<b>Early Implementation of Medicare Part D in Urban and Rural Nursing Facilities</b>

Abstract

To determine if differences occurred in the early implementation of Medicare Part D (prescription drug program) between urban and rural nursing facilities. Nursing facility demographic data, obtained from the Nursing Facility Compare Medicare Web site, were used to create matched pairs of rural and urban facilities. On-site interviews were conducted in June and July 2006 with one designated representative from each nursing facility. Details for each prescription drug plan (PDP), identified by the facility representatives, were obtained from the PDP's Web site. A prospective pilot field study of rural and urban nursing facilities was created from among 40 facilities in the 26-county Texas Panhandle. Five rural/urban nursing facilities of identical ownership and of similar perceived quality (number of cited deficiencies) and staffing (total nursing staff time per resident) were used for the pilot study. Nursing facility employees charged with overseeing Part D implementation and trained interviewers. None. Number of PDPs per nursing facility and distribution of persons providing enrollment decision support. Rural facilities used more PDPs (7.4 +/- 3.9) than did urban facilities (4.6 +/- 3.8, NSS). Independent samples Student's t-test determined that there was a significant difference in the average number of drugs per resident. Rural residents received fewer medications (8.2 +/- 1.9) than urban residents (11.2 +/- 2.2; P = 0.049, t = 2.32). These early findings suggest that rural nursing facilities interact with more PDPs than urban facilities and that Medicare Part D enrollment decisions are more likely to be aided by family members in rural facilities than in urban nursing facilities.