NOVEMBER 01, 2005

The pace of change in the health care field, like the recent burst of hurricanes in the Atlantic and Caribbean, may seem overwhelming. Wave after wave of technological advances, huge new entitlement programs, and enhanced roles and responsibilities for direct patient care are forming into what Bruce Roberts (pictured below), RPh, executive vice president and CEO of the National Community Pharmacists Association (NCPA), likens to a "do or die" situation for independent pharmacy.

E-Prescribing: "Do or Die"

What is the crux of the looming problem for independent pharmacy? It is the profession's slowness in adopting electronic prescribing (e-prescribing), Roberts said. Medicare Part D is coming and, with it, enhanced opportunities to provide pharmaceutical care through the program's Medication Therapy Management (MTM) services. Yet, without a portal such as SureScripts, the nation's largest provider of electronic prescribing services, essential medical information such as patient health records cannot be exchanged securely and efficiently. Without this capability, pharmacists will be ill-equipped to grow with the rest of the profession as it takes on clinical responsibilities via Medicare Part D. According to Roberts, who did not mince words, "Do it, or you're out of business."

Somewhat ironically, because pharmacy innovation has historically originated within independent pharmacy and spread outward, SureScripts has been adopted by 70% of chain pharmacies to date, but only 1% of independent pharmacies have signed on. The fact remains that, with more physicians opting to send electronic prescriptions rather than using the old paper process, and with more pharmacies capable of handling such transactions, medical errors and costs are reduced and overall patient care is enhanced.

Gearing Up for MTM Services

Another challenge facing independent pharmacy is the provision of MTM services. Long sought as a natural extension of pharmacists' training and expertise, MTM services are now a required offering of the Medicare Part D drug benefit. Conceived as a counseling service, MTM services will include a medication review, and documentation of the service is key to reimbursement.

Community Care Rx, 1 of 10 national Medicare Part D prescription drug plans approved by the Centers for Medicare and Medicaid Services, has been operating a pilot program that reimburses pharmacies for providing similar counseling services. Guidelines under the Medicare Part D program are somewhat vague, however, and pharmacists must prepare in order to deliver high-quality MTM services and receive appropriate reimbursement.

To aid independent pharmacies in successfully delivering MTM services, NCPA has created Community MTM—a Web-based service that provides clinical content and policies and procedures, a set of tools to implement the following array of MTM services:

  • It will indicate which of the pharmacist's patients are eligible for MTM services
  • It will provide all necessary medical records and clinical information to support the pharmacist's counseling function with those particular patients
  • It will prompt the pharmacist to provide all necessary information in order to adequately document the provision of services
  • It will submit all claims for payment purposes

Medicare Part D has opened the door to pharmacists so that they can begin to provide the sort of care that they are well-trained to provide. As the profession learned with the Asheville Project, the pharmacist is uniquely equipped to deliver high-quality clinical care that will improve patient outcomes while at the same time saving money. According to Roberts, the first step, however, is to get on-line with SureScripts!

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