Wpqc Certification Quiz – Pharmacy Quality Review

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 medications

Reflecting back the patient's concern validates their belief. Asking their permission to share information puts the patient in charge of the conversation.

The WPQC portal on the PSW website has a large variety of helpful resources which are available to all WPQC members.

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.

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.

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.

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.

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.

It is a requirement of the WPQC program that patients receive a PMR and MAP after receiving a Level II service.

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.

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)

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 alerts

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 ...."

If you are a health care provider/pharmacist who bills for services, you need an NPI number.

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.)

 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.

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 literacy

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.

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.

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 Consolidation

The CMS innovation grant is focused primarily on improving patient health outcomes in the disease states of asthma, geriatric syndromes, heart failure, and diabetes.

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.

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.

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.

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.

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.

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.