6: Physician Perspective on Medication Therapy Management

KEY POINTS

• Physician perspectives on medication therapy management (MTM) will vary widely.

• Many physicians, dealing with increasing regulations and paperwork, likely will see MTM as simply more paperwork.

• Physicians are faced with eroding autonomy, increasing administrative burdens, medical group and hospital consolidation, onslaughts of new patients, and implementation of the Patient Protection and Affordable Care Act.

• MTM will be resisted by physicians to the degree that it is perceived as increasing administrative burdens.

• MTM has the potential to help with transformational changes in healthcare, such as the patient-centered medical home and continuity of care.

• Real-time interactions between prescribers and pharmacists at the time of the patient encounter would undoubtedly improve patient care.

INTRODUCTION

As defined by Medicare, the goal of medication therapy management (MTM) is to optimize therapeutic outcomes for individual patients. As described elsewhere in this book MTM encompasses the following services:

1. Assessment of the patient's health status

2. Formulation of a medication treatment plan

3. Selection of medication

4. Monitoring and evaluating the patient's response to therapy, including safety and effectiveness

5. Performing a comprehensive medication review to identify, resolve, and prevent medication-related problems, including adverse drug events

6. Documenting the care delivered and communicate essential information to the patient's other primary care providers

7. Providing verbal education and training designed to enhance patient understanding and the appropriate use of medications

8. Provide information, support services, and resources designed to enhance patient adherence to therapeutic regimens

9. Coordinate and integrate MTM services within the broader healthcare services being provided to the patient

Established in 2003 and implemented in 2006 as part of Medicare Part D to help enrollees avoid drug-related problems and achieve desired clinical benefits from medications, MTM has had limited success over the last 7 years. Prior to 2010, when requirements were clarified, there were wide variations in MTM program components. Some pharmacist-led initiatives demonstrated that pharmacists could identify drug-related issues, but there was scarce data available on the overall effectiveness of MTM services.¹ It was not until January 2013 that the Centers for Medicare and Medicaid Services (CMS) sent physicians a guide to MTM, emphasizing that as part of Medicare Part D, patients may be contacted by MTM providers, and patients may be asking physicians if they would benefit from MTM services. The goal of improving medication management is laudable, but many issues related to the implementation remain unresolved. Regardless, it is clear from their advance notices that CMS will continue to encourage more widespread use of MTM for targeted chronic diseases and to encourage shared decision-making by providing incentives to both patients as well as providers.

PHYSICIAN ATTITUDES

Physician perspectives on MTM will vary widely. Many physicians, dealing with increasing regulations and paperwork, likely will see MTM as simply more paperwork. Most physicians would consider items 1 to 4 above as being within their domain or responsibility and may see MTM ...