- CONDITION CENTERS
Pharmacy is a profession infused with acronyms: MAC, PBM, NCPA, APhA, NACDS, ASHP, AMCP, ASCP, AACP, ACP, APA, ACCP, NABP, NCSPAE, WAC, and SMAC, just to name a few.
A new acronym has now entered the profession's glossaryMTMSwhich stands for Medication Therapy Management Services. MTMS refers to the new pharmaceutical care, cognitive services, or patient care services. For decades, we as pharmacists have been clamoring for recognition of our professional services, using the various terms listed. The marketplace has been slow to accept and compensate this changing role on a widespread basismaybe because we have been explaining it wrong.
No one would have thought that the US Congress'passage of the legislation called the Medicare Modernization Act of 2003 would help us "tell our story," but it has. People are finally starting to "get it."Who would have thought that we needed another acronym?
I recently rediscovered a great wordonomatopoeiawhich describes a word that imitates its own sound, such as hiss or drip or buzz. Although not exactly onomatopoeia, Medication Therapy Management Services similarly describes what we as pharmacists do: help patients manage their medications by ensuring that they are taking the right drug, the right strength, the right dose, in the right combination with others if necessary, and finally at the right time (or at all).
On January 21, 2005, the Centers for Medicare and Medicaid Services published its final rules governing the Medicare Prescription Drug benefitand vague they are. Many of the comments within the 1162-page document discuss the lack of standardized examples in the marketplace, which has led to the current flexible regulations. It is true that no system yet is standard. There are, however, many examples of programs in which pharmacist-delivered MTMS has shown a positive impact on patient care. Some examples are the programs being administered by Outcomes Pharmaceutical Health Care.
Outcomes was formed in early 1999 to develop a market for what is now known as MTMS. The firm's founders shared an insight that pharmacists were highly trained and underutilized experts in drug therapy. They also shared a conviction that, positioned with appropriate systems, pharmacists could improve health care quality and reduce costs. Outcomes has established an impressive track record for its MTMS system, which includes pharmacist training, a menu of covered services, practice tools, and a unique Internet-based claims-processing program. Through this system, the company collects claims data and compensates pharmacists for MTMS, without requiring providers to purchase or obtain a proprietary MTMS software program for their site. More than 54,000 MTMS interventions have been documented in the Outcomes system, resulting in an estimated cost avoidance and prevention of >$2 million in additional health care costs.
Pharmacists across the country have numerous opportunities to service Outcomes-covered patients. Two of the more prominent programs are those offered through Florida Medicaid and through Community Care Rx.
The Outcomes system facilitates 1- on-1 patient care delivered by registered pharmacists in independent and chain community pharmacies, as well as consultant pharmacists meeting with patients in their homes or in a senior center. Outcomes MTM-covered services include comprehensive medication reviews, prescriber consultations, and education and monitoring on any new, changed, or OTC medication.
Florida Medicaid covers >1 million of the state's indigent population with MTMS through Outcomes. If you are a Florida pharmacist, are you providing these services and being compensated? If not, why not?
Community Care Rx (CCRx) is a Medicare-approved drug discount card that began covering 300,000-plus seniors nationwide (and growing) with MTMS through Outcomes in October 2004. If you have CCRx patients, are you providing these services and being compensated? If not, why not?
Many of our colleagues question whether the profession is ready to answer this call to take its rightful place in the provision of MTMS. If we as pharmacists do not answer this call, someone else in the health care marketplace willPDQ.
Ms. Kumbera is chief operating officer of Outcomes Pharmaceutical Health Care.