the problem with MTM

[lorain]

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we've been getting the kool aid about how MTM is the future and can help open more job chances for the rph

(i actually agree its a great thing for rph)

but the reality is:

your organizations administrator will ask: why hire rph to do this mtm, why cant I just use the nurses and hire some more of them at less cost of that of a rph who'll cost 100K?

just something to think about, I agree MTM is a great thing with a future, but I dont think organizations will hire more rph to do it

 

[ValeRx]

At the chain I currently work for, they are trying to force the retail pharmacists to come in early and stay late in order to work on the Outcomes TIPS. No increase in salary and no current bonuses for providing these extra services. MTM is the future of increasing chain profits, adding more workload to our already hectic workday and not compensating pharmacists in any way. Maximizing profits and overworking the RPh.

 

[joetrisman]

With the guidelines ever changing, the FDA advisories that roll out, and the constant drug shortages, I think there is a potential for a ton of business to be had for rphs. But I agree that administrators aren't getting behind putting any investment in new positions for such functions. Additionally, all the rphs I run into are so worn down by the system (insurance, physicians, and management) that the last thing the want to do is try to incorporate another facet to their job. Its almost like a catch 22 getting the ball rolling on this.

 

[lorain]

At the chain I currently work for, they are trying to force the retail pharmacists to come in early and stay late in order to work on the Outcomes TIPS. No increase in salary and no current bonuses for providing these extra services. MTM is the future of increasing chain profits, adding more workload to our already hectic workday and not compensating pharmacists in any way. Maximizing profits and overworking the RPh.

i agree

they wont hire more rph to do it, just ask the current ones to do it

 

[lorain]

With the guidelines ever changing, the FDA advisories that roll out, and the constant drug shortages, I think there is a potential for a ton of business to be had for rphs. But I agree that administrators aren't getting behind putting any investment in new positions for such functions. Additionally, all the rphs I run into are so worn down by the system (insurance, physicians, and management) that the last thing the want to do is try to incorporate another facet to their job. Its almost like a catch 22 getting the ball rolling on this.

but i have seen private data showing mtm works and saves money

if the administrator is willing to do more of it, but why spend 100k when they think a cheaper nurse can do it?

 

[joetrisman]

but i have seen private data showing mtm works and saves money

if the administrator is willing to do more of it, but why spend 100k when they think a cheaper nurse can do it?

I think most people are familiar with the Asheville project and the potential for MTM. And I'm speaking of community pharmacy for my situation, not hospital or LTC. I've tried to get classmates to approach their rphs at their intern positions to get involved in MTM as students need the volunteer hours, are freshly familiar with the guidelines, and are free labor for the volunteer hours. I could see interns getting their volunteer hours and getting the ball rolling but I haven't had any rphs get into the idea either out of apathy or worries of liability. I've even suggested that the intern does all the work and supplies referencing with the rph checking at the end and still nada in terms of interest. All the rphs I've seen in community only reach for the low hanging fruit interventions from TIPS so that they can hit their required corporate quota for the month.

 

[ValeRx]

I think most people are familiar with the Asheville project and the potential for MTM. And I'm speaking of community pharmacy for my situation, not hospital or LTC. I've tried to get classmates to approach their rphs at their intern positions to get involved in MTM as students need the volunteer hours, are freshly familiar with the guidelines, and are free labor for the volunteer hours. I could see interns getting their volunteer hours and getting the ball rolling but I haven't had any rphs get into the idea either out of apathy or worries of liability. I've even suggested that the intern does all the work and supplies referencing with the rph checking at the end and still nada in terms of interest. All the rphs I've seen in community only reach for the low hanging fruit interventions from TIPS so that they can hit their required corporate quota for the month.

That would be a great idea in theory. We have required projects due every year and completing TIPS is one option we have available. The problem is, most of the interns I know (including myself) are used more for tech work rather than intern duties. I would love to sit down and spend my shifts going over TIPS. It would help with my clinical evaluation skills and let me think critically. In fact we would more than earn our wage in the money we could save both the patient and the chain. Unfortunately that will never happen because we have ELMS which won't allow the pharmacist to schedule any extra hours.

 

[joetrisman]

That would be a great idea in theory. We have required projects due every year and completing TIPS is one option we have available. The problem is, most of the interns I know (including myself) are used more for tech work rather than intern duties. I would love to sit down and spend my shifts going over TIPS. It would help with my clinical evaluation skills and let me think critically. In fact we would more than earn our wage in the money we could save both the patient and the chain. Unfortunately that will never happen because we have ELMS which won't allow the pharmacist to schedule any extra hours.

