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PPA > Exam 2 > Flashcards

Exam 2 Flashcards

1
Q

Why do we need pharmacists?

A 
Medication Use
Healthcare Reform
Physician shortages
Increased healthcare costs
Population health
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2
Q

What is the US healthcare system performance rating?

A

Last in most things

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3
Q

Healthcare reform

A 
Fee-for-service (FFS)
-pay for outcomes
IHI triple/quadruple aim
goal- to improve individual healthcare and experience along with that of communities and populations
Improve patient experiences
Increase population health outcomes
Reduce costs
Care team well being
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4
Q

Pharmaceutical care

A

Introduced in 1990
Patient-centered, outcome-oriented pharmacy practice
Principles- professional relationship with patient must be established and maintained
Medical information must be collected and evaluated
Pharmacists assures that the patient has all supplied, information and knowledge necessary . Pharmacists reviews, monitors therapeutic plan

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5
Q

Medication therapy management (MTM)

A

Officially recognized by the Medicare Prescription Drug, Improvement, and Modernization act of 2003
Required Med part D to establish MTM programs

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6
Q

MTM patient eligibility

A

Multiple chronic disease states (2-3)
Take multiple part D drugs (2-8)
Likely to incur $4,376 for covered part D drugs

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7
Q

5 core elements of MTM

A 
Medication therapy review
Personal medication record
Medication-related action plan
intervention or referral
Documentation and F/U
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8
Q

Comprehensive Medication Review (CMR)

A

Annual
Collecting patient specific information
Assessing medication therapies and identifying medication-related problems.
Developing prioritized list of med-related problems.
Creating a plan to resolve problems
All meds are addressed to determine appropriateness, effectiveness, safety, able to be taken by patient

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9
Q

Targeted Medication Review (TMR)

A

Quarterly
Addresses specific or potential medication related problem
Examples- adherence, cost savings, new or changed therapy, inappropriate dose or duration

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10
Q

Pharmacists patient care process (PPCP)

A 
Collect- subjective and objective info
Assess- analyzes clinical effects of pts therapy
Plan-
Implement
Monitor and Evaluate
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11
Q

Medication management services (MMS)

A

Encompasses ALL collaborative pharmacy services focusing on:

medication appropriateness, effectiveness, safety, adherence

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12
Q

Hospital pharmacy models

A

Community vs academic health centers
Centralized vs decentralized
Virtual
Specialized vs general

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13
Q

Community pharmacy models

A

Independent vs chain
Clinical initiatives
Flip the pharmacy (ftP)
ACT collaborative/CPESN

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14
Q

CPESN

A

Focus on getting reimbursement for clinical services by forming a group and negotiating with payors

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15
Q

FtP

A

Focuses on implementation, workflow, etc. of innovations for CPESN pharmacies

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16
Q

ACT collab

A

Brings faculty together with CPESN pharmacies to unite, mobilize and amplify community pharmacy transformation efforts

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17
Q

Ambulatory Care Definition

A

Ambulatory care pharmacy practice is the provision of integrated, accessible healthcare services by pharmacists who are accountable for addressing medication needs and sustained partnerships with patients, and practicing in the context of family and community.

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18
Q

Ambulatory care is accomplished through

A 
Direct patient care
Medication management
Long-term relationships
Coordination of care
Patient advocacy
Wellness and health promotion
Triage and referral 
Patient education and self-management
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19
Q

Ambulatory care models

A 
Pharmacists run clinics Vs. Provider run clinics
Collaborative practice agreements
Hospital based
Physician group
Specialty vs generalized
Federally qualified health centers
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20
Q

Benefits of am care pharmacists

A

Clinical- improved outcomes and markers
Economic- decreases healthcare costs
Humanistic- patient reported satisfaction improves. Provider burnout is reduced.

