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Nayak Exam 2 > Lecture 5 > Flashcards

Lecture 5 Flashcards

1
Q

____ and _____ are disease specific specialized services

A

MTM and CDTM

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2
Q

_____ involves a CPA

A

CDTM involves a CPA (collaborative practice agreement) between pharmacist and physician

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3
Q

MTM/CDTM/MR/PS/CMR are all ___ based.
what does this mean

A

PHARMACY BASED

this means that they are all about ADR/ADE/DRP/DRM

ADR = adverse drug reaction
ADE = adverse drug event
DRP = drug related problem
DRM = drug related morbidity/mortality

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4
Q

As mentioned, MTM and CDTM are disease specific

what do you mean by “disease specific”

A

4 C’s
chronic
costly
coordination of care (best treated this way)
compliance (aka issue with nonadherence)

could be a 5th C: no Cure

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5
Q

true or false

mental health fits all the 4 C’s

A

true
chronic
costly
coordination
compliance

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6
Q

coordination of care can be between what parties?

A

providers, patients, payers, etc

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7
Q

is SMOI voluntary or mandatory?

A

voluntary

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8
Q

can MTM be done by nurses?

A

yes, but pharmacists are better equipped to do so

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9
Q

MR is more of a ___ than a ____
CDTM is a ____

A

MR is more of a SERVICE than a MODEL
CDTM is a MODEL

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10
Q

what does DM/DSM mean?
what service(s) does it apply to?

A

DM = disease management
DSM = disease state management

applies to MTM/CDTM – focused on disease specific states

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11
Q

true or false

an MR pharmacist has to be CDTM trained

A

true

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12
Q

MR used to be hospital based.
now what is it?

A

hospital SYSTEM based – network of hospital-like institutions
IDS – integrated delivery systems.

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13
Q

explain the difference between a horizontal and vertical integration and what these topics apply to

A

applies to the integration of hospital systems to form an integrated delivery systems

1 hospital merging with another = a horizonal integration.

vertical integration = hospital merging with a medical home/nursing home/hospice/pharmacy/primary care
1 thing they all have in common = healthcare

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14
Q

a secondary hospital merges with a tertiary hospital.
is this considered a horizontal or vertical integration?

A

horizontal — they’re both still hospitals

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15
Q

when CVS merged with Aetna, was this a horizontal or a vertical integration?

A

vertical
CVS is a pharmacy and Aetna is an insurer

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16
Q

is CVS merging with caremark considered a horizontal or vertical integration

A

can be considered both
CVS is a retail pharmacy and caremark is a mail order pharmacy. – both are pharmacies = horizontal shift

but caremark is also a PBM – vertical

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17
Q

is CVS caremark becoming CVS health considered a horizontal or vertical merge?

A

definitely vertical

CVS health includes a PBM, insurer, and a pharmacy

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18
Q

what is ASHP
explain how it has changed throughout the years

A

the american society of health systems pharmacists – NOW

used to be just the american society of hospital pharmacists

now says “health systems” includes hospital, managed care, etc

19
Q

what is CMS

A

centers for medicare and medicaid services

20
Q

CMS is a ____ agency, part of what department? what do they oversee?

A

FEDERAL agency part of the dept of health.
oversee medicare and medicaid

21
Q

true or false

both medicare and medicaid are managed by CMS

A

true

22
Q

medicare.gov is a website containing a lost of ONLY medicare participating institutions.
what is a requirement to be on this list?

A

have to be accredited by the joint commission

23
Q

what did the joint commission used to be called?

A

JCAHO

24
Q

who accredits pharmacy schools?

A

ACPE (accreditation council for pharmacy education)

25
Q

medicare.gov also contains ratings of hospitals.
what are these ratings based on?

A

partly based on readmission rates.
based on the QUALITY of the hospital

26
Q

does medicare REQUIRE all of their participating hospitals to share their star ratings?
why?

A

YES – required
medicare can use the bad ratings against the hospital. if ratings are continually low, medicare won’t give the hospital full pay for their services

27
Q

if medicare-participating hospitals have continually low ratings, medicare can withold some payment to the hospital.

this is called ____ healthcare

A

punitive

28
Q

most health care services today are prospective payments or retrospective payments?

A

prospective

29
Q

true or false

medicare only works with accredited organizations

A

true

30
Q

do hospitals NEED to be accredited?

A

not technically, but most hospitals view it as mandatory.
this is so bc if they’re not accredited, they can’t serve medicare and medicaid patients and would essentially serve no patients

31
Q

as mentioned, medicare documents and keeps track of the “quality” of hospitals to determine id they will receive full payment for their services.

under ways that medicare measures quality, which measure is the most applicable to a pharmacist who is employed in a hospital?

A

readmission rates (rehospitalization)

32
Q

explain why readmission rates are bad for both the patient and hospital

A

increased risk of nosocomial infections, iatrogenic.
costs more $ for both the patients and the hospital
ruins hospital quality ratings

33
Q

what is the benchmark for measuring the readmission rates of hospitals

A

15.9%
measured over a 30 day period

34
Q

what is HRRP

A

hospital readmission reduction programs

35
Q

HRRP is linked to which law?

A

the affordable care act

36
Q

___% of readmissions are avoidable.
preventing ___% of readmissions could save $1 billion

A

12% of readmissions are avoidable.
preventing 10% of readmissions could save $ 1 billion

37
Q

what is DRG

A

medicare established “diagnosis related groups” to determine how much to reimburse the hospital

38
Q

changes to medication therapy =

A

SMOI

39
Q

explain why pharmacists have to be CDTM trained to perform med rec

A

certain med rec functions overlap with CDTM

40
Q

what are PAPS

A

patient assistance programs

41
Q

who sponsors PAPS

A

usually pharmaceutical manufactureres

42
Q

what is needymeds.com

A

a PAP

43
Q
A

Nayak Exam 2 (13 decks)

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