I was speaking of interns as they have the rapport and trust of their pharmacist in addition to being less red tape to get through to performing the functions. However, I was speaking of it as volunteer hours, not clocked hours. I don't know about your school, but at my school we have to complete 80 service learning hours that go towards our total 1500 hours of rotations. So this would eliminate the pay issue.

 

[ValeRx]

I was speaking of interns as they have the rapport and trust of their pharmacist in addition to being less red tape to get through to performing the functions. However, I was speaking of it as volunteer hours, not clocked hours. I don't know about your school, but at my school we have to complete 80 service learning hours that go towards our total 1500 hours of rotations. So this would eliminate the pay issue.

Right, I gotcha. Everyone benefits in either scenario, whether it be clocked hours or volunteer hours. Interns are in a better position to make these choices because as you pointed out, may be more familiar with current studies or guidelines. I would imagine with our without the pay issue, a pharmacist in the current job situation of being overworked and understaffed would much rather have you/me doing data entry or running the counter than making doctor calls to change diovan to losartan, etc etc.

 

[MountainPharmD]

we've been getting the kool aid about how MTM is the future and can help open more job chances for the rph

(i actually agree its a great thing for rph)

but the reality is:

your organizations administrator will ask: why hire rph to do this mtm, why cant I just use the nurses and hire some more of them at less cost of that of a rph who'll cost 100K?

just something to think about, I agree MTM is a great thing with a future, but I dont think organizations will hire more rph to do it

That is the problem.....Pharmacists have priced themselves out of MTM. Nurses can do it for much less than a Pharmacist can. Two of the most well run diabetic clincs I have ever seen were run by nurses. They did an excellent job as well.

MTM is not gping to save the profession. Done as an adjunct to dispensing it may be a way to genertae a little more cash but not much.

 

[MountainPharmD]

That would be a great idea in theory. We have required projects due every year and completing TIPS is one option we have available. The problem is, most of the interns I know (including myself) are used more for tech work rather than intern duties. I would love to sit down and spend my shifts going over TIPS. It would help with my clinical evaluation skills and let me think critically. In fact we would more than earn our wage in the money we could save both the patient and the chain. Unfortunately that will never happen because we have ELMS which won't allow the pharmacist to schedule any extra hours.

ELMS rocks!!!👎

 

[ValeRx]

ELMS rocks!!!👎

Lol. We've been told that corporate knows the flaws of ELMS and is working on some sort of fix because we are having a "tech crisis." Hmmm, I wonder why senior techs are quitting to go work for mail order for better pay and less stress.

 

[joetrisman]

Lol. We've been told that corporate knows the flaws of ELMS and is working on some sort of fix because we are having a "tech crisis." Hmmm, I wonder why senior techs are quitting to go work for mail order for better pay and less stress.

Have fun with all of the ESI scripts we're sending over from wags 😉

 

[ValeRx]

Have fun with all of the ESI scripts we're sending over from wags 😉

Funny you say that because my manager was just talking about all the extra business we will get from Wags across the street due to ESI. Increase in script count and no extra hours and not enough techs. Life will be great.

 

[lorain]

I think most people are familiar with the Asheville project and the potential for MTM. And I'm speaking of community pharmacy for my situation, not hospital or LTC. I've tried to get classmates to approach their rphs at their intern positions to get involved in MTM as students need the volunteer hours, are freshly familiar with the guidelines, and are free labor for the volunteer hours. I could see interns getting their volunteer hours and getting the ball rolling but I haven't had any rphs get into the idea either out of apathy or worries of liability. I've even suggested that the intern does all the work and supplies referencing with the rph checking at the end and still nada in terms of interest. All the rphs I've seen in community only reach for the low hanging fruit interventions from TIPS so that they can hit their required corporate quota for the month.

i wasnt referring to asheville

other lesser known places have privately shown + outcomes and COST savings....but the problem is the admin wants more MTM, but not at the rph salary

 

[spacecowgirl]

The problem with MTM is that it cannot be as efficient or effective in a retail environment as it is in a clinic environment unless you have 1) a shared EMR and 2) collaborative agreements

MTM is not an efficient way to generate revenue. It is a health cost-savings service.

 

[Taurus]

we've been getting the kool aid about how MTM is the future and can help open more job chances for the rph

(i actually agree its a great thing for rph)

but the reality is:

your organizations administrator will ask: why hire rph to do this mtm, why cant I just use the nurses and hire some more of them at less cost of that of a rph who'll cost 100K?

just something to think about, I agree MTM is a great thing with a future, but I dont think organizations will hire more rph to do it

This is what I've been saying about MTM all along. Pharm's can't justify the cost of providing MTM unless their salaries decrease to the level of NP's.

