[MT-L] JW Drug Build

[SCHLAK, JEFFREY]

Hi Everyone,

 

Quick question – do you build each vial size for all of your oncology meds?  For example, do you build both 150 mg and 450 mg carboplatin vial sizes?  I am thinking this is the way we have to go in order to make the JW rules work correctly. 

 

Thoughts?

 

Thanks!

 

Jeffrey Schlak PharmD, RPh

Clinical Informatics Pharmacist

Information Technology & Solutions

University Hospitals Parma Medical Center

7007 Powers Blvd Parma, OH 44129

440.743.4240

jeffrey...@UHhospitals.org

 

Visit us at www.UHhospitals.org.

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[Ventura, Andrew]

Hi Jeffrey,

 

Yes, we build so that the pharmacist and tech see on the labels and orders exactly what gets used to mix.  Not only could there be concentration differences, but billing for the correct NDC is a fairly significant compliance issue.

 

 

Andrew Ventura, Pharm.D, MBA

Pharmacy Informaticist, Information Systems

Augusta Health, Fishersville VA

C/S 5.67pp6

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[Charles Downs]

I have each vial size as a separate drug dictionary entry. Since we use PHA MM, we stress that the pharmacist enter exactly what they are using. I had my analyst years ago do some magic with the label where if the generic name is the same, it only lists the entry once and combines the amount from each entry into one line item in mg or gm.

Charlie

 

 

Charles Downs Pharm.D.

Informatics Pharmacist

Trivergent Health Alliance

1116 Medical Campus Road

Hagerstown, MD, 21742

Office: 301-790-8904

Fax: 301-790-9229

charle...@trivergenthealth.com

 

CONFIDENTIALITY NOTICE: This electronic mail transmission and any accompanying data files is confidential and is intended exclusively for the individual or entity to which it is addressed. The communication may contain information that is proprietary, privileged or confidential or otherwise legally exempt from disclosure. If you are not the named addressee or you otherwise have received this message in error, you are not authorized to read, print, copy or disseminate this message or any part of it. If you have received this message in error, please notify the sender immediately by email and delete all copies of this message. Receipt by anyone other than the named addressee is not a waiver of any attorney-client work product or other applicable privilege.

[SCHLAK, JEFFREY]

I could use that labeling magic!  Can I borrow your analyst for a few days???

 

Thanks,

Jeff

[Pamella Martin]

Jeffrey,

 

I’m with Andrew on this one.  You should build each medication vial separately with it’s own procedure code to ensure appropriate billing, J-code units and compliance.  I do tend to use the same dictionary entry and procedure code for drugs that are identical in size and concentration, however, if there’s a large charge difference, for example between a brand and generic, I would make a new dictionary entry.

 

 

Pam Martin, PharmD, RPh

Director of Pharmacy

Arizona Spine & Joint Hospital

Mesa, Arizona

 

Office: 480-824-1260

Cell:     480-250-3030

Fax:     480-824-1271

 

 

 

From: Meditech-l [mailto:meditech-...@mtusers.com] On Behalf Of SCHLAK, JEFFREY
Sent: Wednesday, October 12, 2016 12:02 PM
To: 'medit...@mtusers.com'
Subject: [MT-L] JW Drug Build

 

Hi Everyone,

NOTICE: This email may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. If you are not the intended recipient of this email, you are hereby notified that any unauthorized use, dissemination or copying of this email or the information contained in it or attached to it is strictly prohibited. You may be subject to penalties under law for any improper use or further disclosure of any Protected Health Information in this email. If you have received this email in error, please delete it and immediately notify the sender of this email by reply mail. Thank you.   ­­  

[Limauro, Rebecca]

Hello,

 

We also build a separate entry for each vial size for compliance reasons.

 

Rebecca

 

Rebecca Limauro (Davis), PharmD, MBA

Clinical Informatics Pharmacist

Exeter Hospital - Department of Pharmacy

5 Alumni Drive

Exeter, NH 03833

Phone: 603-580-7596

Pager: 603-385-0506

 

From: Pamella Martin [mailto:PAMa...@nshinc.com]
Sent: Thursday, October 13, 2016 11:04 AM
To: 'SCHLAK, JEFFREY'; 'medit...@mtusers.com'
Subject: Re: [MT-L] JW Drug Build

 

Jeffrey,

[Ventura, Andrew]

Hi Folks,

 

While we’re on the subject of drug build:

 

Is it common practice to just build the drug’s page 1, order size and dispense size to match the full vial, or do sites change those values (proportionally) so that it really represents the smallest we’d order or dispense an additive in?   Meditech doesn’t really lend much info on how those fields should be setup. 

 

e.g.   for a 10mg/2mL SDV,  do you build that as order size 10, and dispense size 2,  or order size 1, dispense size 0.2?

 

We’re looking to standardize how SDVs and MDVs are built in PHA, and subsequently have BAR’s multipliers set.   The thought was that if pharmacy builds the drugs to send BAR the mg always, it would be less confusing, but then it seems that we can’t leverage the FSV loads to pull in AWP since that’s by full vial size typically.