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21
Q

Specialty pharmacy

A

Meds are high cost, high complexity, high touch

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22
Q

Transitions of care

A

Coordination and continuity of healthcare between different settings
Most effective if f/u is done after hospital stay

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23
Q

PAI goal

A

PAI is a group of recommendations developed by ASHP to drive pharmacy change at a local level

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24
Q

PAI domains

A 
Patient centered care
Pharmacy technician role
Pharmacist role
Technology and data science
Leadership
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25
Q

Steps to develop a clinical practice

A 
1.) Define scope
2,) Build support
3.) Demonstrate value
4.) Determine practice model
5.) Identify resource requirements
6.) Anticipate and manage growth
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26
Q

Define scope

A

Complete a needs assessment and focus on services that provide the most value and is the most feasible.
Service needs to align with your skills AND the needs of the institution.

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27
Q

What attributes should you consider when you define scope?

A

Valuable- quality divided by cost
Scalable- can easily grow to accommodate demand
Reproducible
Sustainable

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28
Q

Needs assessment questions

A
  1. ) What is the current state of the proposed service?
  2. ) What is the current standard of care?
  3. ) What current and future developments may impact the success of this service?
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29
Q

Comprehensive Medication Management (CMM)

A 
All of a patients medications are individually addressed to determine: 
Appropriateness
Effectiveness
Safety
Able to be taken by the patient.
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30
Q

PPCP

A

Collect, assess, plan, implement, monitor and evaluate

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31
Q

Steps to developing a clinical practice

A
  1. ) Define scope
  2. ) Build support
  3. ) Demonstrate value
  4. ) Determine practice model
  5. ) Identify resource requirements
  6. ) Anticipate and manage growth
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32
Q

Steps for other providers to implement a pharmacist into their team

A

Identify roles
Decide how the practice could benefit
Find a pharmacist and tech match
Prepare and set expectations for your team and pts
Determine the resources the pharmacist needs and the impact on the physicians workflow
Measure impact

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33
Q

4 key attributes to scope

A
  1. ) Valuable- quality divided by cost
  2. ) Scalable- can easily grow to accommodate demand.
  3. ) Reproducible- can be replicated
  4. ) Sustainable- able to be maintained at a high level.
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34
Q

High risk medications or requiring frequent monitoring

A 
Warfarin
Insulin
Digoxin
Anticonvulsants
Lithium
Antiarrhythmics
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35
Q

Potential services for ambulatory care clinics

A 
Patient education
Prevention and wellness
Medication reconciliation
Immunizations
Transitions of care
Comprehensive medication management
MTM
Point of care testing
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36
Q

Performing a needs assessment, what 3 questions should you ask?

A
  1. ) What is the current state of the proposed service?
  2. ) What is the standard of care currently?
  3. ) What current and future developments may impact the success of this service?
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37
Q

Key stakeholders for am care clinics

A

Patients, physicians. NP/PAs, nurses, medical assistants, office managers, care coordinators

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38
Q

Steps for ambulatory care: Build support

A

Include people that are initially skeptical
Get everyone engaged early
Use supporting information from outside pharmacy organizations

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39
Q

Steps for ambulatory care clinic: Prepare and set expectations for your team and pts

A

Designate a physician champion
Delineate roles and responsibilities
Manage up the pharmacists to patients (create introductory letter, do a “meet and greet”)

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40
Q

How do you demonstrate value of an ambulatory care clinic?

A

Use evidence!
Internal- other pharmacy services within your organization, pilot study.
External- similar orgs/competitors, similar services.
Select evidence that clearly supports a PHARMACIST completing the service

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41
Q

Steps for ambulatory care clinic: how can the practice benefit from a pharmacist

A

Reviews considerations for how to include a pharmacist

  • cost of hiring a pharmacist
  • share with another practice
  • collaborate with community pharmacist
42
Q

Consider the physical space of a ambulatory care practice

A

Integrated in the clinic- desk space, availability to team, pt room
In another location- how to communicate? EHR

43
Q

Practice model

A

Patient interactions- face-to-face, telephonic, team visits

Special agreements- collaborative practice agreements, protocols, standing orders

44
Q

Ambulatory care- integrating into the clinical team

A

Inclusion of stakeholders early-improves perception of service.
Keep provider goals in mind and align with your goals.
Remain flexible.
Consider providing disease state management presentations or clinical guideline updates.
Elevator speech
“Face Time”
Create a document for providers on what they can expect when they consult you.

