Exam 1 Flashcards
Medication Therapy Reviews (Core Element)
The medication therapy review is a systematic process of collecting patient-specific information, assessing medication therapies to identify medication-related problems, developing a prioritized list of medication-related problems, and creating a plan to resolve them
____ passed in 2003 required Part D plans to provide MTM services to a defined subset of beneficiaries to optimize therapeutic outcomes by improving medication use, reducing adverse drug events and interactions
MMA
Group 1 medicare part D
have multiple chronic diseases (3)
take multiplw part D drugs
likely to incur annual costs (1,623)
How many chronic diseases are there for medicare part D eligibility
10
Group 2 medicare part D
at-risk beneficiaries
potential for misuse or abuse
history of opioid overdose
what are the required services of medicare part D
annual CMR
quarterly TMRs
intervention for both beneficiaries and prescribers
info about safe disposal of drugs
what are the 5 core elements of MTM service model
CMR or MTR
persoanl medication list (PML)
Medication action plan (MAP)
intervention or referral
documentation and follow-up
what is CMR
collecting patient info
assess meds and drug-related problems
develop list of drug problems
plan to resolve issues
what is the CMR designed to do
improve pt knowledge of drugs
identify problems or concerns
pt to self-manage health
what is personal mediation list (PML)
Comprehensive record of the patient’s medications
recieved by pharmacist
written for literacy
what may a PML include
Patient demographics
Emergency contact information
Primary care physician (name and phone number)
Pharmacy/pharmacist (name and phone number)
Allergies and other medication-related problems
Date last updated and date last reviewed by health care provider
For each medication, include name, dose, indication, instructions, start date, stop date, ordering physician information, and special instructions
what is medication-related action plan (MAP)
-Patient-centric document containing a list of actions for the patient to use in tracking progress
-Collaborative effort between the patient and pharmacist
-Includes only elements that the patient can act on and that are within the pharmacist’s scope
-Patient should use the MAP as a guide to track progress toward a specified goal
What is intervention and/or referral
-The pharmacist provides consultative services and intervenes to address medication-related problems
-When necessary, the pharmacist refers the patient to the appropriate health care professional
-The intent of this element is to optimize medication use, enhance continuity of care, and encourage patients to take steps to prevent future adverse events
Intervention or Referral may be advised when:
The patient exhibits problems discovered during the CMR
The patient may require disease state management education
The patient may require monitoring for high-risk medications
patient perspective of payers
unfamiliar or dont think they need the service
pharmacists filld meds fast
don’t want to betray PCP
don’t want to waste pharmacist time
preference varies from in person to on phone
pharmacist perspective of payers
low compensation
busy schedule on top of this
paperwork varues
understaffed
cancelled appointments
lack of data
physician perspective of payers
admin burden (workload, less pt care, burnout)
pt health overall
professional roles
overall goals of payers
promote MTM
support outcomes
promote collab
refine services to admin burden
EHRs and improve MTM
leverage telemedicine
payment structure
What is SPO (structure process outcomes)
S: characters of prescribers, tools and resources, phsyical organization settings
P: activities btw pt and provider, services provided and the manner of them, tech or interpersonal
O: effects of care on health status of pt, intermediate or long-term, indicator of service quality
ECHO model (economic, clinical, humanistic, outcomes)
E: cost, actual vs estimates, direct vs indirect
C: disease state change, labs, adverse drug events
H: pt reported outcomes, surveys or interviews
O: end result
Star relationships meaning
medicare program rating: provide beneficiaries info on plane quality and performance
impact on pharmacies for star ratings
pharmacy can impact 50% of Medicare PDP’s
plans want to contract with pharmacies that will help them achieve high quality ratings
your pharmacy could be Preferred, Non-preferred, or excluded on Medicare Plans
changes in prescription reimbursement and DIR fees
what are the 2024 performance measures
diabetes med adherence
HTN (RAS antagonist) adherence
statin adherence
CMR completion rate
statin use in pt with diabetes
What is a CMR
A systematic process of:
* Collecting patient-specific information
* Assessing medication therapies to identify drug-related problems
* Developing a prioritized list of drug-related problems
* Creating a plan to resolve them
What is a CMR designed to do
- Improve patients’ knowledge of their prescriptions, OTC
medications, herbal therapies, and dietary supplements - Address problems or concerns
- Empower patients to self-manage their health conditions and medications
Where do medication reviews occur
hospital admission
transitions of care
hospital discharge
office visits
local pharmacist
What is the information needed to collect before an CMR
med list
disease states
healthcare providers
identify potential medication-related problems
What are the medication-related problems information needed to collect before a CMR
indication
safety
efficacy adherance
What medications are included in a PML
prescriptions, OTC, vitamins, minerals, herbals, supplements
What are the different nonverbal commincation
body language
proximity
tone of voice
facial expressions
silence
rate of speech
What are some strategies to improve nonverbal communication
facial expressions
-smile, raise pitch/tone of voice
open stance
-square in front of person, slight lean, 50-75% eye contact
self-awareness
-monitor yourself during session
What are leading/loaded questions
guides patients towards certain answers you hope to hear
may force patient to recall incorrect information
more common when pharmacists have time limitations
should be avoided
What are the special population groups when communication barriers might occur
non-english patients
patients in poverty
elderly
hard of hearing/deaf
LGBTQIA
caregivers
How to communicate effectively with healthcare providers
assertive (not aggressive)
avoid inappropriate behaviors
develop collaborate relationships
SBAR
avoid accusing providers of errors or not informing patient
