P516 Health Systems questions with correct answers 100%

P516 Health Systems questions with correct answers 100%Define direct and indirect remuneration fees (DIR) fees and describe why they are controversial. - correct answer DIR fees are fees that pharmacies may see PBMs charge outside of the administration fees that are generally collected after the point of sale. They can be controversial because they often create a net loss for the dispensing pharmacy when the claim is processed through medicare part D. What are the economic impacts of DIR fees on pharmacy reimbursement and overall revenue? - correct answer DIR fees can create a loss in revenue that can surpass the cost of drug acquisition. This happens by essentially recalling a part of the reimbursement the pharmacy receives for drug dispensing. Understand the general trend of DIR fees over time. - correct answer General trend is that the DIR fees are increasing every year. Define 'clawbacks'. - correct answer A recovery of money already disbursed. This occurs when a PBM charges a DIR fee after the point of sale. What role do star-ratings and other quality measures play in determining DIR fees? - correct answer Sometimes performance DIR fees are weighted where PBMs compare pharmacies regardless of if they are retail or specialty on the same scale and then base the fee off the percentile the pharmacy falls in. This hurts specialty pharmacies because they don't usually offer the same services retail pharmacies do that are rated (MTM and HTN or diabetes management measured, NOT cancer or HIV) Understand the role and impact of federal legislation and state policy in DIR fees. - correct answer The Improving Transparency and Accuracy in Medicare Part D Spending Act will prohibit PBMs/Plan sponsors from retroactively reducing payment on clean claims submitted under Medicare Part D. This will effectively eliminate clawbacks. This will also save patients from falling into the "doughnut hole." Compare and contrast pharmacy benefit manager's "spread pricing" model and "pass-through" model of reimbursement. - correct answer In the spread pricing model, the PBM charges a payer more than it reimburses the pharmacy for a certain drug and retains the difference. In the pass-through model, payers the same amount that they reimburse pharmacies, plus a set administrative fee. What do pharmacists do in the hospital - correct answer Provide Clinical Services (medication histories, patient education, monitor drug therapy, attend CPR events, Teach students/residents/nurses/physicians), Oversee drug distribution (sterile product prep/non-sterile medication distribution), Assure medication safety, serve on committees, manage medication use and costs What are the financial, quality, safety, human resource, and technology challenges in hospital pharmacy - correct answer Financial: Increasing expenses of labor, equipment, supplies, and facilities. Reimbursement not keeping up. Changing imbursement system (moving towards "value based reimbursement" vs. "fee for service"- don't know when it will change. Quality: The service conundrum-better, faster, cheaper=pick two at the expense of the other. A quality principle-higher quality leads to decreased costs. At least a dozen organizations that measure quality that impact health reimbursement. Safety: Medications are perhaps the largest safety risk in hospitals. "To err is to be human." Technology: Constantly changing and updating, costly new software and solutions, expensive to buy and maintain, staff must be trained, optimization. What training is required for hospital pharmacy today - correct answer Residency (1 to 2 years), MS/MBA/or MHA for administrative positions, Experience, Miscellaneous (energy, patience, passion, comm skills, etc.) What adaptations has institutional pharmacy undertake that other industries have implement to promote safety - correct answer Airline industry, safety checklists, attention to detail What are the challenges facing pharmacy in regards to human resource issues - correct answer recruiting sufficient numbers of qualified technicians and pharmacy managers, people are mobile and turnover is higher (10%-15%), training to level of competence/excellence, employee retention. Define what a specialty drug is/ What are characteristics of that make a specialty drug a specialty drug - correct answer To be considered a specialty drug a medication may have some or all of the following characteristics: treatment of complex, chronic and/or rare conditions, have special storage, handling or admin requirements, High cost (often exceeding $10,000 per month), require ongoing monitoring for safety and/or efficacy, availability through exclusive, restricted or limited distribution, Have REMS requirements: Risk Evaluation and Mitigation Strategy What is a specialty pharmacy - correct answer As per the National Association of Specialty Pharmacy: A pharmacy that solely or largely provides only medications for people with serious health conditions requiring complex therapies. What medical conditions are targeted today with specialty drug development - correct answer Orphan and rare diseases, Immune deficiencies, hemophilia, rheumatoid arthritis, multiple sclerosis, Hep C, Cystic Fibrosis, Crohn's, HIV/AIDS What does "high-touch" pharmacy mean - correct answer "high-touch" refers to the involvement of personal attention and service. In pharmacy this means constant communication with patients. What characteristics of a pharmacy are needed to be able to handle specialty drugs - correct answer Should be accredited by independent third parties to ensure consistent quality of care. Describe different types of adherence tools used by specialty pharmacists - correct answer Technology, Proactive adherence calls, prophylactic starter kits, compliance packaging, patient training/education, MedSync