"Privatizing" VA Health Care? = Equals LESS care!

[DMZ-LT]

" We watched out for each other in VietNam I can see no reason to quite once we are home"

[Andy]

Now this is just the thing that breaks my heart. While on the mountain I really wanted a 2 hour block of instruction regarding VA hospitals in an eyeball to eyeball format. Well, maybe next year.

I?d say we are a capitalist nation so everyone should have a choice but the only truly capitalist professions we have left are lawyers and hookers. If you guys have an epiphany on the mount, let me know.

Stay healthy,
Andy

[DMZ-LT]

I think I had one last night with fries and a large coke.

[SuperScout]

As a military retiree, I'm not stuck in some mythical and evil HMO, but have been able to select my own primary care provider (PCP) from a very long list of exceptionally qualified doctors. And I don't have to wait in line at some VA clinic to be treated by some doctor with questionable credentials, who is invariably different from the doctor that I saw the month before. If I need a referral to a specialist, usually a very brief office visit (at the princely sum of $12.00), or sometimes even a telephone call, and shazamm, I have the requested referral.

Of the four VA hospitals or clinics that I've seen in a non-patient status, none of them was user-friendly, all of them were questionable from a sanitary prospective.

Humana is the service provider for TriCare, and for the princely sum of $460 per year for my bride and I, excellent care is provided by my PCP and by specialists when needed. That is an obscenely low premium, when compared to the civilian rate structure. If they make billions fromthe government administering TriCare, I'm sure they will have earned every dollar. I for one to not begrudge the capitalist system for companies making a profit.

And why should duplication of facilities and services be embraced as some sort of medical panacea? If a rural community already has a clinic, and it is already staffed by competent physicians, why should the taxpayers be stuck with the VA building ANOTHER clinic, and importing VA doctors? Is the rural veteran going to receive better care? Probably not. Is the taxpayer going to stuck with more costs? Probably yes.

I volunteer to drive disabled veterans from Wimberley, a small town south of my home, to Temple, about 80 north, just so that GI Joe Vet can receive care. There are scores of more qualified doctors and other care providers within a radius of 50 miles from his home that could provide better care at a fraction of the cost. It is a waste of time, gasoline, and money, while exposing the veteran and the driver to the perils of driving on IH 35.

[Rebelwitho]

One of the biggest problem that the V.A. has is the Director of the medical center has all the power. He/She can run ut the way he'she see fit, thats why some V.A.'s are better than other.

[Gimpy]

you go again Superfella.

Attempting to undermine the 'facts' with a simplistic and evidently biased "personal" opinion rather than the overwhelming proof to the contrary of your 'opinion'.

Let's see what the EXPERTS have to say about your "position", OK?



----START----



STATEMENT OF THE MILITARY COALITION

on

TRICARE CONCERNS


provided to the

HOUSE NATIONAL SECURITY COMMITTEE

SUBCOMMITTEE ON MILITARY PERSONNEL


Presented by
Sydney Hickey
National Military Family Association

And


CDR Virginia Torsch, MSC, USNR
The Retired Officers Association


On behalf of The Military Coalition, we would like to express appreciation to the Chairman and distinguished members of the House National Security Committee's Subcommittee on Military Personnel for holding these important hearings. This testimony provides the collective views of the following military and veterans organizations which represent approximately 5 million members of the seven uniformed services, officer and enlisted, active, reserve, veterans and retired plus their families and survivors.

Air Force Association
Army Aviation Association of America
Association of the United States Army
Chief Warrant Officer and Warrant Officer Association,
United States Coast Guard
Commissioned Officers Association of the United States
Public Health Service, Inc.
Enlisted Association of the National Guard of the United States
Fleet Reserve Association
Gold Star Wives of America, Inc.
Jewish War Veterans of the United States of America
Marine Corps League
Marine Corps Reserve Officers Association
National Military Family Association
National Order of Battlefield Commissions
Naval Enlisted Reserve Association
Navy League of the United States
Naval Reserve Association
Reserve Officers Association
The Military Chaplains Association of the United States of America
The Retired Enlisted Association
The Retired Officers Association
United Armed Forces Association
United States Army Warrant Officers Association
United States Coast Guard Chief Petty Officers Association
Veterans of Foreign Wars

INTRODUCTION


The Military Coalition (TMC) has been privileged to observe the design and implementation of Tricare from a front row seat over the last few years. The Coalition was delighted to have the opportunity to participate in the development of the Tricare benefit package and to provide extensive comments on the Tricare rules and regulations. Open dialogue between the Office of the Assistant Secretary of Defense for Health Affairs (OASD/HA) and the Coalition has allowed actual beneficiary experience to be part of the daily evaluation of the program as Tricare has been implemented throughout the country. The Coalition is very committed to making Tricare a better health care plan for all participants and has been working vigorously with DoD and Congress to remedy some of the problems with the program, even as it pursues other more comprehensive fixes to the military medical care system.

