As product reimbursement falls and pharmacies must find other sources of income, medication therapy management (MTM) provides opportunities for pharmacists to increase revenue while using their clinical skills to make a difference in patient care.
“I think our value is no longer in the product-based world,” says Timothy W. Cutler, PharmD, BCGP, interim assistant chief, Department of Pharmacy at UC Davis Medical Center in Sacramento and clinical professor of pharmacy at the University of California, San Francisco. “We can’t get away totally from the product, but we have to be able to have the ability and the bandwidth to do the cognitive function that we were trained to do,” he says.
Monetizing Clinical Services
Income streams from MTM include not only direct reimbursement for comprehensive medication reviews (CMR) and targeted medication reviews (TMR), but also indirect reimbursement from decreased direct and indirect remuneration (DIR) fees based on improved quality ratings. According to Miriam Mason, PharmD, staff pharmacist at New Utrecht Pharmacy in Brooklyn, NY, the fee is about $60 for CMRs and $10 to $12 for TMRs.
“For a pharmacy with good volume, that can be a significant amount of revenue,” says Nikki J. Scott, PharmD, director of education at Harps Food Stores pharmacies in Springdale, AR.
What impact this will have on a pharmacy’s revenue stream depends on its contracts, Scott says. In pharmacies where DIR fees are assessed at the pharmacy level, effective provision of MTM can significantly impact pharmacy DIR fees in just three to six months, she says, adding up to tens of thousands of dollars quarterly. Pharmacies where DIR fees are assessed at the pharmacy services administration organization (PSAO) level can encourage improved quality of care across the PSAO, which in turn affects all the pharmacies’ DIR fees.
There are several resources that community pharmacists can use to increase and improve their MTM services. Rachel Stafford, PharmD, assistant professor of pharmacy practice at University of Arkansas for Medical Sciences (UAMS) College of Pharmacy says signing up with MirixaPro and OutcomesMTM is the bare minimum for community pharmacies. These programs allow a pharmacy to be assigned MTM cases from Medicare Part D plans. Pharmacy students on rotation are also a great resource, she says, and can probably accomplish MTM set up in a day. (Cardinal Health, owner of Outcomes, recently acquired Mirixa Corporation and plans on merging the two platforms.)
Stafford notes that when plans assess a pharmacy’s metrics, including adherence to different medication classes, they look at all the patients on the plan, not just those for whom MTM cases are being assigned. Pharmacy ratings also factor in a plan’s decisions whether to continue including a pharmacy in their network. Pharmacists can identify their nonadherent patients and work on improving metrics by using resources like the EquiPP platform and PrescribeWellness, she adds.
Continue reading on page 2...