Comprehensive Medication Review (CMR) & Medication Therapy Management (MTM): A Guide for Directors of Nursing in Long-Term Care

What Is MTM?

Medication Therapy Management (MTM) is a Medicare-sponsored clinical program designed to improve medication use, optimize therapeutic outcomes, and reduce the risk of medication-related problems.

MTM services focus on:

• Identifying medication-related issues
• Improving medication adherence
• Reducing unnecessary medications
• Preventing adverse drug events
• Ensuring medications are appropriate, safe, and effective
• Supporting residents’ quality of life and clinical outcomes

For long-term care residents, MTM can serve as an additional layer of medication oversight beyond routine pharmacy services and consultant pharmacist reviews.

What Is a Comprehensive Medication Review (CMR)?

A Comprehensive Medication Review (CMR) is the foundational service of Medicare MTM programs. It is a structured, person-centered review conducted by a qualified pharmacist that includes:

Review of All Medications:

• Prescription medications
• Over-the-counter products
• Vitamins and supplements
• Herbal products

Assessment of:

• • Therapeutic effectiveness
  • Drug interactions
  • Duplicate therapies
  • Medication adherence barriers
  • High-risk medications
  • Opportunities for deprescribing

• Medication-related recommendations
• Resident and caregiver education
• Communication to prescribers when intervention is needed

The Importance of CMRs to Directors of Nursing

CMRs can support several priorities important to nursing leadership:

How the CMR Process Typically Works:

Step 1: Resident Identification

Medicare health plans identify residents who qualify for MTM.

Step 2: Outreach and Consent

The resident, responsible party, or designated caregiver is contacted to complete the review.

Step 3: Pharmacist Review

A pharmacist conducts a comprehensive evaluation of all medications and medical conditions.

Step 4: Recommendations

Recommendations may be sent to:

• Prescribers
• Nursing staff
• Facility leadership
• Caregivers when appropriate

Step 5: Documentation

The resident receives a Personal Medication List or a Medication Action Plan.

The Role of Nursing Leadership in MTM

Directors of Nursing play a critical role in supporting successful MTM and CMR completion.

Facilitate Resident Access

• Help identify appropriate contacts
• Assist with care coordination
• Support communication with responsible parties

Promote Collaboration

Work with:

• Attending physicians
• Consultant pharmacists
• MTM pharmacists
• Care teams

Encourage Timely Follow-Up

Ensure medication recommendations are reviewed and addressed when clinically appropriate.

Support Medication Safety Initiatives

Use MTM findings to:

• Reduce unnecessary medications
• Improve transitions of care
• Address adherence concerns
• Enhance resident outcomes

Common Medication Issues Identified During CMRs:

• Duplicate therapies
• Medication adherence concerns
• High-risk medications in older adults
• Drug interactions
• Excessive use of sedatives
• Opportunities for deprescribing
• Inappropriate dosing
• Gaps in therapy
• Vaccination opportunities

Benefits to Long-Term Care Facilities

Clinical Benefits

• Improved medication safety
• Better chronic disease management
• Reduced medication-related risks
• Enhanced resident engagement

Operational Benefits

• Additional pharmacist oversight
• Collaborative care opportunities
• Support for quality initiatives
• Improved communication among care team members

Resident Benefits

• Better understanding of medications
• Increased confidence in therapy
• Improved adherence
• Enhanced quality of life