Lecture 5

Question 1

____ and _____ are disease specific specialized services

Answer 1

MTM and CDTM

Question 2

_____ involves a CPA

Answer 2

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

Question 3

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

Answer 3

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

Question 4

As mentioned, MTM and CDTM are disease specific

what do you mean by “disease specific”

Answer 4

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

could be a 5th C: no Cure

Question 5

true or false

mental health fits all the 4 C’s

Answer 5

true
chronic
costly
coordination
compliance

Question 6

coordination of care can be between what parties?

Answer 6

providers, patients, payers, etc

Question 7

is SMOI voluntary or mandatory?

Answer 7

voluntary

Question 8

can MTM be done by nurses?

Answer 8

yes, but pharmacists are better equipped to do so

Question 9

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

Answer 9

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

Question 10

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

Answer 10

DM = disease management
DSM = disease state management

applies to MTM/CDTM – focused on disease specific states

Question 11

true or false

an MR pharmacist has to be CDTM trained

Answer 11

true

Question 12

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

Answer 12

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

Question 13

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

Answer 13

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

Question 14

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

Answer 14

horizontal — they’re both still hospitals

Question 15

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

Answer 15

vertical
CVS is a pharmacy and Aetna is an insurer

Question 16

is CVS merging with caremark considered a horizontal or vertical integration

Answer 16

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

Question 17

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

Answer 17

definitely vertical

CVS health includes a PBM, insurer, and a pharmacy

Question 18

what is ASHP
explain how it has changed throughout the years

Answer 18

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

Question 19

what is CMS

Answer 19

centers for medicare and medicaid services

Question 20

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

Answer 20

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

Question 21

true or false

both medicare and medicaid are managed by CMS

Answer 21

true

Question 22

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

Answer 22

have to be accredited by the joint commission

Question 23

what did the joint commission used to be called?

Answer 23

JCAHO

Question 24

who accredits pharmacy schools?

Answer 24

ACPE (accreditation council for pharmacy education)

Question 25

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

Answer 25

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

Question 26

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

Answer 26

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

Question 27

if medicare-participating hospitals have continually low ratings, medicare can withold some payment to the hospital. this is called ____ healthcare

Answer 27

punitive

Question 28

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

Answer 28

prospective

Question 29

true or false medicare only works with accredited organizations

Answer 29

true

Question 30

do hospitals NEED to be accredited?

Answer 30

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

Question 31

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?

Answer 31

readmission rates (rehospitalization)

Question 32

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

Answer 32

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

Question 33

what is the benchmark for measuring the readmission rates of hospitals

Answer 33

15.9% measured over a 30 day period

Question 34

what is HRRP

Answer 34

hospital readmission reduction programs

Question 35

HRRP is linked to which law?

Answer 35

the affordable care act

Question 36

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

Answer 36

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

Question 37

what is DRG

Answer 37

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

Question 38

changes to medication therapy =

Answer 38

SMOI

Question 39

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

Answer 39

certain med rec functions overlap with CDTM

Question 40

what are PAPS

Answer 40

patient assistance programs

Question 41

who sponsors PAPS

Answer 41

usually pharmaceutical manufactureres

Question 42

what is needymeds.com

Answer 42

a PAP