APP Exam 2

What are some ways of meeting each standard that patients use to evaluate services?

(Basically—- what can we do to meet the standard of good care)

(Ex: the standard is “fairness”, to meet that standard or be FAIR we can treat customers in the order they arrive to the pharmacy)

• responsiveness (give prompt service)

• assurance (be knowledgeable)

• empathy (be caring)

• friendliness (be polite)

• RELIABILITY- receive the promised service dependably and accurately. also accurate prescription filling and patient counseling

A service failure is when you fail to meet the expectations of a patient. In order to recover from a service failure, you choose a service ____________ effort and they are classified as low, mid, or high criticality. FYI

recovery

What are the specific service recovery efforts for low-mid, and high criticality?

• low- and mid-criticality— Apology, Empathy, Follow-Up, Discount/Refund, Sincerity

• HIGH-CRITICALITY— Attempt to compensate for costs related to time, money, and inconvenience through financial settlements

Identify ways to develop pharmacy staff members to provide good customer service?

• hire employees with a caring, attitude, empower, support, encourage, and model

• ensure employees quality of work life and job satisfaction, make customer service EVERYBODY’s job

List in order the recommended steps for dealing with “difficult patients”

1. Let the customer VENT

2. avoid getting trapped in a negative filter

3. express empathy to pt.

4. begin active problem solving

5. mutually agree on a solution

6. follow-UP

What is sensemaking?

a cognitive process that occurs before using an EDM to help make sense of a difficult situation

(basically: identify/evaluate a problem prior to EDM)

3 steps of sensemaking:

1. Learn

2. Plan

3. Act

List the 5 different types of Ethical Decision-Making Models.

1. Markula Center Framework

2. PLUS model

3. Rationalist Model

4. Non-Rationalist Model

5. Integrated Model

Describe the following EDM model:

Markula Center Framework

• provides specific examples of what ethics is not (feelings, religion, abiding by laws, following norms/scientific data)

• aimed towards making decisions as an INDIVIDUAL

• Utilizes classic philosophical perspectives to evaluate potential solutions

  • Utilitarianism, Rights-based, Justice-based, common good, virtue-based

Describe the following EDM model:

PLUS Model

• provides context for making decisions within ORGANIZATIONS

• Utilizes ethical “filters” rather than classic philosophical perspectives

  • policies, legal, universal, self

Describe the following EDM model:

Rationalist Model

• ability to reason ethically is dependent on COGNITIVE DEVELOPEMENT STAGE

• REASONING THAN JUDGEMENT

Describe the following EDM model:

Non-Rationalist Model

• JUDGEMENT THAN REASONING

PRACTICE:

Does the rationalist or non-rationalist use reasoning before judgement?

rationalist

Describe the following EDM model:

Integrated Model

• integrates rationalist and non-rationalist approaches

2 key components:

1. EDM process follows similar stepwise approach to Markula and PLUS model

2. Recognizes MODERATING FACTORS can influence process —> issue, organization, personal factors

What are the benefits of feedback?

• reinforce good performance

• poor performance corrected

• provides steps for improvement

• encourage self-reflection

What are some components of effective feedback? (pretty much common sense)

• provide in a private area

• timely, regular, specific, descriptive

• focus on BEHAVIORS not TRAITS

• limit info provided

• receive input for others

• provide steps for improvement

• limit info to 2-3 behaviors at a time

What is the difference between feedback and evaluation?

feedback- more frequent and informal. asseses a specific task/skill

evaluation- more reflective of overall performance, judgement of achievement of goals

What are 3 approaches to giving feedback? (just the names)

1. sandwich approach

2. Pendleton 4-step method

3. ARCH Model

What is the “sandwich method” for providing feedback?

• it’s like a “sandwich”

  • positive feedback, then negative, then positive

• softens blow of corrective feedback (possible downside)

What is the “Pendleton 4-step method” for providing feedback?

• 2-sided discussion that DOES NOT INCLUDE steps for improvement

• FYI ———How it works:

  • What learner feels they’re doing well

  • What manager thinks they’re doing well

  • What learner feels they need to improve

  • What manager thinks they need to improve

What is the “ARCH Model” for providing feedback?

• 2-sided discussion that DOES INCLUDE steps for improvement/ improvement plan

• may take extra time

Asking questions to a person being evaluated to assist them in self-reflection is the definition of…

facilitative questioning

What are the 2 types of negotiating?

