If the government has its way, a doctor’s prescription pad soon may be obsolete.

Beginning in January, Medicare will start paying a little extra to physicians who "e-prescribe," meaning that a prescription is transmitted directly to the pharmacy via a secured Internet site, and no paper is involved.

Officials with the Centers for Medicare & Medicaid Services believe this method will reduce the number of medication errors caused by illegible handwriting. It may also cut down on fraud, because no one could steal the doctor’s prescription pad and use it to commit forgery.

E-prescribing is another step toward the federal government’s goal of transitioning to electronic medical records. Both Democrats and Republicans have been pushing for computerization of the health care system, believing the change will help control costs.

But doctors have remained skeptical. Only about 10 percent of physicians nationwide have started e-prescribing.

That’s why Medicare is offering an incentive. And if the carrot doesn’t work, maybe the stick will be more persuasive. Doctors who aren’t e-prescribing by 2012 will have to pay a penalty.

For 2009 and 2010, the bonus is 2 percent of allowed Medicare charges. In other words, if Medicare reimburses a doctor $50 for a patient visit, they’ll give him an extra dollar for e-prescribing.

In 2011 and 2012, the bonus is 1 percent, and in 2013, it’s 0.5 percent. Meanwhile, doctors who don’t e-prescribe by 2012 will see their reimbursement cut by 1 percent. In 2013, the penalty jumps to 1.5 percent, and to 2 percent for 2014 and beyond.

The incentive program seems to be having its intended effect. Loren Funk, chief operating officer of the Longstreet Clinic in Gainesville, said there’s a waiting list to get e-prescribing software from vendors because so many clinics are asking for the service.

Funk said Longstreet expects to get its software installed in February and should begin e-prescribing in March.

"It’s more than just e-mail. The message is encrypted and privacy-protected," he said. "We’ll be using the SureScripts network. They’re the clearinghouse for all the transactions with different pharmacies."

Longstreet was among the first local providers to convert to electronic medical records, which could make the transition a bit smoother for its physicians.

"It is going to be easier for our guys because they’re already used to not using a prescription pad," said Funk.

But what Longstreet currently does is not true e-prescribing. The physician enters his prescription order into a computer, but then a paper copy is printed out and given to the patient, or in some cases it is faxed to the pharmacy.

Once Longstreet is linked into SureScripts, doctors’ prescription orders will be transmitted instantly to the pharmacy, and a confirmation will be sent back to the clinic when the prescription is filled.

"It comes directly into our dispensing system," said Laird Miller, owner of Medical Park Pharmacy in Gainesville.

Miller said his pharmacy has been using SureScripts for several years.

"Both the pharmacies and the physicians have to subscribe in order for it to work," he said. "E-prescribing currently accounts for less than 10 percent of prescriptions at my pharmacy, but it’s growing fast."

However, there are costs. In addition to installing the software, there are ongoing fees.

"We will be paying (SureScripts) $30 per month, per physician, to subscribe to this software," said Funk. "It’s an investment for us. Though the incentive is only for Medicare patients, we will be doing this for all our patients. The benefit to them is convenience. But the main thing is safety. That’s our No. 1 goal."

The losers under the new system will be the pharmacists.

"It saves money for the insurance companies, but not for us," said Miller. "Pharmacies are charged a fee of about 25 cents each time they receive an e-prescription. We’re also charged from 12 to 20 cents each time we transmit a claim to an insurance company. The pharmacy benefits managers try to make money any way they can."

Still, there may be some advantages for pharmacies.

"A real busy store might be able to get by with less personnel, because you wouldn’t have to answer the phone as often," Miller said.

But there may be confusion among patients, who won’t have a piece of paper they can physically carry to the pharmacy.

"We’ve had instances where patients didn’t even realize they had a prescription waiting for them (because it was sent to the pharmacy without their involvement)," he said.

For a while, paper prescriptions won’t be completely eliminated. Until the law changes, prescriptions for narcotics will still have to be brought in by hand.

"The (Drug Enforcement Agency) still hasn’t given the green light to e-prescribing controlled substances," said Miller. "They’re still afraid someone might be able to hack into the system."