(Step 5 In The Wpqc-certification Process)
You have completed the required action items in the WPQC homestudy and you are well on your way to becoming WPQC certified! Now, you need to answer the following questions to ensure you have a basic working knowledge of WPQC program requirements. Once you pass, you will receive a certificate announcing you have completed the homestudy assessment. (Once you have completed all of the training components, you will receive a formal certificate in the mail stating you are WPQC-certified!)
- 1.
The CMS innovation grant is focused primarily on improving patient health outcomes in which four disease states?
- A.
Depression, geriatric syndromes, hypertension, and asthma
- B.
Asthma, geriatric syndromes, heart failure, and diabetes
- C.
Chronic heart failure, diabetes, hyperlipidemia, and asthma
- D.
Diabetes, depression, hypertension, and COPD
- E.
None of the above
Correct Answer
B. Asthma, geriatric syndromes, heart failure, and diabetesExplanation
The CMS innovation grant is focused primarily on improving patient health outcomes in the disease states of asthma, geriatric syndromes, heart failure, and diabetes.Rate this question:
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- 2.
To become a certified WPQC pharmacy, which quality measures are required to be in place?
- A.
Consistent verification and documentation of allergies and adverse drug reactions
- B.
Implementation of a continuous quality improvement (CQI) program for medication risk management
- C.
Use of a standard procedure to show every patient each medication
- D.
A & C
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
WPQC Network Certification Requirements
Pharmacies are required to have policies and procedures in place for the following requirements:
1. Performance of a brief medication history on all new patients or patients who fill medications at
multiple pharmacies
2. Consistent verification and documentation of allergies and adverse drug reactions
3. Consistent documentation of weight and dose/weight or dose/body surface area for pediatric
patients
4. Use of a standard procedure to show each patient each medication
5. Use of at least two unique identifiers for each new prescription order and upon consultation when
patient is unknown to pharmacist
6. Implementation of a continuous quality improvement (CQI) program for medication risk
management
7. Establishment and maintenance of standards for communicating and executing Class I drug recalls
and necessary actions pertaining to FDA drug safety alertsRate this question:
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- 3.
All WPQC participating pharmacists are required to have a personal NPI number (National Provider Identifier).
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
If you are a health care provider/pharmacist who bills for services, you need an NPI number.Rate this question:
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- 4.
All professional pharmacy staff, including pharmacy technicians, may participate in the identification of Level I interventions.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
Some of the places where identification of potential WPQC services by technicians could occur include: prescription entry, review of insurance company rejection messages in the dispensing system, preparation of the prescription, or speaking to patients during intake or consultation.Rate this question:
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- 5.
Only pharmacists are allowed to join Practice Interest Networks (PINs). There are no networks in which pharmacy technicians can join.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
The PINs are open to all PSW members, including technician members. However, to participate in the WPQC PIN, you must also be WPQC-certified. Since WPQC pharmacists are not required to be PSW members, the WPQC PIN is also unique in that WPQC PIN members are not required to be PSW members.Rate this question:
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- 6.
Mr. Jones stops into the pharmacy on a Monday afternoon with a new prescription for Nexium™ 20mg. Judy, the pharmacy technician, notes that he is eligible for a Level I service. Judy fills the prescription as is and puts a hot pink note card in the basket to flag the pharmacist. The pharmacist notes this is a possible ______________________ intervention.
- A.
Focused Adherence
- B.
Medication Addition
- C.
Medication Device Instruction
- D.
Cost Effectiveness
Correct Answer
D. Cost EffectivenessExplanation
It is likely Nexium™ will be either a higher tier medication or non-formulary medication on the health plan's formulary. If the pharmacist switches the medication to a lower tier/covered medication, a cost effectiveness could be submitted.
Cost Effectiveness Interventions include:
Formulary Interchange
Therapeutic Interchange
Tablet Splitting Opportunity
Conversion to an OTC Product
Dose ConsolidationRate this question:
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- 7.