 

[cycloketocaine]

This is what I've been saying about MTM all along. Pharm's can't justify the cost of providing MTM unless their salaries decrease to the level of NP's.

Your signature is quite entertaining!!

 

[MountainPharmD]

Funny you say that because my manager was just talking about all the extra business we will get from Wags across the street due to ESI. Increase in script count and no extra hours and not enough techs. Life will be great.

Yeah we get all the ESI scripts from Wags...The reimbursement wasn't good enough for them so we get to pick up the slop! Yeah!!!!

 

[MountainPharmD]

Lol. We've been told that corporate knows the flaws of ELMS and is working on some sort of fix because we are having a "tech crisis." Hmmm, I wonder why senior techs are quitting to go work for mail order for better pay and less stress.

Gasp! Flaws in ELMS?!?!?!? No way. ELMS is the all knowing perfect computer model of the exact hours we need. I do not believe there could be a flaw....

Actually I am surprised anyone admitted there might be a flaw.

 

[ValeRx]

Gasp! Flaws in ELMS?!?!?!? No way. ELMS is the all knowing perfect computer model of the exact hours we need. I do not believe there could be a flaw....

Actually I am surprised anyone admitted there might be a flaw.

I have asked my regional/zone managers why the pharmacy is allowed to be run by a computer model not designed for health care, and when they are going to care more about patient safety and not profit. Surprising I have a job still considering I asked this in front of our entire class.

 

[Ackj]

While I'm sure there are competent nurses out there who could do a great job with MTM, I don't think they are the majority. Maybe I have a bias here, but I would say the average pharmacist would do a better job with MTM than the average nurse. Is a retail pharmacy the place for it? Most likely not. A nurse would probably have the advantage of being in a clinic/doctor's office more often, although pharmacist-staffed clinics have shown some promise in terms of diabetes and anticoag.

On one of my rotations last year there were some pharmacists who would do the Outcomes thing with patients. The pharmacy was very well staffed, so there were 4 pharmacists working at a time. Apparently they were given a bonus for each patient, don't recall how much, but I don't think it was anything too crazy. They had an appointment with the patient and they would just sit down with them and go over everything for 30 min or so. Most pharmacies would not fit this model, unfortunately.

 

[MountainPharmD]

While I'm sure there are competent nurses out there who could do a great job with MTM, I don't think they are the majority. Maybe I have a bias here, but I would say the average pharmacist would do a better job with MTM than the average nurse. Is a retail pharmacy the place for it? Most likely not. A nurse would probably have the advantage of being in a clinic/doctor's office more often, although pharmacist-staffed clinics have shown some promise in terms of diabetes and anticoag.

On one of my rotations last year there were some pharmacists who would do the Outcomes thing with patients. The pharmacy was very well staffed, so there were 4 pharmacists working at a time. Apparently they were given a bonus for each patient, don't recall how much, but I don't think it was anything too crazy. They had an appointment with the patient and they would just sit down with them and go over everything for 30 min or so. Most pharmacies would not fit this model, unfortunately.

Why do you think a Pharmacist would be better than a nurse? A BSN in nursing is more than adequate to handle MTM. I would argue that nurses are better qualified to do MTM because of there training which focuses on Patient care. And the kicker is nurses can do it far cheaper than a pharmacist can.

 

[PharmaTope]

Why do you think a Pharmacist would be better than a nurse? A BSN in nursing is more than adequate to handle MTM. I would argue that nurses are better qualified to do MTM because of there training which focuses on Patient care. And the kicker is nurses can do it far cheaper than a pharmacist can.

when people look at price-tag that is what really matters. bottom line. i dont care what fancy service you offer, the bottom line matters.

pharmacists will not get this amazing situation that they are selling you from APhA.

 

[Its Z]

MTM is no more.... just like the old Pharmaceutical Care.

Get on with it y'all... and don't get left behind. It's a fast moving train.

The new buzzword of the day is PPMI.

Pharmacy Practice Model Initiative.

GOT IT??

 

[KARM12]

MTM is no more.... just like the old Pharmaceutical Care.

Get on with it y'all... and don't get left behind. It's a fast moving train.

The new buzzword of the day is PPMI.

Pharmacy Practice Model Initiative.

GOT IT??

This is true....we have weekly PPMI meetings

 

[Its Z]

This is true....we have weekly PPMI meetings

Yes, more meetings are what we need. Meet until your eyeballs bleed.