What is the importance of documentation
permanent record
performance measures
law/regulations
finanaces
EHRs (information technology)
What is the PPACA
state pharmacists should document and communicate information to other healthcare providers in a timely fashion
What are the methods of documentation
paper
electronic
-EHR
-MTM vendors
Methods of information collected for documentation
identify med-related problems and provide info
SBAR
SOAP
What are the 5 c’s of risk management practice
correct
complete
concise
consistent
cautious (word choice is important)
What is the importance of follow-up
comprehensive care
safety
efficacy
collaboration/trust
What are some follow-up considerations
next steps for patients
timeframe
contact method
CMR vs TMR
collaborative goal setting
What are AMA Current Procedural Terminology (CPT) codes
master set of medical billing codes, descriptions, and guidelines for services and procedures
What are category 1, 2, and 3 of AMA Current Procedural Terminology (CPT) codes
1: primary codes
2: supplemental tracking and performance measurement codes
3: temporary or emerging technology
What are CPT advisors
participate by providing input and guidance on healthcare billing
review/update CPT codebook annually
What is the code for outpatient CMS and inpatient CMS
outpatient: 1500
inpatient: 1450
What is code 99605
New patient, initial encounter provided face-to-face up to 15 minutes
What is code 99606
Established patient, initial encounter provided face-to-face up to 15 minutes
What is code 99607
Each additional 15 minutes added onto initial encounters (new or established)
What codes are “incident to” records
99211-99215
What is code 99490
At least 20 minutes of time is spent on care management activities
-multiple chronic conditions
-pt might experience death/decline with chronic conditions
-comprehensive care plan established
What is code 99487
At least 20 minutes of time is spent on care management activities
-multiple chronic conditions
-pt might experience death/decline with chronic conditions
-comprehensive care plan established
WITH moderate/high complexity and minimum of 60 minutes/month
What is code 99489
Additional code for complex patients for each additional 30 minutes/month
What is code 99495
Transitions of Care (TOC)
-moderate complexity, visit completed within 14 days
What is code 99496
Transitions of Care (TOC)
-high complexity, visit completed within 7 days
What is code 99441
Telephone evaluation and management service
5-10 minutes of medical discussion
not 7 days prior e/m nor 7 days after e/m service
What is code 99442
11-20 minutes of medical discussion
Telephone evaluation and management service
not 7 days prior e/m nor 7 days after e/m service
What is code 99443
21-30 minutes of medical discussion
Telephone evaluation and management service
not 7 days prior e/m nor 7 days after e/m service
What is code 98966
5-10 minutes of medical discussion
Telephone evaluation and management service
not 7 days prior e/m service or e/m service w/in 24 h
What is code 98967
11-20 min
Telephone evaluation and management service
not 7 days prior e/m service or e/m service w/in 24 h
What is code 98968
21-30 min
Telephone evaluation and management service
not 7 days prior e/m service or e/m service w/in 24 h
What is code G0438
initial visit, once/lifetime
What is code G0439
subsequent visit, annual visit
What is code G0108
Diabetes Self-Management Training (x30 minutes)
individual
What is code G0109
Diabetes Self-Management Training (x30 minutes)
group
What is code 98960
Diabetes Education (x30 minutes)
individual
What is code 98961
Diabetes Education (x30 minutes)
2-4 patients
What is code 98962
Diabetes Education (x30 minutes)
5-8 patients
________ ______ _______ Update Committee performs the financial survey to determine the value range of the code
Relative Value Scale (RVS)
-they determine costs
-they estimate professional time, staff, liability, and resources
Does the RVS provide codes for medicare part B
No, Codes not used for Medicare Part B services need to be surveyed by their own
organization to determine market value (various algorithms available
Prevalence of common chronic conditions aged >65 years
HTN
hyperlipidemia
arthritis
ischemic heart disease
diabetes
CKD
HF
depression
What is frailty considered
unintentional weight loss >10 lbs in 12 months, physical exhaustion, weakness in grip strength, declined walking speed, low physical activity
Risk factors for adverse drug events in older adults
Using ≥5 medications
Taking ≥12 doses/day
Dementia
Depression
Female sex
Low body weight or body mass index <22
Multiple chronic conditions
Age ≥85 years
CrCl <50 mL/min
Recent hospitalization
Multiple prescribers
Multiple pharmacies
Prior adverse drug event
Regular use of alcohol
Common symptoms of ADEs in elderly patients
fatigue
altered mental status
falling
constipation
blurred vision
depression
dizziness
What are the goals of the Beers Criteria
improve med selection
reduce adverse drug events
educate clinicians and patients
evaluate quality of care, cost, and patterns of drug use in older patients
What meds are inappropriate due to strong anticholinergic properties
antihistamine
antiparkinsonian
skeletal muscle relaxant
antidepressants
antipsycotics
antiarrhythmics
antimuscarinics
antispasmodics
antiemetics
What is STOPP criteria version 2
Screening Tool of Older Person’s potentially inappropriate Prescriptions
-significantly associated with adverse drug events
START criteria version 2
Screening Tool to Alert doctors to the Right Treatment
-Physiological systems-based
-Aims to identify common instances of under prescribing or omission of medicates that would be beneficial
-Lists 34 evidence-based prescribing indicators for drugs and drug classes that should be prescribed for older patients with specific clinical conditions
What is Medication Appropriateness Index (MAI)
indication?
effective for condition?
right dose/directions/duration?
any DD interactions?
duplication?
least expensive?
What is stopping elderly accidents, death, and injuries (STEADI)
-An initiative by CDC to address the fall burden and help healthcare providers implement fall prevention as a routine part of care
-STEADI provides members of the healthcare team with the tools and resources they need to reduce their older patients fall risk.
STEADI resources include
online training
clinical decision tools (EHR)
patient and provider materials
STEADI encourages healthcare providers, including pharmacists to do what
screen older adults for fall risk
assess modifiable risk factors
intervene to reduce risk
