Oft-criticized agency fields drug queries


For years, workers at the Centers for Medicare and Medicaid Services in Woodlawn toiled in relative obscurity, politely correcting people who confused their employer with the other - much larger - federal agency down the street, Social Security.

Then the president put their agency in charge of offering prescription drug coverage to 43 million seniors within two years. And these once-faceless bureaucrats found themselves in the spotlight, with the answers everyone wants. "The dean at my cathedral has asked me to organize a seminar," marveled Robert E. Adams, 54, director of the Medicare agency's community outreach division and a member of Baltimore's Episcopal Cathedral of the Incarnation.

Rochel Schnur's 6-year-old son thinks his mom works directly for President Bush; he's not the only one who thinks she has the inside track: Her mother-in-law called last week to ask whether the president would extend the May 15 deadline to enroll in the program.

"One of my co-workers is planning to fly down to Florida to help her grandmother and her friends figure out what plans they need," said Schnur, a 29-year-old lawyer already working on the 2007 version of the drug program.

The agency's 1-800-Medicare call centers - 23 of them around the country - are fielding about a million calls per week, said Neal Denion, who oversees them.

It's all coordinated from the agency's 3,100-worker headquarters in Woodlawn, a secluded compound behind a black fence at the very end of Security Boulevard and one of Baltimore County's largest employers.

The entrance to the 10-year-old building is adorned with a silver, 15-foot-wide Health and Human Services seal. Workers zip through a vaulted lobby that features terrazzo floors and columns wrapped in cherry and maple wood veneer.

The building's work space, on the other hand, is bureaucratic standard issue. Employees find each others' cubicles using a six-character desk-numbering system.

The parking lot is so full that late-arrivers often must tail people walking to their cars. Contractors' offices have cropped up around the campus, as they do around military bases.

Security is tight. The parking lot guards require visitors to lift car hoods and open glove compartments for inspection.

The agency, which changed its name from the Health Care Financing Administration four years ago, moves about $502 billion in health care payments each year for the poor, elderly and disabled.

Harry S. Truman was the first president to champion the idea, creating a commission on the nation's health needs and repeatedly calling on Congress to act. It took two decades of debate over "socialized medicine" to win a far more limited program as part of Lyndon Baines Johnson's "Great Society." But Truman was pleased - he and his wife were Medicare's first enrollees.

Over time, however, the agency became the subject of harsh criticism for poor management and endless red tape. In 2002, doctors operated under 110,000 pages of Medicare regulations. It was an agency that Capitol Hill loved to hate - costly, complex and far from the Washington Beltway - and many thought the employees weren't up to the task of managing the new drug benefit program.

The workers have refuted those predictions.

"CMS has met the main implementation deadlines, and I guess I would say that whether you are a fan of this law or you don't like this law at all, it's been a pretty amazing performance by health care's most-maligned bureaucracy," said Drew Altman, president of the Kaiser Family Foundation.

First, the agency got authority to bypass many of the regulatory tangles that complicate federal hiring. The effort has drawn bright, young employees from the private sector. Congress also gave the agency more money to run the program.

But outsiders say the key to the program's success has been the agency's outreach to states, grassroots groups and individuals. In a series of conference rooms on the fifth floor, experts meet daily via video and teleconference systems. Hundreds of people listen in on the calls. Feedback is instantaneous.

"That our deadlines have been met is not an accident," said Abby Block, one of CMS' highest-ranking executives, who splits her time between Baltimore and the agency's Washington offices. "I was in Baltimore yesterday, and I left at 8 p.m., and there were still cars in the parking lot."

Stories of worker dedication abound.

Erin Pressley, 34, edited one of the 52 versions of the Medicare & You booklet while in labor with her third child. Employees send messages over BlackBerrys until 2 a.m. or 3 a.m. Many say their spouses or relatives complain about their hours.

"My parents still have that stereotype that when you work for the government, you don't really work," said Zabeen Chong, 29, the agency's Webmaster - and consistently the last person to pick up her child from day care. "They once said to me, `They're making you work weekends? Don't you work for the government?'"

Attorney Helaine I. Fingold, 41, left the agency a decade ago for a Washington law firm. Her most recent job was at the Nemours Foundation in Newark, Del. She returned to the government with the goal of shortening her days. It didn't work.

"I merely exchanged my commuting time for work time," Fingold said. "I would certainly say the agency's workload seems to have tripled since I left."


For expanded coverage of the Medicare changes, and to ask questions about this article, go to baltimoresun.com/medicare.

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