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Pharmacists are taking a more proactive approach to handling their business, and it’s all thanks to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA changes the way Medicare reimburses prescribers for their services. The traditional volume-based, fee-for-service system has been replaced by a value-based system, and pharmacists can have a great impact on this, according to Blair Thielemier, PharmD.
Blair is an independent pharmacy consultant and founder of Pharmapreneur Academy, an online resource for community pharmacists who want to take their practice to the next level. Her most recent webinar “Leveraging MACRA for Pharmacists” is an in-depth explanation of CMS’s newest standards for clinicians and how pharmacists play a crucial role in the Merit-based Incentive Payment Systems (MIPS).
Anyone can read about MACRA and MIPS, but Blair knew a pharmacy-centric webinar about this “seismic shift” in reimbursement would be valuable for pharmacists. “I hear pharmacists call themselves the ‘medication experts’ when talking about their value,” she says. “That’s great, but what does that mean? How does that do anyone any good? I really feel like it’s time for pharmacists to redefine their value in the healthcare industry.” In her research, Blair found that physicians struggle to manage their patients’ adherence, adverse drug reactions, readmission rates, and medication reconciliation. The solution? Pharmacists. “Physicians can really improve their benchmarks, scores, and quality metrics by outsourcing some of this care management to pharmacists.” She cites an example of an Atlanta-based physician who was struggling with noncompliant patients. He knew that simply diagnosing a nonadherent patient wasn’t a long-term solution. He was excited to learn he could refer these patients to a clinical pharmacist who would conduct routine comprehensive medication reviews (CMR), then he and the pharmacist could help their mutual patients overcome their medication-related barriers. This collaborative agreement between providers and pharmacists could save lives and help decrease the overall cost of healthcare.
Unfortunately, these collaborative agreements aren’t a standard healthcare practice yet. Providers obviously need help, but they don’t know who can help them with medication-related issues. Clearly, pharmacists need to do a better job of communicating their value to other healthcare professionals. That’s where Blair’s webinar comes in. “It teaches pharmacists to speak the language of CMS and the language of these providers so we can ask them about their benchmarks,” she explains. “If you start talking to them about MTM or CMRs, they won’t have any idea what you’re talking about, but if you go in and use their language, you can start a conversation about how you can really make a difference.”
How can pharmacists start that conversation? Blair recommends identifying the local providers with whom the pharmacy shares a high volume of mutual patients. Choose one patient in particular who is struggling, and work with that patient to show the provider how a pharmacist’s intervention can make a difference. Also, Blair notes that many providers will agree to meet with other healthcare professionals as a courtesy, so schedule a face-to-face meeting that will help build that relationship.
According to Blair, the MACRA and MIPS programs offer pharmacists an opportunity to stand out. “The value-based reimbursement model is one of those things that if you do it and do it well, it can be a huge positive for your business. But if you want to stick your head in the sand and wish things were the way they used to be, then you may not be in business too much longer.”