My native language is Swedish which is a pitch-accent language. Even though there are homonyms in the Swedish language where the pitch-accent determine the meaning there’s no problem understanding foreigners. It just sound like they have a particularly noticeable accent. Japanese probably have more homonyms due to using less phonemes but I’m sure Japanese people are quite good at distinguishing what you’re trying to say none-the-less.
About studying it I can hear the differences in pitch accent but It’s still a lot of work and practice to remember the correct pronunciation of words, especially when they modify the pitch of the next particle 
During reviews I’m actively listening for it and trying to repeat the correct pronunciation. Still I’ve been told a lot that my pitch-accent is funny, japanese is truly humbling.