Information From Medicare Call Centers Inaccurate

Customer service representatives at call centers operated by insurers sponsoring Medicare prescription drug plans provide callers with accurate and complete information about the drug plans' products and the Medicare prescription drug benefit only about one-third of the time, according to a report released on Monday by the Government Accountability Office, the New York Times reports (Pear, New York Times, 7/11). For the report, GAO investigators in March made 900 calls to call centers at 10 of the largest drug plan sponsors (Freking, AP/Arizona Daily Star, 7/11).

Callers reached customer service representatives in 864 of the 900 calls, the report finds. According to the report:

• Drug plans provided accurate and complete responses during 294 of the 864 answered calls;
  


• Plans provided inaccurate responses during 22% of the answered calls and incomplete responses during 29% of the answered calls (New York Times, 7/11);
  


• Plans were unable to answer 15% of questions;
  


• Overall accuracy and completeness of answers ranged from 20% to 60%;
  


• One drug plan provided accurate and complete information more than 50% of the time (AP/Arizona Daily Star, 7/11).
  


• Two of the 10 drug plans provided inaccurate or incomplete information at least 75% of the time; and
  


• Drug plans provided inaccurate or incomplete information about cost more than 70% of the time (New York Times, 7/11).
  

The report says that the majority of calls were answered promptly and that many of the customer service representatives were courteous and offered helpful suggestions (AP/Arizona Daily Star, 7/11). However, callers sometimes received different responses to the same questions from the same call centers, and "[r]elatively few customer service representatives were able to accurately identify the least costly plan and calculate its annual costs," the reports states.

The "poor performance" of the drug plan call centers might lead beneficiaries to choose plans that cost more or provide fewer benefits than they expected, according to the report. For questions about beneficiaries who take several prescriptions, customer service representatives often incorrectly estimated the annual cost of the treatments by thousands of dollars, according to the report (New York Times, 7/11).

The report concludes that beneficiaries "face challenges in obtaining the information needed to make informed choices about the prescription drug plan that best meets their needs" (Colliver, San Francisco Chronicle, 7/11).

Bush administration officials "took issue with the report and defended the work of the plans," according to the Times. Administration officials said investigators "should have asked different questions or should have phrased the questions differently," the Times reports (New York Times, 7/11).

CMS Administrator Mark McClellan said, "Medicare has never required drug plan call centers to provide detailed information about the prices of specific combinations of drugs," adding, "Despite this fact, two of GAO's five questions were on this topic" (AP/Arizona Daily Star, 7/11). McClellan also said a third question was "unclear and inaccurate," adding, "We have had a pretty low rate of complaints, 2.2 per 1,000 beneficiaries in prescription drug plans, and inaccurate information has not been a major reason for complaints" (New York Times, 7/11).

Karen Ignagni, president and CEO of America's Health Insurance Plans, said the report evaluates plans "on their ability to discuss some information that customer service representatives are expressly forbidden from providing under regulations governing the program and responses to vague and misleading questions that are not representative of questions posed by real beneficiaries" (Barrett, CQ HealthBeat, 7/10).

Ignagni said the findings "will be misused by opponents of the program" (LaMendola, South Florida Sun Sentinel, 7/11).

According to the Times, the findings "are significant because the premise of the [drug benefit] is that consumers will make informed choices among dozens of competing plans." The investigation comes after a similar GAO report released in May found that operators at Medicare's toll-free help line often provide inaccurate or incomplete information.

Rep. Pete Stark (D-Calif.), one of the Democrats who requested the report, said, "Medicare should guarantee that plans provide accurate and complete information," adding, "If private plans can't meet basic standards for quality service, they should not be in the program" (New York Times, 7/11). He added that the study confirms the need to reopen enrollment in the benefit this year (CQ HealthBeat, 7/10).

Rep. John Dingell (D-Mich.), who also requested the report, said, "The lack of accurate and understandable information for our seniors has been a chronic problem since the beginning of Medicare Part D." He added, "Senior citizens are being hurt by the indifference and incompetence of the Bush administration and its friends in the insurance industry" (Zucco, St. Petersburg Times, 7/11).

The report is available online. Note: You must have Adobe Acrobat Reader to view the report.

CQ HealthBeat recently examined two other issues related to the Medicare drug benefit. Summaries appear below.

• Nursing homes: Many nursing home residents have been automatically enrolled in Medicare prescription drug plans that are not good matches for their specific needs, Long Term Care Pharmacy Alliance Executive Director Paul Baldwin told congressional staffers on Monday, CQ HealthBeat reports. CMS officials said pharmacists and providers in nursing homes are allowed to advise beneficiaries on what plan is most appropriate for them. CMS said nursing home staff and pharmacists can assist residents by making "an objective assessment" of plans -- by using the Medicare drug plan finder tool, for example. However, LTCPA said nursing home employees are barred under federal regulations from helping residents compare, choose and enroll in plans. In addition, doctors from nursing homes said paperwork and procedures that are required to obtain exemptions for drugs not covered under Medicare plans "must be simplified," CQ HealthBeat reports. CMS officials said they are encouraging the drug plans to use standard exemption forms (Reichard, CQ HealthBeat, 7/10).
  


• Pharmacy survey: A bipartisan group of senators has asked CMS to expand a recent survey on how quickly pharmacies participating in the drug benefit receive payments from drug plans, CQ HealthBeat reports. The senators -- who include Senate Health, Education, Labor and Pensions Committee Chair Mike Enzi (R-Wyo.), Senate Appropriations Committee Chair Thad Cochran (R-Miss.) and Sen. Daniel Inouye (D-Hawaii) -- said the original survey was "misleading" because it relied only on information from drug plans and was based on contractual requirements for payments rather than actual payment dates. According to the survey, pharmacists generally are paid within 30 days. The senators asked CMS to report the findings from the expanded "equitable" survey within 90 days (CQ HealthBeat, 7/10).