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FED UP WITH BUREAUCRACY, A FAMILY DOCTOR GIVES UP ON

TRICARE -- Even the most basic services required special approval

because so few doctors or hospitals were on the approved list.

For more about TRICARE, use the VA Watchdog search engine...click here...
http://www.yourvabenefits.org/sessearch.php?q=tricare&op=and

Story here... http://online.wsj.com/article/SB121019218456174647.html?mod=WSJBlog

Story below:

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THE DOCTOR'S OFFICE

By BENJAMIN BREWER, M.D.

Hassles Force a Retreat From Military Families

After four years of providing care to military personnel, their families and retirees, I've had it.

The hassles of working with the Tricare program that covers health care for these people got the better of me. I've taken care of about 80 Tricare patients. But I won't be seeing them anymore. I pulled out of the Tricare network of civilian doctors in January.

I was one of a few physicians in the area to participate in Tricare. Patients sometimes came as far as 50 miles, bypassing several large hospitals and hundreds of other doctors who weren't in the network, to be seen in my small-town clinic.

The patients were sicker than average. They had a lot of chronic medical problems, and many needed referrals for specialty care. That care was hard to come by because the list of available specialists in Tricare was mighty thin.

Early on I began to understand what a tough job treating Tricare patients was going to be.

One woman needed a colorectal surgeon because she had a fistula, an abnormal connection between her bowels and uterus. The specialized surgeons in our region weren't in the network, and the closest Tricare doctors who could help were in Indiana. She traveled out of state to get her problem fixed.

When she had complications following her operation, I ended up managing her surgical skin infection because the surgeon was three hours away. Everything about her case required special arrangements -- emails to Tricare, faxes to Tricare, and my nurse holding on the phone to Tricare.

Even the most basic services like arranging a foot exam for a diabetic patient or finding an X-ray facility to do a mammogram required special approval because so few doctors or hospitals were on the approved list.

One patient had a car wreck with a head injury requiring care by multiple doctors and therapists, and multiple referrals for everything. He lived an hour away and he saw me three times total. Still, for more than a year my staff worked about an hour a week on referrals for him and on coordinating his follow-up care. We didn't get paid for the effort.

Two other patients had high-risk pregnancies, and I couldn't get Tricare to approve ultrasounds for them. There were no high-risk obstetrics specialists in the local network and no easy access to an endocrinologist for one of the pregnant women, who was also a brittle diabetic.

The nearest services I could arrange for her were an hour away from her home, and she didn't keep many appointments. She would show up in the ER with her blood sugar out of control or in insulin shock. Her baby died before birth.

A spokeswoman for Health Net Federal Services, which administers Tricare in my area, said the network of participating doctors around here meets the program's standard for adequacy. She acknowledged there could be bottlenecks, especially for specialists, but said those may be eased when a big clinic in Champaign, Ill., becomes accredited for Tricare. That's expected in June, she said.

Still, that clinic is about 50 miles from my main office and doesn't strike me as being enough to solve the shortage of participating doctors around here.

All in all, the Tricare patients were appreciative mostly. Some became irritated at the system not giving them what they wanted or not getting to it fast enough. My nurse bore the brunt of their frustrations when things didn't go as expected.

The Health Net spokeswoman acknowledged that my aggravation about paperwork and hassles wasn't just my imagination. As a government program, Tricare has to have a lot of processes in place to provide checks and balances on the care provided, she said.

Even so, I found Tricare was three times the work of any other health plan we've worked with, including Medicare and Medicaid. When I was the doctor for the Vigo County Jail in Terre Haute, Ind., it was easier to get the prisoners care than it has been to get some Tricare patients treated.

For patients who live closer to a military base with a lot of doctors, Tricare may work better than in Central Illinois. But it seemed that nearly everything a patient needed outside of my office required some type of permission from a clerk. It would have been easier to send Tricare patients to the ER and avoid the paperwork, but I didn't do that.

In 2006, the American Academy of Family Physicians asked doctors like me to support Tricare and our military families, even if it meant a headache or a financial loss. I agreed to take part; there are plenty of good military people putting their lives on the line for us around the world, after all.

As I look back, the baby's death bothered me more than anything else. Maybe things would have been different if the mother had more support and access to the care she needed from the beginning of her pregnancy.

I felt isolated and ineffective navigating the roadblocks in the Tricare system just to get basic care for her and my other patients. It seemed too often that I was doctoring with one hand tied behind my back.

Due to his schedule and the volume of email he receives, Dr. Brewer may not be able to respond to all reader email. He does participate in his forum, where readers are urged to post. His email address is thedoctorsoffice@wsj.com.

-------------------------

posted by Larry Scott
Founder and Editor
VA Watchdog dot Org

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