Tuesday, August 30, 2011

I hope I'm wrong about the future of MTM

As a pharmacist, it is my duty to be correct one-hundred percent of the time. Correct medication, correct strength, to the correct patient at the correct time. If I am not correct, there may be some serious consequences.

Well today I am writing to say that I hope that I am not correct with what I am thinking, but from what I have been reading and researching, I just may be correct.

What is it that I hope I am incorrect about? It’s the thought that medication therapy management (MTM) is the model for the future of pharmacy. I’m afraid that the profession has gone all-in on this one practice model before the cards have even been dealt. Let me explain.

For the past twenty years, pharmaceutical care/ medication therapy management has been touted to be the future of pharmacy practice. There have been a few projects that have shown how interventions by pharmacists can improve the quality of health care and decrease expenses for employers and insurers (Ashville, Diabetes Ten City). But these have not been able to be duplicated and rolled out across the country.

In fact, after twenty years all we have are three CPT codes that we can bill our services under, but the insurers and Medicare do not recognize individual pharmacists as providers of medical services. We are still viewed by the product that we dispense instead of the services that we provide. It has only been in the recent past that the profession has been able to get language written that provides for grant money for MTM services. No funding yet, just language that might provide funding.

So where does that leave us today? Right now the only MTM that is being provided (and compensated for) is to patients who are enrolled in Medicare Part D Prescription Drug Plans. When the Medicare Modernization Act was passed several years ago, one of the selling points to pharmacists was that we were going to be able to provide MTM services to the Medicare Part D patients. At least with this community pharmacists should be able to provide the MTM services to a segment of the population who should be able to benefit.

The 2011 CMS Fact Sheet on Medicare Part D MTM (dated 6-30-11) provides some insight on how the MTM services are being provided. According to the fact sheet, all of the Medicare D PDPs offer telephonic consultations. And 27 percent of the plans offer face-to-face consultations. Only 27 percent. That is sad. The Medicare D plans are not allowing their patients to receive MTM services from the pharmacists that they know and trust.

The service that is being compensated is a comprehensive medication review (CMR). For those of you who have never provided a CMR consultation, it’s basically a medication reconciliation with a Q & A session afterwards. After twenty years of hoopla, the future of pharmacy is a med-rec and a Q & A?

Since I began writing my blog, I have had the opportunity to talk with several national-level pharmacists who are in the know about MTM. Folks who are higher up the national organizations. From these conversations I have learned that there aren’t any pharmacists who have been able to create a business model that is able to stand on its own financially. I have talked to a couple pharmacists who have been able to bill for their services and collect enough from insurers to cover their salaries and benefits. But these pharmacists have done so using billing codes that are “incident to” physician services, not utilizing the CPT codes that have been established for pharmacists.

If you have paid attention to recent articles, medication therapy management hasn’t been talked about as a service to be provided by community pharmacists. It’s now being thrown in as the pharmacist’s role in the medical home models and accountable care organizations (ACOs). It’s almost as if the national organizations have realized that medication therapy management as it was originally envisioned isn’t going to come to fruition so now they are trying to find a way to incorporate MTM into the ACOs to they can say that they were successful.

Like I said at the beginning, I hope I’m wrong about this. I want to see pharmacists able to bill for MTM services as individual providers. I want to see pharmacists recognized as individual practitioners by Medicare/insurers and not as extensions of the buildings that they work in. I want to see pharmacists reimbursed for the knowledge in their heads, not the pills in the bottle.

By embracing medication therapy management as the future of the profession of pharmacy, it seems to me that the national organizations and the pharmacy educators have gone all-in on this before the cards have even been shuffled, let alone dealt.

Sunday, August 28, 2011

Master of Pharmacy Medication Therapy Management

University of Florida Online Master of Pharmacy
Medication Therapy Management

If you have questions about the online Master's in Medication Therapy Management, we invite you to join us for a live information session on August 30.

The session will feature program director, Dr. Karen Whalen who will discuss program curriculum, the demand for MTM providers, and the many benefits of earning your specialized degree in MTM. In addition, current students will discuss their experiences in the program, their goals after graduation, and how they are applying classroom skills into their practice.

At the end of the session, you will have the opportunity to ask questions of our panel.

Date: Tuesday, August 30
Time: 7:00 pm EST / 6:00 pm CT/ 5:00 pm MT/ 4:00 pm PT

Register Now!

Best Regards,

Your MTM Admissions Department


I received this email a few days ago. Anybody else?

I would call to find out the details, but I am already attending a workshop on Tuesday night. If you call in to find out details, please leave a comment here or send me an email to let me know what was said.

As an editorial comment, I find it interesting that a university is offering a Masters program in medication therapy management. Especially since insurers are not recognizing pharmacists as individual providers of MTM services.

Tuesday, August 16, 2011

MTM... The future of pharmacy?

Keep your eyes open. If you've read this blog long, you know that I believe in the concept of MTM.

But is it the future of our profession?

