Department  of Health  and Human  Services 
OFFICE  OF 
INSPECTOR  GENERAL 
Beneficiary  Awareness  of  HCFA 
Publications  in  1995 
JUNE  GIBBS  BROWN 
Inspector  General 
APRIL 1997 
OEI-04-93-00152  OFFICE  OF INSPECI-OR  GENERAL 
The  mission  of the  Office  of Inspector  General  (OIG),  as mandated  by Public  Law 
95-452, is to  protect  the  integrity  of the  Department  of Health  and  Human  Services 
programs  as well  as the  health  and  welfare  of beneficiaries  served  by them.  This 
statutory  mission  is carried  out  through  a nationwide  program  of audits,  investigations, 
inspections,  sanctions,  and  fraud  alerts.  The  Inspector  General  informs  the  Secretary 
of program  and  management  problems  and  recommends  legislative,  regulatory,  and 
operational  approaches  to correct  them. 
Office  of Evaluation  and Inspections 
The  Office  of Evaluation  and  Inspections  (OEI)  is one  of several  components  of the 

Office  of Inspector  General.  It conducts  short-term  management  and  program 

evaluations  (called  inspections)  that  focus  on  issues  of concern  to the  Department,  the 

Congress,  and  the  public.  The  inspection  reports  provide  findings  and 

recommendations  on  the  efficiency,  vulnerability,  and  effectiveness  of departmental 

programs. 

The  OEIs  Atlanta  Regional  Office  prepared  this  report  under  the  direction  of Jesse  J. 

Flowers,  Regional  Inspector  General,  and  Christopher  Koehler,  Deputy  Regional 

Inspector  General.  Principal  OEI  staff  included: 

Region 
 Headquarters 

Betty  Apt,  Team  Leader 
 Winnie  Walker,  Program  Specialist 

James  Green,  Contractor 
 Stuart  Wright,  Program  Specialist 

Jackie  Watkins,  Program Analyst 
 Barbara  Tedesco,  Statistician 

Joe  Townsel,  Program Analyst 
 Brian  Ritchie,  Technical  Support 

Tammy  Hipple,  Statistician 

To  obtain  a copy  of this  report,  call the  Atlanta  Regional  Office  at 404-331-4108.  EXECUTIVE  SUMMARY 
PURPOSE 
To  determine  Medicare  beneficiary  awareness  of Health  Care  Financing 
Administration  publications. 
BACKGROUND 
The  Health  Care  Financing  Administration  (HCFA)  publishes  various  booklets 

designed  to help  Medicare  beneficiaries  make  informed  health  care  decisions.  The 

booklets  are  available  from  several  sources,  such  as Social  Security  offices  and  senior 

citizen  organizations.  However,  the  department  has  little  information  on the  extent  . 

that  beneficiaries  know  the  booklets  are  available. 

As part  of our  1995 survey  to  determine  beneficiary  satisfaction  with  Medicare,  we 

asked  beneficiaries  about  their  awareness  of the Medicare  Handbook  and  eight  other 

HCFA  publications.  The  nine  publications  included  the  handbook  and  six booklets  we 

reported  on  in  1994. 

