Are You a Battle with DIR Fees?

Copyright 2021, CEimpact. All Rights Reserved. Any reproduction of this course without express permission is strictly forbidden. 1

Are You in a Battle with DIR Fees?Put On Your Independent Pharmacy Armor!

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• Randy P. McDonough, PharmD, MS, BCGP, BCPS, FAPhA• Co‐Owner of Towncrest Pharmacies in Iowa City and Solon

• Co‐Owner of Towncrest Wellness and Apothecary

• Co‐Owner of Towncrest Pharmacy LTC

• Co‐Owner of Innovative Pharmacy Solutions

• Co‐Owner of Towncrest Properties and KMLM Properties

• Professor of Pharmacy Management and Innovation at Loma Linda University School of Pharmacy

Meet the Speaker

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• Randy McDonough discloses that he is:• A board of trustee member of the American Pharmacists Association

• A recipient of several Community Pharmacy Foundation grants

• A CPESN‐USA Luminary

• A CPESN‐IA Luminary

• Director of Practice Development for Flip the Pharmacy

Faculty Disclosure

Financial support was provided for this activity through an unrestricted educational grant from McKesson and Health Mart Systems, Inc.

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Upon successful completion of this knowledge‐based course pharmacists should be able to:

• Discuss how to effectively access and utilize appropriate performance platforms that impact the delivery of patient‐centered care and the subsequent financial implications.

• Engage pharmacy team members in effectively prioritizing and providing personalized, evidence‐based clinical services to patients.

• Complete a comprehensive medication review (CMR) using best practice procedures to strategically retain more patients, improve patient outcomes, and boost revenue.

Learning Objectives

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Upon successful completion of this knowledge‐based course pharmacy technicians should be able to:

• Discuss how to effectively access and utilize appropriate performance platforms that impact the delivery of patient‐centered care and the subsequent financial implications.

• Engage pharmacy team members in effectively prioritizing and providing personalized, evidence‐based clinical services to patients.

• Complete components of a comprehensive medication review (CMR), as allowed by state regulations, using best practice procedures to strategically retain more patients, improve patient outcomes, and boost revenue.

Learning Objectives

Knowing Your NumbersAccessing Your Data

EQuIPP Dashboard. EQuIPP. https://www.equipp.org/default.aspx. Accessed October 26, 2021.

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• PDC• Cholesterol, diabetes, and RASA

• High risk medications• Beers’ list

• Polypharmacy of high‐risk medications• Anticholinergic and CNS active drugs

• Medication appropriateness• Statin use in diabetes and cardiovascular

disease

Understanding Your Numbers

Definitions Measurement Periods

• 6‐month• Rolling period that pharmacy team

members can monitor to see the impact of interventions

• Year‐to‐date• Assess performance throughout the

calendar year starting January 1st

(about a two‐month lag)

• Immunization• Only applies to the annual influenza

vaccination rate during the “flu season”

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1. Monthly Review of EQuIPP Data2. Pharmacists’ Action Plans/Clinical

Interventions

3. Review Impact and Adjust

4. Repeat process

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True or False

The EQuIPP Platform provides the star rating of a pharmacy.

A proactive, patient‐centered approach that aligns all a patient’s refills to a single “appointment” date each month

Better for patients, pharmacy teams, and owners!

Practice Changes needed to Optimize Patient Care

From: Multiple scripts, multiple refill dates, and multiple store visits

To: Multiple scripts, ONE refill date, and ONE scheduled store visit

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Medication Synchronization (Med Sync)

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IncorporatingABM

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Technician‐driven, pharmacist‐managed dispensing process:

• Sufficient support staff (e.g., certified pharmacy technicians) to prepare medications

• Pharmacists are free to focus efforts on CMM

• If possible (and if respective board of pharmacy is supportive) implement tech‐check‐tech for distribution

• Develop workflow

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Optimal Use of Technology

Evolving Role of Pharmacists

• Therapeutic outcomes are achieved

• Medications are safe

• Medications are effective

• Medications are affordable/available

Ensuring the patient’s medications are optimized

• Identifying and resolving medication‐related problems:

• Untreated indications

• Wrong drug

• Failure to receive drugs

• Dose too low

• Dose too high

• Adverse Drug Reactions (ADRs)

• Side effects

• Drug interactions

• Drug use without an indication

Becoming interventionists

Requires ongoing monitoring, follow‐up, and evaluation

The pharmacists' patient care process. JCPP. https://jcpp.net/patient‐care‐process/. Published October 26, 2018. Accessed October 25, 2021.

