Monday, March 14, 2011

Starting an independent MTM business

One of the most common email topics that arrives in my inbox is "how do I start my own independent MTM business?". I've tried to reply to these messages, but there just aren't enough hours in the day to adequately reply to all of them. So I thought that I would share everything that I have done, with the hope that it will help any other pharmacist who is trying to start.


First and foremost, you should apply for your own NPI if don't already have one. This will uniquely identify you as a provider. If you are going to operate your MTM consulting as separate business entity, you will need an NPI for it as well. Note: wait until you have a registered business name before applying for the business NPI.

Which brings up the next thing that I did... I registered my MTM business as an LLC. Once that was done, I applied for the NPI for the MTM business. Why wait until after the business is registered? That way you can make sure that the name is available. For me, my first two choices for a business name were already registered. I want my business name and NPI to be the same.

All of this so far took about a week or two.


Now for the part that we all really want to know about.


How do I get patients for my business?

This is the point where you need to decide what your MTM business focus will be. Are you going to go after the Medicare Part D patients? How about self-pay patients who might be looking to decrease their out of pocket expense? Corporate clients? Who are you trying to help with your MTM services?

Me...My target market is self-insured, small to mid-sized businesses. My thoughts are to get to these patients before they hit retirement age and help improve their health and save their employers on health-care expenses. I want to go on-site to provide my company's services. But this is a tough market to break into because, surprise, companies don't want to do business with individual pharmacists who are not recognized as health care providers by their insurance company.

The APhA is working on getting the legislation in place to get us the recognition, but it's going to take some time. So I have spent the last two years contacting the medical insurance companies in my area, attempting to get my business recognized as a provider within their networks. My thoughts are that if my company is listed as a provider, the small to mid-sized businesses will be more likely to enter into a contract. If nothing else, the employees could seek me out on their own and bill it to their insurance.

It's been tough going. I've done some direct marketing to my target market and have had some meetings and phone calls with benefits directors. But so far no contracts.

As for getting recognition as a provider with the medical insurance companies, the first two years have been rough. I submit provider applications, only to be turned down with "try back in six month" messages. But recently I have had two insurers request additional information about the services that my company provides. This is promising and I will share what happens at a later time.

I have attempted to become an MTM provider for the Medicare D plans that operate in my state. I have contacted every plan in both 2009 and 2010. The plans that respond usually give me the "we provide MTM services with in-house staff" responses. In my state, there is only one plan that will contract with individual pharmaCISTS to provide MTM services. Outcomes Pharmaceutical Health Care provides MTM services to Humana patients in my state. So I have my business set up as an alternate site provider. I am also currently filling out my application to become a provider in the PharmMD network. Until the medical insurers recognize pharmacists as providers, I am getting access to some patients through the Medicare D plans.

As for training and such, I went to the Delivering Medication Therapy Management Services in the Community session at APhA 2010. It reinforced what I was already thinking that I needed to do. I also bought a couple books from the APhA. Nothing earth-shattering there either. But they did have some good stuff. My previous management experience has done more for me than the books with regards to developing a business plan, etc...

There are several companies that have MTM software programs. I have blogged about them previously.

Hopefully this helps answer some of the questions that you have. Please contact me if you have a specific question. Or leave a comment so that others can benefit from or answer your questions. The more information that we share, the better patient care we can deliver.


* * * * *


If my employer (a chain) wanted to provide MTM services, I would embrace it. But I would want compensated above and beyond my regular wage for providing these services. I don't want to see MTM become simply another ploy to get people in the store to buy over-priced dog biscuits. I'm afraid that as chains enter into the MTM arena it will be another area where they expect pharmacists to provide top-notch patient care without providing adequate support.

As pharmacists, we need to be active politically as individuals. Right now we have MTM legislation sitting in two House committees. The bill needs to make it to the House floor, then to the Senate, then to the President. Remember the old I'm just a bill ditty from Saturday morning cartoons? We need to be active to make the bill become a law.

You can follow the bill at the Library of Congress to see where it is in the process. We need to contact the Congressional committee members who hold the future of MTM in their hands.

27 comments:

Anonymous said...

When it comes to pharmacist services in the hospital settig/amb care, you need to find some physician endorsement. It is important to have a physician champion, offering input and informing patients and colleagues about the services. I have seen independents make clinic visits to inform nurses and doctors about the level of patient care and durable medical equipment their pharmacies sell.

A few of them would have business pens and some brochures made up and leave them at the doctor's offices. The days of mass quantity of pharma pens is over, so why not have some inexpensive custom business pens made and drop them off at physician offices.

I know my local hospital does health seminars all the time, I wonder if it would work to contact them about offering a seminar on the benefits of MTM. Worth a shot maybe.

Maybe approach a clinic or private physician practice about offering services on-site if they have any patients who may benefit.

I really appreciate the post! I am still a student but graduate in a couple months, no matter where I end up working, after a while I plan on setting up a LLC MTM company like you and seeing where it takes me. If anything it will be an adventure.

Anonymous said...

Hi Eric,
Thanks for sharing your journey.
Regarding creation of an LLC: what kind of LLC did you go with? Sole Proprietor, Corporation, Partnership, S-Corporation?
If you could share your reasoning to this regard that would be greatly appreciated.
Thanks.

Shirley said...

Thanks Eric for starting the blog, we can have a portal to go. Each state has different legislation. Eric had frontier experience and understanding. I could not thank more for his sharing.
From MTM concept, legislation, platform (Health information technology), patient-insurance-provider-health care team coordination to MTM reality, this whole process takes visinary leaders. One of many innovator is Outcome Pharmaceutical Health Care, they have taken the MTM concept to the MTM reality step by step. As a pharmacist, I am glad I can contribuite a bit every day to push MTM into reality by driving every mile to visit every patient.