FINDINGS 

Mmt  beneficiari4s were aware ofthe Medicare Handbook 
Three-fourths  of the  beneficiaries  surveyed  in  1994 and  1995 said  they  knew  about  the 
Medicare  Handbook. 
fewer bttmq&kti  used  the 
In 1995,  handbook  than in 1994 
In  1994, 58 percent  of the  beneficiaries  who were  aware  of the  handbook  said  they 
had  used  it in the  past  year.  This  number  significantly  decreased  to  38 percent  in 
1995. 
Few benejZiz&  were aware of selected HCFA publications 
. 	 Twenty-six  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey 
were  aware  of HCFAs  Guide  to Health  Insurance  for People  with Medicare 
Coverage. 
. 	 Eighteen  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey 
were  aware  of HCFAs  booklet  on Medicare  and  Other Health  Benefits. 
. 	 Ten  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey  were 
aware  of HCFAs  booklet  on Medicare  and Home  Medical  Equipment. 
i  . 	 Nine  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey  were 
aware  of HCFAs  booklet  on How to Help  Stop Medicare from  Being Ripped  Ofl 
. 	 Eight  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey  were 
aware  of HCFAs  booklet  on Medicare  Hospice  Benejits. 
. 	 Seven  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey  were 
aware  of HCFAs  booklet  on Medicare  Coverage for  Second  Surgical  Opinions. 
. 	 Seven  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey  were 
aware  of HCFAs  Guide  to Choosing  a Nursing Home. 
. 	 Five  percent  of the  Medicare  beneficiaries  who  responded  to  our  survey  were 
aware  of HCFAs  booklet  on Medicare  and  Coordinated  Care Plans. 
Mm  btme@hh  do mt know how to obtainHCFA publications 
Seventy-five  percent  of the  beneficiaries  said they  did not  know  how  to  obtain  the  free 
publications. 
RECOMMENDATIONS 
We  realize  that  awareness  of the  publications  may  depend  on  a beneficiarys  needs. 
However,  beneficiaries  cannot  benefit  from  HFCAs  guidance  if they  do not  know  the 
information  is available. 
We  recommend  that  HCFA  (1) continue  current  efforts,  as well  as experiment  with 
new methods,  to  develop  a more  effective  strategy  to increase  beneficiary  awareness  of 
their  publications,  and  (2) reinstate  the  listing  of HCFA  publications  in the  Medicare 
Handbook,  and  provide  instructions  in the  handbook  on how beneficiaries  can  obtain 
the  publications. 
AGENCY  COMMENTS 
The  Assistant  Secretary  for  Planning  and  Evaluation  concurred  with  our 

recommendations. 

The  HCFA  Administrator  concurred  with  our  recommendation  that  HCFA  should 

continue  efforts  to  develop  a more  effective  strategy  to increase  beneficiary  awareness. 

He  reported  that  HCFA  has  established  an  Internet  site that  lists available 

publications,  and  includes  the  text  of each  publication. 

The  Administrator  did not  concur  with  our  recommendation  to reinstate  a listing  of 

HCFA  publications  in the Medicare  Handbook.  He  stated  that  HCFA  believes  the 

1996 handbook  contains  a better  option  by providing  a State-by-state  listing  of 

ii  Medicare  carriers,  insurance  counseling  offices,  and  other  organizations  beneficiaries 
can  call through  toll-free  numbers  to get publications. 
We  still believe  it would  be  useful  to list the  publications  as we recommended. 
However,  if that  is not  practical,  we hope  HCFA  will consider  mentioning  in the 
handbook  that  publications  are  available  on various  topics,  such  as choosing  a nursing 
home  and  Medigap  insurance.  Further,  we suggest  that  the  handbook  inform 
beneficiaries  that  the  publications  are  available  from  the  organizations  listed.  If 
beneficiaries  do not  know  the  publications  exist, they  will not  know  to  call these 
organizations  to get  copies. 
... 
111  TABLE  OF  CONTENTS 
PAGE 
INTRODUCIION  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 

FINDINGS 
Most  Beneficiaries 
 Were  Aware  of the  Medicare  Handbook  .............  4 
Fewer  Beneficiaries 
 Used  the  Handbook  in  1995  .......................  4 
Few  Beneficiaries 
 Were  Aware  of HCFAs  Other  Publications  .............  5 
Most  Beneficiaries 
 Do  Not  Know  How  to Obtain  Free  Publications  .........  5 
RECOMMENDATIONS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 