1. principal- goal of solving problem in a way that is mutually beneficial/agreeable to both sides—- (looking for a win-win scenario)—— 4 aspects: people, interests, options, and criterea

2. positional- GOAL OF WINNING! GOAL OF CONVINCING THEM TO CONVERT TO YOUR POINT OF VIEW

For principled negotiations what is key?

communication and listening skills

What does BATNA stand for? What does it mean?

BATNA- Best alternative to negotiated agreement

• basically the “bottom line”

• if you have having a negotiation and can’t agree, the BATNA is the best option

How do you approach a tense situation?

• reassure

• mirror

• empathize

• employ labeling

• slow down

What are the 3 types of negotiators? Briefly describe each.

1. Analytical- methodical will want to analyze info deeply before agreeement

2. Accommodator- values relationship> everything, may agree to less reasonable solutions if it keeps people happy

3. Assertive- values time, wants quick resolution, self-focused

Deception, extreme offers, arbitrary deadlines (fake deadline to rush you), personal attacks, ambiguous authority, good cop/bad cop are all examples of….

dirty tricks

Motivational Interviewing is useful to help strengthen what?

another party’s commitment to a new idea/option

What mnemonic is used for Motivational interviewing?

DARN-CAT

What does DARN-CAT stand for?

DARN- prep talk to assess readiness

• Desire, Ability, Reasoning, Need

CAT- action

• Commitment, Activation, Taking steps

What some example of leadership theories? FYI

• trait theories

• behavioral theories

• situational theories

(Dr. Z has a test question on each of these)

The trait theory says that what personality characteristics could distinguish leaders from non-leaders?

• extroversion

• agreeableness

• emotional stability

• high energy/self confidence

• others: conscientiousness, openness

DESCRIBE the LAISSEZ-FAIRE behavioral theory:

• THINK: EMPLOYEEEEEEE

• laissez-faire leaders allow employees to have complete autonomy, set their own goals, and work toward them without interrupting

• EX: A LAISSEZ-FAIRE LEADER WOULD NOT MENTION A NEW IDEA UNLESS THE EMPLOYEES CAME TO HIM WITH IT AND THE LEADER WOULD THEN ALLOW THE EMPLOYEES TO DEVELOP THE ENTIRE PROGRAM AND IMPLEMENT THE PLAN

From this chart, what does the blue highlighted box mean in terms of the behavior of the leader?

• leader turns over ALL DECISIONS AND RESPONSIBILITIES for completing tasks, reaching goals, and follower implementation.

  • “delegating”

• leader MAY BE AVAILABLE FOR CONSULATION, but usually maintains low profile

• THINK: HANDS OFF, IMMA JUST WATCH and if you need me I’m here

For this chart, “delegation” or S4 has what type of followers?

R4 or HIGH

they are ABLE, WILLING, and CONFIDENT

What are the 4 components of the situational leadership model?

• TASK ORIENTATION BEHAVIOR

• RELATIONSHIP ORIENTATION BEHAVIOR

• FOLLOWER READINESS OR MATURITY

• LEADER EFFECTIVENESS

(task and relationship oriented, mature followers, effective leader)

What is the definition of:

• asset

• financing

• liabilities

• owner’s equity

• capital

• liquidity

• fiscal year

Definitions:

o Asset – things that are owned that can be used to generate income

o Financing – money needed to acquire assets

o Liabilities – money owed to others

o Owner’s equity – owner’s funds

o Capital – money used to acquire land, buildings, and equipment

o Liquidity – how much cash is currently on hand to pay bills, etc.

o Fiscal Year – unit of time (1 year) that businesses use to record financial interactions

• Not always the same as the calendar year

What is accrual vs. cash accounting?

• accrual—> revenue/expenses tallied when they are incurred

  • ex: If you provide a service in December but receive payment in January, you record the revenue in December. (AKA WHEN IT OCCURED)

• cash—> revenue/expenses tallied when they are paid

  • ex: If you receive a payment in January for a service provided in December, you record the revenue in January. (AKA WHEN YOU WERE PAID)

What’s the difference between capitation and per diem?

capitation- fixed amount received per patient per month/year

per diem- payment received at a daily rate

(think: per diem= per day aka you receive money at a daily rate)

What’s the difference between “value-based payments” and “fee for service”?

