Like Paul Revere riding the streets of Boston warning about the arrival of British troops, this article is meant to shout to all physicians, "Part D is coming, Part D is coming." Consider the message fair notice to get educated about the changes to the Medicare program and what they mean for patients and providers.

As a result of the passage of the Medicare Prescription Drug, Improvement and Modernization Act of 2003, the Centers for Medicare and Medicaid Services will begin to implement the new law on Jan. 1, 2006. The good news is Medicare will be offering prescription drug benefits for the first time. The bad news is there is likely to be a ton of confusion that has the potential to cause significant problems in healthcare delivery to some of the nation's most vulnerable patients.

As physicians learned with HIPAA, any major change to federal law is complicated and creates a lot of uncertainty, at least initially. The Medicare law is no different. With a myriad of new drug plans, all with different formularies, and the addition of several new Medicare Advantage plans, Medicare consumers and providers are going to have to pay attention to what is happening in order to properly adapt. So what exactly does this mean?

Patients and providers must ask questions of CMS to understand how the new law will impact them personally. For patients, it is critical to explore their provider options and understand their drug plan choices. For physicians, it is important to understand their role in the new system and how the different plan options impact their patients.

For instance, here in Orange County, CalOptima has created a new Medicare Advantage Plan called OneCare that is designed to serve the Medi-Medi (Medicare and Medi-Cal) patient. The Medi-Medi patients have been given a choice of enrolling in OneCare or staying in original Medicare and choosing from a variety of drug plans. Patients not indicating a choice will automatically be enrolled (passive or default enrollment) into OneCare. For physicians, this means that if you are not a contracted provider with one of the OneCare physician groups, your Medi-Medi patients may be assigned away from you if they have not indicated to CalOptima that they want to stay in original Medicare.

This default enrollment process began on Oct. 30, 2005, and is likely to impact about 30,000 of the 55,000 Medi-Medi patients in Orange County. The Orange County Medical Association and the California Medical Association are encouraging physicians to communicate with their patients to assist them in making the choice that will best serve their healthcare needs and continuity of care. OneCare will be a good choice for some, and not for others. Because patients will be confused and in many instances not know the best choice, physicians can help by educating themselves on the benefits of each option and communicating that information to patients. In most instances, physicians will be the only people who patients are able to meet with on a face-to-face basis to discuss their Medicare choices.

It is important for Medi-Medi patients to understand that if they are not happy with their assigned choice, they will be able to change at any time during a month and their new choice will take effect on the first of the next month. They will not have to wait for an annual enrollment period to make a new choice.

Finally, providers are encouraged to sit down with all of their Medicare patients and help them choose the Part D drug plan that will work for them. To assist patients and providers in this regard, CMS has established a Web site that enables users to determine the drug plan(s) best suited to their individual needs. The Medicare Prescription Drug Plan Finder is at www.medicare.gov.

For more information, visit the CMS Web site at www.cms.hhs.gov.