AGENCYCOMMENTS  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 

APPENDICES 
Responses  to  1995 Survey  of Medicare  Beneficiaries  . . . . . . . . . . . . . . . . . . .  A-l 
HCFA  Comments  . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .  B-l  INTRODUCTION 
PURPO!SE 
To  determine  Medicare  beneficiary  awareness  of Health  Care  Financing 
Administration  publications. 
BACKGROUND 
Medicare  is a Federal  health  insurance  program  for  individuals  age  65 and  older  and 
for  certain  categories  of disabled  people.  Authorized  in  1965 by title  XVIII  of the 
Social  Security  Act,  Medicare  paid  benefits  in  1995 totalling  over  $159 billion  to 
approximately  37.6 million  beneficiaries.  The  Health  Care  Financing  Administration 
(HCFA)  within  the  Department  of Health  and  Human  Services  has  responsibility  for 
the  Medicare  program. 
HCFA hblications 
HCFA  publishes  a Medicare  handbook  for beneficiaries  that  explains  how  the 
Medicare  program  works  and  what  the  benefits  are.  HCFA  also  publishes  various 
booklets  designed  to help  beneficiaries  make  informed  health  care  decisions.  The 
booklets  provide  (1) guidance  on  Medicare  coverage  for  specific  services,  such  as 
hospice  and  second  surgical  opinions,  (2) advice  on  criteria  beneficiaries  should 
consider  in selecting  services,  such  as nursing  home  care  and  supplemental  health 
insurance,  and  (3) tips  that  should  alert  beneficiaries  to fraudulent  activities. 
HCFA  publishes  a new handbook  every  year,  but  generally  mails  it only  to new 
enrollees.  Prior  to  1995, the  year  of our  survey,  the  last  mailing  to  all beneficiaries 
was in  1990.  In  1996, the  year  following  our  survey,  HCFA  again  mailed  a new 
handbook  to  all beneficiaries.  HCFA  officials  now  are  considering  the  feasibility  of 
mailing  a new  handbook  to  all beneficiaries  every  year.  The  handbook  and  other 
booklets  are  available  upon  request  from  several  sources,  such  as Social  Security 
offices,  insurance  offices  that  process  Medicare  claims  (called  carriers),  and  senior 
citizen  organizations.  However,  the  Department  has  little  information  on  the  extent 
that  beneficiaries  know  the  booklets  are  available. 
Health  Care  Financing  Administration,  United  States  Department  of Health  and Human  Services. 
Data  compendium,  March  1995. 
1  In  1993, the  Office  of Inspector  General  conducted  a survey  of Medicare  beneficiaries 
to  determine  their  awareness  of the  Medicare  handbook  and  two booklets  published 
by HCFA?  In  1994, we conducted  a similar  survey  of Medicare  beneficiaries,  and 
asked  about  their  awareness  of the  handbook  and  seven  booklets.3 
In both  surveys,  we found  that  while  most  beneficiaries  (about  three-fourths)  were 
aware  of the  handbook,  less than  a fourth  knew  about  the  booklets. 
METHODS 
In September  1995, we mailed  a questionnaire  to  1244 randomly  selected  Medicare 
beneficiaries  for whom  Part  B claims  had  been  filed  in Calendar  Year  1994.  We  used 
standard  equations  for  estimating  sample  size with  a binary  response  variable. 
Beneficiary  participation  in the  survey was voluntary.  A total  of 942 beneficiaries 
returned  completed  questionnaires,  for  a response  rate  of 76 percent.  Percentages  in 
the  report  are  based  on  the  number  of people  answering  each  question.  Based  on  our 
response  rate,  estimates  are  within  3.2 percent  of the  true  value  at the  95 percent 
confidence  level.  The  individual  findings  may be  less precise,  depending  on the 
number  of beneficiaries  who  responded  to specific  questions.  Appendix  A shows 
beneficiary  responses  to the  questionnaire. 
As part  of our  1995 survey  to  determine  beneficiary  satisfaction  with  Medicare:  we 
asked  beneficiaries  about  their  awareness  of nine  HCFA  publications.  The  nine 