 

[spacecowgirl]

 

[MountainPharmD]

MTM is no more.... just like the old Pharmaceutical Care.

Get on with it y'all... and don't get left behind. It's a fast moving train.

The new buzzword of the day is PPMI.

Pharmacy Practice Model Initiative.

GOT IT??

http://www.ashp.org/PPMI

Additional factors that have impacted hospital/health-system pharmacy practice include curricular changes in colleges/schools of pharmacy that led to an entry level Doctor of Pharmacy degree, increasing numbers of pharmacists who undertake residency training, professional expectations that pharmacists will have a direct patient care role, recognition of pharmacists among interdisciplinary peers as experts on drug therapy and medication-use processes, and demographic changes within the profession.
At this pivotal time, there is an urgent need to engage key stakeholders to create a forward thinking hospital and health-system pharmacy practice model.* ASHP and the ASHP Research and Education Foundation will sponsor a Hospital and Health-System Pharmacy Practice Model Initiative that will include a consensus summit, a robust social marketing campaign, and program evaluations.* The goal of this initiative is to significantly advance the health and well being of patients by developing and disseminating a futuristic practice model that supports the most effective use of pharmacists as direct patient care providers.* This initiative will also create passion, commitment, and action among hospital and health-system pharmacy practice leaders to implement this practice model.*

Got it!!!

 

[KARM12]

Yes, more meetings are what we need. Meet until your eyeballs bleed.

We have an interesting administration. We have meetings for strategic planning about everything...but nothing ever gets implemented.

 

[Its Z]

We have an interesting administration. We have meetings for strategic planning about everything...but nothing ever gets implemented.

But I bet they use a lot of buzz words, cliche', and intelligent business lingo. That's really important.

 

[Pharmacy Kid]

Why do you think a Pharmacist would be better than a nurse? A BSN in nursing is more than adequate to handle MTM. I would argue that nurses are better qualified to do MTM because of there training which focuses on Patient care. And the kicker is nurses can do it far cheaper than a pharmacist can.

Nurses cheaper than pharmacists? Yes

Nurses better at medication therapy than pharmacists. No way. The nurses at my medical campus were taught med therapy by a pharmacy professor. He said their material didn't touch the pharmacy students' material.

 

[MountainPharmD]

Nurses cheaper than pharmacists? Yes

Nurses better at medication therapy than pharmacists. No way. The nurses at my medical campus were taught med therapy by a pharmacy professor. He said their material didn't touch the pharmacy students' material.

You do not need 4 years of med chem and therapeutics to counsel a patient on thier medication. The training nurses get in school is more than adequate to provide MTM. You are providing the very basic infomation said in simple terms the patient can understand. Your not sittting down taking about structure activity relationships and organic chem with them.

 

[PharmDstudent]

You do not need 4 years of med chem and therapeutics to counsel a patient on thier medication. The training nurses get in school is more than adequate to provide MTM. You are providing the very basic infomation said in simple terms the patient can understand. Your not sittting down taking about structure activity relationships and organic chem with them.

Not exactly. You are also addressing therapeutic duplications, drug-drug interactions, and appropriate therapeutic interchanges.

 

[lorain]

Not exactly. You are also addressing therapeutic duplications, drug-drug interactions, and appropriate therapeutic interchanges.

still not enough to justify the price difference


sorry to say it, but rph are out of the mtm....next idea

 

[MountainPharmD]

Not exactly. You are also addressing therapeutic duplications, drug-drug interactions, and appropriate therapeutic interchanges.

And still a nurse can do all this cheaper....MTM is AphA's wet dream. In the real world not feasable for Pharmacists.

 

[iFarm]

Why do you think a Pharmacist would be better than a nurse? A BSN in nursing is more than adequate to handle MTM. I would argue that nurses are better qualified to do MTM because of there training which focuses on Patient care. And the kicker is nurses can do it far cheaper than a pharmacist can.

Mountain, while I generally agree with most of your comments, I'd have to go with Ackj on this one. In my experience, nurses have very little medication knowledge. I get questions from them every day regarding fairly basic side effects and interactions. Many of them can't even pronounce medication names - it's really pretty ridiculous. And as far as patient care goes, MTM is basically just "extended counseling", which is supposedly our domain.

I do agree that nurses COULD do MTM, but I think they'd have to get additional training to do a decent job. For example, an RN CDE is well qualified to do diabetes education (even more so than an RPh), but the average RN probably doesn't know nearly enough to discuss all of the different classes of DM meds. Theoretically, a pharmacist should be able to.

$$ talks, so I'm guessing nurses will get the nod.

