to pharmacies, in the first three years of the 5CPA, 80 per cent of EPF payments were not paid to pharmacies but were instead used to pay:
· the two PES providers to make their proprietary software compatible with each other (to enable the transfer of electronic prescriptions between the two systems);
· software vendors to align their proprietary software with PES providers(to enable pharmacists to download eligible electronic prescriptions);
· the Pharmacy Guild to undertake promotional activities to support improved uptake of the EPF; and
· Human Services to manually process EPF claims, at the request of the Pharmacy Guild.
(and a final zinger)
Further, Health did not advise the Health Minister on a range of issues, including: its decision to temporarily increase the incentive payment to pharmacies from 15 cents to $1.00, and to use the 85 cent difference to provide financial assistance to IT service providers; and that a study it had commissioned indicated that both PES providers were, at that time, working through a range of financial issues.
So basically this EPF has been fiasco where the Ministers have not been told by the Department what is going on! Looks like mismanagement central with a bit of a cover up to boot!
I wonder what the ANAO would find with NEHTA and the PCEHR if they were asked?
Posted by Dr David More MB PhD FACHI at Sunday, March 08, 2015