publications  included  the Medicare  Handbook,  and  eight  other  HCFA  publications. 
The  nine  publications  are  described  below. 
.  HCFAs  Medicare  Handbook  explains  the  Medicare  program  and  benefits. 
. 	 HCFAs  Guide  to Health  Insurance  for  People  with Medicare  Coverage  booklet 
provides  information  on  (1) Medicare  coverage,  (2) types  of Medigap  policies, 
and  (3) tips  for  purchasing  Medigap  insurance. 
20ffice  of Inspector  General,  United  States  Department  of Health  and Human  Services.  Use of 
Nursing Home and Medigap Guides.  OEI-04-92-00481,  May 1994. 
30ffke  of Inspector  General,  United  States  Department  of Health  and Human  Services.  Beneficiary 
Awareness of HCFA Publications. OEI-04-94-00141,  June  1995. 
40ffice  of Inspector  General,  United  States  Department  of Health  and Human  Services.  Medicare 
Beneficiq  Satisfaction:1995.  OEI-04-93-00150. 
2  . 	 HCFAs  Medicare  and  Other Health  Benefits booklet  explains  how  Medicare 
coordinates  with  other  insurance  that  beneficiaries  may  have,  such  as Medigap, 
employer  health  plans,  and  Workmans  Compensation. 
. 	 HCFAs  Medicare  and Home  Medical  Equipment  booklet  explains  how 
Medicare  pays  for  medical  equipment  beneficiaries  use in their  homes. 
. 	 HCFAs  How to Help  Stop Medicare from  Being Ripped  off  booklet  describes 
what  beneficiaries  can  do to prevent  Medicare  fraud. 
. 	 HCFAs  Medicare  Hospice  Benefits booklet  explains  (1) hospice  services,  (2) 
eligibility  requirements,  and  (3) Medicare  payments  for  hospice  services. 
. 	 HCFAs  Medicare  Coverage for  Second  Surgical Opinions booklet  provides 
information  on  (1) when  beneficiaries  should  get  second  surgical  opinions,  (2) 
how  to find  physicians  to give second  surgical  opinions,  and  (3) Medicare 
payments  for  second  surgical  opinions. 
. 	 HCFAs  Guide  to Choosing  a Nursing Home  booklet  contains  information  on  (1) 
factors  to  consider  in selecting  a nursing  home,  and  (2) Medicare  and  Medicaid 
coverage  of nursing  home  care. 
. 	 HCFAs  Medicare  and  Coordinated  Cure PZuns booklet  contains  information  on 
managed  health  care  plans  (health  maintenance  organizations  and  competitive 
medical  plans)  that  contract  with  HCFA  to provide  health  care  for  Medicare 
beneficiaries. 
erlpa?iYon to Ikvious  surveys 
During  our  1993, 1994, and  1995 surveys, we asked  Medicare  beneficiaries  similar 
questions  about  the Medicare  Handbook.  We  compare  their  responses  in this  report. 
We  asked  Medicare  beneficiaries  similar  questions  about  two of HCFAs  publications 
in our  1993, 1994, and  1995 surveys.  In  1994 and  1995, we asked  similar  questions 
about  six of the  publications.  For  those  publications  on which  we asked  similar 
questions  in more  than  one  survey year,  we calculated  the  percentage  of responses  so 
that  they  were  comparable  from  year  to year. 
We  have  determined  significant  differences  in responses  to the  1994 and  1995 surveys 
through  the  use  of a t-test. 
We  conducted  this  inspection  in accordance  with  the  Quality Standards for  Inspections 
issued  by the  Presidents  Council  on  Integrity  and  Efficiency. 
3 
 FINDINGS 
MOSTBENEFICIARIES  WERE AWARE  OF  THE  MEDICARE fi?ANDBOOK 
About  three-fourths  of the  beneficiaries  surveyed  said they  knew  about  the  Medicare 
Handbook.  Table  1 illustrates  that  the  percent  of beneficiaries  who  knew  of the 
handbook  has  changed  little  since  1993. 
TABLE  1 
BENEFICIARY AWARENESS OF TI-IEMEDICARE HANDBOOK 
1 
.. .. . .  1993  1994:  1995  .; 
76%  76%  75% 
FEWER BENEFICIARIES USED THE MEDICHRE IMNDBOOK  THAN  IN 1994 
Table  2 shows that  the  number  of beneficiaries  who  had  used  the  Medicare  Handbook 
significantly  declined  in  1995. 
Of the  beneficiaries  who  had  used  the  handbook,  94 percent  thought  the  handbook 
was helpful.  Beneficiaries  responded  virtually  the  same  in our  1993, 1994, and  1995 
surveys. 
TABLE 2 

