With all the confusion created by Medicare Part D, the new drug prescription plan, which went into effect January 1, 2006, many patients are turning to their physicians for help navigating the system. To prepare doctors to assist patients, CME providers are developing new activities. “Physicians were getting a lot of questions from their patients about Medicare D. We wanted to create something that would allow physicians to get a definition of a term, or find out where to go to learn how various plans had interpreted the Medicare D offerings,” says Frederick Munschauer, MD, chair of the Department of Neurology, University of Buffalo School of Medicine and Biomedical Sciences; and medical director of the Baird MS Research Center in Buffalo, N.Y. His online CME program on Part D, developed by the Jacobs Neurological Institute at the Unaxiversity at Buffalo, is designed for physicians treating multiple sclerosis patients.

There are challenges in creating Part D CME. Mila Kostic, director, continuing medical education, University of Pennsylvania School of Medicine, Philadelphia, says that the needs assessment for the Part D program her office developed, while intuitively obvious, was not easy to do. “Initially we reviewed everything relevant and reliable we could get our hands on, such as Center for Medicare and Medicaid Services' teaching materials, and we did not find much that was detailed enough to be helpful,” she says. “Once we were able to identify our faculty, we talked to them to fine-tune our understanding of the educational needs.” Based on this assessment, her organization decided that there were three levels of involvement healthcare professionals would have with their patients on this topic. They range from basic (provide resources and referrals to available educational materials) to intermediate (answer basic questions about enrollment, co-payment amounts, and so on) to advanced, where they could serve as a primary source of information about finding the right program and options for a specific patient. Munschauer says of his activity, “It gets down to how the process works and the pitfalls to watch out for.”

Taking It to the Web

Both decided to make their Part D CME Web-based, to make the activities easily accessible for a national audience. Kostic's team's original program was developed in collaboration with CECity, Homestead, Pa., and through the use of its technology, an independent resource Web site, LearnMedicare.com, was created to host the activity, as well as other resource materials. She adds, “CECity powers a network of educational Web sites that allows access to the activity from such sites as CE Medicus, as well as from the University of Pennsylvania CME Portal and MedPage Today, our other partner in online CME. This approach also allows for automated credit issuance and record keeping.” This was no small order for this program, which launched in August 2005, since the project included working with other CE providers so that participants could get different types of credit, including AMA PRA Category 1, and credits offered by the American Academy of Family Physicians, the American Osteopathic Association, the Accreditation Council for Pharmacy Education, and the American Nurses Credentialing Center.

“The other nice thing about doing it on the Internet is that we can update it as new information and resources become available,” says Munschauer. The Institute's site offers a maximum of 1 AMA PRA Category 1 credit, depending on the physician's extent of participation.

Creating the Content

“There's really just too much to know,” says Munschauer. “Developing the content is always the hardest part of this type of program.” He gives Medicare and Medicaid Services the credit for serving as his primary reference source, saying that the information on its Web sites was good, if slow, hard to use, and not very user-friendly. After gleaning what they could from the MMS sites, “we sat down with physicians to come up with a list of questions we were most frequently asked when talking with our patients and colleagues,” went to seminars on Medicare Part D, and talked with industry consultants “who did a good job in trying to pinpoint where the pinch points are in the Medicare Part D process.” His team also spoke with pharma companies and HMOs as part of the content development process. “We pulled that all together while maintaining the focus that this was created for doctors by doctors.

“It was a more daunting task than we thought when we first started,” he adds. To make it easy to access just the information they want, physicians can pick low-, medium-, or high-intensity knowledge tracks on the site, and they can access links to primary sources and definitions of terms.

Kostic also found the content creation to be a challenge. First her team selected two faculty members based on their expertise in Medicare issues — one on the academic research side, and one who represented the Pharmaceutical Research and Manufacturers of America and had “intimate knowledge of the development of Medicare Part D and significant experience in providing lectures and other educational materials on the topic.” After the two faculty members created the material, the group then convened at the CECity headquarters in Pittsburgh, where the faculty recorded the content for online audio, slide, and text presentation.

Pharma Involvement

Neither found the involvement of industry in the development of the content to be a conflict of interest. As Kostic says, “There were no specific therapeutic/pharmacologic issues discussed or even mentioned in this activity. It was a conscious decision on the faculty side, as well as our recommendation, not to get involved in advocating benefits of any one prescription drug program over another. Rather, the content focused on how the healthcare provider could help the patient determine which program was best for him/her individually, and what to look for in that decision process — the emphasis being on an individual patient and his or her specific case.”

Munschauer adds that getting commercial support, in his case, from Biogen Idec, Pfizer, Serono, and TEVA Neuroscience, wasn't a problem. “It was the easiest sell I've ever had. The pharma companies applauded the effort.”

The University of Pennsylvania activity was supported by an educational grant from Informed Decisions, an independent entity with a mission to provide education and resources in this area, “so there was no potential for a conflict of interest or bias in that respect, either,” says Kostic. “Nevertheless, as is our usual practice, the presentations were subject to peer review.”

The Need Continues

Even though the Part D benefits are no longer a novelty, there still is a continuing need for CME in this area, Kostic and Munschauer agree. As the issues surface during the initial enrollment period and experience from the different states comes in, more education will be needed. “The government has set up a hot line — 1-800-MEDICARE — and a Web site, medicare.gov. But, according to MSNBC, many seniors say the phone service often is not helpful and the Web site is simply overwhelming. Patients must turn for help to healthcare professionals, who must understand the provisions of the plan if they are going to be able to help their patients navigate successfully through the system,” says Kostic.

She suggests that CME and CE providers developing content in this area should keep two points in mind:

  • Make sure that the program provides current and accurate information in an effective educational format and does not confuse the learner and in turn the beneficiary.

  • Be aware that funding from some commercial support sources, such as individual pharmacy plans, could create the potential for conflicts of interest because they have a vested interest in specific plan recommendations. Also, CME providers should steer clear of “providing specific recommendations on the use of any one prescription drug plan over the others.”



Munschauer's best advice is to know your audience and what their concerns are. “The questions we get from neurologists who are dealing with stroke patients — who can get by with an annual pharmacy bill of $3,000 to $4,000 a year — are different from those who have MS patients, who can easily have bills of $60,000 to $70,000 a year.”

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