Having said that, it is important to note that despite the progress in fixing some of the problems with Tricare, to be addressed shortly, there are still significant issues that need to be resolved. These issues include a lack of a uniform health care benefit, low reimbursement levels, slow claims processing and others to be detailed later.


CONCERNS THAT REMAIN:

Although great strides have been made by DoD and Congress in fixing some of the more egregious problems with Tricare, the Coalition remains concerned about problems we noted last year that still have not been addressed. For example:


TRICARE STILL DOES NOT PROVIDE A UNIFORM HEALTH CARE BENEFIT .


For now, Tricare Senior will only benefit those Medicare-eligible beneficiaries residing in the catchment areas of major MTFs: Thus Medicare subvention through Tricare Senior will only benefit at most 30-40% of the Medicare-eligible uniformed services beneficiaries.

Tricare does not help Medicare-eligible beneficiaries residing overseas. These individuals are in a Catch-22 situation. They cannot enroll in Tricare Prime because they are no longer eligible for CHAMPUS and they cannot use Medicare because that program does not operate in foreign countries. Their only alternative is to rely on space available care in the military hospitals which is becoming increasingly difficult to find since many overseas medical facilities have been closed. Unfortunately, Medicare subvention will not help these beneficiaries.

In addition to the problems faced by Medicare-eligible retirees overseas, the Coalition is also concerned by the delay in allowing former CHAMPUS-eligible retirees to enroll in Tricare Prime overseas. The Coalition urges this Committee to direct DoD Health Affairs to expedite the enrollment of these individuals.

Tricare Prime enrollees who do not reside in a catchment area and are unable to enroll with a military primary care manager (PCM) have a different Prime benefit than those enrollees residing in catchment areas who have a military PCM. This situation has been further exacerbated by the alternative financing method which will be implemented in Tricare Regions 1, 2 and 5. Tricare Prime enrollees in noncatchment areas are assigned to civilian PCMs and receive most of their care in the civilian Prime network with copayments for all visits and services, while enrollees in catchment areas have a greater chance of being assigned to a military PCMs and receiving care in MTFs with no copayments. The alternative financing method further encourages a military commander to ensure that his Prime enrollees (those assigned to a PCM in his facility) receive first priority for care in his MTF since he now assumes financial risk for these Prime enrollees. This incentive could potentially lock out any Prime enrollee with a civilian PCM from receiving care in the MTF. The Coalition is concerned that the alternative financing method considerably worsens the lack of a uniform health care benefit, by effectively creating two distinct Tricare Prime plans - an MTF Prime, where enrollees receive most of their treatment in MTFs with no co-payments; and a civilian Prime, where enrollees receive their care through civilian providers with the requisite copayments.

Although the Defense Authorization Act included report language expressing concern over the alternative financing method and requesting DoD to only test this method in only two Tricare regions before extending it throughout the rest of the country, the final Authorization Act did not address this issue. The Coalition urges this Committee to evaluate the alternative financing methodology to determine its impact on the uniformity of the Tricare Prime benefit before allowing DoD Health Affairs to expand this methodology to the rest of the Tricare regions. The Coalition also requests the Committee's assistance in ensuring that Prime enrollees in noncatchment areas have the same equal opportunity for care in an MTF as a Prime enrollee in a catchment area with a military PCM.


TRICARE PRIME PROBLEMS :


Access standards for Tricare Prime are still not being met in most Regions. The Coalition continues to document numerous instances in most Tricare Regions where access standards for time and for distance have not been met. A GAO report on Tricare noted that DoD did not have a system for tracking access data. The GAO report stressed that such a system was extremely important for measuring how well Tricare is meeting this key performance goal. Recent briefings from DoD officials on their new quality assurance and utilization management contracts have not reassured the Coalition that DoD will measure access data through this new contract. The Coalition requests this Committee to direct DoD to establish a method of tracking access data as recommended by GAO. The Coalition also requests DoD be directed to give immediate attention to all reports of access problems.

Tricare Prime enrollees are still occasionally charged Tricare Standard fees by some civilian health care providers such as anesthesiologist and pathologists . These providers are not part of the Tricare Prime network, but are sometimes part of the health care team at a civilian hospital that is part of the Tricare Prime network . Tricare Prime enrollees should not be subjected to these "hidden" fees. If an enrollee receives care from a civilian hospital that is part of the Tricare Prime network, the enrollee should pay only the Tricare Prime co-payment per day and no more.


