Medication therapy management definition can help achieve payment
Opportunity to develop direct patient care services
Developing a widely accepted definition of medication therapy management (MTM) and its role in the pharmacist patient care continuum is important if pharmacists are to receive additional payment for providing such services. That's the conclusion of researchers led by University of Pittsburgh School of Pharmacy assistant professor Melissa Somma McGivney, PharmD, who developed a conceptual model delineating the relationship between MTM and contemporary pharmacist-provided services including patient counseling, disease management, and pharmaceutical care.
McGivney says incorporation of MTM services into the array of services funded by the new Medicare Part D drug program is giving pharmacists an opportunity to develop direct patient care services in the community.
The pharmacy profession has defined MTM as "a distinct service or group of services that optimize therapeutic outcomes for individual patients [that] are independent of, but can occur in conjunction with, the provision of a drug product." Specific MTM outcomes are appropriate drug use, enhanced patient understanding of appropriate drug use, increased patient adherence with prescribed drug therapies, reduced risk of adverse events associated with drugs, and reduced need for other costly medical services.
The federal Centers for Medicare and Medicaid Services views MTM as a mechanism to ensure that "medications prescribed for targeted beneficiaries are appropriately used to optimize therapeutic outcomes and reduce the risk of adverse events." The American Pharmacists Association and National Association of Chain Drug Stores have identified "core elements" of MTM services including medication therapy review, personal medication record, medication action plan, intervention and/or referral, and documentation and follow-up. McGivney says these core elements provide a means to accomplish MTM's comprehensive goal—to focus on and create solutions for patient-specific drug therapy problems and collaborate with other health care professionals.
She points out the philosophy of pharmaceutical care focuses on the responsibility of the pharmacist to "meet all of a patient's drug-related needs, to be held accountable for meeting those needs, and to assist patients in achieving their medical goals through collaboration with other health professionals."
Patient counseling is drug-specific
Under the general heading of "patient counseling," McGivney says, pharmacists are expected to offer an explanation of a prescribed drug's purpose, proper administration, length of therapy, special directions for use, proper storage, refill instructions, common adverse events, potential interactions, contraindications, and guidance on steps to take given specific outcomes.
While more than 3.2 billion prescriptions were dispensed in 55,375 community pharmacies in 2004, only 63% of people, on average, received any verbal information from the pharmacist about their drug therapy.
Based on guidelines in the Omnibus Budget Reconciliation Act of 1990 and the Indian Health Service, McGivney says patient counseling alone does not constitute pharmaceutical care. Rather, it is a tool that is included in providing pharmaceutical care. From payers' perspectives, patient counseling is focused on a specific drug product and generally involves one-way transmission of information from a pharmacist to a patient or caregiver. "Despite the casual use of the term patient counseling to mean more than this, payer groups and the literature support this simple view of patient counseling," she says. "This is an important distinction when considering the scope of MTM to encompass more than just patient counseling. Patient counseling begins with, and focuses on, providing information related to the immediately prescribed drug, with the final responsibility for following the instructions belonging to the patient. The only documentation required is a 'yes' or 'no' checked on a form next to the patient's signature to indicate whether the offer to provide the information was accepted. Follow-up is not required and no formal compensation mechanism is in place beyond the dispensing fee."
Pharmacists also are involved in disease management programs that have been developed to ensure that population guidelines are followed. The programs are interprofessional in nature and may be provided by a wide variety of health care professionals, including physicians, nurses, nutritionists, and pharmacists. Disease management focuses on a specific disease, providing patients with the tools and knowledge they need to assume some responsibility for their own care.
Developing disease-management programs
Disease management programs developed by pharmacists include anticoagulation, hypertension, dyslipidemia, asthma, diabetes, and others. Payment for disease management services is usually through payer contracts, with the payments not distinct to any one profession. McGivney says pharmacists often have had difficulty obtaining adequate compensation for managing a patient's drug-related needs because the time is often shared with other health professionals. While disease management goes beyond patient counseling by addressing a patient's drug and non-drug therapy, as well as lifestyle modifications associated with a specific disease, by definition is does not address a patient's entire drug regimen.
MTM is a comprehensive framework
So how is MTM different? It goes beyond patient counseling associated with dispensing a single product and goes beyond the education and management of a specific disease. MTM's focus is on the individual patient, with the intention of optimizing the patient's drug regimen to best achieve appropriate therapeutic goals for that patient.
McGivney says that for a pharmacist to best understand a patient's experience with a drug regimen, the pharmacist must enter into a dialog with the patient about expectations and current drug regimen results. The pharmacist must gather pertinent patient history to understand the scope of the patient's health needs. And if drug therapy problems are identified, the pharmacist works with the patient and the patient's health care practitioners to create a solution.
Documentation of the consultation provides a basis for follow-up between the patient and the pharmacist to determine the outcome of the devised plan and further optimize the therapy, if needed. The pharmacist's documentation also facilitates communication among the involved health care professionals and justification for the services provided and is required by the payer, along with follow-up, to receive compensation for the service.
"MTM services offer an opportunity for a patient to engage with his or her pharmacist in a more meaningful and effective way," McGivney says. "The pharmacist takes the responsibility to prevent or identify and resolve drug therapy problems that arise by using a variety of strategies, including comprehensive medication therapy review, discussion with and education of the patient and/or caregiver, discussion and intervention with other health professionals, and possible referral to other health professionals and pharmacist specialists as needed. MTM focuses on the whole patient, drug therapy use, and the recognition of a specific patient's drug therapy needs. It integrates the philosophy and practice of pharmaceutical care and elements of disease management through the pharmacist's provision of personalized drug-related information and interventions suited to individual patient needs."
McGivney suggests MTM services be viewed as a "comprehensive framework for all drug-focused patient care service components of the practice of the pharmacist. The pharmacist is the ideal professional to provide MTM services, based on his or her knowledge of drug therapy and accessibility to patients, especially in the community."
McGivney tells Drug Formulary Review that while MTM came into existence through Medicare's willingness to pay for MTM services, there are many other programs now outside Medicare, including some Medicaid contracts. In addition, she says, "employer groups are doing it with a group of pharmacies or are partnering with for-profit companies to direct data to pharmacists."
She says she hopes her paper will serve as a baseline and will provide guidance to others on being clear in how they describe various programs.
[For more information: Contact Dr. McGivney at (412) 624-8142 or e-mail [email protected].]
Developing a widely accepted definition of medication therapy management (MTM) and its role in the pharmacist patient care continuum is important if pharmacists are to receive additional payment for providing such services.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content