Mrs. Smith stops into the pharmacy for the second time this month to refill her albuterol inhaler. When reviewing her profile, the pharmacist notices Mrs. Smith’s past medical history includes asthma and hypertension. Her current medication list includes hydrochlorothiazide, omeprazole, her albuterol HFA, and a fluticasone/salmeterol inhaler that has not been refilled in over a month. “I don’t like that one,” Mrs. Smith admits. “It doesn’t work as well as my albuterol.” The pharmacist sees the opportunity for which WPQC services?
- A.
Medication Deletion (L1) and Cost Effectiveness (L1)
- B.
Comprehensive Medication Review/Assessment (L2), which includes Focused Adherence (L1) and Medication Device Instruction (L1)
- C.
Focused Adherence (L1), Mrs. Smith does not qualify for a CMR/A.
- D.
Three-Month Supply (L1), Mrs. Smith clearly finds it inconvenient to pick up her medications every month.
Correct Answer
B. Comprehensive Medication Review/Assessment (L2), which includes Focused Adherence (L1) and Medication Device Instruction (L1)Explanation
Mrs. Smith takes 4 medications to treat 2 or more chronic health conditions, one of which is asthma. Therefore, she meets the eligibility requirements for a CMR/A. As part of a CMR/A, focused adherence consultations and medication device services are expected--they cannot be billed for in addition to the CMR/A.
LEVEL II ELIGIBILITY TRIGGERS
**See WPQC Program Description for more detail.
Four or more medications to treat two or more chronic conditions, one of which must include: hypertension, asthma, diabetes, chronic kidney disease, chronic heart failure, dyslipidemia, COPD or depression
Diabetes
Multiple prescribers
Hospital or LTCF discharge
Health literacyRate this question:
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- 8.
Which of these patients is not eligible for a Level II Comprehensive Medication Review/Assessment at this time?
- A.
A 45 year old gentleman with a history of hypertension, recently diagnosed with type II diabetes mellitus
- B.
A 19 year old young woman who had a kidney transplant one year ago and seems only to be able to identify her 7 medicines by color
- C.
A 57 year old woman currently taking citalopram daily and lorazepam prn for depression and anxiety
- D.
A 78 year old gentleman who was discharged from a local hospital yesterday due to a myocardial infarction
Correct Answer
C. A 57 year old woman currently taking citalopram daily and lorazepam prn for depression and anxietyExplanation
Does the patient take four or more medications to treat or prevent two or more chronic conditions (one of which must include hypertension, asthma, diabetes, chronic kidney disease, chronic heart failure, dyslipidemia, COPD or depression)?
Does the patient have diabetes?
Does the patient receive prescriptions from multiple health care providers?
Has the patient been discharged from the hospital or from a long term care setting in the past 14 days?
Is the patient experiencing health literacy issues?
If you answered yes to any one of these questions, your patient is eligible for a Level II service.Rate this question:
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- 9.
In preparation for a Level II CMR/A appointment, the pharmacy technician or pharmacist should ask the patient to bring in:
- A.
All medication devices (inhalers, blood glucose meters, etc.)
- B.
Allergy information
- C.
All medications including over-the-counter products and samples
- D.
Logbooks or health journals
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Things to remind your patient to bring with them to their CMR/A include:
• Medications: (prescriptions, over the counter, samples, herbals, dietary supplements, vitamins, mail order, internet, borrowed from someone else)
• Devices used with their medications: (blood glucose meters, inhalers, injectables, blood pressure cuffs, spacers, peak flow meters, nebulizers)
• Medication list
• Allergy information
• Records or logbooks: (blood pressure, blood sugar)
• Lab results
• Vaccination records
• Health journals: (symptom diary, diet and nutrition)
• Caregiver
• Prescription insurance information
• Any other important information about their health or medicationsRate this question:
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- 10.
What information is important to gather before the patient arrives for a CMR/A?
- A.
Medications the patient has filled at your pharmacy
- B.
Lab values from the patient's health care provider
- C.
Adherence issues based on refill history
- D.
Possible drug therapy problems or interventions
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Gathering as much relevant information as you can before the patient arrives, will help cut down on subsequent time spent conducting the CMR/A and formulating formal recommendations for the patient's health care provider.Rate this question:
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- 11.
