Index

A

accountable care organization (ACO), 20, 22-24, 232

Accreditation Association for Ambulatory Health Care (AAAHC), 152

accreditation programs/organizations, 152, 227-228

administrator, as stakeholder, 47

Advancing Team-Based Care Through Collaborative Practice Agreements, 52

advertising, 125

Affordable Care Act (ACA), 19-20, 25, 176, 197, 233

after-hours contacts, 147, 149

Agency for Healthcare Research and Quality (AHRQ), 28

quality priorities, 225, 226

Question Builder App, 248

TeamSTEPPS, 54

alternative payment model (APM), 20, 177, 202, 228, 231-232

ambulatory care practice attributes, 42-43

essential elements, 12-17

implementation model, 35, 36

importance of standardization, 15

introductory presentation, 149-150

location, 124

management system, 17

pharmacist patient care process (PPCP), 6-8, 13-16

philosophy of practice, 12-13

settings, 17-25, 52-53

Ambulatory Payment Classification (APC), 190

American Academy of Medicine, 168

American Association of Colleges of Pharmacy, 9

American Diabetes Association, 146

American Medical Association (AMA), 233

American National Standards Institute X12, 159

American Pharmacist’s Association (APhA), Medication Therapy Management in Pharmacy Practice, 28

American Society of Health-System Pharmacists (ASHP), Practice Advancement Initiative recommendations, 32-34

annual wellness visit (AWV), 192, 193-195

antibiotic stewardship, 29

appointments, missed, 140-141

appointment scheduling, 134-137, 140-141

art, definition of, 256

artificial intelligence (AI), 169

asthma resources, 148

ASTM International, 159

B

Balanced Budget Act (1997), 190

balanced scorecard, 216-217

big data, 169

billing, 173-208

alternative payment model (APM), 20, 177, 202

annual wellness visit (AWV), 192, 193-195

case, 178, 183, 189, 191, 192, 195, 197-198, 201

chronic care management (CCM), 192, 198-199, 200

employer-sponsored programs, 207

federally qualified health center (FQHC), 19, 202-203

forms, 181

general rules, 181-182

healthcare common procedure coding system (HCPCS) codes, 178-180, 190

ICD-10 codes, 144, 181

incident-to, in office-based setting, 184-189

incident-to, in outpatient setting, 189-192

Merit-Based Incentive Payment System (MIPS), 199, 201

pharmacist-provider auxiliary relationship, 183

Quality Payment Program (QPP), 49, 199, 201

reimbursement rates, 182

resource-based relative value scale (RBRVS), 178, 180-181

structure, 178

transitional care management (TCM), 192, 195-198

block chain technology, 169

Board of Pharmacy Specialties, 76

building your books, 136

bundled payment model, 20, 24

burnout, 251-252

business plan, 76-77, 81-98

analysis of service, 86-90

background information and sources, 83

case, 83, 90, 94-95, 96-97, 98

conceptualization, 82

consistency of mission, 90-91, 266-267

cover page, 84-85

definition, 81-82

description of service, 90, 264-266

evaluation, 96, 271-272

example, 263-275

executive summary, 85, 263-264

facility, technology, and equipment, 93, 270-271, 274

feasibility, 83-84, 274-275

financial summary, 95-96, 271

implementation plan, 92-93

market analysis, 85-86, 267-269

marketing plan, 93-95, 269-270

organizational structure, 91-92, 271, 273

outline, 84

presentation, 97-98

process, 82-98

table of contents, 85

business plan example consistency with mission, 266-267

description of service, 264-266

evaluation, 271-272

executive summary, 263-264

facility and equipment, 270-271, 274

financial summary, 271, 274

floor plan, 273

management and organization, 271, 273

market analysis, 267-269

marketing plan, 269-270

pro forma income/expense statement, 274-275

C

cancer resources, 148

capital request, 81

Center for Pharmacy Practice Accreditation (CPPA), 152, 228

Centers for Disease Control and Prevention (CDC) Advancing Team-Based Care Through Collaborative Practice Agreements, 52