Tricare managed care contractors have acknowledged the problem and for the most part have tried to ensure that all those who deliver care to Prime enrollees participate in the Prime network. The Coalition still believes, however, that DoD Health Affairs should revise its regulations to stipulate that if an enrollee receives care from a civilian hospital that is part of the Tricare Prime network, the enrollee will only be subjected to the Tricare Prime co-payment per day.

Tricare Prime enrollees are still occasionally being referred to non-network providers, thus invoking point of service charges which include their deductible and a 50% copay. The point of service charges have also been applied when a Prime enrollee has been seen by a network provider who happens to be on call that day, but is not the enrollee's primary care manager, even though the enrollee did not request to be seen by that provider.

DoD and the contractors have acknowledged the problem and have made great progress in correcting it. However, the Coalition believes a more permanent solution would be to have a Tricare Prime enrollee sign a form that he or she is knowingly choosing to exercise the point of service option and realizes the higher copayments and deductibles he or she will incur. This will eliminate situations where the Tricare Prime primary care manager mistakenly refers the enrollee to a non-network provider.


Tricare Prime enrollees are paying the lion's share of the cost of mental health services. The Coalition was appalled to learn that Prime enrollees are paying 44 % - 55% of the allowed amount for mental health outpatient visits in some Tricare Regions. Exhibit A is a copy of a provider's explanation of benefits. On pages one and two are the reimbursement rates for active duty and retired Prime enrollees. The total allowed amount for the visit is $45. Tricare pays $25 of that for an active duty Prime enrollee, and the enrollee pays the rest ($20). For a retired Prime enrollee, Tricare pays only $20 and the retiree must pay $25. Pages three and four show the provider's reimbursement and beneficiary copayment for a Tricare Standard beneficiary. Note the provider receives $102 per visit and the active duty beneficiary pays $15.30 per visit and the retiree $20.40 per visit. The copayments under Tricare Standard for both active duty and retired beneficiaries are less than under Tricare Prime!

The Coalition urgently requests that this Committee investigate how prevalent this disparity in payment is for other areas of the country, and for other services. The Coalition does not believe it is the intent of Congress that Prime enrollees be paying almost half of the cost of mental health care.


DoD has not established an effective Ombudsman Program in every Tricare Region. The Coalition has received numerous complaints that beneficiaries are having a difficult time getting through to the Tricare Service Center or Health Benefits Advisor to get questions answered about Tricare benefits, or to resolve Tricare Standard ( old CHAMPUS) claims. Frequently, beneficiaries become so frustrated they call various Coalition associations in desperation because they feel they have no other place to go to get their questions answered . The Coalition strongly recommends that DoD be directed to establish an Ombudsman office staffed by independent parties (not DoD or the managed care contractor) in every Tricare region to serve as the advocate for the beneficiary.

Tricare Managed Care Support contractors are still not notified of Congressionally mandated changes in CHAMPUS benefits and policy in a timely manner. This is a particular problem with Tricare Prime portability. The Tricare Support Office has provided dates for full portability in its News Releases, yet Tricare managed care support contractors seem unaware of this information. Although the lines of communication have improved, it is clear more work needs to be done.

Improve quality control oversight of Tricare managed care support contracts, to include better monitoring of patient satisfaction, assessment of clinical outcomes, oversight of provider networks, and adherence to access standards in addition to utilization management. The Coalition remains concerned that DoD continues to focus on utilization management as the mainstay of its quality control program, while overlooking other equally important measures of quality such as adherence to access standards, patient satisfaction and most importantly, clinical outcomes. The Coalition urges this Committee to continue to closely evaluate DoD's progress in implementing a more complete quality control program.

The Coalition continues to hear about problems with Tricare Prime network providers. Directories of Prime providers are still not accurate - the provider either does not accept Prime patients (and never did), or has closed his practice to new Prime patients; the offices of some network providers are located in undesirable, and even unsafe, parts of town; and there have been reports of a dearth of Prime providers, especially specialists.


The Coalition is particularly concerned even though standard (old CHAMPUS) rates are the same as Medicare for most health care services, most of the Tricare managed care support contractors have negotiated Tricare Prime reimbursement rates with network providers that are even lower than Medicare. Although providers are not happy with the discounted rates, most providers have accepted them. However, in the last few years, some major provider groups have dropped out of Tricare Prime (including a 250-member provider group in Colorado and the entire provider network of the Medical University of South Carolina), and we are concerned this trend may accelerate. The Coalition urges this Committee to take immediate steps to increase the reimbursement rates for Prime providers in order to attract and retain quality health care providers.


