INSIDE MEDICATION THERAPY MANAGEMENT: Independents Lagging in Tech Realm

The pace of change in the healthcare field, like the recent burst ofhurricanes in the Atlantic andCaribbean, may seem overwhelming.Wave after wave of technologicaladvances, huge new entitlement programs,and enhanced roles and responsibilitiesfor direct patient care are forminginto what Bruce Roberts (picturedbelow), RPh, executive vice presidentand CEO of the National CommunityPharmacists Association (NCPA), likensto a "do or die" situation for independentpharmacy.

E-Prescribing: "Do or Die"

What is the crux of the looming problemfor independent pharmacy? It is theprofession's slowness in adopting electronicprescribing (e-prescribing),Roberts said. Medicare Part D is comingand, with it, enhanced opportunities toprovide pharmaceutical care throughthe program's Medication TherapyManagement (MTM) services. Yet, withouta portal such as SureScripts, thenation's largest provider of electronicprescribing services, essential medicalinformation such as patient healthrecords cannot be exchanged securelyand efficiently. Without this capability,pharmacists will be ill-equipped to growwith the rest of the profession as it takeson clinical responsibilities via MedicarePart D. According to Roberts, who didnot mince words, "Do it, or you're outof business."

Somewhat ironically, because pharmacyinnovation has historically originatedwithin independent pharmacyand spread outward, SureScripts hasbeen adopted by 70% of chain pharmaciesto date, but only 1% of independentpharmacies have signed on.The fact remains that, with morephysicians opting to send electronicprescriptions rather than using the oldpaper process, and with more pharmaciescapable of handling such transactions,medical errors and costs arereduced and overall patient care isenhanced.

Gearing Up for MTM Services

Another challenge facing independentpharmacy is the provision ofMTM services. Long sought as a naturalextension of pharmacists' trainingand expertise, MTM services are now arequired offering of the Medicare PartD drug benefit. Conceived as a counselingservice, MTM services willinclude a medication review, and documentationof the service is key toreimbursement.

Community Care Rx, 1 of 10national Medicare Part D prescriptiondrug plans approved by the Centersfor Medicare and Medicaid Services,has been operating a pilot programthat reimburses pharmacies for providingsimilar counseling services.Guidelines under the Medicare Part Dprogram are somewhat vague, however,and pharmacists must prepare inorder to deliver high-quality MTMservices and receive appropriate reimbursement.

To aid independent pharmacies insuccessfully delivering MTM services,NCPA has created Community MTM—a Web-based service that provides clinicalcontent and policies and procedures,a set of tools to implement thefollowing array of MTM services:

• It will indicate which of the pharmacist'spatients are eligible forMTM services
• It will provide all necessary medicalrecords and clinical informationto support the pharmacist'scounseling function with thoseparticular patients
• It will prompt the pharmacist toprovide all necessary informationin order to adequately documentthe provision of services
• It will submit all claims for paymentpurposes

Medicare Part D has opened the doorto pharmacists so that they can beginto provide the sort of care that they arewell-trained to provide. As the professionlearned with the Asheville Project,the pharmacist is uniquely equipped todeliver high-quality clinical care thatwill improve patient outcomes while atthe same time saving money. Accordingto Roberts, the first step, however,is to get on-line with SureScripts!