BENEFICIARY USE OF THE MEDICARE HANDBOOK 

II  I 
1993  I  1994  I  1995  I/ 
I
Percent  of Beneficiaries  Aware  of the  55%  58%  38% 
Handbook  Who  Used  It in Past  Year 
I 
In  1993, 1994, and  1995, half  of the  beneficiaries  surveyed  said they  would  refer  to 
their  Medicare  Handbook  to get information  about  what  Medicare  pays  for. 
We  hope  to  obtain  additional  information  about  beneficiary  use  of the  handbook  for 
our  survey  about  the  1996  Medicare  Handbook. 
4 
 FEW BENEFICIARIES WERE AWARE  OF HCFAs OTHER PUBLICATIONS 
Table  3 illustrates  that  from  5 to  26 percent  of the  942 beneficiaries  responding  to our 
survey  in  1995 were  aware  of HCFAs  other  publications. 
TABLE 3 

AWARENESS OF HCFA PUBLICATIONS 

,.  ..:: 
.. 
..  .,  .::  
..  
Guide  to Health  Insurance  for  People  with  Medicare  13%  24%  26% 
Coverage 
* 
Medicare  and  Other  Health  Benefits  14%  18% 
*  * 
Medicare  and  Home  Medical  Equipment  10% 
*  * 
How  to Help  Stop  Medicare  from  Being  Ripped  Off  9% 
* 
Medicare  Hospice  Benefits  9%  8% 
* 
Medicare  Coverage  for  Second  Surgical  Opinions  9%  7% 
Guide  to  Choosing  a Nursing  Home  9%  8%  7% 
*
Medicare  and  Coordinated  Care  Plans  6%  5% 
*If no  percentages  are  shown,  we did not  ask about  the  publication  in that 
particular  year. 
The  publications  most  familiar  to beneficiaries  related  to insurance  policies  that 
supplement  Medicare.  We  realize  that  awareness  of the  other  publications  may 
depend  on  a beneficiarys  needs.  For  example,  it is understandable  that  a beneficiary 
who  has  not  needed  surgery  may  not  be  aware  of the  publication  on  second  surgical 
opinions. 
MOST BENEFICIARIES DO NOT KNOW HOW TO OBTAIN  HCFA 
PUBLICATIONS 
Seventy-five  percent  of the  beneficiaries  surveyed  said  they  did not  know  how  to 
obtain  HCFAs  free  publications. 
HCFA  publications  provide  information  that  Medicare  beneficiaries  and  their  families 
may  use  to make  informed  health  care  decisions.  Publications  such  as the Medicare 
Handbook  and  the  Guide  to Health  Insurance  for People  with Medicare  have  broader 
5  applicability  to beneficiaries.  We  noted  that  the  rate  of awareness  for  these 
publications  is higher  than  for  other  publications.  We  also  realize  that  awareness  of 
some  of the  other  publications,  such  as the  booklet  on  choosing  a nursing  home,  may 
depend  on  a beneficiarys  needs.  However,  beneficiaries  cannot  benefit  from  HCFAs 
guidance  if they  do not  know  the  information  is available. 
6 
 RECOMMENDATIONS 
We  are  aware  that  HCFA  has  implemented  several  initiatives  to improve  distribution 
of existing  publications.  For  example,  HCFA  has worked  with  the  Social  Security 
Administration  and  the  Assistant  Secretary  for  Public  Affairs  to make  HCFA 
information  more  accessible  to beneficiaries.  However,  awareness  of the  publications 
has  not  improved. 
HCFA  is now  considering  the  feasibility  of mailing  the Medicare  Handbook  to  all 
beneficiaries  every  year.  Prior  to  1996,  the Medicare  Handbook  listed  some  of 
HCFAs  publications  and  included  an  order  form  beneficiaries  could  use  to obtain  the 
publications.  However,  this  list and  form  has been  deleted  from  the  new  handbook. 
To  contain  the  cost  of mailing,  HCFA  cut the  number  of pages  of the  I996  Medicare 
Handbook  by revising  the  format  and  including  fewer  details. 
We recommendthatHCFA 
.  continuecurrentefforts,aswell as experimenwtithnewmethodst,o developa 
moreeffectivestrategyto increasebeneficiaryawarenessof theirpublications. 
For  example,  HCFA  could  distribute  publications,  or a listing  of publications 
through  offices  of physicians  and  other  health  care  providers. 
.  reinstatethelistingof HCFA publicationisn the Medicare  Hundbook,  and 
provideinstructionins  thehandbookon howbeneficiariecsanobtainthe 
publications. 
7 
 AGENCY  COMMENTS 
The  Assistant  Secretary  for  Planning  and  Evaluation  concurred  with  our 

recommendations. 

