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PCC > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Medication Therapy Reviews (Core Element)

A

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

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1
Q

____ 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

A

MMA

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2
Q

Group 1 medicare part D

A

have multiple chronic diseases (3)
take multiplw part D drugs
likely to incur annual costs (1,623)

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3
Q

How many chronic diseases are there for medicare part D eligibility

A

10

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3
Q

Group 2 medicare part D

A

at-risk beneficiaries
potential for misuse or abuse
history of opioid overdose

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4
Q

what are the required services of medicare part D

A

annual CMR
quarterly TMRs
intervention for both beneficiaries and prescribers
info about safe disposal of drugs

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5
Q

what are the 5 core elements of MTM service model

A

CMR or MTR
persoanl medication list (PML)
Medication action plan (MAP)
intervention or referral
documentation and follow-up

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6
Q

what is CMR

A

collecting patient info
assess meds and drug-related problems
develop list of drug problems
plan to resolve issues

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7
Q

what is the CMR designed to do

A

improve pt knowledge of drugs
identify problems or concerns
pt to self-manage health

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8
Q

what is personal mediation list (PML)

A

Comprehensive record of the patient’s medications
recieved by pharmacist
written for literacy

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9
Q

what may a PML include

A

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

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10
Q

what is medication-related action plan (MAP)

A

-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

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11
Q

What is intervention and/or referral

A

-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

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12
Q

Intervention or Referral may be advised when:

A

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

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13
Q

patient perspective of payers

A

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

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14
Q

pharmacist perspective of payers

A

low compensation
busy schedule on top of this
paperwork varues
understaffed
cancelled appointments
lack of data

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15
Q

physician perspective of payers

A

admin burden (workload, less pt care, burnout)
pt health overall
professional roles

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16
Q

overall goals of payers

A

promote MTM
support outcomes
promote collab
refine services to admin burden
EHRs and improve MTM
leverage telemedicine
payment structure

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17
Q

What is SPO (structure process outcomes)

A

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

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18
Q

ECHO model (economic, clinical, humanistic, outcomes)

A

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

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19
Q

Star relationships meaning

A

medicare program rating: provide beneficiaries info on plane quality and performance

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20
Q

impact on pharmacies for star ratings

A

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

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21
Q

what are the 2024 performance measures

A

diabetes med adherence
HTN (RAS antagonist) adherence
statin adherence
CMR completion rate
statin use in pt with diabetes

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22
Q

What is a CMR

A

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

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23
Q

What is a CMR designed to do

A
  • 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
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24
Q

Where do medication reviews occur

A

hospital admission
transitions of care
hospital discharge
office visits
local pharmacist

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25
Q

What is the information needed to collect before an CMR

A

med list
disease states
healthcare providers
identify potential medication-related problems

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26
Q

What are the medication-related problems information needed to collect before a CMR

A

indication
safety
efficacy adherance

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27
Q

What medications are included in a PML

A

prescriptions, OTC, vitamins, minerals, herbals, supplements

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28
Q

What are the different nonverbal commincation

A

body language
proximity
tone of voice
facial expressions
silence
rate of speech

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29
Q

What are some strategies to improve nonverbal communication

A

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

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30
Q

What are leading/loaded questions

A

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

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31
Q

What are the special population groups when communication barriers might occur

A

non-english patients
patients in poverty
elderly
hard of hearing/deaf
LGBTQIA
caregivers

32
Q

How to communicate effectively with healthcare providers

A

assertive (not aggressive)
avoid inappropriate behaviors
develop collaborate relationships
SBAR
avoid accusing providers of errors or not informing patient

33
Q

What is the importance of documentation

A

permanent record
performance measures
law/regulations
finanaces
EHRs (information technology)

34
Q

What is the PPACA

A

state pharmacists should document and communicate information to other healthcare providers in a timely fashion

35
Q

What are the methods of documentation

A

paper
electronic
-EHR
-MTM vendors

36
Q

Methods of information collected for documentation

A

identify med-related problems and provide info
SBAR
SOAP

37
Q

What are the 5 c’s of risk management practice

A

correct
complete
concise
consistent
cautious (word choice is important)

38
Q

What is the importance of follow-up

A

comprehensive care
safety
efficacy
collaboration/trust

39
Q

What are some follow-up considerations

A

next steps for patients
timeframe
contact method
CMR vs TMR
collaborative goal setting

40
Q

What are AMA Current Procedural Terminology (CPT) codes

A

master set of medical billing codes, descriptions, and guidelines for services and procedures

