Our tradition with the first issue of the year is to report the results of an industry-wide survey we conduct on the outlook for the new year. Since we are clearly in a recession, I thought that this would have an impact on how industry executives see things shaping up. But I was pleasantly surprised to find that there was still optimism. There was general agreement that pharmacies will continue to upgrade systems and install new technology that will increase productivity and provide revenue opportunities. Tax incentives will help. According to the January 16 Kiplinger Letter, the 50% bonus depreciation will be reinstated, as well as the higher $250,000 ceiling on expensing equipment.

The federal government sees information technology as pivotal to a more cost-efficient healthcare system in this country. The HIPAA legislation mandated the use of standards for billing and other administrative tasks to reduce costs. However, it has not worked as planned. One problem with pharmacy was that the 5.1 standard did not have all the pieces to address Part D claims, causing workarounds. There were other problems with the X12 transactions, namely the 837’s inability to handle ICD-10 codes. CMS wants to move to this new code set. Consequently, CMS recently published new regulations that require the industry to move to newer versions of the HIPAA standards by 2012. With the new standards, CMS feels that we will see improved administrative efficiency. While there are always tremendous costs associated with the conversion to new versions, CMS points out that these are one-time costs and that time and dollar savings will accrue rather quickly.

The big developments that should be a boost for pharmacy are the changes proposed by CMS that will be required of plan sponsors for Part D medication therapy management. These proposed changes will put a lot more people into the pool for MTM. This will be accomplished by preventing plan sponsors from setting the threshold for coverage higher than eight prescriptions. The beneficiary’s dollar spend will be reduced to $3,000 from $4,000, and plan sponsors cannot require more than a minimum of three chronic diseases in order for a person to qualify for MTM. Quoting from the January 8 Call Letter from CMS, it states: “We want to promote greater consistency and raise the level of the MTM interventions offered to positively impact medication use.” In addition, CMS will allow only opt-out programs and require person-to-person consultations. I assume pharmacists will be at the forefront of these consultations; however, the proposal doesn’t mention pharmacists specifically. These are the requirements that bidders must meet for the Part D program in 2010. However, the new administration has put a hold on all new regulations until it has had a chance to review them, so CMS has retracted the Call Letter with plans to reissue it once reviewed. Whether there will be changes remains to be seen.  

There is plenty of evidence that pharmacists can make a difference in outcomes and also save people money on their prescriptions. This is what convinced the AMA to add Category I CPT codes for the exclusive use of pharmacists. Pharmacy is turning up the volume on the role it can play as a service provider. The message appears to be getting through.

On a closing note, I was pleased to receive word that Tom Menighan has been selected to succeed John Gans as executive VP and CEO of APhA. I have known Tom for a number of years, and to see him at the helm of this prestigious pharmacy association is a very positive development for the profession. While he has big shoes to fill, I am certain he will excel in his new position. CT

Bill Lockwood is the publisher of ComputerTalk.