What information would be important to gather from the patient during the CMR/A interview?
- A.
Medication list/wallet card
- B.
Recent admissions to the hospital
- C.
Smoking history
- D.
Other pharmacies the patient uses
- E.
His/her goals for the CMR/A
- F.
All of the above
Correct Answer
F. All of the aboveExplanation
Ensuring the patient's home medication list matches your medication list is vitally important. Knowing if the patient has been hospitalized recently will help prioritize potential problem lists and help focus the CMR/A. Smoking history is relevant to the patient's health status and possible recommendations made. Knowing if the patient uses multiple pharmacies is important because the patient may or may not want medications you are recommending a change on filled at your pharmacy location. It is important for the patient to choose which pharmacy they would like to fill their medications at. You should not assume that because the patient is seeing you for a service, that they want all of their medications filled by your pharmacy as well.Rate this question:
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- 12.
Which of the following would be appropriate questions to ask when interviewing a patient during a CMR/A?
- A.
Are you using your inhaler correctly?
- B.
How are you taking your cholesterol medication?
- C.
You don't smoke, do you?
- D.
A & C
- E.
None of the above
Correct Answer
B. How are you taking your cholesterol medication?Explanation
It is important to use open-ended questions when gathering information. Using open-ended questions helps expand the conversation and will allow for non yes or no answers.Rate this question:
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- 13.
Following each Level II CMR/A, the patient must be provided their updated Personal Medication Record (PMR) and Medication Action Plan (MAP), which can be provided at the time of the visit or mailed to the patient afterward.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
It is a requirement of the WPQC program that patients receive a PMR and MAP after receiving a Level II service.Rate this question:
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- 14.
Patient: “I am just not willing to exercise four days a week right now.” Keeping good motivational interviewing techniques in mind, the correct health care provider response would be:
- A.
Okay, that is your decision. You do what you want.
- B.
I really wish you would reconsider. This really could help you so much.
- C.
Ok. What would you be willing to do right now?
- D.
Well, on a scale of 1-10, how ready are you to consider an exercise plan?
Correct Answer
C. Ok. What would you be willing to do right now?Explanation
Motivational interviewing style questioning includes establishing rapport, eliciting expectations, expressing empathy, enlisting in decision-making, educating and evaluating. Asking the patient what they would be willing to do enlists them in the decision-making process.Rate this question:
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- 15.
Patient: “I am only willing to exercise two days a week. That’s all I can fit in right now.” Keeping good motivational interviewing techniques in mind, the correct health care provider response would be:
- A.
Okay, let me know how it goes.
- B.
Twice a week would be a great start. What type of exercise do you think you will start with?
- C.
Well, ok...I guess I can accept that
- D.
That is your choice. Would you consider three times a week?
Correct Answer
B. Twice a week would be a great start. What type of exercise do you think you will start with?Explanation
Reflecting back the patient's response validates their role in the decision-making process. Eliciting more information by asking an open-ended question helps gather additional information.Rate this question:
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- 16.
Patient: “OK… by the way… someone told me that this medicine can make you feel sluggish. Is that true? I don’t need that.” Keeping good motivational interviewing techniques in mind, the correct health care provider response would be:
- A.
Well, yes it can...but I wouldn't worry about it. It will go away.
- B.
Yes it can, but you want to get your blood pressure controlled, don't you?
- C.
It sounds like this side effect concerns you. May I share with you what some of my other patients have shared with me about their experience with this medication? (Yes) Some patients feel sluggish at first. This doesn't happen to everyone and these symptoms usually go away within a few days.
- D.
I doubt that will happen to you. I wouldn't worry about it.
Correct Answer
C. It sounds like this side effect concerns you. May I share with you what some of my other patients have shared with me about their experience with this medication? (Yes) Some patients feel sluggish at first. This doesn't happen to everyone and these symptoms usually go away within a few days.Explanation
Reflecting back the patient's concern validates their belief. Asking their permission to share information puts the patient in charge of the conversation.Rate this question:
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- 17.
