Now that all five Senate and House committees have completed their work on health care reform (HCR) bills, we feel good that medication therapy management (MTM) provisions are included in some form in each version. They are not ideal, but the bills represent a good start at ensuring Americans’ access to pharmacists’ MTM services, in addition to our dispensing of medications.
The merging of House proposals and the merger of Senate proposals must occur before each body debates and votes on HCR bills. If each chamber approves HCR legislation, a conference committee will then take a shot at merging the two bills into one for final passage and consideration by President Obama.
APhA is now engaged in seeking improvements to language that clarifies what we believe to be the intent of legislators. We want “pharmacist-provided” or similar language added in several places where the term “MTM” appears. We also will present the data that pharmacists are effective in identifying medication problems.
In addition, we will seek to keep MTM in both the CMS Innovation Center and as a stand-alone grant program. As an alternative, we will ask that at least one of the MTM models tested in the CMS Innovation center be pharmacist-specific.
We want to ensure that the lack of Part B payment doesn’t preclude pharmacists from participating in programs. We don’t want a poor payment policy to limit patient access or hamper best practices.
We are encouraging prevention and wellness programs such as diabetes screenings, and we are seeking transition of care (hospital to home) programs that recognize pharmacists’ essential contributions. Currently, some believe that hospitals can’t bill for those services now if provided by pharmacists, so nurses are used instead.
We want any integrated care models that emerge from HCR to ensure that pharmacists are part of any team that involves medication management. As our VP of Government Affairs Kristina Lunner likes to say, “You like Asheville? You like General Mills? Well then, you need a pharmacist.”
We are supportive of NACDS and NCPA efforts to fix AMP and provide relief from accreditation to certain qualified pharmacies that want to provide DMEPOS.
Keep up with all this and more on our Health Care Reform Hub. Frequent updates on HCR keep you informed about the latest pharmacy-related action on Capitol Hill.
Dear Tom: I think that we must insist on adequate payment for knowledge and expertise. We cannot ask pharmacists to continue to give away their knowledge and advice as we have done for the past 60 years that I have been involved in the profesion. I am out of the active practice of pharmacy since I retired in 1999. We still need a new method of compensation for pharmacists!!
APhA has been fighting to get reimbursed for MTM services for decades, and this is an extremely important “victory” for our profession. What’s really troubling is to think that we still have to go through nurses or doctors to get reimbursed. It’s like begging at the “back door for a handout”.
The claims process, by itself, is likely designed to be complicated and time-consuming (to discourage claims). So I have to wonder how many pharmacists are actually billing for services. Unfortunately, it’s always easier and quicker to just give advice and be done with it. But we can no longer afford to keep doing “Business as usual”… Admittedly, I’ve been out of this part of the practice since 2000, and this may have been done already, but FWIW – APhA needs to push for a simplified process or provide claims processing guides, so more members can better understand how to utilize the payment process.
The trend toward prevention and wellness programs such as diabetes screenings is an excellent way to go, and the Association also needs to provide our members with simple and effective patient-focused care enhancement tools to expand the practice in this area.
Good Luck with this!