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Evolving Role of Technicians

Order Entry

Prepare Prescriptions

Triage Patients

Final Verification

Preparing Technicians for New Roles

• Optimization of technicians to create more time for the pharmacist to conduct clinical tasks as opposed to technical tasks

• Expanded job roles and responsibilities

• Triaging

• Medication Synchronization

• Compounding

• Immunizations

• Manage Dispensing Functions

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Make Every Encounter CountPerforming Clinical Interventions on the Run (Quick Clinical)

Identify Triggers:• Medication categories• Adherence issues• Medical conditions• Medication‐related

problems

Develop an Interventional Strategy:• Flag patients• Review patient clinical

information• Identify medication‐

related problem(s)

Implement a Patient Action Plan:• Level of the patient• Level of the prescriber• Monitoring• Follow‐up• Document

www.thethrivingpharmacist.com/2015/08/07/ the‐new‐community‐pharmacist/MTMPEARLS| VOLUME 21, ISSUE 10, P54, OCTOBER 01, 2015 in Pharmacy Today

Pharmacist Work‐up of Drug Therapy (PWDT)A strategy to perform comprehensive medication reviews (CMRs)

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• PWDT is a thought process.

• Similar to the medical work‐up, except it is relative to the patients’ drug therapies.

• The PWDT includes a standardized strategy to collect patient information (including review of systems) and pertinent laboratory values to create a medication therapy problem list.

• Utilizing a problem‐solving process, the pharmacist identifies the possible solutions to the patient’s medication‐related problems, develops an intervention plan, and then creates the therapeutic monitoring plan.

Drug Intell Clin Pharm 1988;22:63‐7

Pharmacist Work‐up of Drug Therapy (PWDT)

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PWDT• Patient specific information

• Medical problem list/diagnosis

• History of Present Illness (HPI)

• Past Medical History (PMH)

• Current medications

• Medication history

• Allergies

• Smoking/alcohol/recreational drug use history

• Compliance

• Systems review

• Pertinent laboratory values

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Community pharmacy practice changes that enhance the delivery of clinical services within workflow (quick clinical) include all the following EXCEPT?

a. Pharmacists’ work‐up of drug therapy (PWDT)

b. A robust medication synchronization program incorporating the appointment‐based model

c. Technician‐driven, pharmacist‐managed dispensing process

d. Optimal use of technology

FindingMedication‐Therapy

Problems(MTP)

PWDT provides the information for pharmacists to identify medication therapy problems (MTP).

MTP categories:

• Need for additional therapy

• Dose too high

• Dose too low

• Unnecessary drug therapy

• Non‐adherence

• Drug‐drug interactions

• Side effects

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ResolvingMedication‐Therapy Problems

• Inform patients of any potential medication‐therapy problems identified

• Explain to patients your intended action(s) and seek approval from the patient

• Keep patients informed throughout the process

ResolvingMedication‐Therapy

Problems

•Communicate with Prescribers• Keep the focus on the patient ‐ not the medications

• Provide prescribers with complete (yet concise) information that accurately describes the potential and/or actual medication‐therapy problems

• Provide potential solutions for the MTPs

• Structure the clinical recommendations to clarify your ask

• Follow‐through with your actions once a response is received from the prescriber

Am J Pharm Educ 2006 Jun 15;70(3):58. doi: 10.5688/aj700358.

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Patients may become defensive or upset about your new role

• Explain your responsibilities and that you are working as part of a team

• Make sure your patients are informed consumers of their own health care

• Keep patients informed of your actions

Prescribers may believe you are encroaching on their turf

• Build their trust in your competence

• Make high quality, evidence‐based clinical recommendations

• Follow‐through with what you say you are going to do

It all sounds good, but…

Am J Pharm Educ 2006 Jun 15;70(3):58. doi: 10.5688/aj700358.

Patient Case

Which of the following statements is FALSE?

a. Pharmacists communicating to physicians regarding medication‐related problems should focus on the patient versus the medications.

b. Medication‐related problems should only be communicated to prescribers.

c. The pharmacist work‐up of drug therapy (PWDT) is a similar process to a physician work‐up of a patient’s medical problems.

d. Triaging patients is an example of an expanded job opportunity for pharmacy technicians.

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Thank You!

Randy P. McDonough, PharmD, MS, BCGP, BCPS, FAPhA

Practice: [email protected]

Academic: [email protected]

Questions?

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Are You a Battle with DIR Fees?

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