antibiotic stewardship, 29

CVX code, 162

Good Laboratory Practices, 154

laboratory testing requirements, 152, 154

Centers for Medicare & Medicaid Services (CMS) accountable care organizations, 20, 22-24, 232

billing rules, 181-182

Independence at Home Demonstration project, 25

Medical Learning Network (MLN) Newsletter, 188

Medicare Physician Guide, 188

Patients Over Paperwork initiative, 189

character, moral and ethical, 256

chart, shadow, 144

check-in, 140

cholesterol resources, 148

chronic care management (CCM), 192, 198-199, 200

chronic obstructive pulmonary disease (COPD) resources, 148

CLIA waiver, 150, 154

clinical decision support (CDS), 168

clinical documentation architecture (CDA), 165, 166

clinical episode model, 20, 24

Clinical Laboratory Improvement Amendments (CLIA) waivers, 150, 154

clinical pharmacy, definition, 4

clinic/office manager, as stakeholder, 47

clinic operations, 130-151

collaboration, 138

EHR access, 138-139

miscellaneous considerations, 147, 149-150

patient education, 146-147, 148-149

referral process, 137-138

scheduling, 134-137

space considerations, 130-134

teamwork, 145

training, credentialing, privileging, 150

triage, 138

workflow, 139-142, 145

codes, 160

coding systems, standardized, 161-164

collaboration, 13, 138

competencies of, 25-26

collaborative drug therapy management (CDTM), definition, 4

collaborative practice agreement (CPA), 52

College of American Pathologists, 134

commercial payer contract manager, as stakeholder, 47

commercial stimuli, 106

communication, 243-244, 255

Community Health Accreditation Program, 152

community health center practice, 19

community pharmacy practice, 19

compassion, 255

competency(ies) assessment, 76

establishment, 254-255

knowledge, 254-255

for team-based care, 54

of patients, 247-248

complex adaptive system (CAS), 213-214

compliance officer, 47, 69

comprehensive medication management (CMM), 31-32

definition, 4, 31-32

comprehensive medication review (CMR), definition, 4

comprehensive patient care services, 30-31

connections, 255-256

consolidated clinical documentation architecture (C-CDA), 165

Consumer Assessment of Healthcare Providers and Systems (CAHPS) scores, 50

consumer behavior, 104-114

case, 105, 106, 107, 108-109, 113

consumption phase, 109

postpurchase evaluation, 109-110

prepurchase phase, 104-105

stimuli, 106-109

tips for incorporation of behavior principles into marketing, 110

consumer need, 115-119

Core Competencies for Interprofessional Collaborative Practice, 54

cost avoidance, 69-71

Council on Credentialing in Pharmacy (CCP), 75

credentialing, 75-76, 130, 150-151

Crossing the Quality Chasm, 242-243

Current Procedural Terminology (CPT) codes, 178, 179

CVX, 162

D

data, big, 169

DaVinci Project, 167

demonstration devices, 147

diabetes education and prevention programs, 206-207

resources, 148

diabetes self-management training (DSMT), 203, 206

dictation/scribe service, 142

directed patient care services, 27

direct supervision, 185

disease state management, definition, 4

documentation considerations, 141-142

legal issues, 142-144

dual eligibility, for Medicare/Medicaid, 175

E

ECHO (economic, clinical, and humanistic outcomes), 215-216

economic outcome measures, 216

education, patient, 146-147, 148-149

efficiency, care, 71

electronic health record (EHR) access, 138-139

