WASHINGTON – Two years after the Government Accountability Office scolded Medicare for the inaccurate information its carrier call centers provided to physicians, a follow-up report finds that call-center performance has deteriorated even more.
In its February 2002 report, “Medicare: Communications With Physicians Can Be Improved,” the GAO noted that customer service representatives at Medicare carriers' call centers “rarely provided appropriate answers to questions, answering only 15% of our test calls completely and accurately.”
In a July 2004 report, the agency got right to the point: “Only 4% of the responses GAO received in 300 test calls to 34 call centers were correct and complete.”
In addition, the report noted, “[The Center for Medicare and Medicad Services'] efforts to provide oversight of carrier call centers are inadequate.” For instance, in 2002 the agency carried out only one evaluation of a carrier's telephone services; in 2003, there were none.
Stephanie Huff, government affairs analyst for the Medical Group Management Association (MGMA), said her organization was not surprised by the results. At MGMA, “we have two people specifically designated to deal with member calls, and a lot of time is spent sidestepping the call center process,” she said. “We will call CMS directly to get answers to questions our members have.”
The American Medical Association also agreed with the study results. “While the Medicare call centers' inability to correctly answer physicians' questions is troubling, sadly, it is not surprising,” Dr. J. James Rohack, chair of the AMA's board of trustees, said in a statement. “The GAO report confirms longstanding complaints from physicians about the lack of clear and reliable guidance on complex Medicare policy questions.”
The report's authors attributed the call centers' problems to a variety of factors, including:
▸ Fragmented information. “When responding to Medicare inquiries from providers, customer service representatives (CSRs) rely on fragments of information from multiple electronic sources,” such as both CMS and carrier Web sites, the report said. They also use various paper documents, including the Medicare carrier manual, program memorandums, carrier bulletins, and “printed Medicare program information, including policy changes, which CMS estimates at about 200 per year.”
For a question about billing for services delivered by therapy students, the CSRs who were contacted referred callers to 13 different documents. “Twelve of the references were either incorrect or did not include all of the information needed to give a correct and complete answer,” the report said. The 13th document was in a “Q and A” format, and it “included our specific test question but without the complete answer. Fragments of the answer, however, were located earlier in the document… It was evident to us that without reading the entire document, it would be plausible for the CSR to have read the test question and mistakenly given the caller the wrong answer, while assuming that the response given was correct and complete.”
▸ Difficulties in retaining CSRs. The report noted that an internal CMS study found the turnover rate for carrier call center CSRs to be as high as 23% from calendar years 1999 through 2001 for all of CMS's call centers. “This is significantly higher than the attrition rate for CMS's call centers for beneficiaries … which one CMS official estimates is close to industry standards–about 10%. Although there are no more recent data, CMS officials view this as troubling.”
CMS is currently trying out two initiatives to help CSRs, but neither of them is likely to help the representatives answer policy-oriented questions from providers, the report said. For instance, CMS has retained a consulting firm to write explanatory articles about new Medicare policies, but is not doing anything special to help CSRs get easy access to them.
“Although these articles contain citations to regulations and laws, for example, they are not electronically linked to the policies they describe,” the report noted. “In addition, the policies they support are not annotated to reflect that an article exists … Moreover, there are no plans to publish articles for the majority of existing policies.”
The report included several recommendations for improvement, including routinely screening and triaging calls by routing complex policy-oriented questions to staff with the expertise to adequately address them, developing clear and easily accessible policy-oriented materials to assist CSRs and making sure the materials are electronically searchable, and establishing an effective monitoring program for call centers to assess CSRs' performance.
Ms. Huff of MGMA applauded the recommendations. “The recommendations would be a quick and easy way for CMS to reduce its administrative burdens,” she said.