“value-based payments”- reimbursement rate based on QUALITY OF CARE received

• most patient/positive outcome focused

“fee for service”- payment based on NUMBER OF visits/tests/services received

• more focused on numbers> care

What is a vertical healthcare system?

organization with group of related, but not identical providers

• ex: a healthcare system that includes PCPs, specialists, hospitals, rehab centers, and nursing homes. like LECOM with all it’s dif buildings

What is a horizontal healthcare system?

organization with group of similar providers

• ex: several hospital/clinics joining together

What are the 4 C’s of finance?

(said not to worry about in review)

• COST measurement/minimization

• CASH management/sufficiency

• CAPITAL access/acquistion

• CONTROL of resources

Sole proprietorship vs. Partnership vs. Corporation

• sole-proprietorship: individual owning business

• partnership: multiple individuals owning a business

• corporation: legal entity separate from owners/shareholders

What type of business organization protects owners/shareholders from liability?

corporation

What are a couple types of hybrid business organizations?

• limited partnership (LP)- like partnership but limited partners only liable for initial investment

• limited liability partnership (LLP)- partners only liable for their own malpractice

• limited liability company (LLC)- similar liability to stockholders, taxed like partners

• professional cooperation/association (PC/PA)- includes benefits of incorporation but still liable for malpractice

What is a snapshot of an organization’s assets, liabilities, and shareholder equity at a point in time?

balance sheet

What provides info about income/expenses over a given time period?

income statement

What records inflow/outflow of cash?

statement of cash flows

How do you calculate gross profit margin?

gross profit margin= (total sales- cost of goods sold) / total sales

How do you calculate net profit margin?

net profit margin= net income after tax/ total sales

How do you calculate current ratio?

current ratio= current assets / current liabilities

(current assets= cash, accounts, inventories)

For a current ratio what is considered low and high?

<2 = low assets/ too risky

>5 = high assets/ too conservative

How do you calculate quick ratio?

quick ratio= quick assets/ current liabilities

(quick assets= cash, accounts, NOT INVENTORY)

A quick ratio goal is >_____.

>1

How is ITOR calculated?

ITOR= cost of goods sold/ average inventory

A formal budget system is used in order to…

in order to create a plan so that actual results can be compared to that plan

What is the role of budgeting?

• planning

• improves communication

• allocates resources

• controls profit/operations

• evaluate performance—> provide incentives

What are some types of budgeting?

• master budget

• budgeted financial statements

• others: capital budget, financial budget, rolling budget, operational budget, cash receipts budget

What is a master budget?

• “profit plan”

• comprehensive set of budgets covering all phases of an organizations operations for a specified time period

What are budgeted financial statements?

• “pro forma financial statements”

• shows how the organization’s financial statements will appear at a specified time

• includes budgeted balance sheet, income statement, cash flow statement

What are some factors looked at when “sales forecasting”?

• historical report (past sales, trends etc.)

• economic trends

• legal events

• promotions

• market research

What are operational budgets?

• how operations will be carried out to meet demand for goods/services

• includes: material, labor, overhead

What are 3 types of financial budgets?

1. Cash Receipts Budget- info about cash flows into pharmacy based on sales

2. Cash Disbursements Budget- info about cash flow out of pharmacy

3. Cash Budget- summary of inflow/outflow of cash from operations

What does the following describe:

Manufacturers—> Distributors—> Provider—> Patient

pharmaceutical supply chain

Padding the budget or budgetary slack is a possible ________________ behavioral implication of budgets.

a. positive

b. negative

b

What is the goal of demand planning? What does the demand forecast reflect?

Goal: produce a reliable projection of future customer demand—a forecast for the items that a pharmacy expects to dispense to pts./sell to customer

(basically: how much demand for each product is expected)

Inventory management deals with controlling inventory/stock and the goal is what?

to keep minimum stock necessary to fulfill need/demand without selling out

What are 3 methods of inventory management?

1. visual method- look at the # of units in inventory and compare them with a listing of how many should be carried

2. periodic method- requires counting stock on hand at predetermined interval and comparing w/ minimum desired levels

3. perpetual method- inventory monitored at all times—> computerized—> may need to be checked by counting stock at predetermined intervals to ensure accuracy

Procurement refers to sourcing and purchasing and that means you have to identify/manage ___________ and place ______________.

suppliers, orders

What are some costs associated with inventory?