electronic medical record (EMR), 157

empathy, 255

employer-based reimbursement, 207

entrustable professional activities (EPAs), 9, 10

environmental scan

equipment and supplies cost estimation, 64-65, 66

for patient care space, 132, 134

esprit de corps, 251-252

evaluation & management (E&M) codes, 179

services, 184-189

exam room, 130-134

blueprint, 133, 273

essential items, 132

expanded patient care services, 27-32

expense estimation, 65-66

extended visit code, 189

F

facility

fee billing, 189-192

needs, 93

federal medical assistance percentage (FMAP), 175

federally qualified health center (FQHC), 19, 202-203

fee-for-service (FFS), 15, 18, 67-69

finances assessment, 65-72

demonstrating value using comparative data, 72

expenses, 65-67

pro forma, 71-72

value of service, 67-71

focus groups, 117

4 Ps of market mix, 122

free text data, 160

full-time equivalents (FTEs), 61

G

geographic practice cost indexes (GPCI), 180

Good Laboratory Practices, 154

Griffin, Brooke L. (narrative), 256-257

growth anticipation/management, 72-76

H

health information technology (HIT), 157-171

advances, 167-169

case, 159-160, 167, 170

goals, 158

Pharmacy Health Information Technology Collaborative, 139, 169-170

relevance to pharmacist practice, 165-169

standardized coding systems, 161-164

standardized electronic structured documents, 164-165

standards, 158-159

terminology, 160-165

value sets, 164

Health Information Technology for Economic and Clinical Health Act (2009), 157

Health Insurance Portability and Accountability Act (HIPAA), 140, 144, 181

Health Level Seven International (HL7), 158-159, 165, 166, 167

Fast Healthcare Interoperability Resources (FHIR), 167

health maintenance organization (HMO), 175

HealthPartners, 70

healthcare current state of, 2, 212-213

settings, 17-25

spending, 1-2

Triple Aim framework, 2-3, 42, 211

healthcare common procedure coding system (HCPCS) codes, 178-180, 190

Healthcare Effectiveness Data and Information Set (HEDIS), 49, 227, 233

healthcare failure mode and effect analysis (HFMEA), 223, 224

heart failure resources, 149

Hippocratic oath, 240

history of present illness (HPI), documentation for billing, 186, 187

hospital readmissions, 197-198

hospital readmissions reduction (HRR) program, 232

humanistic measures, 50, 215-216

hypertension resources, 148

I

ICD-10 codes, 144, 181

identification badge, 147

Implementation System Model, 35, 36

incident-to billing, 67-69

institutional outpatient settings, 189-192

and location of space, 132-133

Medicare requirements, 184-185

in physician-based setting, 184-189

indemnity plan, 175

Independence at Home Demonstration project, 25

in-depth interviews, 118

Indian Health Service, 216

influence, 255-256

information technology (IT), 158

in-home care, 25

initial preventive physical examination (IPPE), 193

Institute of Electrical and Electronics Engineers (IEEE), 159

Institute of Healthcare Improvement, 233

Triple Aim framework, 2-3, 42, 211

Institute of Medicine (IOM), Crossing the Quality Chasm, 242-243

Institute for Patient and Family-Centered Care, 242

integration of pharmacist into practice, 54-57, 134-136

intermediate outcomes, 50

International Consortium for Health Outcomes Measurement, 233

Interprofessional Education Collaborative Expert Panel (IPEC), competencies for collaborative practice, 25-26, 54

