Friday I was in Dallas to talk to care and case managers from Blue Cross of Texas. The topic was Hospital Readmissions and the impact on the coordination of care continuum. The focus of the presentation was how to keep patients from returning to the hospital. One of the most overlooked areas that we discussed was using pharmacists to review all medications before discharge, and care managers after patients are discharged from the hospital for follow-up. The change in healthcare reimbursement associated with the Affordable Care Act dictates that hospitals and plans who keep patients from returning will get more money and that those who don’t will get less. After I finished my talk I got to speak with the Medical Director from BC Texas and during our discussion the topic of MTM came up. For those of you not familiar, MTM or Medication Therapy Management is a requirement that was established with the advent of Part D medication coverage and all plans are required to provide this service for patients who meet the criteria. The medical director was a big proponent of MTM but asked me if I felt that primary care physicians thought it was another intrusion on their practice.
The real answer is it depends on the clinician. I have spoken to clinicians who feel like they know best and that MTM is just a way to control physician prescribing, but the vast majority realize the value of having the "drug expert" review therapy. One physician who I had recently talked to had an alternative reason for inviting pharmacists to do MTM. He realized that in addition to his patients getting better drug therapy and better medication adherence, he was able to divert part of the liability for drug decisions to the MTM pharmacist and that made him feel much more secure in having the pharmacist do MTM for his patients.
Last week, I shared three ideas to increase metabolism and help lower glucose levels, one of these being the consumption of high protein for breakfast. Now a study presented at EASD Barcelona earlier this month shows that increased protein at breakfast lowers glucose as well.
Dave Joffe, Editor-in-chief