The  HCFA  Administrator  concurred  with  our  recommendation  that  HCFA  should 

continue  efforts  to develop  a more  effective  strategy  to increase  beneficiary  awareness. 

He  reported  that  HCFA  has  established  an  Internet  site that  lists available 

publications,  and  includes  the  text  of each  publication. 

The  Administrator  did not  concur  with  our  recommendation  to reinstate  a listing  of 

HCFA  publications  in the  Medicare  Handbook.  He  stated  that  HCFA  believes  the 

1996 handbook  contains  a better  option  by providing  a State-by-state  listing  of 

Medicare  carriers,  insurance  counseling  offices,  and  other  organizations  beneficiaries 

can  call through  toll-free  numbers  to get publications. 

We  still believe  it would  be  useful  to list the  publications  as we recommended. 

However,  if that  is not  practical,  we hope  HCFA  will consider  mentioning  in the 

handbook  that  publications  are  available  on various  topics,  such  as choosing  a nursing 

home  and  Medigap  insurance.  Further,  we suggest  that  the  handbook  inform 

beneficiaries  that  the  publications  are  available  from  the  organizations  listed.  If 

beneficiaries  do not  know  the  publications  exist, they  will not  know  to  call these 

organizations  to get  copies. 

Appendix  B contains  the  full text  of HCFAs  comments. 

8 
 APPENDIX  A 
RESPONSES To  1995SURVEY OF MEDICARE BENEFICIARIES 
(942 Respondents) 
Question  Percentage 
1.  Wherewouldyougo to getinformationaboutwhatMedicarepaysfor? 
The  following  are  some  places  people  might  go to get  answers  if they  have 
questions  about  what  Medicare  pays  for.  Check  all the  places  you  would  go to 
find  out  what  Medicare  pays  for. 
(IV = 908- NumberRespondingto Question) 
Your  doctors  office  632  70 
Friend  or relative  104  11 
AARP  or  other 
membership  organization  126  14 
Insurance  company  that 
processes  your  Medicare  claims  367  40 
Medigap  insurance  company  209  23 
Social  Security  office  299  33 
Local  senior  citizens  group  58  6 
Insurance  salesperson  27  3 
Medicare  Handbook  506  56 
Medicare  Peer  Review 
Organization  38  4 
States  Information,  Counseling, 
and  Assistance  office  26  3 
Other  40  4 
Not  Answering:  28 
A-l  Question  ReSponSeS  Percentage 
2 	 Listedbeloware Medicarebookletsthatyoucanobtainfree of charge. 
Pleasecheckthebookletsyouwere awareof beforetoday. 
Guide  to Health  Insurance 
for  People  with Medicare  249  26 
Guide  to Choosing  a 
Nursing Home  69  7 
Medicare  Coverage for 
Second  Surgical Opinion  67 
Medicare  Hospice  Benefits  75 
Medicare  and  Coordinu ted 
Cure Plans  43 
Medicare  and  Other 
Health  Benefits  173  18 
Medicare  and Home  Medical 
Equipment  93  10 
How to Help  Medicare from 
Being  Ripped  Ofi  81  9 
Number  Who  Checked  One  or More  Publications:  405 
3.  How manytimesin thepastyearhaveyouusedyourMedicareHandbook? 
(Checkm  answer.) 
1 to  3 times  202  23 
More  than  3 times  53  6 
I have  not  used  the 
Medicare  Handbook  in 
the  past  year  410  46 
I do not  know  what  the 
Medicare  Handbook  is  45  5 
I do not  recall  receiving  a 
Medicare  Handbook  173  20 
Not  Answering:  59 
A-2  Question  ReSpOnSe!4  Percentage 
4. 	 Do  you think  the M&are  Handbmk  is: 
(Checks  answer.) 
(N = 255- NumberWho Had Used Handbook) 
Very  Helpful  97  39 
Generally  Helpful  135  55 
Generally  Not  Helpful  11  5 
Not  Helpful  3  1 
Not  Answering:  9 
A-3 
 APPENDIX  B 