interprofessional team member, 10

interview, for marketing research, 118

J

jidoka principle, 221

Joint Commission of Pharmacy Practitioners (JCPP) accreditation program, 228

establishment of medication management services, 5

pharmacist patient care process (PPCP), 6-8, 13-16

Pharmacy Health Information Technology (HIT) Collaborative, 139, 169-170

resources, 151-152

just-in-time principle, 221

K

knowledge, as competency, 254-255

L

labor expenses, 61

laboratory testing policies, 152, 154

lawsuit avoidance, 143

lean process, 220-221

location of service, 124

Logical Observation Identifiers Names and Codes (LOINC), 159, 162

M

machine learning, 169

malpractice avoidance, 143

Marcus & Millichap’s Medical Office Research Report, 65

market research and analysis, 44-45, 85-86, 114-119

case, 83, 115, 117, 118-119

items, 89

qualitative research and data, 116-118

quantitative research and data, 116, 118-119

reevaluation of practice, 119

marketing, 101-127

7 Ps of marketing mix, 93-94, 122-126

case, 102, 105, 106, 107, 108-109, 113, 115, 117, 118-119

consumer behavior, 104-114

definition, 101-102

educating consumers on service, 113-114

envisioning consumer needs and wants, 103-104

relationship, 126-127

research, 114-119

service characteristics, 110-113

strategic thinking about, 102-103

tips for incorporating consumer behavior principles, 110

unrealistic expectations, 112

value proposition, 102-103

marketing department, 121

marketing plan, 93-95

7 Ps of market mix, 93-94, 122-126

creation and implementation, 122-127

groundwork, 121-122

identification and assessment of practice model, 120

situation analysis, 120-121

measures anatomy, 218

for demonstrating value of service, 49-51

quality, 217-220, 221

Medicaid, 133-134, 175-176

regulation of free items for patients, 134

state-level quality improvement, 233

Medicaid Adult Core Set, 233

medical decision making (MDM), documentation for billing, 187-188

medical devices CLIA-waived, 154

demonstration, 147

Medical Learning Network (MLN) Newsletter, 188

medical necessity, 182

medical office, 18

medical supplies, 64-65, 66

Medicare, 176-177

accountable care organization (ACO), 20, 22-24, 232

annual wellness visit (AWV), 192, 193-195

bundled payment model, 24

diabetes prevention program, 206-207

Part A, 176, 181

Part B, 176, 181

Part B billing, 184-189

Part C (Medicare Advantage Plan), 177

Part D, 27-28, 133-134, 177, 204-206

Physician Fee Schedule, 182, 189, 231

preventive visit, 193

quality improvement initiatives, 229

regulation of free items for patients, 134

Shared Savings program, 22, 24, 232

Star Ratings, 212, 229-230

Medicare Access and CHIP Reauthorization Act (MACRA), 177, 199, 201-202, 230

Medicare Administrative Contractors (MACs), 177

Medicare Physician Guide, 188

medication management, definition, 4

medication management services (MMS), 5

medication optimization, definition, 4

medication reconciliation, 29

definition, 4, 29

skills/knowledge needed for, 9

medications high-risk, requiring comprehensive management, 31

skills needed to teach adherence, 9

storage, 134

usage rates, 3

medication therapy management (MTM), 115-116, 204-205

in accountable care organization, 23

codes, 179, 205-206

definition, 4, 28

elements of, 28

reimbursement, 67

through Medicare Part D, 27-28

Medigap, 175

Merit-Based Incentive Payment System (MIPS), 199, 201

mHealth, 168

mindfulness, 250-251

mission consistency, 90-91

statement of, 114-115

mobile health (mHealth), 168

N

National Academy of Medicine (NAM), 225

National Association of Boards of Pharmacy Accreditation Program, 152

National Association of Chain Drug Stores (NACDS), Medication Therapy Management in Pharmacy Practice, 28

National Committee for Quality Assurance (NCQA), 20, 152, 227

National Council for Prescription Drug Programs (NCPDP), 159, 166

National Drug Codes (NDCs), 161

National Library of Medicine (NLM), 161, 164

National Provider Identifier (NPI), 181

National Quality Forum (NQF), 227

National Quality Measures Clearinghouse, 49

Next Generation ACO model, 22, 232

no-show management, 59, 140-141

O

office furniture, 66

security, 149

space, 65, 130-134

supplies, 64-65, 66

office manager, as stakeholder, 47

Office of the National Coordinator for Health Information Technology (ONC), 157, 168

