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x F2: PCC > Exam 1 > Flashcards

Exam 1 Flashcards

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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
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
24
Where do medication reviews occur
hospital admission transitions of care hospital discharge office visits local pharmacist
25
What is the information needed to collect before an CMR
med list disease states healthcare providers identify potential medication-related problems
26
What are the medication-related problems information needed to collect before a CMR
indication safety efficacy adherance
27
What medications are included in a PML
prescriptions, OTC, vitamins, minerals, herbals, supplements
28
What are the different nonverbal commincation
body language proximity tone of voice facial expressions silence rate of speech
29
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
30
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
31
What are the special population groups when communication barriers might occur
non-english patients patients in poverty elderly hard of hearing/deaf LGBTQIA caregivers
32
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
33
What is the importance of documentation
permanent record performance measures law/regulations finanaces EHRs (information technology)
34
What is the PPACA
state pharmacists should document and communicate information to other healthcare providers in a timely fashion
35
What are the methods of documentation
paper electronic -EHR -MTM vendors
36
Methods of information collected for documentation
identify med-related problems and provide info SBAR SOAP
37
What are the 5 c's of risk management practice
correct complete concise consistent cautious (word choice is important)
38
What is the importance of follow-up
comprehensive care safety efficacy collaboration/trust
39
What are some follow-up considerations
next steps for patients timeframe contact method CMR vs TMR collaborative goal setting
40
What are AMA Current Procedural Terminology (CPT) codes
master set of medical billing codes, descriptions, and guidelines for services and procedures
41
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
42
What are CPT advisors
participate by providing input and guidance on healthcare billing review/update CPT codebook annually
43
What is the code for outpatient CMS and inpatient CMS
outpatient: 1500 inpatient: 1450
44
What is code 99605
New patient, initial encounter provided face-to-face up to 15 minutes
45
What is code 99606
Established patient, initial encounter provided face-to-face up to 15 minutes
46
What is code 99607
Each additional 15 minutes added onto initial encounters (new or established)
47
What codes are "incident to" records
99211-99215
48
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
49
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
50
What is code 99489
Additional code for complex patients for each additional 30 minutes/month
51
What is code 99495
Transitions of Care (TOC) -moderate complexity, visit completed within 14 days
52
What is code 99496
Transitions of Care (TOC) -high complexity, visit completed within 7 days
53
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
54
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
55
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
56
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
57
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
58
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
59
What is code G0438
initial visit, once/lifetime
60
What is code G0439
subsequent visit, annual visit
61
What is code G0108
Diabetes Self-Management Training (x30 minutes) individual
62
What is code G0109
Diabetes Self-Management Training (x30 minutes) group
63
What is code 98960
Diabetes Education (x30 minutes) individual
64
What is code 98961
Diabetes Education (x30 minutes) 2-4 patients
65
What is code 98962
Diabetes Education (x30 minutes) 5-8 patients
66
________ ______ _______ 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
67
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
68
Prevalence of common chronic conditions aged >65 years
HTN hyperlipidemia arthritis ischemic heart disease diabetes CKD HF depression
69
What is frailty considered
unintentional weight loss >10 lbs in 12 months, physical exhaustion, weakness in grip strength, declined walking speed, low physical activity
70
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
71
Common symptoms of ADEs in elderly patients
fatigue altered mental status falling constipation blurred vision depression dizziness
72
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
73
What meds are inappropriate due to strong anticholinergic properties
antihistamine antiparkinsonian skeletal muscle relaxant antidepressants antipsycotics antiarrhythmics antimuscarinics antispasmodics antiemetics
74
What is STOPP criteria version 2
Screening Tool of Older Person's potentially inappropriate Prescriptions -significantly associated with adverse drug events
75
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
76
What is Medication Appropriateness Index (MAI)
indication? effective for condition? right dose/directions/duration? any DD interactions? duplication? least expensive?
77
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.
78
STEADI resources include
online training clinical decision tools (EHR) patient and provider materials
79
STEADI encourages healthcare providers, including pharmacists to do what
screen older adults for fall risk assess modifiable risk factors intervene to reduce risk

x F2: PCC (2 decks)

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