MTM reimbursement gets a big push from the feds.
David StanleyThis time they may really mean it … I’m talking about pharmacy getting away from being paid only for putting a product in a bottle. I know that means that a lot of you just stopped reading. I understand why.
Around the time of Nirvana and Bill Clinton, I started hearing that there was no future in count, pour, lick, and stick. We were on the verge of a new era, so the story went, when pharmacists would get paid for actually affecting the outcome of drug therapy; they would be viewed as valuable healthcare partners, contributing clinical knowledge toward improvement of a patient's well-being.
More than 20 years later, I found myself with a vantage point deep within chain pharmacy, where I saw two major changes in the profession: a check box added to the signature log for a patient to decline counseling and the imposition of a flu shot quota. Two decades later, we were still predominantly doing work that had “no future.” So I can understand why you're skeptical.
But seriously, this time they may really mean it.
What’s different? This time the federal government is involved - and with something more meaningful than a toothless, unfunded requirement that we counsel patients at prescription pickup. Money is on the table, and mandates are in the air.
Along with the two major changes I mentioned above, you also may have noticed a minor one. Medication therapy management (MTM) cases might have begun to dribble into your computer, bringing with them the opportunity to make a few for such activities as coaching people on their medication compliance or contacting doctors about potentially inappropriate therapy.
I say “may” have noticed, because MTM hasn't exactly caught on like wildfire. The Centers for Medicare & Medicaid Services (CMS), the agency of the federal government responsible for administration of Medicare and Medicaid, recently reported that among Medicare Part D patients, only 11% of eligible MTM cases were being completed. CMS is not happy about this.
By the way, if you are not convinced that the federal government can force major changes in heathcare practice when it really wants to, take a look at that separate trash can you now keep for garbage with anyone's name on it.
As I said, this time it looks like they really want to. CMS has announced that Comprehensive Medication Reviews (CMRs) - the backbone of MTM, whereby a pharmacist does a once-a-year, top-to-bottom review of a patient's medication therapy in person or over the phone - will become part of the Medicare Part D plan Star Ratings quality measures.
I wrote earlier [“Dancing as fast as you can? Get ready for CMS’s Star Ratings,” July 10, 2014] that Part D plan sponsors would be fighting tooth and nail to look as good in these ratings as they possibly can, and would be putting pressure on pharmacies to do the things that will help them.
Soon one of those things will be CMRs. We've all heard the old saying about how money talks; if you listen closely, you will hear Benjamin Franklin, on that hundred-dollar bill, starting to clear his throat. So get ready to implement the CMR into your workday.
Like it or not, with an average reimbursement of around $60 apiece and access to Medicare Part D preferred provider networks on the line, I'm guessing that your employer will soon be finding ways to “encourage” you to take on your share of CMR cases. You can only hope that the encouragement comes in a less coercive form than the quotas we saw when we were granted immunization authority. While I'm not one to dash hope where I find it, I will say that I believe some things in pharmacy will never change, among them the management style of the major chains.
Of course I could be wrong, and this article could end up being just one more false alarm in the long series of “the future of pharmacy” pronouncements that were quickly ignored.
The addition of money has a way of changing things, though, and this time billions of dollars are on the line. Which means that the next big change in pharmacy is likely to be more significant than a signature log check box.
I think this time they may really mean it.