office visits, duration, 59-60

ontology, 162

organizational structure, 91-92

Ottawa Hospital Research Institute, 249

outcome measures, 49-50, 215-216

Outpatient Prospective Payment System (OPPS), 190

overhead, 67

P

PACE, 232

Part D medication therapy management, 27-28

patient care check-in, 140

rooming process, 140

tasks associated with, 10

patient care services as defined by patient needs, 5-6

directed, 27

expanded, 27-32

types of, 27-32

patient-centered care, 242-247

definition, 13

negative/positive language, 243-244

in patient-centered medical home, 20-21

patient-centered medical home (PCMH), 20-22, 242

pharmacist integration into, 54-57

pharmacist’s roles in, 56-57

team members in, 21

Patient-Centered Outcomes Research Institute, 242

Patient-Centered Primary Care Collaborative (PCPCC), 20, 22, 233, 242

patient education, 146-147

web resources, 148-149

patient volume, 58-61

patients complexity of, 58-59

engagement, 247-249

safety, 29

as stakeholder, 47

Patients Over Paperwork initiative, 189

payers, 174-178

commercial, 174-175, 233

Medicaid, 175-176

Medicare, 176-177

mix, 174

responsibility for quality, 228-229

pay-for-performance, 51

payment models, 20

Peabody, Francis, 240

personal health information (PHI), 144

personal selling, 126

pharmaceutical care, 4, 115-116

pharmacist after-hours contact of, 147, 149

characteristics of successful, 254-256

integration into practice, 54-57, 134-136

knowledge and skills, 8-11

pharmacist patient care process (PPCP), 6-8

responsibilities, 3-8

terminology for describing responsibilities and services, 3-5

time requirements, 61-62, 63-64

Pharmacist e-Care Plan CDA (clinical documentation architecture), 166

pharmacist patient care process (PPCP), 6-8, 13-16

pharmacist-provider electronic health record (PP EHR), 139

Pharmacy Health Information Technology (HIT) Collaborative, 139, 169-170

Pharmacy Quality Alliance (PQA), 32, 225

pharmacy readiness, 77

philosophy of practice, 12-13, 239-257

characteristics of successful pharmacist, 254-256

effective healthcare team, 250-254

patient centeredness, 242-247

patient engagement, 247-249

statement of, 240

physical exam, documentation for billing, 186, 187

physical stimuli, 107

physician, as stakeholder, 47

Physician Consortium for Performance Improvement (PCPI), 233

physician fee schedule (PFS), 182, 189, 231

Pioneer accountable care organization, 22, 24

plan-do-study-act (PDSA), 222

point of care devices and tests, 152, 154

point of service payment, 175

policy and procedures, 130, 151-154

document, 151-152, 153

for no-shows/late cancellations, 141

point-of-care testing, 152, 154

population health promotion, tasks associated with, 10

Practice Advancement Initiative (PAI) recommendations, 32-34

practice management, 17

practice model construction of, 51-57

scope of practice, 51-52

setting, 52-53

team-based, 54-57

preferred provider organization (PPO), 175

prescription drug plans (PDPs), 177

preventive visits, Medicare, 193-194

price/pricing policy, 123-124

Primary Care Initiative, 232

privileging, 75-76, 130, 150

pro forma, 71-72, 96, 274-275

process measures, 49, 50, 215

professional organizations patient educational materials, 148-149

quality improvement programs, 233

professionalism, Brown and Ferrill’s taxonomy, 254

progress notes, 142, 144

promotion, 124-125

Ps, marketing plan, 93-94, 122-126

public reporting, 51

Q

Quadruple Aim, 42

qualitative research, 116-118

quality definition, 213

domains, 214-217

quality improvement case, 216, 220, 223, 235

creators and leaders, 223-233

partners, 212

processes, 220-223

quality improvement organizations (QIOs), 226-227

recommendations, 235

and systems thinking, 213-214

quality measures, 217-220, 221

categories and types, 220, 221

challenges, 234-235

for demonstrating value of service, 49-51

important characteristics, 218-219

selection, 234

Quality Payment Program (QPP), 49, 199, 201, 230-231

quantitative research, 116, 118-119

Question Builder App, 248

R

referral binder, 143-144

