New directions for health care law in the u.s.: emphasis on preventive, holistic therapies offers possibilities for pharmacists.

Expanding payment for pharmacist-provided MTM services was pharmacy’s key objective, and three provisions address that issue directly. The MTM grant program, which may or may not be funded, was one. Another provision puts the congressional imprimatur on a Medicare policy decision, made in October 2009, that would marginally expand Medicare’s Part D MTM program. Still another provision opens the door to bonuses to Medicare Advantage plans (the managed care alternative to Medicare’s fee-for-service model) when they include MTM “programs that are more extensive” than is required under Medicare Part D MTM. The MTM grant program authorized by the bill will be run through a new Patient Safety Research Center, also created by the bill, plopped down into the Agency for Healthcare Research and Quality (AHRQ), which in turn is part of DHHS. The grants would go to licensed pharmacists employed by “entities”— an example of that foggy congressional language that will become better defined later—who are involved in collaborative, multidisciplinary care of chronically ill patients. APhA’s Ms. Lunner interprets this to mean that the grants would be for start-up costs for a physician practice, for example, that wants to hire pharmacists and set up a subsidiary business in order to qualify for grants. That is implied by the provisions requiring the entities submitting applications for grants to include a plan for achieving “long-term financial sustainability.” Presumably, after getting the business up and running (if we substitute “hospital” for “physician practice” in this example), the MTM subsidiary would provide MTM services to perhaps a local public health agency or a health insurer or, in the case of a hospital, to patients going home after an acute-care episode. Ideally, those MTM services would be reimbursed, either as part of the grant or, even better, via payment to the pharmacists from the insurance company or agency. The entity could provide MTM services only to specific patient populations, such as: Stephen Barlas is a freelance writer based in Washington, D.C. New Directions for Health Care Law in the U.S.