Have you heard about the new Medicare Access and CHIP Reauthorization Act (MACRA)? This new law will go into effect in 2019, changing the way reimbursement works for many physician offices. In short: to receive reimbursement from Medicare, offices will have to either:
- Use an alternative payment model (such as the patient-centered medical home)
- Take part in the new Merit-based Incentive Payment System (MIPS) in which physicians’ Medicare reimbursements are linked to performance metrics of quality, resource use, clinical practice improvement, and meaningful use of electronic health records.
Patient outcomes, and thus adherence, will play an increasingly large role in payment. Key hindrances to adherence include financial barriers, education, depression, and social support. Physicians can influence some of these factors, but pharmacists are in a better position to positively influence patient medication adherence.
Pharmacies, in particular specialty pharmacies like ours, develop care plans for every patient and then closely track adherence to this plan. By taking the lead in this area, a specialty pharmacy will communicate with the physician’s office when there is a lack of adherence and take steps to get the patient back on track, including even in some cases bringing in support from the patient’s caregiver and close family members.
This model of pharmacist-patient partnership has been borne out in research, for example with chronic myeloid leukemia patients prescribed tyrosine kinase inhibitor therapy. In one study comparing adherence in patients treated by usual care or through an oncology pharmacist, adherence improved significantly (66% vs. 89%).
Pharmacists, by educating and monitoring, provide a significant benefit to both adherence and outcomes for patients, which will bode well for physician offices facing the 2019 billing changes.
Stephen C. Vogt, Pharm.D.
President and CEO
BioPlus Specialty Pharmacy
What do you think?
I’d love to hear your opinion in the comments section below.
Bendix J. Tips for overcoming nonadherence. Med Econ January 25, 2016.
Lam MSH, Cheung N. Impact of oncology pharmacist-managed oral anticancer therapy in patients with chronic myelogenous leukemia. J Oncol Pharm Pract 2015 doi: 10.1177/1078155215608523.