process, 137-138

reimbursement methods, 67-69

payers, 174-178

relationship marketing, 126-127

relationships, working, 255-256

relative value unit (RVU), 178

reporting hierarchy, 17-18, 91-92

reproducibility, 42

resource-based relative value scale (RBRVS), 178, 180-181

resources, 261-262

case, 60, 61-62, 64

maintaining service with limited, 73

needs evaluation, 57-65

for patient education, 148-149

return on investment (ROI), 95

risk manager, as stakeholder, 47

rooming process, 140

root cause analysis (RCA), 223, 224

RxNorm, 161-162

S

safety, patient, 29

scalability, 42

scheduling, 134-137, 140-141

scope of practice, 51-52

scribe service, 142

service proposal attributes of ambulatory care practice, 42-43

available resources, 65

care delivery model, 52-53

case, 43-44, 45, 48-49, 51, 53

demonstrating value through evidence, 48-51

demonstrating value using comparative data, 72

equipment, supplies, and other resources, 64-65, 66

financial assessment, 65-72

managing growth, 72-76

needs assessment, 44-45

reassessment of service, 77

resource needs and financial impact, 57-72

resource requirements, 58-64

scope of practice, 51-52

stakeholders, 45-48

steps for development, 42-43

team-based care model, 54-57

services characteristics, 110-113

demand analysis, 58-61

education of consumers on, 113-114

outline of, for business plan, 122-123

7 Ps of the marketing mix, 93-94, 122-126

shadow chart, 144

show rate, 59

Six Sigma, 222, 223

Skelley, Whalen Jessica (narrative), 245-246

smoking cessation resources, 149

SNOMED CT (Systematized Nomenclature of Medicine Clinical Terms), 162-163, 181

SNOMED International, 159

SOAR analysis, 86

social stimuli, 107

soft dollars (cost avoidance), 69-71

space needs, 130-134

staff auxiliary, definition for billing purposes, 188

credentialing and privileging, 75-76

expectations for pharmacists, 252-254

expenses related to, 61, 65-66

full-time equivalents, 61

hiring of, 73-75

marketing skills and credentials of, 125

in patient-centered medical home (PCMH), 21

reporting structure, 91-92

support, 63, 134, 135

time requirements, 61-64

stakeholders, 45-48

standardized electronic structured documents, 164-165

stroke resources, 149

structure measures, 49, 215

surrogate outcomes for clinical events, 50, 215

surveys, 50

sustainability, 42, 73

SVOR analysis, 86

SWOT analysis, 86-88

systems thinking, 213-214

T

targeted medication review, 4

team-based patient care, 25-26

effective, 145, 250-251

effective integration into, 54-57

TeamSTEPPS, 54

telehealth, 24-25, 168

340B Drug Pricing Program, 202-203

Through the Patient’s Eyes, 242

thyroid resources, 149

To Err Is Human, 143

Tool for Assessing Ambulatory Care Pharmacist Practice, 35

training, 74, 150

transition of care, 29

transitional care management (TCM), 192, 195-198

Triple Aim framework, 2-3, 42, 211

21st Century Cures Act (2016), 157

U

unstructured data, 169

U.S. Department of Health and Human Services, 19

U.S. Food and Drug Administration, 152, 154, 161, 168

Utilization Review Accreditation Commission (URAC), 20, 152, 228

V

vaccines, storage of, 134

value assessment of service’s potential, 67-71

comparative data for demonstrating services, 72

definition of, 42

value-based payment model (VBPM), 20, 68-69, 228-229

value chain, 102

value proposition, 102-103

Value Set Authority Center (VSAC), 164

value sets, 164

virtual private network (VPN), 139

vision statement, 114-115

visits, duration, 59-60

Vital Signs, 235-236

vocabularies, in information technology, 164

W

websites CLIA-waived laboratory tests, 154

HL7 Fast Healthcare Interoperability Resources, 167

Medicare Physician Fee Schedule, 182

Medicare quality initiatives, 229

Merit-Based Incentive System, 201

patient education materials, 148-149

Pharmacy Health Information Technology Collaborative, 139

quality improvement organizations (QIOs), 226

RxNorm database, 162

shared decision making, 249

word-of-mouth promotion, 124-125

workflow, 139-142, 145

World Health Organization (WHO), 181, 223, 224