 

I’d love to hear from a site that uses AWP via FSV load for pricing too, since that’s only going to come in one way, and we’d probably want to build to that convention so we didn’t have to edit that field.

 

 

Thanks,

 

 

Andrew Ventura, Pharm.D, MBA

Pharmacy Informaticist

Augusta Health, Fishersville VA

C/S 5.67pp6

[Charles Downs]

If you set up the multipliers in BAR, for single dose vials, you can build as the whole vial. For multiple dose vials, you want to set up with the order size and dispense size equal to the J code (billing unit). For instances, I have Doxorubicin set up as an order size of 10 mg and a dispense size as 5 ml and a multiplier of 1 in BAR. Now, you also have to make sure that your cost is for 10 mg and not the 200 mg vial. If you use PHA MM like we do, you also have to have your packaging string as 20 eaches in a vial so it hits your inventory correctly. The bad part is that you have to receive 20 for each 200 mg vial instead of 1

Charlie

 

 

Charles Downs Pharm.D.

Informatics Pharmacist

Trivergent Health Alliance

1116 Medical Campus Road

Hagerstown, MD, 21742

Office: 301-790-8904

Fax: 301-790-9229

charle...@trivergenthealth.com

 

 

 

 

 

 

CONFIDENTIALITY NOTICE: This electronic mail transmission and any accompanying data files is confidential and is intended exclusively for the individual or entity to which it is addressed. The communication may contain information that is proprietary, privileged or confidential or otherwise legally exempt from disclosure. If you are not the named addressee or you otherwise have received this message in error, you are not authorized to read, print, copy or disseminate this message or any part of it. If you have received this message in error, please notify the sender immediately by email and delete all copies of this message. Receipt by anyone other than the named addressee is not a waiver of any attorney-client work product or other applicable privilege.

[Lee, Jeffrey A]

We did some of this long ago, matching the fields to the JCODE payable amount.  For a number of reasons we moved away from this…primarily 1) it impacts dispense quantities for MED order type types, 2) even for SDV you end up not billing for any waste and that sends up signals to CMS and they start asking questions, 3) statistics…

 

Jeff Lee, MS, RPh

Pharmacy Manager Informatics

205.750.5323

[SCHLAK, JEFFREY]

 

For both SDV’s and MDV’s, I think you have to build by the size of the vial.  Where else will it look to perform the calculation to see how much drug is used/wasted?  If you are doing it differently and it is working with the JW rule, please let us know. 

 

I attached the MT drug building best practice pdf. 

 

Thanks,

Jeff

[SCHLAK, JEFFREY]

Thanks Charlie, good information.  How would you set up something that is not as clean – such as Herceptin MDV’s?

 

Thanks,

Jeff

 

From: Charles Downs [mailto:Charle...@trivergenthealth.com]

Sent: Wednesday, October 19, 2016 8:56 AM
To: SCHLAK, JEFFREY; 'MEDIT...@MTUSERS.COM'
Subject: RE: [MT-L] FW: JW Drug Build

 

Jeff – For MD vials, you can only round to the nearest billing unit. If you say have the Doxorubicin 200 mg vial built 200 mg/100 ml, that sends a 1 over to BAR. Since the billing unit is 10 mg, then you would have a multiplier in BAR of 20. Say you only bill for 100 mg. You only want to bill for 10 billing units. But, if you have built in the drug dictionary as 200 mg/100 ml, it will send a 1 to BAR and then when it hits the multiplier, put 20 instead of 10 on the claim. Medicare doesn’t care what dollar amount that you bill for. They will overpay you for 20 billing units at ASP, and therefore you have just overcharged by 10 billing units. You do not have to document waste if you round up to the closest billing unit; only if you waste 1 or more whole billing units. Meditech needs to restate what their best practice says because it is wrong.

Thanks,

Charlie

 

 

Charles Downs Pharm.D.

Informatics Pharmacist

Trivergent Health Alliance

1116 Medical Campus Road

Hagerstown, MD, 21742

Office: 301-790-8904

Fax: 301-790-9229

charle...@trivergenthealth.com

 

 

 

 

 

 

CONFIDENTIALITY NOTICE: This electronic mail transmission and any accompanying data files is confidential and is intended exclusively for the individual or entity to which it is addressed. The communication may contain information that is proprietary, privileged or confidential or otherwise legally exempt from disclosure. If you are not the named addressee or you otherwise have received this message in error, you are not authorized to read, print, copy or disseminate this message or any part of it. If you have received this message in error, please notify the sender immediately by email and delete all copies of this message. Receipt by anyone other than the named addressee is not a waiver of any attorney-client work product or other applicable privilege.

Visit us at www.UHhospitals.org.

[Charles Downs]

Jeff - For MD vials, you can only round to the nearest billing unit. If you say have the Doxorubicin 200 mg vial built 200 mg/100 ml, that sends a 1 over to BAR. Since the billing unit is 10 mg, then you would have a multiplier in BAR of 20. Say you only bill for 100 mg. You only want to bill for 10 billing units. But, if you have built in the drug dictionary as 200 mg/100 ml, it will send a 1 to BAR and then when it hits the multiplier, put 20 instead of 10 on the claim. Medicare doesn't care what dollar amount that you bill for. They will overpay you for 20 billing units at ASP, and therefore you have just overcharged by 10 billing units. You do not have to document waste if you round up to the closest billing unit; only if you waste 1 or more whole billing units. Meditech needs to restate what their best practice says because it is wrong.