 

[PumpkinSmasher]

And still a nurse can do all this cheaper....MTM is AphA's wet dream. In the real world not feasable for Pharmacists.

APha does not know their ass from a hole in the ground, or they just do not care about reality....probably a little of both.

Just getting decent counseling in retail is tough to come by anymore from what I have seen. From time to time I take my grandma to the doctor and pharmacy. I have encountered a number of retail pharmacists during these encounters and have yet to see a remotely decent counseling job, flat out garbage counseling actually. When she was initiated on glargine, the pharmacist told her to ask her doctor if she had any questions and said to keep it in the fridge, that is it.

 

[lorain]

APha does not know their ass from a hole in the ground, or they just do not care about reality....probably a little of both.

Just getting decent counseling in retail is tough to come by anymore from what I have seen. From time to time I take my grandma to the doctor and pharmacy. I have encountered a number of retail pharmacists during these encounters and have yet to see a remotely decent counseling job, flat out garbage counseling actually. When she was initiated on glargine, the pharmacist told her to ask her doctor if she had any questions and said to keep it in the fridge, that is it.

shouldnt you counsel your grandma, instead of a diploma mill guy at a retail store

 

[PumpkinSmasher]

shouldnt you counsel your grandma, instead of a diploma mill guy at a retail store

You got me, I do go over everything with her and her doctor is a great guy but I still tell her to always ask for counseling. I never mention being a pharmacist at pharmacies, I am always curious about quality of counseling.

 

[lorain]

had a private meeting with a company today

they ran a study: the medical cost of pt who was enrolled in a adherence program was more than the avg cost of pt in the non adherence program

the adherence program is where the rph follows up with pts, checks in them , etc

another blow, their company ceo is wondering why he has rph doing adherence when their study showed the adherence pt are costing them more.

this whole rph counseling programs are fluff pieces...need to find a new avenue for rph, as the necessary stuff can be done by cheaper nurses

 

[xiphoid2010]

The more I work the more apparent that the future of pharmacy is about outcome and cost. Since I started, I gained popularity with MDs and RNs by making their lives easy. The CEO likes me because the per patient day cost is down $20 some dollars due to much reduced antibiotics cost like zyvox and tygacil.

As we move forward, pharmacists will increasing justify their existence through these rather than legal dispensing laws.

 

[Its Z]

The more I work the more apparent that the future of pharmacy is about outcome and cost. Since I started, I gained popularity with MDs and RNs by making their lives easy. The CEO likes me because the per patient day cost is down $20 some dollars due to much reduced antibiotics cost like zyvox and tygacil.

As we move forward, pharmacists will increasing justify their existence through these rather than legal dispensing laws.

Interesting. Considering Average Antibiotic Cost per Patient Day throughout the US hospitals is around $12 - $16... you decreasing it by $20/day..your cost must be -$8 per day.

 

[PumpkinSmasher]

Interesting. Considering Average Antibiotic Cost per Patient Day throughout the US hospitals is around $12 - $16... you decreasing it by $20/day..your cost must be -$8 per day.

He did say "some" of the cost...but I see your point and it is interesting to know average antibiotic cost throughout US hospitals. Is there a specific site to find such information?

 

[Its Z]

Is there a specific site to find such information?

No

 

[PumpkinSmasher]

no

k

 

[xiphoid2010]

Interesting. Considering Average Antibiotic Cost per Patient Day throughout the US hospitals is around $12 - $16... you decreasing it by $20/day..your cost must be -$8 per day.

We are a small hospital, and you should seen what the abx prescribing pattern was when I got here. Tygacil + levaquin was like the empiric coverage of choice. 😱 In fact, abx cost was the biggest category in drug cost.

The prescribers here are not the same ones you find in the big or even medium sized teaching hospitals. Why do you think a small place like this went looking for an ID pharmacist in the first place?

 

[Its Z]

Your math is completely wrong.

That's not how you do pharmacy financials and cost savings analysis. You may have lowered your Abx cost some but you didn't lower it by $20 per day.

I can learn you the stuff right here if you want.

 

[xiphoid2010]

Your math is completely wrong.

That's not how you do pharmacy financials and cost savings analysis. You may have lowered your Abx cost some but you didn't lower it by $20 per day.

I can learn you the stuff right here if you want.

Sure, how to do the financials? I looked at our monthly abx orders $ from our wholesaler and divided it by number of patient days of that month. Is there another way to calc it?

 

[Its Z]

You at an LTAC?