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Provider Perspectives
Part D: Inaccessibility and Inherent Flaws
As Part D complications begin to receive some media coverage, one largely ignored group has been people related to disability issues. Access Living, an organization serving people with disabilities, has been deeply affected by the Part D transition. As the organization's Health Policy Coordinator, Marcia Rothenberg has seen substantial changes in her work scope. She conducted far more senior outreach before last year's public introduction of the new prescription drug program, and received over 100 Part D phone calls in January alone. Some cases are delegated to a colleague who was also not hired to specialize in Part D issues. Rothenberg has put in more time than she gets reimbursed for, and Medicare Part D has taken away from Rothenberg's organizational role at Access Living.
Dealing with Part D issues is no easy task. With the influx of Medicare Part D questions, Rothenberg has been unable to address more than a few phone calls at one time. She describes the experience as stressful, time-consuming, and emotionally tolling on social service workers. This is because each caller needs the undivided attention of an individual-specific consultation. People have no idea how to begin sifting through the large number of private plans. At times, Rothenberg has spent forty-five minutes on the phone with pharmacists, trying to sort out a loss or mistake in coverage. One caller was so distraught over his son's inability to get his medications that he handed the phone over to his wife, unable to continue the conversation. Lucky Medicare consumers with creditable prescription coverage do not have to deal with Part D problems and are, in Marcia's words, the "privileged few."
Even with a Master's Degree in English, the language and complexity of Part D is still confusing to Rothenberg. This is after attending day-long sessions, trainings and conferences calls on the issue. If providers are in need of this intensive training, imagine the position of Medicare consumers who might receive no guidance or comprehensive information. Much of Rothenberg's energy has been spent decoding Part D in efforts to properly understand it for her clients. She emphasizes that Part D is far too complicated, and this is severely straining social services and their overarching objectives. Next year plan premiums will be higher, so the cycle of confusion and instability will begin once again. Consumers who make appeals to receive non-covered drugs through Part D might have to wait three or four years to complete the process. Consumers could pass away waiting for the medications they need.
Adding prescription drug benefits to Medicare has the potential to be a simple and comprehensive process. Marcia Rothenberg sees Part D as a process of adding "a private plan, private medicine, private health delivery, to a public health system... This is a plan that can't work. It's extremely complicated. I can't advise people on what to do picking a
plan!". Part D should be modeled on the Parts A and B programs, which are not privatized and work very well for Medicare consumers. Rothenberg does not think Part D can be fixed; she sees something inherently wrong with the principles of the program.
Social service providers are conducting Part D counseling throughout the country. Some groups, such as Metro Seniors in Action of Chicago, are not getting paid. Some groups like Access Living are getting subcontracted to deal with it, but still scrambling to meet professional needs. Energy is being spent focusing on clients and consumers, with "little time to think about anything but Part D". The complications of Part D have become professionally distracting, even for part-time workers. On the provider reaction to Part D's complications, Rothenberg states, "Most of us predicted there was a problem, but we didn't know the depth of the problem".
And what could have been done to make Part D a more adequate addition to Medicare? Rothenberg insists, simply, that pharmaceutical companies cannot write the bill.
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