The Scary Future of MTMs

If you have been listening to the recent news and trends in the pharmacy industry any time in the past few years the chances are that you have heard of medications therapy management programs (MTMs or also called MTMPs).

"Medication therapy management, also referred to as MTM, is a term used to describe a broad range of health care services provided by pharmacists, the medication experts on the health care team." - APhA

MTMs were first mentioned in the Medicare reform under President George Bush and have shown to decrease healthcare costs significantly as well as show increased patient compliance and overall improvements in healthcare quality. MTMs have a big role in the future of pharmacy and could really develop a new face for the profession.

There is one key thing to all of this, however. MTMs must be performed in the right way, with physicians and patients who are open to the concept. This way the programs can have optimal results and show other professional and members of the public the benefits of having a pharmacist perform such activities.

I recently found out, through a source not to be named, that a major chain pharmacy is rolling out an "MTM" program. This program however is being done in a very poor manner. The chain is trying to force all of their pharmacists to participate, even those who are older and not fully up to date with current practice guidelines. This chain is also having pharmacists call physicians office and recommend adding/changing medications, which may sound like a good idea however, these pharmacists are doing so with no lab work, no practice agreements with physicians or with patients and nor formal training in how to run or operate and MTM program!

The practicality of this chain's "MTM" setup is just atrocious. How many physicians are open to a pharmacist (or anyone) calling them and recommending they put their patients on more medicine or changes in dosages, outside of the normal calls that occur already? How many patients really want to be on more medications? From my own experience both of these issues provide serious obstacles that I do not see going over very well for the pharmacists involved.

The main problem here is greed. This chain is not reimbursing their pharmacists any more for their time spent performing MTM services. They are forcing them to do all of this on top of giving flu shots, filling the same number of prescriptions (if not more caused by the calls they will be making), answering phone calls, counseling patients and any other duties that need to be performed. This chain has held stagnant is sales while others have increased over the same time period, thus they are trying to increase business by forcing pharmacists to make more phone calls. I am curious to see if the chain will also try to bill insurance companies, particularly Medicare, for these MTM services and how successful they will be in doing so. Let us not forget that all of this is also occurring after this chain cut both pharmacist and technician hours. YIKES!

Another thing that worries me here is the lack of cohesion that this may cause in the pharmacy industry. Accrediting bodies have fought long and hard to get these type of programs set in place and reimbursement for these services, which is great! They have also established residency programs with the specific focus of MTMs and have recently established a board certified program for these types for these types of positions. This chain is single-handedly degrading everything these bodies have worked for by having under qualified professionals perform these duties.

Now, before everybody thinks I am demeaning MTMs I must say that I am in full support of MTM programs and really believe that they are a great thing for pharmacists to be involved in. The provide a great benefit to both the patient, the payer and the healthcare system. That being said, they should be done correctly and rolled out in a manner where all participants are accepting of it. It should not be forced on pharmacists, physicians and patients like this chain is essentially doing.

The problem here is a simple one to me. Too many under qualified pharmacist will be forced to execute MTM services in a poor manner. This could potentially lead to resistance to it's acceptance and eventual adoption into the healthcare system. This would be greatly disappointing because of the potential delay in improved healthcare, education and substantial money saved. I would love to see these types of programs rolled out over the whole U.S.A., I believe the way to do it is start in a manner that will be better accepted by all participants. A suggestion of mine would be to start in smaller areas where pharmacists, physicians and patients all, generally speaking, know each other a little better. This much has already happened to some degree, seeing as how many independent pharmacies currently provide these services. The chains need to start in a similar fashion and be sure to include such services in a manner that takes pressure off of the pharmacist so they are performing these services while prescriptions and other duties are piling up on them. This may mean that one pharmacist has to cover a few different stores until the program is more widely accepted but at least a properly trained professional will be focused and undistracted from what they are to do. This is an idea the previously stated chain is clearly not concerned about.

The biggest thing here is that pharmacists need to step up and show what they can do, but stop trying to be Superman and do everything all at once, which sadly is what we are known for doing. I would love to see MTM services rolled out in a greater scale but I am afraid if not done correctly it could cause years of delays in acceptance and costing this country a lot of money in several different ways. I hope this chain realizes their soon to be potential misstep and really thinks about what they are doing. The problem is stock prices and greed may win out.

(Note: I have left out several citations for fear of fully divulging which chain this is. Any comments left after this are not mine and that of individuals who do not speak on my behalf.)