What kinds of resources can you find on the PSW WPQC web portal to help with WPQC services?
- A.
Medication wallet cards for your patients to carry with them and share with their health care providers
- B.
Fax forms to inform physicians of the services you provided to the patient
- C.
Marketing tools to help inform patients about WPQC services
- D.
Motivational interviewing tips to help with apprehensive patients
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
The WPQC portal on the PSW website has a large variety of helpful resources which are available to all WPQC members.Rate this question:
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- 18.
My pharmacy must provide both Level I and Level II services in order to be considered WPQC-accredited.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
As long as the pharmacy continues to meet the WPQC requirements as evidenced by successful completion of the quarterly WPQC quality assurance surveys, there is no requirement that they provide Level II services. However, there is a level of commitment that participation brings, which includes identifying eligible patients and responding to opportunities presented to the pharmacy for Level II services.Rate this question:
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- 19.
In addition to having pharmacists become WPQC-certified, it is recommended pharmacies have at least one WPQC-certified technician.
- A.
True
- B.
False
Correct Answer
A. TrueExplanation
It is recommended, not required, that each WPQC-accredited pharmacy identify at least one pharmacy technician to become WPQC-certified. The pilot program has shown that sites involving one or more technicians are more active and experience greater program success.Rate this question:
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- 20.
Follow-Up visits to the CMR/A can be submitted ______ times annually.
- A.
4
- B.
3
- C.
6
- D.
0
Correct Answer
B. 3Explanation
There are up to 3 follow-up CMR/As allowed annually. More visits may be able to be conducted as needed by obtaining a Prior Authorization from the payor.
We want to encourage participants to schedule follow-ups when appropriate for patients. Follow-ups are likely to help increase patient adherence as well as impact health care outcomes.Rate this question:
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- 21.
Mr. Todd was discharged from the local hospital last week following a hypoglycemic episode which caused him to fall and break his left hip. You are quite familiar with Mr. Todd because his medications have changed many times over the past year. He has come to really enjoy and value his “medication check-ups,” and has had four sit down visits with you so far in the past 10 months. This time, you note multiple discrepancies on his discharge orders that require much effort to resolve for him. You spend additional time with Mr. Todd explaining these items, reviewing his understanding of the changes, checking in on how he managed his diabetes (including medication adherence) prior to the fall, developing a plan that might help him to avoid such hypoglycemic events in the future, and provide him an updated PMR and MAP. You also communicate to his physicians the interventions that you have made. Can you submit a WPQC claim for this service?
- A.
No. He already has had his 4 Level II visits for the year.
- B.
No. This was not a true CMR/A.
- C.
Yes. He was discharged last week.
- D.
Yes. He has diabetes.
Correct Answer
C. Yes. He was discharged last week.Explanation
He meets the criteria for hospital discharge in the past 14 days, regardless of the number of standard CMR/A visits he has already participated in.Rate this question:
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- 22.
“Your insurance company said I had to switch your medication” is an appropriate way to communicate a Level I service opportunity to a patient.
- A.
True
- B.
False
Correct Answer
B. FalseExplanation
When offering a Level I or II service to a patient, it is not okay to "blame" the reason for the discussion/opportunity on the patient's insurance company. The preferred way to invite someone to receive a service is to personalize the message by expressing concern for their health and well being. Example: "When I was checking your [medication name], I noticed you may benefit from ...."Rate this question:
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- 23.
Technician roles for WPQC may include the following:
- A.
Flagging prescriptions for potential level I opportunities
- B.
Promoting the program to patients on intake or at the consultation area
- C.
Providing reminder calls to patients for upcoming CMR/As
- D.
Making CMR/A follow-up appointments and helping patients fill out patient satisfaction surveys
- E.
All of the above
Correct Answer
E. All of the aboveExplanation
Technicians are a valuable partner in WPQC. They can help streamline workflow processes within the pharmacy by completing non-pharmacist essential tasks. This will free up more time for the pharmacist to provide WPQC services.Rate this question:
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- 24.
