Medicare Part D prescription drug benefits and administrative burden in the care of dually eligible psychiatric patients.
OBJECTIVE
With implementation of Medicare Part D, concerns were raised that patients with severe mental illness who were dually eligible for both Medicaid and Medicare benefits would be at clinical risk. In addition to concerns about medication access and continuity, there were concerns about administrative burden for physicians and their staffs. This study aimed to quantify the amount of administrative burden for psychiatrists and their staff related to Medicare Part D prescription drug plan administration in a national sample of dually eligible psychiatric patients and to identify factors associated with increased burden.


METHODS
A total of 5,833 psychiatrists were randomly selected from the American Medical Association's Physicians Masterfile. Responses were obtained from 64% (N=3,247) with a mailed survey using practice-based survey research methods during the first four months of Medicare Part D implementation (January to April 2006); 1,183 psychiatrists met eligibility requirements.


RESULTS
Psychiatrists and their staff spent 45 minutes in administrative tasks for every one hour of direct patient care for dually eligible patients. Drug plan features, including prior authorization and preferred drug formularies, and medication access problems were associated with increased administrative time.


CONCLUSIONS
Results of this study indicate several drug plan features and medication access problems related to Part D implementation were associated with significant increases in administrative burden for psychiatrists and their staff, which may result in less time for direct patient care. Given the vulnerability of this high-risk population, this increased administrative burden may pose a significant risk to the overall quality of care for psychiatric patients.
Wilk
Joshua E
JE
American Psychiatric Institute for Research and Education, Arlington, VA 22209, USA. joshua.wilk@amedd.army.mil
West
Joyce C
JC
Rae
Donald S
DS
Rubio-Stipec
Maritza
M
Chen
Jennifer J
JJ
Regier
Darrel A
DA
D000368:Aged; D001291:Attitude of Health Personnel; D017831:Diagnosis, Dual (Psychiatry); D011307:Drug Prescriptions / Q000191:economics*; D004608:Eligibility Determination; D005260:Female; D006297:Health Services Accessibility / Q000191:economics; D006801:Humans; D008297:Male; D008484:Medicaid; D054524:Medicare Part D; D054539:Medication Therapy Management / Q000191:economics*; D001523:Mental Disorders / Q000188:drug therapy* / Q000191:economics*; D008605:Mental Health Services / Q000191:economics*; D008875:Middle Aged; D011216:Practice Management, Medical; D011570:Psychiatry / Q000191:economics* / Q000458:organization & administration; D019966:Substance-Related Disorders / Q000188:drug therapy* / Q000191:economics*; D011795:Surveys and Questionnaires; D014481:United States