Thanks,
Charlie


Charles Downs Pharm.D.
Informatics Pharmacist
Trivergent Health Alliance
1116 Medical Campus Road
Hagerstown, MD, 21742
Office: 301-790-8904
Fax: 301-790-9229
charle...@trivergenthealth.com

[cid:image0...@01D0F21A.B195CB40]

From: Meditech-l [mailto:meditech-...@mtusers.com] On Behalf Of SCHLAK, JEFFREY

Sent: Wednesday, October 19, 2016 7:32 AM
To: 'medit...@mtusers.com'
Subject: [MT-L] FW: JW Drug Build

Quick question - do you build each vial size for all of your oncology meds? For example, do you build both 150 mg and 450 mg carboplatin vial sizes? I am thinking this is the way we have to go in order to make the JW rules work correctly.

Thoughts?

Thanks!

Jeffrey Schlak PharmD, RPh
Clinical Informatics Pharmacist
Information Technology & Solutions
University Hospitals Parma Medical Center
7007 Powers Blvd Parma, OH 44129
440.743.4240

jeffrey...@UHhospitals.org<mailto:jeffrey...@UHhospitals.org>


Visit us at www.UHhospitals.org<https://urldefense.proofpoint.com/v2/url?u=http-3A__www.UHhospitals.org&d=CwMFAg&c=pfeIQmjeWSQrTKVd17oRzLqx1DbWN3j2IemUjCFpt50&r=HMqHunH0K1MuEe0zN_14Sf012pZ59dQImMahPqQj7Co&m=EnsXyHF8W4gfznqtAOmw7mlmDg7MxOoUQGTJb8guTFg&s=TsLattHo7T7L3VIpscZET4e2AbXLP4DI1ooSsJuaU1o&e=>.

The enclosed information is STRICTLY CONFIDENTIAL and is intended for the
use of the addressee only. University Hospitals and its affiliates disclaim
any responsibility for unauthorized disclosure of this information to anyone
other than the addressee.

Federal and Ohio law protect patient medical information, including
psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions,
alcohol, and/or drug_dependence or abuse disclosed in this email. Federal
regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and
3701.243 prohibit disclosure of this information without the specific
written consent of the person to whom it pertains, or as otherwise permitted
by law.

NOTICE: This email may contain PRIVILEGED and CONFIDENTIAL information and is intended only for the use of the specific individual(s) to which it is addressed. If you are not the intended recipient of this email, you are hereby notified that any unauthorized use, dissemination or copying of this email or the information contained in it or attached to it is strictly prohibited. You may be subject to penalties under law for any improper use or further disclosure of any Protected Health Information in this email. If you have received this email in error, please delete it and immediately notify the sender of this email by reply mail. Thank you.

________________________________
This e-mail message, including any attachments, is for the sole use of the person(s) to whom it was intended and may contain information that is privileged, confidential or legally protected from disclosure. If you are not the intended recipient or have received this message in error, you are not authorized to copy, distribute, or otherwise use this message or its attachments. Please notify the sender immediately by return e-mail and permanently delete this message and any attachments.

Visit us at www.UHhospitals.org<http://www.UHhospitals.org>.

The enclosed information is STRICTLY CONFIDENTIAL and is intended for the
use of the addressee only. University Hospitals and its affiliates disclaim
any responsibility for unauthorized disclosure of this information to anyone
other than the addressee.

Federal and Ohio law protect patient medical information, including
psychiatric_disorders, (H.I.V) test results, A.I.Ds-related conditions,
alcohol, and/or drug_dependence or abuse disclosed in this email. Federal
regulation (42 CFR Part 2) and Ohio Revised Code section 5122.31 and
3701.243 prohibit disclosure of this information without the specific
written consent of the person to whom it pertains, or as otherwise permitted
by law.

[Zammett, Lorna]

Hi Rebecca

I’m a bit confused on the workflow.

Let’s just say the provider orders 1200 mg of cyclophosphamide.   From the OM side, the provider has no idea what vials the pharmacy has and just enters the order.

On the pharmacy side, I presume it comes across as being tied to one of the size vials that you carry (eg 500 mg vial).

Do the pharmacists edit the order to use 200 mg of the 500 mg vial and 1000 mg of a 1000 mg vial?

 

Input appreciated. 

PS – love NH – can’t wait for this weekend’s Pumpkinfest in Laconia.

Lorna

 

Lorna O. Zammett, RPh, BS, PharmD

Clinical Informatics Specialist

Bristol Hospital

Bristol, CT  06010

860-585-3328

Meditech 6.08 PP13, HIMSS Stage 7

 

 

 

From: Meditech-l [mailto:meditech-...@mtusers.com] On Behalf Of Limauro, Rebecca

Sent: Thursday, October 13, 2016 12:16 PM

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