The Medicare prescription drug plan, perhaps the most substantial change in Medicare coverage in the program’s history, has been successfully implemented at Parker by a group comprised of representatives from the Institute’s departments of finance, pharmacy, social work and administration. “The key,” noted President/CEO Michael N. Rosenblut, “was that they began strategic planning one full year in advance.”
First, under the direction of CFO Mary Jane Gigatti, Parker assessed the efficacy of maintaining its in-house pharmacy, which processes 43,000 prescriptions for 347 long term care residents annually, about half of its volume. (Patients in the Institute’s 180-bed Sub-Acute Care Program are covered by Medicare Part A.) Once it was determined that the pharmacy could remain financially viable, Parker pursued contracts with all the drug plans designated for dual-eligibles, and upgraded its computer software for billing. (Ninety-seven percent of Parker’s long term care residents are dual eligible.)
Chris Ferreri, Associate Vice President of Administration, and Maribeth Lavin, Pharm. D., Director of Pharmacy, forwarded a roster of dual-eligibles to CMS, to determine if residents were auto-enrolled, and into which plans. Fifteen percent of Parker’s residents had not been enrolled. Social workers assisted those residents in securing and completing the proper paperwork. As soon as confirmation of enrollment was received, Director Lavin compared coverage provided by the residents’ assigned plans with their current medication needs. Working closely with physicians, she obtained authorization to cover some drugs, and switched some residents to other appropriate medications on the plans’ formularies. Simultaneously, VP Ferreri conducted intensive education sessions, coordinated by Leslee Mavrovic, DSW, VP of Social Work Services, at the residents’ council, family council and volunteer auxiliary meetings.
While problems and questions regularly arise, the hands-on team that first implemented the new system continues to successfully resolve them. In fact, Parker’s Medicare Part D team has become an important source of information and assistance for Medicare beneficiaries in communities of Queens and Long Island.
