Epic RX

Myth vs Fact: The Truth Behind Pharmacy Performance Data

Quality measures, medication therapy management (MTM), patient outcomes, etc., are all ways pharmacies are evaluated and affect the bottom line of independent pharmacies. Below are some reality checks to help your pharmacy on the path to success.

Myth: Pharmacies receive a star rating.

Reality: Medicare plans receive star ratings from the CMS; pharmacies do not. Star ratings may be used as a general term by third-party payers and technology vendors when discussing pharmacy performance. However, pharmacies are evaluated on a plan-by-plan basis and the quality measures evaluated can vary significantly across plans.

Myth: It’s ok to focus on performance scores from one technology platform.

Reality: Many payers use EQuIPP to track pharmacy quality measure performance, which in turn determines direct and indirect remuneration (DIR) fees and pay-for-performance (P4P) bonuses. A wider field of view by using different platforms, including dispensing software, strengthens your pharmacy by allowing you to create benchmarks, identify patients in need of intervention, and facilitate outreach.

Myth: Not completing MTM cases won’t have a big impact on my performance.

Reality: Not completing MTM cases can significantly impact your pharmacy’s performance and bottom line.

  • Comprehensive medication review (CMR) completion rate is used by some payers to determine DIR fees and can affect a pharmacy’s ability to qualify for P4P program bonuses.
  • MTM cases often address drug therapy problems that directly relate to quality measures, such as medication non-adherence and gaps in therapy.
  • Pharmacies that regularly engage in MTM services often demonstrate high-quality performance.

Myth: If we focus on quality measures and scores once a month or so, the pharmacy will be ok.

Reality: You should check your pharmacy’s performance at least weekly, if not daily. Most third-party payers use quality measures to determine DIR fees and P4P payments. By monitoring your scores at least weekly, you can identify opportunities for improvement and make subtle changes in your workflow to make big impacts in the long term.

Contact EPIC Rx today to learn how our clinical programs team can help your pharmacy stay ahead of the game when it comes to performance and patient care.