45
Q

Keys to integration into a clinical team

A

Visability and accessibility

46
Q

Ambulatory care clinic- how to determine demand for service/patient volume

A 
Start with billing officers
-ICD codes to determine pt diagnoses
-Services provided
-Insurance/payer mix
-Basic demographic information
EHR- show rate, obtain basic lab information
47
Q

Referral system

A

Automatic= more patients

Provider initiated= fewer patients

48
Q

Time for appointments

A

Pharmacists
8-12 patients per day for CMM
15-30 patients per day for targeted disease state management

49
Q

FTE

A

Full time equivalent

Maximum number of compensable hours an individual will work in a year= 2080

50
Q

Financial potential of service

A

Reimbursement (billing)

  • incident-to
  • MTM services
  • Value-based contracts

Cost-avoidance (“soft dollars”)

Care efficiency- improving the productivity of other providers who can see more patients and generate additional revenue.

51
Q

What resources does the pharmacist need and the impact on the physicians workflow?

A

Clinic desk space
Patient room space
Reimbursement
Co-signing notes

52
Q

Anticipate and manage growth when making a am care clinic

A

Keep services within your means

Maintain patient volume

53
Q

payer/payor definition

A

Insurance company including commercial insurance, Medicare, Medicaid

54
Q

Why is sustainability important?

A

Best practice does not equal sustainable practice.

Service MUST be AT LEAST cost neutral

55
Q

4 Pillars of sustainable practice

A

Leadership
Staffing
Information Technology
Compensation

56
Q

4 pillars of sustainable practice: Leadership

A 
Advocates for pharmacy
Nurtures stakeholder relationships
Stays informed about local management changes
Staffing
Writes BP
57
Q

4 pillars of pharmacy leadership: Staffing

A

Establishing training needs.
Are current pharmacists qualified to offer new service?
Maximize efficiencies- ensure that everyone practices at the top of their license.

58
Q

Strategies used to ensure pharmacists practice at the top of their license

A

Integrate into current workflows, establish own workflows that are efficient

59
Q

Advantages/disadvantages of pharmacy learners

A

Advantages- rewarding for current staff, identification of future employees, inexpensive labor, financial benefits.
Disadvantages- may or may not be consistent
Requires time for current employees.

60
Q

Information technology

A

Always changing
Assess current technology before investing in new
Opportunities- workload tracking, clinical reports
Appoint someone to be the IT expert on the team,

61
Q

Compensation of ambulatory care clinic

A

Diversify
-billing for services
-pay-for-performance
cost savings and cost avoidance

62
Q

Cost savings and cost avoidance

A

Cost savings= real dollars
-Not lost due to financial penalties imposed by a payer
Cost avoidance= “soft” dollar
-Avoided by avoiding an event (hospitalization, thromboembolic event, etc.)

63
Q

Do CFOs want to see cost savings or cost avoidance?

A

Cost savings

64
Q

Do payers prefer cost savings or cost avoidance?

A

Cost avoidance

65
Q

Cost savings example

A

HRRP

-Financially penalizes hospitals for high readmission rates

66
Q

Measuring readmission rates

A

Before and after service implementation
Among similar populations with and without a pharmacist
Between organizations (competition)

67
Q

How to demonstrate value over time?

A

Select quality measures to demonstrate value over time
ECHO model
-Economic- costs
-Clinical- lab values, adherence measures
-Humanistic- patient, provider, staff satisfaction

68
Q

Measure impact of ambulatory care

A 
Clinical outcomes
Impact on process metrics
Med adherence 
Change in costs
Utilize current measures, if possible
69
Q

Pay for performance

A

Local pay for performance initiatives
5 star ratings
Value based purchasing
PCMH, ACO

70
Q

Accountable Care Organizations (ACO)

A

Groups of doctors, hospitals, and other health care providers, who come together voluntarily to give coordinated high-quality care to the Medicare patients they serve.
CMS
MANY different programs

71
Q

Patient Centered Medical Home (PCMH)

A

Transforming how primary care is organized to improve health in America.
5 functions- comprehensive care, patient-centered, coordinated care, accessible services, quality and safety
Reimbursement for services traditionally not reimbursed

72
Q

Star Ratings

A

Measures= outcomes, intermediate outcomes, patient experience, access to care, process
Reimbursed based on star rating

73
Q

Examples of measures

A

Screening measures- osteoporosis screening, cancer screenings
Medication use and adherence- statin, ACE/ARB, oral diabetes agents
Monitoring- glycemic control, INR monitoring

74
Q

Revenue

A

Payment for services provided
Payment for downstream services
Product sales
Potential grant support

75
Q

What does billing depend on?

