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Medicare Drug Program News
Medicare Drug Plan Call Centers Slammed by GAO for
Poor Service
Senior citizens
probably did not get right information 66% of the time
 July 10, 2006 The call center service provided by
Medicare prescription drug plans received light praise and heavy
criticism today from the Government Accountability Office based on their
test of responses from the call centers. GAO found the CSRs "prompt and
courteous" and with "helpful suggestions." The problem was they "did not
consistently provide accurate and complete responses." They failed
to give the right information
66 percent of the time.
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The GAO obtained accurate and complete responses to
about one-third of the 864 calls for which GAO reached a CSR at 10 of
the largest PDP sponsor call centers. The GAO asked five questions,
which GAO developed using information from CMS and other sources.
The overall accuracy and completeness rate for each
call center ranged from 20 to 60 percent. CSRs were unable to answer 15
percent of the questions posed, primarily those related to plan costs.
Furthermore, CSRs within the same call center
sometimes provided inconsistent answers. For example, in response to
questions about PDP cost comparisons for specified sets of drugs, CSRs
at three call centers told GAO that it was against the sponsors
policies to identify any of their plans as lowest cost. However, other
CSRs at each of these call centers did not cite this policy and did
identify a plan as lowest cost.
Other highlights of the critique:
● GAO found that in most instances, drug plan
providers were unable to give accurate information in response to simple
questions about plan costs, low-income coverage, plan formulary
procedures, and plan utilization management techniques. Specifically,
GAO found:
● Two-thirds of phone calls to provider hotlines
were not answered completely or accurately. The phone centers operated
by private Medicare providers gave inaccurate or incomplete answers
during 66% of calls. Two Medicare plan providers gave inaccurate or
incomplete information at least 75% of the time.
● Medicare drug plan providers were unable to
provide critical cost information for seniors to choose among plans. Two
GAO questions focused on which of drug plans would provide seniors with
the lowest out-of-pocket costs, and what these costs would be. Medicare
providers failed to give accurate or complete answers over 70% of the
time. In one case, the plan sponsor hotline underestimated the actual
costs by $6,000.
● Low-income beneficiaries often received
inaccurate information. One question asked which plans offered by the
provider were available to low-income beneficiaries with no premium.
This question was answered incorrectly or inaccurately 66% of the time.
This is particularly troubling since this information was also incorrect
in the 2006 Medicare & You handbook mailed to all Medicare
beneficiaries.
● Medicare plans often provided conflicting
answers, giving one answer on one call and a different answer on a
second call. For example, some plans said that one of their plans was
the least expensive on one call and then said that a completely
different plan was the least expensive on a separate call.
● GAO did reach a representative in less than 1
minute for 46 percent of the calls CSRs fielded and in less than 5
minutes for 96 percent of the calls fielded.
● While GAO did not reach CSRs for 4 percent of
the calls it placed, mainly because of disconnections.
● GAO found that 98 percent of CSRs with whom GAO
spoke were easy to understand, polite, and professional. In addition,
many CSRs provided helpful suggestions related to GAOs questions, such
as details about a mail-order option to obtain drugs or lower-cost
drugs.
In commenting on a draft of this report, the
Centers for Medicare and Medicaid Services criticized the analysis as
based on inaccurate, incomplete, and subjective methods that limit the
reports relevance and validity. GAO maintains that its methods are
sound and its findings are accurate. CMS officials told GAO at a May
2006 meeting that CSRs should have been able to accurately answer the
questions GAO posed.
Democrats were quick to release the report. Rep.
Henry A. Waxman, Rep. John D. Dingell was joined by Rep. Charles B.
Rangel, Rep. Pete Stark, and Rep. Sherrod Brown in pointing out the
private plans that are responsible for running the new Medicare drug
benefit "did not consistently provide callers with accurate and complete
information."
"The poor quality of the information is
inexcusable," said Waxman, Ranking Member of the Committee on Government
Reform. "Seniors with basic questions about the Medicare drug benefit
are being left in the dark. Even if they call the plans directly, they
can't get accurate answers."
"The lack of accurate and understandable
information for our seniors has been a chronic problem since the
beginning of Medicare Part D," said Rep. Dingell, Ranking Member of the
Committee on Energy and Commerce. "Senior citizens are being hurt by the
indifference and incompetence of the Bush Administration and its friends
in the insurance industry."
This is the second GAO report analyzing the drug
plan information available to Medicare beneficiaries. In May 2006, GAO
analyzed the information provided to seniors by the federal Center for
Medicare and Medicaid Services, concluding that this information was
frequently confusing, inaccurate, or incomplete. The new GAO findings
show that the private plans are also failing to answer seniors'
questions, leaving millions of seniors unable to get accurate answers to
their questions about the Medicare drug plans.
About this report:
The Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (MMA) established a voluntary outpatient
prescription drug benefit, known as Medicare Part D. Private sponsors
have contracted with the Centers for Medicare & Medicaid Services (CMS)
to provide this benefit and are offering over 1,400 stand-alone
prescription drug plans (PDP). Depending on where they live,
beneficiaries typically have a choice of 40 to 50 PDPs, which vary in
cost and coverage.
MMA required each PDP sponsor to staff a toll-free
call center, which serves as a key source of the information that
beneficiaries need to make informed choices among PDPs.
GAO examined (1) whether PDP sponsors provide
prompt, courteous, and helpful service to Medicare beneficiaries and
others and (2) the extent to which PDP sponsor call centers provide
accurate and complete information to Medicare beneficiaries and other
callers.
To address these objectives, GAO made 900 calls to
10 of the largest PDP sponsor call centers during March 2006, posing one
of five questions about their Part D plans during each call. GAO tracked
the amount of time it took to reach a customer service representative
(CSR), the number of calls that did not reach a CSR, and the
appropriateness and clarity of CSRs language. GAO developed criteria for
determining accurate and complete responses based on CMS information.
Links to the report:
Medicare Part D: Prescription Drug Plan Sponsor
Call Center Responses Were Prompt, but Not Always Accurate
GAO-06-710, June 30, 2006
Abstract Highlights-PDF
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