Expanded Pharmacy Services Promise Better Medication Outcomes, Improved Bottom Line
Richard A. Hess Jr., ETSU Bill Gatton College of Pharmacy
As America's healthcare service model and reimbursement strategies evolve, so does the role of today's pharmacist. That means expanded business opportunities for pharmacies, particularly independent and community pharmacies with the flexibility to answer new payer and consumer demands.
"I see the business model shifting, especially in terms of opportunities for medication therapy management. Some of the payers — the Part D plans in particular, but not just restricted to Medicare — are really focusing toward independent pharmacies," said Richard A. Hess Jr., Pharm.D., assistant professor at East Tennessee State University's Bill Gatton College of Pharmacy.
With the advent of Medicare Part D, the prescription drug plan for seniors who enroll in an approved prescription drug plan, medication therapy management (MTM) offers pharmacists a patient-care role and, importantly, reimbursement for that service. Hess defined MTM as "a philosophy where the pharmacist is actively involved with the patient's medication regimen. The pharmacist is working with the patient, as well as the patient's caregivers and the patient's physician." With MTM in play, pharmacists "should take the initiative and responsibility to ensure that the medication the patient is taking is achieving the intended therapeutic outcomes," he said. For a patient on three blood-pressure medications, for example, the pharmacist should check blood pressure and let the patient and his or her physician know if the reading isn't acceptable.
"What we're hoping to see is that, with Medicare, they will see improved outcomes, and then other third-party plans will follow suit and do something similar," Hess said. "With the high cost of some of these medications, it would behoove payers to make sure the patients are receiving the optimum treatment."
Working hand-in-hand with physicians is the key to expanding pharmacists' reach, according to Bruce Roberts, a pharmacist and executive vice president and CEO of the National Community Pharmacists Association, based in Alexandria, Va. In 1976, Roberts opened an independent pharmacy in Leesburg, Va., and still owns it. The store grew from a 1,000-square-foot facility with one employee to a 14,000-square-foot pharmacy with 45 employees by the time he took the helm of NCPA eight years ago. "Our pharmacy is very focused on many niche areas, very much in a collaborative way with the rest of the healthcare community in Leesburg," Roberts explained. His pharmacy has been an innovator and recognized nationally for pushing the envelope in providing patient screenings, point-of-care testing, immunizations and medication compounding. "What we're seeing, and my pharmacy just happens to be one of those that's been leading the way for this for a long time, is the pharmacist having a very collaborative relationship with the physician. Creating that continuity and creating that interdependency really does help drive better outcomes," he said.
What Doctors Are SayingAs pharmacists make significant strides toward some forms of patient care, are they butting heads with physicians?
The American Medical Association, while watching the developments closely, has not mounted a battle against the expanded pharmacist role. In fact, one AMA policy states: "(1) The contribution of pharmacy as an independent profession in assisting physicians toward the constant goal of improved patient care is recognized and commended; and (2) The AMA urges physicians to encourage and support the continued growth of pharmacy as a valuable and necessary member of the health team." AMA policy also supports blood-pressure testing by pharmacists, as long as they are properly trained under the supervision of a physician or other qualified professional.
Said Bruce Roberts, executive vice president and CEO of the National Community Pharmacists Association: "Once you get into a situation, and I've experienced this firsthand, where truly it is a collaborative relationship and you're helping each other out and you're driving better outcomes, most physicians come around very quickly."
The additional services, many made possible by technological advances that allow quick test results onsite, also drive better profits. While the services that pharmacists can provide differ according to each state's laws, pharmacists today are conducting blood tests – checking glucose, cholesterol and hemoglobin A1c levels, monitoring anticoagulant therapy, analyzing liver function and even running entire lipid profiles, all the while ensuring against adverse drug reactions.
Immunizations provided by pharmacists are also state specific. According to Hess, "In some states, pharmacists can only administer influenza vaccinations, whereas in other states, the pharmacy practice act and laws are more liberal. So you can have pharmacists providing vaccines that protect against shingles or pneumococcal or tetanus/diphtheria."
Compounding also offers opportunities for bottom-line building and customized patient service. "You have some pharmacies that will gear their niche toward compounding, especially some of the smaller, independent pharmacies. … It is very profitable for those pharmacies, because many times they don't have to go through a third-party payer for billing those services. They can determine what their usual and customary price is for a compounded prescription," Hess said.
Yet Hess added that MTM is at the heart of pharmacy's future, and that's what he's teaching his students. "In terms of profitability, you're probably going to get more bang for your buck doing MTM than you would point-of-care testing as far as the payer is concerned," he said.
To ensure a consistent approach to MTM, the NCPA launched in 2006 an online tool designed to help pharmacists provide proactive patient services. Called the Mirixa Corp., the service boasts one of the nation's largest networks of pharmacies, with more than 46,000 pharmacies of all varieties involved. Mirixa offers clinical decision support, including medication alerts, to pharmacists who counsel patients. It pinpoints opportunities to counsel patients on optimal use of their drug-plan benefit. In addition, the Mirixa network includes participating payers, thus allowing for streamlined documentation of care and simplified online claims submission. The service also allows pharmacists to report their outcomes. "The key that we're doing with Mirixa is focusing on systemizing that interaction and the gathering of the outcomes of the effort of the pharmacist so that value can be clearly demonstrated," said Roberts, adding that more than 200,000 patient interventions have been conducted using the Mirixa technology.
The goal, Roberts said, is better patient care and a lower healthcare bill. "There is an enormous amount of evidence out there that if prescription drugs are taken correctly, you'll save healthcare costs," he said.