41
Q

What are category 1, 2, and 3 of AMA Current Procedural Terminology (CPT) codes

A

1: primary codes
2: supplemental tracking and performance measurement codes
3: temporary or emerging technology

42
Q

What are CPT advisors

A

participate by providing input and guidance on healthcare billing
review/update CPT codebook annually

43
Q

What is the code for outpatient CMS and inpatient CMS

A

outpatient: 1500
inpatient: 1450

44
Q

What is code 99605

A

New patient, initial encounter provided face-to-face up to 15 minutes

45
Q

What is code 99606

A

Established patient, initial encounter provided face-to-face up to 15 minutes

46
Q

What is code 99607

A

Each additional 15 minutes added onto initial encounters (new or established)

47
Q

What codes are “incident to” records

A

99211-99215

48
Q

What is code 99490

A

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

49
Q

What is code 99487

A

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

50
Q

What is code 99489

A

Additional code for complex patients for each additional 30 minutes/month

51
Q

What is code 99495

A

Transitions of Care (TOC)
-moderate complexity, visit completed within 14 days

52
Q

What is code 99496

A

Transitions of Care (TOC)
-high complexity, visit completed within 7 days

53
Q

What is code 99441

A

Telephone evaluation and management service
5-10 minutes of medical discussion
not 7 days prior e/m nor 7 days after e/m service

54
Q

What is code 99442

A

11-20 minutes of medical discussion
Telephone evaluation and management service
not 7 days prior e/m nor 7 days after e/m service

55
Q

What is code 99443

A

21-30 minutes of medical discussion
Telephone evaluation and management service
not 7 days prior e/m nor 7 days after e/m service

56
Q

What is code 98966

A

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

57
Q

What is code 98967

A

11-20 min
Telephone evaluation and management service
not 7 days prior e/m service or e/m service w/in 24 h

58
Q

What is code 98968

A

21-30 min
Telephone evaluation and management service
not 7 days prior e/m service or e/m service w/in 24 h

59
Q

What is code G0438

A

initial visit, once/lifetime

60
Q

What is code G0439

A

subsequent visit, annual visit

61
Q

What is code G0108

A

Diabetes Self-Management Training (x30 minutes)
individual

62
Q

What is code G0109

A

Diabetes Self-Management Training (x30 minutes)
group

63
Q

What is code 98960

A

Diabetes Education (x30 minutes)
individual

64
Q

What is code 98961

A

Diabetes Education (x30 minutes)
2-4 patients

65
Q

What is code 98962

A

Diabetes Education (x30 minutes)
5-8 patients

66
Q

________ ______ _______ Update Committee performs the financial survey to determine the value range of the code

A

Relative Value Scale (RVS)
-they determine costs
-they estimate professional time, staff, liability, and resources

67
Q

Does the RVS provide codes for medicare part B

A

No, Codes not used for Medicare Part B services need to be surveyed by their own
organization to determine market value (various algorithms available

68
Q

Prevalence of common chronic conditions aged >65 years

A

HTN
hyperlipidemia
arthritis
ischemic heart disease
diabetes
CKD
HF
depression

69
Q

What is frailty considered

A

unintentional weight loss >10 lbs in 12 months, physical exhaustion, weakness in grip strength, declined walking speed, low physical activity

70
Q

Risk factors for adverse drug events in older adults

A

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

71
Q

Common symptoms of ADEs in elderly patients

A

fatigue
altered mental status
falling
constipation
blurred vision
depression
dizziness

72
Q

What are the goals of the Beers Criteria

A

improve med selection
reduce adverse drug events
educate clinicians and patients
evaluate quality of care, cost, and patterns of drug use in older patients

73
Q

What meds are inappropriate due to strong anticholinergic properties

A

antihistamine
antiparkinsonian
skeletal muscle relaxant
antidepressants
antipsycotics
antiarrhythmics
antimuscarinics
antispasmodics
antiemetics

74
Q

What is STOPP criteria version 2

A

Screening Tool of Older Person’s potentially inappropriate Prescriptions
-significantly associated with adverse drug events

75
Q

START criteria version 2

A

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

76
Q

What is Medication Appropriateness Index (MAI)

A

indication?
effective for condition?
right dose/directions/duration?
any DD interactions?
duplication?
least expensive?

77
Q

What is stopping elderly accidents, death, and injuries (STEADI)

A

-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.

78
Q

STEADI resources include

A

online training
clinical decision tools (EHR)
patient and provider materials

79
Q

STEADI encourages healthcare providers, including pharmacists to do what

A

screen older adults for fall risk
assess modifiable risk factors
intervene to reduce risk

PCC (2 decks)

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