A

Clinical practice site location
Payer mix (government, self-payed, commercial)
Type of service

76
Q

Billing for sustainability

A

One aspect of revenue
Likely will not be enough to completely cover costs
Become familiar with potential billing opportunities, but do not completely rely on this income.
Provider status will influence in future.

77
Q

Measuring success

A

Traditional pharmacy benchmarks- number of interventions, patients seen
Aligns with measures for physicians or the group as a whole.

78
Q

Challenges in measuring success

A

Ability to obtain data
Accuracy of data
Timeliness of data
Too much data

79
Q

Return on Investment (ROI)

A

Clinical value of pharmacists must be translated into economic value
Consider partnerships

80
Q

Collaborative practice agreements

A

Establish a formal relationship
Delegate patient care functions
Contain negotiated conditions
Functions delegated to the pharmacist for chronic disease management.

81
Q

What requires a CPA?

A

Authorization of refills
Chronic disease management
Laboratory test
Therapeutic interchange (modify/start/discontinue therapy)

82
Q

What does not require a CPA?

A

Referrals
Medication reviews
Disease screenings
Patient and provider counseling/DI questions

83
Q

Protocol

A

Law allows a pharmacist to work under a standing order from a physician to dispense to anyone without a prescription

84
Q

Privileging

A

Organizations allow individuals to perform a clinical services within a defined scope of practice.

85
Q

Who can pharmacists enter CPAs with?

A 
Certified nurse practitioners
Certified nurse-midwives
Certified Clinical Nurse specialists
PAs
Physicians
86
Q

CPA law

A

Ongoing physician-patient relationship
Scope of practice
Trained within specialty

87
Q

Evolving a CPA

A

Identify areas of need for the population
Build a relationship/trust with the provider
Create the legal agreement/collaboration
Advancing growth of CPA within clinic

88
Q

Who can terminate a CPA?

A

Pharmacist
Practitioner
Patient whose therapy is being managed

89
Q

Billing for CPA appointments

A

CMS rulings
Medicare Part B
Contracts with private payers

90
Q

Provider status?

A

Senate bill 265
NPI number
Advocating for the profession

91
Q

Benefits of CPAs

A

Measuring patient successes
Building relationships
Expanding and growing pharmacy services

92
Q

Credential

A

Documented evidence of professional qualifications

93
Q

Privilege

A

Permission or authorization granted by a healthcare organization to an individual health professional to perform certain patient care services

94
Q

Credentialing

A

Process of granting a credential
Process by which an organization obtains, verifies, and assesses a health professionals qualifications to provide pt care

95
Q

Privileging

A

Process after credentialing where a healthcare organization authorizes an individual to perform a specific scope of pt care

96
Q

Purpose of C&P

A

Ensure capabilities and competence of healthcare professionals
Promote ongoing quality improvement in individual performance via periodic peer review
Lessen risk for malpractice suits
Credentialing- document and demonstrate
Privileging- assure stakeholders that the healthcare professional has the competencies and experience for specific services

97
Q

Purpose of C&P for pharmacists

A

As pharmacists move to more clinical roles, it became necessary to further verify credentials
Gain credibility on an interprofessional team
Provide consistency and increases understanding among providers, insurers, and health systems

98
Q

Council on credentialing in pharmacy (CCP)

A

Provides leadership, guidance, public information, and coordination for credentialing programs relevant to pharmacy

99
Q

Types of credentials

A

Certificates, statement of continuing education, certification, practice-based CPE activities

100
Q

Pharmacists credentials

A

Doctor of pharmacy degree
Entry-level credentials= NAPLEX, MPJE, State license
Voluntary credentials

101
Q

CCP Guiding principles

A

Licensure should ensure entry-level knowledge. Post-licensure credentials should build on this foundation
Credentialing programs should be established through a profession-wide, consensus-building process and should be base don patient and societal needs

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