Which of the following is considered a billable Cost Effectiveness Level I intervention?
- A.
Switching from Prilosec OTC to prescription omeprazole – it saves the patient money.
- B.
Switching a patient currently taking Diovan and hydrochlorothiazide to Diovan HCT – now they only have to take one pill instead of two.
- C.
Switching a patient currently taking fexofenadine (covered by the health plan's formulary) for allergies to OTC loratadine.
- D.
All of the above
Correct Answer
C. Switching a patient currently taking fexofenadine (covered by the health plan's formulary) for allergies to OTC loratadine.Explanation
Some examples of cost effectiveness interventions include formulary & therapeutic interchanges, tablet splitting (for medication on the approved list from the payor only!), conversion from Rx to OTC product, and dose consolidation. Remember, for the intervention to be appropriate and payable, it must provide cost savings for the sponsoring payor. Please consult the WPQC web portal for more guidance and examples.Rate this question:
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- 25.
An intervention push comes through to your pharmacy flagging a patient with a medication profile consisting of simultaneous refills for atorvastatin 40 mg and Vytorin 10/40. The pharmacist realizes this is an opportunity for which Level I service?
- A.
Medication deletion, these are duplicate therapies
- B.
Medication addition, the current hyperlipidemia guidelines suggest an additional medication is indicated for this patient
- C.
Cost effectiveness, the Vytorin can be changed to 2 generic medications
- D.
Focused adherence, the patient is taking these medications incorrectly
Correct Answer
A. Medication deletion, these are duplicate therapiesExplanation
It is highly likely either the atorvastatin or the Vytorin should have been stopped when the other was ordered. In this case, upon approval from the patient's health care provider, this is an example of duplicate therapy, which falls under the category of medication deletion. (Previously in WPQC, therapeutic duplication was a category in itself.)Rate this question:
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- 26.
Ms. Scarlet arrives at your pharmacy for her CMR/A appointment today. Ms. Scarlet had been refilling her albuterol twice a month and you were quite concerned that her asthma symptoms were not well-controlled. She arrives with all the necessary information requested by the astute WPQC technician. After the assessment, the pharmacist discovers that she has been using both her controller and rescue inhalers with proper technique and is fully adherent to her medication therapies… now what?
- A.
Send Ms. Scarlet home with an updated PMR and MAP, no changes are needed at this time
- B.
Recommend she visit her doctor, something else must be wrong
- C.
Tell Ms. Scarlet to just avoid her triggers and start an asthma diary
- D.
Using the Asthma Care Fax that you found on the WPQC portal, communicate to Ms. Scarlet’s physician that you recommend a “step-up” in her asthma therapy based on the current guidelines.
Correct Answer
D. Using the Asthma Care Fax that you found on the WPQC portal, communicate to Ms. Scarlet’s physician that you recommend a “step-up” in her asthma therapy based on the current guidelines.Explanation
The Asthma Care Fax is a tool available to all pharmacists. It can be used to alert the patient's health care provider (HCP) that his/her patient may be excessively using their rescue inhaler. It also can alert the HCP when the patient has:
--Proper or Improper Device Technique
--Appropriate or Inappropriate Adherence to Prescribed Controller Medications
--If their patient uses multiple pharmacies
The pharmacist can then recommend a:
--Step Up in Therapy
or
--Continued monitoring of technique and adherence (if a problem was discovered)Rate this question:
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- 27.
(continued from Q. 26) Ms. Scarlet’s health care provider agrees with your recommendation and increases the dose of her controller medication. You can bill for:
- A.
Medication Device Instruction
- B.
Comprehensive Medication Review and Assessment
- C.
Adherence Intervention
- D.
Medication Addition/Deletion
- E.
Dose/Dosage Form/ Duration Change
Correct Answer
E. Dose/Dosage Form/ Duration ChangeExplanation
Since you have already evaluated her device technique and adherence as part of your CMR/A and there are no problems, this would clearly be a Dose Change billable event. You should try to schedule a follow-up visit with her to reassess her health after the change in dose has been implemented.Rate this question:
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