Teresa said...

I am a pharmacist who lives in one state but wants to provide MTM services in another state through Outcomes. Am I required to register my pharmacy consulting business both in the state that I work in as well as the state that I live in?

Eric Durbin, RPh said...

I guess that I've forgot to respond to a couple of the comments here, so I will now.

I went as a sole proprietor when I set up my LLC simply because I'm the only member of the LLC. When I looked at the types of LLCs, it made sense.

As for the providing MTM in a different state, I would contact the Board of Pharmacy in that state. It may depend on where you are when you are providing the service (in your home state providing tele-MTM vs travelling to the other state for face-to-face).

Oh wait, I just reread the question. I'm no legal expert so this is just my thoughts. I think the business just needs to be registered in state where it is located. Check with a lawyer.

Anonymous said...

Hello Eric,
I am not sure,my comment got posted. Thank you for sharing,MTM is an area I am very interested in and am trusting God to lead me how to go about this.I did the certification course with APhA and I have a registered LLC. Thank you again for sharing,I also have a blog at http://whoistampabay.com/blogs/cookbook
maybe you would like to visit.
Ann

Anonymous said...

Out of curiosity, what is a fair charge per patient? So it seems you still have your day job but do you anticipate just doing MTM and making ends meet that way? I am a hospital pharmacist and looking to venture into MTM- Ivy

Melissa Robinson said...

Thanks for posting! I am a new graduate and interested in developing an independent MTM practice. I was wondering if you had any luck with recruiting self-pay individuals for your services? It may be a long-shot but would that be an option to circumvent the insurance/ employer/ MD roadblocks? I've recently started online fitness coaching (recruiting via social networking) and have some clients with additional health needs and have considered charging for advanced services via an online MTM business. Have been thinking to find a business partner... PharmMD doesn't seem to be hiring at the moment.

Melissa Robinson said...

Thanks for posting! Have you had any success with self-pay clients? I know it's a long-shot but would this circumvent the insurance/ employer/ legislation roadblocks? I recently started online fitness coaching (recruiting via social networking) and have clients with additional health needs. I have been considering offering advanced services via an online MTM business. Been considering finding a business partner. PharmMD doesn't seem to be hiring at the moment- interested to learn more about how they started and how well they are doing..

Anonymous said...

We are trying to start a revolutionary concept on MTM world and trying to connectstart all pharmacists and patients and introduce about medication therapy management and how it benefits the health of an individual. Please join hands with us and stay tuned by liking www.facebook.com/drugexperts

Anonymous said...

What about liability insurance? Do you need one for yourself and the business? Should I obtain before starting?

Anonymous said...

Thank you. This was extremely helpful and a God sent. Do you need liability insurance just for yourself or for the business too? Thanks

Eric Durbin, RPh said...

Re: liability insurance.

I would advise any and all pharmacists to carry their own personal liability insurance. I would also advise the business to carry a policy unless the only employee is the pharmacist who already has their own coverage, however you may want to consult with a lawyer to see if there are any state-specific issues.

Anonymous said...

What is the advantage of having LLC vs working as independent contractor. I am looking to work for a MTM company as a IC but now am thinking of a LLC.

NancePharmD said...

I see that you started an LLC. I am in the process of working with a company that offers MTM services. They will hire me as an independent contractor. What is the advantage of working as IC vs forming LLC?

Anonymous said...

MTM success story
http://www.mymtmcare.com

http://www.thehonestapothecary.com/2013/08/29/the-pharmacist-entrepreneur-meet-mtm-pharmacist-randee-bowder/

Anonymous said...

http://www.thehonestapothecary.com/2013/08/29/the-pharmacist-entrepreneur-meet-mtm-pharmacist-randee-bowder/

www.mymtmcare.com/

Anonymous said...

HI Eric,

When applying for your NPI number for the LLC, what did you use as the business location address? I have a PO Box for my mailing address but it will not let me use that. DID you use your residential address?

Thanks!
Lisa

Eric Durbin, RPh said...

Lisa,

I used my home address.

Eric Durbin, RPh said...

"I see that you started an LLC. I am in the process of working with a company that offers MTM services. They will hire me as an independent contractor. What is the advantage of working as IC vs forming LLC?"

The advantage of working as an independent contractor is that you won't need to find your clients, the vendor will provide them to you.

The disadvantage...there may not be as many clients as you would like, especially if you are hoping to do this full-time.

Anonymous said...

Any updates on how your business has progressed as of now in 2015? Are you still working on this project or have you moved on? Are you finding there is a market for these services on a out of pocket basis, sounds like 3rd party pay is still very difficult to lock down.

Anonymous said...

I am starting to work for a company as an IC and they assure me their are plenty of clients available.

Anonymous said...

I am currently looking into starting an MTM program on my own and doing home visits, but I cant figure out how to contract with insurances or how to go about being able to bill. Can someone reach out to me on this?
My email is Kurian.Mark@gmail.com

Eric Durbin, RPh said...

This is the main issue that I faced, and this is the reason why we need to get provider status. I contacted every major insurer in my state (Ohio) and was either ignored or sent an application to register my pharmacy within the network. The insurers didn't even consider that pharmacists could be providers.

Every pharmacist that I have talked to that has their own MTM practice receives the bulk of their patients through Outcomes/Mirixa/etc...

Anonymous said...

Will Outcomes / Mirixa provide patients to independent pharmacists not linked to a specific pharmacy? Does an NPI / business name and license qualify an individual for Outcomes / Mirixa?

Anonymous said...

Hi Eric,

I have a question about to start MTM, do you need any type of certification like Board Certification or MTM certification etc, or any one can start this?

Eric Durbin, RPh said...

To my knowledge, no. I would advise you to check with your state pharmacy association to see if there are any state-specific requirements.