NPI transition should put patients first

June 4, 2007

Patient care must come first as the pharmacy community works toward implementation of NPI numbers.

Just because the Centers for Medicare & Medicaid Services has allowed healthcare providers to develop contingency plans in order to gain an extension to the May 23, 2007, deadline for implementation of the new National Provider Identifier (NPI) numbers doesn't mean that the compliance date has been extended. And in order to make this work during a difficult transition period, pharmacy and payers will need to work together to ensure a smooth handoff. That was the message delivered by National Council for Prescription Drug Programs experts at the organization's annual conference, held recently in Scottsdale, Ariz.

According to the latest CMS NPI statistics, about 85% of those individuals and organizations needing to obtain an NPI number had done so, some two weeks prior to the implementation deadline date. While several problems have prevented a better percentage of adoption, the least of which has been CMS' ongoing delay in releasing its database of NPI numbers or its National Plan/Provider Enumeration System (NPPES), the industry must continue to work on its contingency planning so that care of patients is not lost in the shuffle.

According to an HHS/ CMS compliance guidance issued in April, the compliance date for obtaining and implementing an NPI number remains May 23. Use of legacy numbers after that date would be technically noncompliant, although providers would all be enumerated, which provides CMS flexibility of enforcement. CMS has indicated that it will accept legacy provider numbers for up to 12 months, as long as companies have made "good faith efforts" in pursuit of compliance.

"In the case of pharmacy, we as an industry need to continue to maintain a crosswalk between the NPI and any legacy identifiers," said Cathy Graeff, R.Ph., MBA, senior VP, communications and industry relations, for NCPDP.

NCPDP found payers, PBMs/clearinghouses, and chains the most ready to meet the compliance-date implementation. Independent pharmacies were challenged to meet the deadline, while the prescriber community faced the biggest challenge because of the delayed release of the NPPES.

NCPDP continues to work as an electronic file interchange organization (EFIO) on behalf of consenting pharmacies in helping CMS build the NPI database. It has developed its own Strategic National Implementation Process (SNIP), a subset of WEDI's (Workgroup for Electronic Data Interchange) SNIP Committee, for pharmacy topics. SNIP activities for NPI include the authoring of a white paper on the impact of the NPI on the pharmacy services section using NCPDP standards to help provide guidance to the industry. It contains a Q&A section, NPI scenarios for pharmacy and prescribers, and an industry-suggested timeline for NPI implementation.

Tools such as these should help pharmacies and prescribers alike to transition to NPI numbers and to help ensure the well-being of all patients, according to the experts. "Service disruption to patients should not be an option," stressed Gilbertson.

In other conference news, NCPDP announced the formation of several new work groups, including Workgroup 17, focused on RFID and Auto ID technologies. This work group, which met for the first time at the conference, identifies the intersection and gaps between RFID/Auto ID standards and healthcare industry requirements and promotes the use of this technology through adherence to and enhancement of related standards. Some of its goals include defining business cases for use of RFID/Auto ID, facilitation of patient safety and privacy, facilitation of implementation of standards for identifying and tracking pharmaceuticals and other regulated products throughout the supply chain, and recommending cost-effective implementation strategies.

Workgroup 15 (Sample Management and Reporting Transactions for Safety) is developing standards that will incorporate prescription drug samples and include a patient's electronic health record regardless of how the patient obtains the record.