Home' Australian Pharmacist : July 2011 Contents Vol. 30 -- July #07
participate in HMRs. Multidisciplinary
Case Conferences were previously
covered by 18 Medicare Benefits
Schedule (MBS) Items and these
have been collapsed into six new
time-based Items (MBS Items
735--779). Team Care Arrangements
with Management Plans (MBS Items
732) as a single Item have replaced
two previously separate Items and
10 Health Assessment Items have
been condensed into four time-based
Health Assessment Items (MBS Items
701--707). HMRs provide a medication
management plan and potential for
a discussion that can contribute as a
part of many of these items.
Thus, there seems to be every
reason to believe that there will be
an increased number of HMRs to be
done. Add to this situation the loss
of incentives for accreditation and
the slow growth in the number of
accredited pharmacists, and there will
be some busy accredited pharmacists
out there! There is a desperate need
for a way to improve the efficiency and
usefulness of HMRs for all concerned.
A challenge in
The current HMR process involves
a referral from the GP finding its
way to an accredited pharmacist
who, after obtaining relevant
patient information, prepares a
report that goes back to the GP,
who then develops a management
plan. At various stages along this
process there are barriers. These are
summarised in Table 1.
Although there are some
entrepreneurial operators who
have added efficiencies to the
process, it remains a system that
is predominantly paper-based and
challenges the organisational skills
of many. Consequently, the vast
majority of pharmacies in Australia
deal with HMRs in a reactive
manner, having determined that the
effort involved in doing them does
not warrant the reward. Similarly,
accredited pharmacists do not seem
to have (with some exceptions)
actively stimulated more HMRs in
their area. The reasons for this are
unclear, but over half of the accredited
pharmacists that undertake HMRs
(some only do RMMRs) do less than
one per week. Many pharmacists and
pharmacies are happy with the status
quo and either do not want to, or
would not be able to, do more HMRs
in the time available to them, without
allocating more resources.
The business case
The key drivers for making HMRs a
part of either a pharmacy or accredited
pharmacist's business plan are the
number of HMR referrals and the
efficiency with which the reviews can
be undertaken. The remuneration for
an HMR (currently ~$194) makes it a
relatively attractive proposition if the
time and effort spent undertaking it
As a pharmacy owner
Many pharmacies do not directly
employ an accredited pharmacist,
and have not considered training staff
members, as the number of HMRs
Phase of HMR
GP obtains consent
Some patients do not want someone to visit them in
their home (interview can be conducted in the pharmacy
or medical clinic if the patient prefers, but not many GPs
HMR can be explained to the patient in the pharmacy and
consent obtained, if previous arrangements have been
made with GP.
Standard clinical software does not automatically include
pathology in referral (requires additional input by operator
to include this).
Referral sent to
Most often faxed, some use of secure messaging.
Referral comes as a document, not data that can be used
in various software applications.
and provides referral
Accredited pharmacist may be a member of staff or an
Referral either collected by outside contractor or mailed/
faxed or can be brought into the pharmacy by the patient
(often at a later date).
Often the scheduling requires an explanation of the
process again for the patient.
Interview may be conducted by non-accredited pharmacist.
A review of the available information prior to interview
allows for identification of possible issues and developing
more targeted questions.
Variety of templates for interview available.
Depending on complexity can take one or more hours.
Report sent to GP and
Reports are often lengthy, discouraging GPs from going
through them to develop a management plan.
Most often the written report is sent by mail to the GP and
pharmacy, some use of secure messaging.
Pharmacy sends claim
All claim lodgements are manual from the pharmacy
Payment returns are difficult to reconcile with
GP sees patient and
Requires a separate document to be prepared by the GP.
sent to pharmacy and
Anecdotally this rarely happens.
GP sends claim to
GP needs to wait for the end of the process before
If outsourced, often there are delays in payment depending
on accounting practices in the pharmacy.
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