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Care Provider Preparedness Could Affect Part D Rollout

When President Bush visited Rancho Cucamonga last month to drum up support for the new Medicare prescription drug benefit, he made a tactical decision to appear alongside local pharmacists. Care providers on the frontlines — especially pharmacists and physicians — might shoulder the burden of educating the public about the benefits and drawbacks of joining the program.

However, care providers might not have the knowledge or tools to serve eligible beneficiaries, and on the eve of the most significant Medicare expansion in 35 years, CMS might find itself scrambling to bring care providers up to speed on the program, known as Medicare Part D.

Some seniors advocates say the federal government overinvested in publicity and PR campaigns to promote the drug benefit to beneficiaries without making a comparable investment in educating the health care professionals who will advise, counsel and help with the drug benefit enrollment. As a result, the campaign has succeeded in raising awareness and motivating beneficiaries to ask questions about Part D. But with just two months left before the program launches, care providers worry that they will be overwhelmed and ill-equipped to handle the influx of curious, if not confused, beneficiaries.

Their concerns may be justified: According to an August 2005 Kaiser Family Foundation poll, 39% of all respondents said they did not understand the benefit program, and 73% of senior respondents said they either would not enroll or did not have enough information to make a decision about enrollment.

Some advocates and care providers cite the federal government’s reluctance to fund community-based groups and physicians’ organizations, as a major factor contributing to the confusion among seniors.

“The government decided to be very restrictive in its spending on outreach to community-based groups and chose to deal only with HICAPs (Health Insurance Counseling and Advocacy Programs),” Gary Passmore — executive director of the Congress of California Seniors, a Sacramento-based advocacy group — said.

CMS spent too much of its allocated funds on public relations efforts, such as television ads and bus tours, and spent too little money on building up the capacity to counsel beneficiaries about their options, Passmore said.

“They made a big mistake relying on direct mail and PR tours because seniors need one-on-one contact with a qualified counselor to understand this,” Passmore added.

Consulting Providers

Many California seniors grew up in an era when patients took questions and concerns about health care — from ailments to insurance coverage — to their family doctor. The California Medical Association predicts that in the coming months, a groundswell of seniors will be contacting physicians with questions about Medicare Part D, but many doctors will not be prepared for the onslaught.

“There’s going to be a crunch, and it’s going to be a problem for tens of thousands of physicians across the state,” CMA spokesperson Peter Warren said.

Likewise, Medicare experts at the California Pharmacists Association have been working overtime to familiarize members with the ins and outs of the program.

“The pharmacy was the No. 1 place that people turned to get information about the Medicare drug discount program,” CPA Medicare specialist Michael Negrete said. “And at the end of the day, if there’s any problem with the program, it’s going to manifest itself at the pharmacy counter,” he added.

Sooner Than Expected

CMA and CPA members might be flooded with inquiries even sooner than expected. The Department of Health Services recently sent a letter to California’s one million dual eligibles, residents who qualify for both Medicare and Medi-Cal. The letter informs these patients of changes to their coverage under Part D — all dual eligibles will be automatically enrolled in the program Nov. 15, 2005 — and advises them to contact their pharmacist or physician with questions.

“It [the letter] presumes physicians know this information, and it presumes that doctors have the time to explain this over and over again to seniors,” Negrete said, adding, “We don’t even know what the plans are yet.”

Moreover, physicians do not have an incentive to spend a great deal of time analyzing patients’ insurance situations to determine if Part D makes sense for them because Medicare does not provide reimbursement for the service.

While both CMA and CPA have been working closely with CMS to coordinate the effort, neither group has received any state or federal funds to educate their members about Part D. In fact, both groups solicited and received grant money from pharmaceutical companies to create educational brochures for their member pharmacists and physicians.

“It’s a big perfect storm brewing, and there are a lot of people scared about how this is going to hit,” said Negrete.

Passmore agreed, saying, “We refer to the roll-out as the ‘train wreck.’ Even people who are being put forward to provide information cannot answer seniors’ questions.”

CMS Response

But CMS says qualified professionals are available to answer seniors’ questions through local HICAPs and through Medicare’s telephone hotline. The agency is asking physicians and pharmacists to refer patients to these resources.

And given the short timeline between announcement of the coverage plans and the roll out, seniors will have to take some responsibility for educating themselves about Part D’s benefits, according to Jack Cheevers, director of communications for CMS’ Region IX . “The program is complicated but it’s worth it, and it’s worth it for people to study it,” he said.

CMS will be staffing a toll-free hotline with hundreds of trained counselors who will provide answers to questions on drug pricing under Part D and provide information about participating health plans. The agency also will be distributing educational materials, such as a toolkit for doctors, a patient handbook, brochures and DVDs for hospitals and clinics throughout California. “We’re building a reinforcing network across the state,” said Cheevers.

At the same time, CMS will ratchet up its PR efforts by expanding its media campaign. For example, CMS in September will purchase an 8-page insert in Parade magazine.

In spite of the concerns voiced by health care provider groups, the agency says it doesn’t anticipate any problems in the busy weeks before the rollout.

“We’re doing everything we can to make sure the capacity is there to handle the interest in the program,” Cheevers said, adding, “And we’re urging families and friends to get together to discuss this before Nov. 15.”

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