Monday, June 1, 2015

Update on my MTM experience

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.


Carla C said...

Washington state just recently passed provider status for pharmacists. I am excited to see how this transforms patient care here in the state. I agree with you that MTM is big step in patient self care management. Thanks for writing this article on your experiences. Best of luck to you and your team!

Anonymous said...

I am curious if you still work as director at a Critical Access Hospital CAH. Typically, there are staffing issues, and too often the pharmacy dept is under nursing management, at least that was the way it worked at two of the other CAH where I staffed. At another CAH the director is 24/7 wearing all sorts of pharmacy hats, including warfarin monitoring using CoagClinic documentation program. Do you employ students, and provide mentoring support for students? At one CAH staffed by alternating hospitalists, I could see where pharmacists monitoring warfarin would fit nicely in our job duties, as the hospitalists jerk doses around too much, using phytonadione quite frequently. But, there is minimal staff (1-FT, 1-PT), and I think training for the director might be too time-consuming (as well as concern about personal liability) considering the amount of new programs that are being installed lickety-split.