• Acquistion

• procurement

• carrying

• stock-out costs

What is ITOR stand for? How is it calculated? Is a high or low ITOR preferred?

• Stands for Inventory Turn Over Ratio

• ITOR= cost of goods sold/ average inventory value

• HIGH ITOR preferred

List and describe the 5-steps in Pharmacist Patient Care Process (PPCP):

Overview: Collect, Assess, Plan, Implement, Follow-Up: Monitor and Evaluate

1. Collect- get pts medical history (medications, lab data, physical, social history, habits, etc.)

2. Assess- use the info from the collect stage to make decisions regarding the patient’s current therapy

3. Plan- individualized plan for the pt. that addresses their problems and sets goals

4. Implement- put the plan in action w/ the PCP, nurses, and other providers

5. Follow-Up: Monitor and Evaluate- watch the pts progress toward therapeutic goals and follow up with providers

Appropriate collaboration, communication, and documentation should occur at what step of the PPCP?

EACH STEP!

Explain the role of the Clinical Laboratory Improvement Amendments of 1988 (CLIA) Waiver:

• pharmacies implementing monitoring/screening services utilizing devices that measure specimens need to apply for a CLIA Waiver

• CLIA waived tests are considered by the CDC and FDA to be simple to administer and have little risk of error

• Pharmacists providing tests —> agree to follow good lab practices

• Makes pharmacists be knowledgeable about OSHA (Occupational Safety and Health Act)

Explain the role of the Collaborative Practice Agreements (CPAs) in pharmacy based services:

• should be developed to help guide the pharmacists therapeutic decisions

• must be evidence-based and supported by national guidelines and the primary literature

• physicians and pharmacists must all sign the CPA, and a copy should be kept at the pharmacy and physician’s practice

Describe the ECHO Model of Outcomes and its 3 outcome measurements of focus:

• ECONOMIC (health care spending)

• CLINICAL (therapeutic targets and goals)

• HUMANISTIC (patient satisfaction)

(Think: ECHO, the first 3 letters stand for each outcome )

Identify 3 strategies used to provide ongoing monitoring to ensure program quality and success:

1. Scheduled staff meetings-

2. Monitor Service Outcomes

3. Request Feedback

The 3 strategies used to provide ongoing service monitoring are _________________ QUALITY IMPROVEMENT STRATEGIES.

CONTINUOUS

What services do PBMs offer?

• establish networks as part of their claims management services

• rebate negotiations with manufacturers

• drug benefit (formulary) design

• formulary management

• drug utilization management

• disease state/ case management

• most offer mail order services

What are networks/preferred networks and how do pharmacies participate?

• What is a network? a group of pharmacies that a PBM contacts with to provide meds and care at lower copays

• To join? MUST accept the third party’s reimbursement rate

What percentage of claims go through PBMs? What impact has that shift had on pharmacies?

86% of all claims. This has had a significant impact on pharmacy management by decreasing the FLEXIBILITY that pharmacies had on PRICING THEIR MEDICATIONS.

How do PBMs reimburse pharmacies?

2 parts: product cost and dispensing fee

total reimbursement rate= product cost + DF

What do each of the following 3rd party reimbursement terms mean?

• AWP

• AAC

• WAC

• MAC

• AWP- average wholesaler price- a list price for what drug wholesalers charge pharmacies. This is an overestimate of what the wholesaler actually charges.

• AAC- actual Acquistion cost- the price the pharmacy pays the drug wholesaler or manufacturer to obtain the drug product

• WAC- wholesaler Acquistion cost- a list price for what pharm manufacturers charge drug wholesalers. this is an overestimate of what manufacturers actually charge.

• MAC- maximum allowable cost- the max cost a third party will pay for a multisource drug. this typically is an average of the generic drug price from several manufacturers.

What are DIR fees? How and when are they assessed? What impact do they have on pharmacies?

• DIR Fees= Direct and Indirect Remuneration Fees

• DIR fees are charges that pharmacies pay after the point of sale.

• Can be a percent or flat fee

• Impact pharmacies by decreasing reimbursement rates

How does a pharmacy combat declining reimbursements?

• increase prescription volume

• diversify revenue streams

  • professional services (MTM, Vaccines)

  • diversify OTC offerings

  • DME

• decrease expenses

  • like labor