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1,500 TRICARE PATIENTS IN WASHINGTON GET TO
KEEP
THEIR DOCTORS -- But, proposed reductions in
Medicare
could still bring on the recently averted
disaster as
TRICARE payments are tied to Medicare.
Be sure to keep an eye on TRICARE /
Medicare stories.
If the proposed reimbursement rate cuts
go through the first of the year, many military members and veterans
could find themselves in a healthcare crunch.
Story here...
http://www.whidbeynewstimes.com/
portals-code/list.cgi?paper=8
4&cat=23&id=975699&more=
Story below:
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Tricare patients keep their docs
By Paul Boring
Successful contract negotiations at Whidbey Community Physicians will
make local Tricare patients breathe a sigh of relief.
An imminent crisis with the entire Medicare system, however, will take
that same breath away.
Whidbey Community Physicans, the largest primary care group on the
island, had watched the Tricare reimbursement rate drop to the point
where renewing the contract with the military health care system was not
an option. An announcement to that effect was made in March. Now the
situation has changed as a re-negotiated contract with TriWest
Healthcare Alliance, the privately held company contracted by the
Department of Defense to administer the Tricare program, has been
successful, at least in the interim.
“Whidbey Community Physicians was able to reach an agreement with
Triwest that will allow us to care for our valued Tricare patients,”
said Dr. Jerald Sanders, president of the group.
The agreement will not pad any of the physicians’ pockets, but it will
allow Tricare patients services for now. The three programs available
are Tricare Prime, Extra and Standard.
“The only thing that has any negotiation at all is with regard to
Tricare Prime,” Sanders said. “And all they can negotiate is a small
management fee in addition to the Medicare rates, but it doesn’t change
anything with our other Tricare.”
Primary care physicians are getting particularly shorted when patients
have Tricare as their secondary carrier. Two separate bills are
processed and the copayment is never charged, negating a system that was
put in place to emphasize at least a minimal level of financial
responsibility for the patient.
“I think if you eliminate that, you’ve negated the purpose of the copay,”
Sanders said. “People who still have Tricare as a secondary still exist.
We’re still in the same game with that. To a degree you can’t limit
those patients because of our obligations with other contracts.”
Tricare for Life, a Medicare supplement, is wholly unaffected by the
Tricare contract. Those folks were never in danger of losing coverage.
“Even if we had cancelled the contract with Tricare and Triwest, that
doesn’t change Tricare for Life,” Sanders clarified.
Approximately 1,500 Tricare patients rely on Whidbey Community
Physicians for medical help. Cutting off the group would have been
devastating to a significant portion of the local population.
Proposed reductions in Medicare could still bring on the recently
averted disaster. To shave dollars off the national deficit years ago,
Medicare was slated to be cut incrementally by 20 percent. Congress
overrode the reductions twice, but it could now be time to pay the
piper.
“Next January there is a 10 percent reduction in Medicare benefits
planned and a similar reduction in 2009,” Sanders said.
The impending crisis is Medicare as a whole, the doctor added. And
Tricare is along for the ride.
“A reduction in Medicare reimbursement directly translates to Tricare as
all reimbursement is locked into Medicare rates,” he said. “Should this
reduction be enacted, there is little chance that Whidbey Community
Physicians or any other providers will be able to continue Tricare
services.”
Staff at the Oak Harbor clinic have examined the problem from all
angles, trying to discern what, if any, solutions exist.
“What you do is you look at your worst paying contracts and determine if
you can afford keeping the contracts,” Sanders said. “And the worst
paying contracts turn out to be Medicaid, Tricare and Medicare. That’s
simple reality. Most practices are already limiting new Medicare
patients.”
The festering health care problem does not lend itself to easy remedies.
Generously insured politicians avoid the problem like the Bubonic
Plague.
“Medicare is facing financial disaster within the next few years, yet no
politician wants to tackle this gigantic problem,” Sanders said. “It’s
the elephant in the house that nobody politically wants to deal with.
Our senators and representatives, who have their own fully-funded health
care, must hear from their constituents if change is to occur.”
The doctor urged the public to formally express their concerns in
writing to senators and representatives.
“It is not inconceivable that the day could come when the doors are
locked,” Sanders said of the reimbursement reduction repercussions.
“Medical rates in general is an expensive game. But the whole process of
providing medical services is expensive. The attitude of most people is
that they’ve paid this much for insurance and they want anything they
want, when they want it and want it to be paid for. There’s a huge
collision coming.”
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Larry Scott --