HCFA  COMMENTS 

B-l  DEPARTMENT  OF HEALTH  QLHUMAN  SERVICES  Health  Ca:e  Financing  Administrztlon 
._  ..  -_ 
The  Adnir,ist:atar 
Washington,  O.C.  20201 
FEB  - 9  1997 
DATE: 
FROM: 	 Bruce C. 
Administrator 
SCBJECT: 	 Office of Inspector General (OIG) Draft Report:  Beneficiary  Awareness 
of HCFA Publications  in 1995, (OJZI-04-93-00152) 
TO: 	 June Gibbs Brown 
Inspector  General 
We reviewed the above-referenced  report that examines Medicare beneficiary  awareness 
of nine Health Care Financing Adm.inistration publications. 
Our detailed  comments  on the report recommendations  are attached for your 
consideration.  Thank you for the opportunity  to review and comment on this report. 
Attachment  OIG Recommendation 

The Health Care Financing Administration  (HCFA) should continue current efforts 
3s 

well as cxpcl&cnt  with new m&ods  to dcvclop a more e11ective strategy  t3 increase 

beneficiary  awareness  of its publications.  For example, HCFA coutd distribute 

publications,  or a listing of publications  through physicians  and health care providers 

offices. 

We concur.  We took  number of  in 1996 of which we are especially  proud in 

3  actions 
light of the constraints  placed on the Agency by both the tilough  early in the year and 

the ongoing budget limitations.  We distiibutcd  a revised user-friendly  v&on  of the 

Medicare  Handbook to ail bcncficiarics  that was extensiveIy  field-tested  by a 

contractor  prior to publication.  Alternative  formats of the Medicare  Handbook  for the 

visually-impaired  (large-ptilt,  braille, and audio cassette) were also made available.  In 

addition,  the publication  was translated  into Spanish and distributed. 

Other actions HCFA took to broaden public awareness of its publications  are: 
Est3blished  an Internet web site that not only announces  the availability  of 
0 	
publications  but includes two versions, i.e., a text-only  copy and the 3ctuaI copy 
that includes gr3phics. 
Implemented  a Publication  Alert announcement  that is sent out to our partners, 
0 	
e.g., peer review organizations  (PROS), intermediaries/carriers,  in advance of the 
actual maiting of the publications. 
0 	 Developed  3 more sophisticated  computerized  address maintenance  system  to 
distribute publication  alerts and actual publications  to our p~tilers  who provide 
this information  to the general public.  The address lists include PROS and 
intermediaries/carriers,  as well as end-stage renal disease networks,  Insurance 
Counseling Assistance  grantees, state agencies, consumer 3nd professional 
advocacy  and support organizations,  and the Social Security Adrninis&zion 
District Offices.  0 	 Continued  efforts with the HCF?, On-Line activities as well as customer  set\-ice 
pilots with contractors.  We plan to focus on the results of the contractor  senice 
pilots and share customer  service best practices with at1 contractors. 
0 	 Reached  out to a wide variety  of benefi&.ry  advocacy  groups.  HCF.4 *andthe 
Administration  on Aging funded elements oi the Aging Setwork  and other 
dcparttncntal  entities where constituencies  overlap.  As a result of this outreach, 
we increased  our pr.esence and voice among this group and developed  additional 
channels for distribution  and feedback. 
We bebeve  the above efforts have produced measurable improvement  in benefici,ary 
awareness  of HCFA publications. 
OIG Recomme~ 
HCF.4 should reinstate the listing of HCFA publications in the Medicare  Handbook 

and provide instructions  on how to obtain tilem. 

HCFACornments 

We do not concur.  We believe the 1996 ;Medicare Handbook contains  a better option. 

It provides  a complete state-by-state  listing of >Iedicare carriers, PROs, Medicare  durable 

medical equipment regional carriers,  and state insurance counseling  offlces.  Lnaddition, 

the Medicare  Handbook  also provides  to11Eree l-800 numbers for both the general 

public and those who arc test  telephone  users.