Even though I haven’t posted much on this blog over the last
few years, I still get emails fairly regularly from fellow pharmacists with
questions about medication therapy management, aka MTM. I thought that I should take a little time to
share what has happened over the last few years.
At one point, I had formed an LLC with the intent of
providing MTM services to local self-insured employers in an attempt to help
them control their health care expenses and to decrease absenteeism due to
preventable complications from chronic illnesses. The idea was to basically conduct
comprehensive medication reviews with high-risk employees and educate them to improve
adherence. I contacted in excess of
two-hundred companies and local governmental bodies. There were phone calls and meetings to
educate the decision-makers on how meeting with a pharmacist regularly could
help the employees and employers.
Two things always prevented the contract paperwork from
being signed…lack of recognition as providers from the insurance companies and
lack of hard data on the financial impact that pharmacists could make. We’ve been told for years about the successes
of the Ashville and Diabetes Ten City projects, but I have yet to see any hard
numbers on the actual impact that has been made. That lack of data was a sticking point with
the companies.
So after several years of trying to make a go of contracting
directly with employers, I gave up.
Since there had not been any progress on obtaining provider status
(other than having members of Congress sign on as co-sponsors to a bill that
never gets to the floor for a vote) I didn’t see the point of continually
spinning my wheels only to get nowhere.
At the same time, I left the retail world to take a director
of pharmacy position at a local critical access hospital. During the interview process several
physicians discussed opening an anticoagulation clinic. That sounded like a neat idea to me. I would be able to actually work directly
with patients to help improve their medication adherence, which was the whole
idea behind MTM when it was initially discussed.
As you can imagine with hospital politics, it took a while to
get the anticoagulation project moving.
I had spent several months working on the project and was told to put it
on the shelf. To say that I was mad
would be an understatement. I grabbed
all of the work that I had done and almost threw it into the trash can. Instead it found the bottom drawer of a
filing cabinet.
Shortly after the project was put on hold, it was resurrected. A few road trips ensued to see how other facilities were operating their anticoagulation clinics. I presented the clinic for approval and was given the nod to move forward. This July we will be celebrating our second anniversary as a clinic.
Looking at how I would have been practicing MTM if I had
been successful with first venture vs what I am doing now, I would have to say
that I am much more satisfied with what I am currently doing. I am actually managing the patients’
medications through the clinic. Through
the collaborative practice agreements that I have signed with the physicians I
am able to adjust therapy as I see fit instead of faxing a recommendation off
to a practice and hoping the nurse or MA will give it to the physician, who may
or may not agree with me.
It is my hope that pharmacists are granted provider status
so other pharmacists can enjoy their profession as I have been able to over the
last two years. When you are able to see
how a patient’s quality of life changes due to the impact of your professional
skills, you get the warm fuzzy feelings.
Not to knock comprehensive medication reviews, but you don’t see the
impact when you only see the patient once (maybe twice) a year.
I encourage all pharmacists and students to contact their
representatives to have them sign-on to the bill that has pushed forward. But don’t stop and be content with having
your Congressperson simply be a co-sponsor.
Contact the APhA and see what can be done to get the bill moved along to
get a vote.
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