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Note to Pharmacists re: Charging for MTM and Cognitive Services

18 Feb

A pharmacy colleague recently posted a LinkedIn discussion revolving around the topic of  how much to charge for a face-to-face comprehensive medication review with a patient. A few days later I noticed one of my Twitter colleagues, Carrie Wilkerson aka The Barefoot Executive, also posted on her blog a discussion simply titled ‘What Are You Worth?’ and shared the following story:

“A woman in Paris spots Picasso in a cafe. She begs and pleads him to sketch her…he finally relents, whips out his pad and draws a sketch of her.

She’s delighted. “How much do I owe you?” she asks.

“$5,000,” he replies. 

“$5,000!” she exclaims. “But it only took you 2 minutes!”

“No madam,” he replies. “It took me my life”.

This is what your clients are paying you for… not your time, not your ‘effort’ – rather, your WEALTH of experience, knowledge, information and networks which you have built up over YEARS of study, practice, failures, successes and experience.”

For the most part, pharmacists know what their value is with regards to the pharmacy dispensing function. They know what they currently get paid or can check out salary surveys or just ask around to find out what the going hourly rate is for pharmacists in retail or hospital settings.

When it comes to payment for cognitive services it’s a different ballgame. This is a new and unexplored area for most pharmacists who are starting an independent medication therapy management MTM consulting business. First of all, we’re told by others, even those associated with MTM training sessions, that we should not discuss fees for MTM services. This creates a very nebulous picture of what the going rate for MTM services is or what others are charging. But even more important is the fact that most pharmacists undervalue the cognitive services they provide. After all, we’ve been giving it away for free far too long. How patients value our services, if it’s seen only as ‘free advice’ for the most part, will be very misleading, especially if they don’t understand we could be saving them untold cost and misery from adverse drug events, improving their physical health and well being, or possibly even saving their life.

Another problem is pharmacists tend to look at the ‘market place’ and only see what Medicare part D is reimbursing for MTM comprehensive drug reviews. It’s easy to be pulled into the mindset that this sets the true value of MTM services. Why not look at this as a 75% reimbursement level and charge the balance to the patient as a copay?

It’s like the story of a factory manufacturing consultant who charged $10,000 for getting the equipment operating properly. The factory owner complained that all he did was turn one screw to get it working right. The consultant re-writes his bill to the factory owner showing a $1 charge for turning a screw and $9,999 for knowing which screw to turn.

Other health care team members can provide a comprehensive drug review. But pharmacists are the health care team member trained to know ‘what screw to turn’ when there are problems with a patient’s medication therapy. And they should get paid at a rate compensating them for their life spent learning and practicing the art of pharmacy.

So ask yourself this question… What Are You Worth?

Why Can’t Pharmacists Prescribe: Response to @ThePharmerGuy

27 Jan

Twitter’s @ThePharmerGuy recently posted on his blog ‘Another Day Behind the Pharmacy Counter…’ asking the question:  Why Can’t Pharmacists Prescribe?  He details a very good argument as to why pharmacists should have prescription authority.   My thoughts on this topic follow below:

I totally agree it’s past time for pharmacists to be given prescribing authority, at least on a limited basis. There are so many instances where a pharmacist could make the decision to appropriately select and prescribe from a limited formulary of medications for a number of common disease states.

Pharmacists receive more intensive training and are more qualified to make decisions regarding appropriate medication therapy than most nurse practitioners or physicians assistants I know, and probably more qualified than many MDs as well.

Prescribing authority is given to MDs, NPs and PAs, in my opinion, after receiving basic training algorithms to assist them in making prescribing decisions based on their diagnosis. They don’t receive near the training or knowledge base in pharmacology, pharmacokinetics, adverse drug reactions and drug interactions that should be used in the drug prescribing process. They are also somewhat dependent on and easily swayed by the influence of pharmaceutical sales and marketing efforts, something which pharmacists are able to sort through by throwing out the hype and making better clinical decisions based on rational therapeutic approaches.

And, from what I have seen, most prescribers are easily swayed by their patients as well. All of the direct to consumer pharma advertising has created a patient population who go the the doctor with their expectations of what should be prescribed… and sometimes get upset when they don’t get what they want!

Pharmacist prescribing would expedite patient care and lower the cost of care by facilitating or streamlining the process of finding the correct medication and dose to reach and maintain therapeutic goals. This would tie in very well with a medication therapy management type of pharmacy practice that monitors new medications and makes changes or adjustments quickly and efficiently based on patient response to therapy.

All this would help to reduce costs associated with patient medication therapy,improve and streamline the process of reaching therapeutic goals, aid in assisting, educating and counseling patients to ensure compliance and adherence to drug therapy and improve patient outcomes.

The PharmD vs. BSPharmacy status for prescribing authority will need to be addressed in some manner. Pharmacists were making decisions regarding appropriate medication selection and use decades ago. It wasn’t until the prescriber and dispenser functions began to change that pharmacists  began to lose the authority to ‘prescribe’ all but those medications given OTC status. Generally speaking, most RPhs have as much knowledge and decision making skills when it comes to prescribing as those who prescribe the prescription orders they fill and dispense. Same with PharmDs.

Yes, it is time for pharmacists to be given prescribing authority, if even on a limited basis. I would expect that this authority would be expanded after a year or two of monitoring said prescribing authority based on the positive outcomes we would see.