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Military losing support since Tricare refusal

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Posted: Sunday, April 10, 2005 12:00 pm | Updated: 3:14 pm, Wed Aug 15, 2012.

By Sarah Chacko

Killeen Daily Herald

Barbara Brown is concerned that the military is losing medical support in the area.

Her concern is in response to a recent decision by Kings Daughters Clinic to no longer take Tricare patients, as of April 1.

Tricare, a Defense Department uniform health benefit option program, is a regional managed-care program that was established to bring together the health care delivery systems of each of the military services.

Since the news, Brown and her husband, both retired military living in Temple, have been assigned to a doctor in Belton who has privileges at Hillcrest Baptist Medical Center in Waco.

With all the medical facilities in Temple, Brown said, the change is unconscionable.

To me it feels like the entire medical community in Temple has turned their back on the military community, she said.

A handout from Kings Daughters Clinic to its Tricare patients stated that the clinic has seen an increase of more than 50 percent in its Tricare volume over the last two years and cannot continue to exclusively bear this load.

The notice stated that the clinic has urged the government to increase the number of physicians at Fort Hoods Darnall Army Community Hospital and add more community physicians to its provider network.

Due to the financial burden associated with taking Tricare assignment, Kings Daughters Clinic cannot continue to service the growing population of Tricare and maintain good stewardship to the other patients we serve, the handout stated.

Tricare patients scheduled after April 1 could continue with the clinic under their self-pay program.

Kristi Glover, CEO of Kings Daughters Clinics, said Tricare patient demand is much higher than the patient load from other programs, like Medicaid.

Medicaid also doesnt have the hoops that Tricare has regarding paperwork and permission, and the health care system just cant seem to keep up cost-wise with the private sector, she said.

Its a federal problem, honestly, Glover said. I think its going to take federal changes.

Brown sought the help of U.S. Rep. John Carter in resolving the situation.

Carter made a governmental inquiry and received a response from Cindy Petrous, a representative from Humana Military Healthcare Services, the DoD contractor for the Tricare South Region.

Petrous letter stated that Tricare is governed and monitored by DoD and has stringent management and administration guidelines to which HMHS must adhere.

Only Congress can make changes in the program.

Payments made to network providers for medical services rendered to Tricare beneficiaries are not to exceed 100 percent of the Tricare Maximum Allowable Charge.

The TMAC is determined by DoD through a national survey of prevailing charges with adjustments made for specific locations similar to the way Medicare establishes rates.

The allowable charge represents the maximum amount Tricare will pay for medical and surgical services rendered to Tricare beneficiaries. Generally, Tricare network providers agree to accept a discount from TMAC.

Since HMHS became the new managed-care support contractor for Texas on Nov. 1, 2004, it had to negotiate new contracts with each provider.

It is our understanding that the contract between Kings Daughters Clinic and Health Net Federal Services, the prior contractor for the former Region 6, contained a discount from the TMAC, Petrous response stated.

HMHS initially offered a contract with a lesser discount, which the clinic refused.

HMHS then offered 100 percent of TMAC, the most that can be offered under contract with DoD, which Kings Daughters also refused.

HMHS has begun negotiations with other area network providers to accept the Tricare beneficiaries currently assigned to the clinic as new patients and is also open to contracting with the Kings Daughters physicians on an individual basis if the groups leadership will allow.

Brown, who has been a patient at Kings Daughters Clinic since November 2003, said once she found a doctor she could trust, the move will be very difficult.

Though the drive to Belton for regular visits wont be too bad, any specialty care will have to be done in Waco.

There are people here that are elderly, people here that are disabled, pregnant women and some may not even have transportation to Belton, much less Waco, Brown said.

Tricare Service Center Manager Gordon Plumlee said when Kings Daughters withdrew its contract, Tricare moved the beneficiaries to other network providers in their area, not back to Darnall.

Due to the limited amount of specialty care in the area, some moves were a little less convenient than beneficiaries may have expected, but Plumlee said overall, beneficiaries have been cooperative.

Nobody is denied care, he said. Thats whats most important.

Brown also sought help from Scott & White Memorial Hospital in Temple.

President and CEO Dr. Alfred B. Knight responded that the hospital understood her concern and has long wanted a contract but has been unable to accommodate Tricares reimbursement schedule.

While both Scott & White and Kings Daughters hospitals in Temple only take Tricare patients through authorized referrals, Plumlee said that is a relatively easy process.

With a large number of returning soldiers and the anticipation of 5,000 more troops with families, medical options are becoming slim.

Plumlee said he expects that hospitals like Darnall are taking appropriate action to prepare for the influx but believes that the incoming patients will be absorbed through the network.

Theyll get the care theyre looking for, he said.

Metroplex Hospital Executive Director of Human Relations Doug Bendall said its too soon to tell if the hospital will see an influx of Tricare patients.

I assume there will be more just because theyll still have to go some place, but its not likely to overburden us by any means, he said.

Emergency room visits involving Tricare patients over the last year have increased quite a bit, but Bendall said its hard to attribute that to anything specific.

At Metroplex, physicians have their own practices but have privileges at the hospital.

Bendall said private-practice physicians with their own clinics will probably be the first to see results.

Dr. Dave Webster, who works with Metroplex, said that since the Kings Daughters announcement, his new patient counts have been up about 25 percent.

The increase has already started to impact his staff and the amount of patients he can see on a daily basis.

Its stretching all of us, Webster said.

Of the 2,000 to 3,000 patients believed to be involved in the change, Webster said the whole medical community will be affected.

Aside from the access of care issues physicians and patients will have to face, Webster said there is also an economic problem.

At some point in time, it will negatively impact our profit margin to see this many Tricare patients, he said.

Because Tricare is not comparable to market forces, if Websters Tricare patients which account for about 30 percent of his business were to become more than 50 percent, he would have to close his doors.

While Brown said there is little she can do personally aside from talking to legislative officials, calling clinic directors and writing letters to anyone who might help she is determined to be a strong voice for the militarys medical needs.

I just keep reaching that brick wall that I cant seem to get over, she said. Ill just have to go along with the program until something happens.

Contact Sarah Chacko at schacko@kdhnews.com

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