Medicare Plan D problems persist

TAFP offers online resources

Since the new Medicare prescription drug plan went into effect Jan.1, doctors and pharmacists have struggled to sort through reams of dizzying formularies, figure out co-pays and sift through insurance plans. More than a month later problems of the initial implementation still exist.

"I don't think anything has gotten better or worse," says Robert L. Hogue, M.D., past president of TAFP. "Patients are still confused which plan to choose and I don't have the resources to help them."

An even larger concern is dealing with the restrictions in treatment once a patient has chosen a plan. Each of the 20 plans in Texas has a different formulary, which, according to Hogue, often means adjusting his patients' medical treatment based on the medications their plans cover.

"Patients finally find a treatment that works for them, then they choose a plan that doesn't provide any of their medications," Hogue says. "Whatever plan they choose, I have to deal with."

But even if a patient finds treatment that matches their drug plan, it's not always as simple as walking into a pharmacy and getting their prescription filled, says Jeff Carson, chief of staff at Oakdell Pharmacies in San Antonio.

"Things aren't as bad as they were at the beginning of the year, but it's still not pretty, and there's still a lot of confusion," Carson says.

Many problems occur with dual eligible patients. Either they have yet to show up on computerized rolls, or the computer shows a co-pay that doesn't coincide with their insurance plan's co-pay.

"I have a moral obligation to my customers [with serious illness], so I give them their medications even if they can't afford to pay," Carson says. "I just have to hope I will be reimbursed later on."

But independent pharmacies pay more for prescription drugs than bigger companies with greater buying power, according to Carson. This means reimbursements won't cover the cost for smaller pharmacies, forcing them to either go out of business or deny dual-eligible Medicare patients.

"Forty-four percent of all pharmacies in America are independent," Carson says, "if they can't afford to serve Medicare patients, it will have a huge impact on not only the patients but the health care system in general."

If Medicare Part D still seems like a Gordian knot, peruse our resources in the Practice Resources section of www.tafp.org. The newest tools include a pharmacist-to-physician fax form, formulary finder and a friends and family first toolkit. Resources are updated frequently, so visit often.

Medicare physician payment cuts reversed

Good news for physicians: the U.S. House of Representatives voted February 1 to reverse the 4.4 percent cut in Medicare physician payment that went into effect on January 1. This measure is part of federal budget legislation that is set to make $39 billion of cuts over five years. It will now be sent to the President's desk to be signed into law.

CMS officials said earlier that Medicare would retroactively adjust physician payment to 2005 levels if the bill passed unchanged and was signed by President Bush. They further explained that resubmission of affected claims by physicians is not expected, as they should be automatically adjusted, and physicians will receive remittance statements that will show the adjusted amounts. Current plans suggest that physicians should receive one check to reimburse the adjustments with documentation indicating which claims were amended.

For more information, click here

Register today for the C. Frank Webber Lectureship

This year's C. Frank Webber Lectureship offers 11.5 Category I & AAFP Prescribed credits packed into one day to fit your busy schedule. Some of the hot topics to be discussed include:

• Outpatient Technological Advances in the Treatment of Enlarged Prostate
• Medical Management of Erectile Dysfunction
• Low Back/Leg Pain Challenge: Clinical Pearls for Primary Care Providers
• Diagnosis & Management of Eczema
• Antibiotic Resistance
• Management of Migraine in Primary Care
• New Advances in the Treatment of ADHD
• Ethics: End of Life Care for the Primary Care Physician
• HRT & Osteoporosis

Vendors will be on hand to showcase their latest. Register today at www.tafp.org

ABFM Announces Changes to Certification Program

Longer certification periods will be available

In a news release Monday, January 30, the American Board of Family Medicine announced major enhancements to their Maintenance of Certification (MC-FP) program. The major change is the opportunity for physicians to go from a seven-year to a 10-year re-certification period. To qualify for the longer period, diplomates need to complete two Part II Modules (Self Assessment Modules) and one Part IV module (currently Performance in Practice Module) during each of the three three-year windows. Other enhancements include the addition of other options to complete Part IV requirements and changes to the payment options to include two ways to "lock in" the price for the entire re-certification period.

For more information, visit: www.theabfm.org/moc/enhancements.aspx

Red-clad TAFP staff participates in Heart Association’s National Wear Red Day

Tell us what your practice did to promote Go Red for Women

To raise awareness about women's heart health, the American Heart Association created Go Red For Women, a nationwide campaign to educate and to raise funds. Companies and organizations were encouraged to participate in the campaign by asking their employees to wear red and jeans to work on Friday, Feb. 3. To raise money for AHA, employees who participated were asked to donate $5 to support the fight against heart disease and stroke. Companies were also asked to distribute lifesaving information about heart health.

Did your office participate in National Wear Red Day? E-mail Kathy McCarthy and let her know what your practice did. She will prepare a report of family physician participation for the American Heart Association.

Calling all members interested in representing TAFP at AAFP’s National Conference of Special Constituencies

Each year, the AAFP holds the NCSC in Kansas City, Missouri and representatives from across the nation gather to discuss various issues and suggest policies and programs to the AAFP. This year's conference will be May 4 - 6. Click here to go to the AAFP site for more information and to register.

If you are interested in being considered for one of the slots, please notify Jonathan Nelson at the TAFP office by February 24, 2006. Be sure to let him know which constituency you would like to represent. The TAFP Section on Special Constituencies will select representatives at the Interim Session meeting. Representatives airfare is reimbursed by AAFP and TAFP reimburses up to $500 in expenses (hotel, registration, etc). Below are the five special constituency slots:

• New Physicians
• Women
• Minorities
• International Medical Graduates
• Gay, Lesbian, Bisexual and Transgendered

Copyright 2006, Texas Academy of Family Physicians