[dropcap color=”white” background=”black” style=”rectangle” size=”big”]M[/dropcap]ore and more, we are hearing that MTM is the future of pharmacy. And while there is some truth with this statement, the reality is a lot more complicated.
MTM, as it has evolved under Medicare Part D’s parentage, is a poorly conceived service. The separation of the medication costs and the medical costs that exists within Medicare Part D gives PBMs (who manage the Part D benefit) little financial motivation to give patients access to the MTM service. This results in fewer MTM opportunities for community pharmacists. Additionally, many PBMs have brought significant amounts of MTM activities in house, using their own nurses or pharmacists to perform the minimum number of required by law. When local community pharmacists in the trenches do get an opportunity to perform MTM, they often end up spending far too much time completing the intervention and are reimbursed too little to cover their expenses. With the recent changes in Medicare Part D and CMS’ adoption of completed patient cases for comprehensive medication reviews (CMRs) as a performance measure for community pharmacies, this may potentially boost pharmacists access to MTM opportunities. Unfortunately, the amount of reimbursement for a CMR will continue to be a significant challenge unless pharmacists find a way to streamline their MTM processes.
The pharmacists approach to MTM needs to change. Consider that each refill picked up by the patient is an opportunity to assess the patient’s medication therapy, identify and document problems, and take action.
Today, pharmacists need to re-train themselves to complete MTM type activities in real time. This means upgrading their clinical knowledge, leveraging documentation systems, and optimizing workflows. Once pharmacists stop thinking about MTM as a sit-down encounter that takes more than 45 minutes, it opens up a host of possibilities.
Using a bite size approach to MTM allows the pharmacist to create, over the course of a few months, a complete medication therapy management description for a large number of patients. The pharmacist gradually collects and documents the information required in a traditional MTM encounter. This collection takes place on the counter, while checking prescriptions. This efficiency means that when a pharmacy is called upon to perform MTM services for a payor, they already have documentation and results in their pocket. The MTM intervention can be done in a matter of minutes.
It should also be point out that MTM does not need to exist only in the context of Medicare Part D. Pharmacists can look to group homes, assisted living centers, and others as potential MTM customers. Once shown the benefits of MTM groups and individuals often become quite interested in this service. Cash based MTM can become a real revenue stream for a pharmacy without requiring hours of desk time to complete.
