February 2015, Vol 3, No 2 - The First Word
Donald J. Dietz, RPh, MS

The retail pharmacy prescription department has traditionally been measured by the number of dispensed prescriptions. Other common pharmacy metrics are closely related to the number of prescriptions processed, including labor cost per prescription, staffing hours, gross profit margins, inventory management, abandoned prescriptions, and return-to-stock measurements.

This prescription-based focus ex­tends beyond the corporate office, district manager, and pharmacist-in-charge. Do you remember the last time you were together socially with pharmacist friends, such as at an alumni event or pharmacy association meeting? My guess is that after exchanging pleasantries and asking about the family, the conversation revolved around work and the pharmacy, including trends in increasing or decreasing prescription volumes, third party insurance issues, or rising generic prices.

In recent conversations with pharmacists, another topic discussed was the number of immunizations provided at their pharmacy. In one discussion, a pharmacist told me that although she enjoyed interacting with patients, the interactions interrupted the prescription workflow process. She conceded that although this interaction is beneficial to patients and professionally rewarding, administering immunizations and simultaneously dispensing prescriptions created stressful staffing challenges and resulted in difficulty allocating personnel at the pharmacy.

Instigating Change

Our dilemma in retail is managing the pharmacist resources for prescription dispensing, immunizations, and clinical services.

Data from Medicare Part D plans indicate a paltry 11% completion rate of eligible medication therapy management (MTM) cases.1 The Centers for Medicare & Medicaid Services has announced that comprehensive medication reviews (CMRs) will become part of the Medicare Part D Star Rating measures in 2016. Even more interesting, the 2016 Star Ratings will be based on CMR completion rates in 2014, with 2015 cases included in the 2017 ratings. Medicare Part D plans will need to exert an increased focus on CMR completion rates, which includes integrating retail pharmacies.

Although most pharmacies have not embraced MTM and the completion of CMRs in retail pharmacies in the past 9 years, there is more evidence that an accelerated need for pharmacist-provided clinical services is on the horizon, as future Medicare D payments will be tied to value or quality.

In late January, the US Depart­ment of Health Human & Services (HHS) announced a goal of using alternative payment models (eg, accountable care organizations or bundled payment arrangements) to tie 30% of traditional fee-for-service Medicare payments to value or quality.2 The HHS goal of tying 30% of payments to quality-based models would go into effect by the end of 2016, with payments increasing to 50% by the end of 2018.2 I believe that one avenue for Medicare D plans to achieve these goals is to increase the level of pharmacy clinical services.

Setting Goals Beyond Medicare

Many experts believe that tying Medicare Part D payments to quality will require the involvement of community pharmacies. It is the government’s hope that this model will transcend Medicare Part D and impact commercial and Medicaid patients.2

Finally, we are moving closer to achieving a pharmacist provider status legislation in both the House of Representatives and the Senate. Initially targeting underserved areas, if this legislation passes, it will be a landmark moment for pharmacists. For more information about this opportunity, please see the Health Policy article Team-Based Care as an Analogue to Pharmacists’ Scope of Practice.

It is my belief that a more rapid adoption of pharmacist-provided clinical services is in the foreseeable future for retail pharmacy. How do you prepare for this transition? Completion of eligible Medicare Part D MTM or CMR cases is a good first step. Focusing on improving medication adherence for patients receiving long-term medications for chronic conditions—which involves patient counseling—will certainly be beneficial. Understanding ways that you can help improve Medicare Part D Star Ratings by focusing on patients currently receiving targeted hypertension, diabetes, cholesterol, and high-risk medications is another beneficial step.

Medicare Part D plans will consider many options in order to meet these value-based payment goals, including ones involving retail pharmacies. Retail pharmacy management will need to evaluate and experiment with staffing models and services that enable pharmacists to provide clinical services while still dispensing prescriptions and without overstressing the retail pharmacy environment. Expect experimentation that involves centrally controlled activities (eg, Central Fill or hub-based MTMs), as well as activities that are integrated with clinical services provided at the retail pharmacy.

It will not be a smooth process. Retail pharmacies will need to try a variety of models to determine which one works best in varying retail settings. Yes, there will be flawed models that will need to be discarded, but this is how we will learn and improve. Dispensing retail pharmacists should expect to start seeing new processes and opportunities in the near future. Change is never easy, but this is the opportunity we have been seeking for more than 2 decades, and it is a chance for us to demonstrate our clinical value.




References

  1. Hoey, Douglas. Sections of a Recent Letter Entitled Not Crying Wolf This Time. PFOA. www.pfoai.org/news/348-sections-of-a-recent-letter-entitled-not-crying-wolf-this-time. Published February 3, 2015. Accessed February 6, 2015.
  2. Better, Smarter, Healthier: in historic announcement, HHS sets clear goals and timeline for shifting Medicare reimbursements from volume to value [news release]. Washington, DC: US Department of Health & Human Services Press Office; January 26, 2015. www.hhs.gov/news/press/2015pres/01/20150126a.html. Accessed February 4, 2015.
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