I'm working on a post that examines where we are with regards to medication therapy management. With my new position as director of pharmacy, I have kept busy with the duties of my position so I haven't been able to keep up with the blog entries.

But I'm still working on posts, just not getting them typed up. Like I said, keep your eyes open for my future posts.

Wednesday, August 10, 2011

I need counseling...seriously

Last week I developed a condition with my right eye. I had spent the weekend working in the yard, trimming the trees, pulling weeds. All kinds of landscaping/gardening activities. As Sunday evening rolled around I started to feel something in my right eye. I assumed it was some sort of allergic reaction since pollens typically cause me problems.

So I took some loratadine on Monday morning and assumed all would be well by the end of the day. After finishing a round of golf after work, my eye wasn't better. By the time I returned home, the upper eyelid of my right eye was swollen.

In between rounds and meetings on Tuesday, I was able to run over to one of the nurse practitioner's offices to have my eye looked at. The diagnosis wasn't an allergic response. It was cellulitis. The nurse practitioner decided to e-scribe an antibiotic for me.

Since our facility doesn't have an outpatient or employee pharmacy, I had to decide where to have my prescription filled. This was the first time in my career where I wouldn't be using my own pharmacy to fill a prescription. I decided to use the grocery pharmacy that I had managed a few years ago.

Being the responsible patient, I called the pharmacy to give them my new insurance information ahead of time. It would be four or five hours until I would be picking up my medication. The pharmacist on duty was one of my partners from ten years ago. We've always joked around when we run into each other. As we finished the call, I told him to make sure he had his whole counseling bit together because I needed to know how to store my medication and what to do if I missed a dose. We laughed and hung up.

After finishing at the hospital, I drove to the pharmacy to pick up my prescription. After paying for my prescription I asked about the counseling. Steve informed me that when I signed for my insurance, I was also documenting that I declined the offer of counseling. I remember that about that system. We laughed again and I went on my way.

Fast forward to Saturday. My family decided to do some school shopping and see what was left at the local Borders. It was getting to be late in the afternoon and hunger was starting to set in. As we drove to the Italian restaurant, a storm kicked up. I dropped my wife and kids at the door and ended up parking a considerable distance away from the door. I hopped out in the rain and hurried in. The only part of my body that the umbrella protected was my face and hair. Everything else was soaked.

By the time that we finished eating, I was still pretty damp. The storm had passed so we decided to hit another store.

While in the store I put my hand in my left front pocket. That's when I realized what had happened.

You see, I was going to need a dose of my antibiotic while we were out shopping. Rather than bringing along the prescription vial, I just shoved a capsule in my pocket.

What happens when the gelatin of a capsule gets wet? You know, like when it sits in a damp pocket for a couple hours.

That's right the gelatin dissolved to the point to where the contents of the capsule were now lining my left front pocket. I was half mad, half amused at what happened. Over the sixteen years of my career I have preached and preached and preached about not storing medications in humid environments. And look what happened to me, the pharmacist.

If only I had agreed to my counseling.

Saturday, August 6, 2011

Senna + bisacodyl + docusate + PEG =

I've kept this photo saved on my computer for a while, not sure when the appropriate time to post it would be.

Well a couple weeks ago, we had a couple incidents on our med/surg floor that made me think of this picture. We had people (on back-to-back days) produce BMs after 5+ days of constipation each. The hospitalist's words "it was all over the room".

Nursing and housekeeping earned their pay on those two days.

Have a great weekend.

Tuesday, August 2, 2011

Fellow pharmacist's lament

I don't think I can do this anymore.

I'm tired of the customer's word weighing more heavily than mine. Then, after they take the trouble to call in a complement on my behalf...

It's more or less disregarded or soon forgotten.

I'm tired of being asked to do more and more and more, and given practically no incentives whatsoever.

I'm tired of being talked down to by grocery personnel. I'm tired of being resented. I'm tired of pharmacy being mis-understood/appreciated.

I'm tired of being surrounded by incompetents and maniacs, then getting hammered whenever I happen to screw up something.

I'm tired of having to be a customer service kiss-ass to some of the worst scum and biggest jerks. And if they complain, I get rear-ended.

I'm tired of corporate breathing down our back telling us to increase flavoring, give more flu shots, take this training on your off day, et

I'm tired of catering to everyone else and then being treated like a drone in return.

I'm tired of getting lectured and scolded for petty things that aren't even my fault or that big of a deal

Where's the respect? Where's the appreciation? Where's the benefit of the doubt? Why are we never cut any slack?

I'm almost 40 and I hate my job. What the hell am I gonna do now?

Those are a series of tweets from a fellow pharmacist on Twitter several days ago. Sadly I can relate, as can many of you. In fact, I imagine that just about every chain pharmacist feels the same as this pharmacist.

I'm waiting for a member of management, somebody at the district manager-level, to grow a pair and stand up for their pharmacists. If you have such a DM, praise them. They are your voice.

Don't wait for the national organizations to speak up for you, it's not going to happen anytime soon. You invested the time and money to earn your degree. Don't sit back and let some corporate officer ruin YOUR profession.

Speak up.