PROBLEMS WITH TRICARE STANDARD (CHAMPUS ):


Tricare Standard (old CHAMPUS) reimbursement levels are still much too low to attract quality health care providers. There are also unreasonable delays in reimbursement for Tricare Standard (old CHAMPUS) claims. The Coalition has continuously expressed its concern over the low CHAMPUS reimbursement rates. Beneficiaries have reported that in the more rural areas, (and increasingly even in urban areas), where providers do not depend on a military patient base, health care providers have become increasingly unwilling to accept Tricare Standard (old CHAMPUS) patients at all. (Ain't that what we're talking about here?????----Gimp)


It is difficult to estimate the impact of the lower rates on access to care. Although the Secretary of Defense has the authority to waive the old CHAMPUS Maximum Allowable Charge (CMAC) if it is affecting access, the Tricare Support Office (TSO) has never requested such a waiver, claiming it has never adequately documented access problems. However, this is akin to a self-fulfilling prophecy because the TSO only reviews claims where the only data provided are from those physicians or other health care providers who are willing to accept Tricare Standard reimbursement levels . The TSO does not document how far the beneficiary may have had to drive to find a provider, how many times he was turned away before he was able to find a provider; or what rates are charged by providers who refuse to accept Tricare Standard.


The problem goes beyond mere anecdotal information. Last year the Board of Directors of the American Medical Association contemplated a resolution stating that since TRICARE STANDARD reimbursement rates were too low, DoD should first raise the CMAC to at least the Medicare level, and second, as a long term answer, turn Tricare into a program similar to the Federal Employees Health Benefit Program. Although the AMA has since backed off its position, it still remains concerned about the TRICARE STANDARD program.


The low reimbursement rates are just part of the problem. By themselves, low rates may not be a deterrent to care. However, low rates combined with the "hassle" factor in filing claims and delays in reimbursements have proven to be too much in some cases for health care providers who now simply refuse to accept TRICARE STANDARD patients at all. The Coalition has also received numerous complaints from its members who when filing their own TRICARE STANDARD claims, had to resubmit the claim two or three times before receiving payment.

Although the Defense Authorization Act has a provision directing DoD to make TRICARE STANDARD reimbursement rates more consistent with Medicare, the Coalition has heard that DoD is delaying implementation of this provision. The Coalition would like a definitive date as to when DoD is going to increase substandard TRICARE STANDARD rates to the level of Medicare.

Another significant problem that must be addressed is the delays in reimbursements. The Coalition urges this Committee to exert pressure on DoD to simplify the claim form and exercise greater oversight to significantly reduce unwarranted delays in reimbursements.

The enforcement of the 115% billing limit in cases of third party insurance, has resulted in loss of reimbursement to beneficiaries. In the last few years, DoD's policy of employing the 115% limit in the case of third party reimbursement had the effect of shifting TRICARE STANDARD payment approach from "coordination of benefits" to "benefits less benefits." Before the 115% limit was enforced, a third party insurer would pay first, then TRICARE STANDARD would pay the balance up to what TRICARE would have paid had it been first payer. Now that the 115% limit has gone into effect, TRICARE STANDARD will not pay anything if the third party insurer paid an amount in excess of the 115% billing limit. So if a third party insurer would pay 80% of a physician's bill of $500 (or $400), but TRICARE STANDARD would only have paid 115% of its maximum allowable charge of $300 (or $345), TRICARE STANDARD will pay nothing toward the balance of $100 that the patient must pay. Whereas under the previous "coordination of benefits" method, CHAMPUS would have paid the difference as long as it did not exceed the amount payable under CHAMPUS. We have repeatedly expressed our concern that the shift in policy unfairly penalizes beneficiaries with other health insurance plans.


TRICARE STANDARD reimbursement amounts have been steadily decreasing over the years , and almost all other civilian insurance plans are more generous than TRICARE STANDARD in their payments to providers.

The Defense Authorization Act contained report language that urged DoD to enforce a requirement that health care providers charge TRICARE STANDARD beneficiaries no more than 115% of old CMAC rate, or that TRICARE STANDARD continue to pay for health care services when paying as second payer to other health insurance under DoD's previous policy. Unfortunately this committee report was not addressed in the final Act. The Coalition urges this Committee to revisit this issue in the previous years Defense Authorization Act and include statutory language to re-establish "coordination of benefits" as the DoD payment methodology.

The Tricare Standard catastrophic cap out of pockets is still too high for retirees , which is much higher than other civilian fee-for-service plans which traditionally set limits between $2,000 and $3,000. The Coalition strongly recommends this cap be reduced.

Beneficiaries who choose Tricare Standard still have to obtain non-availability statements from the MTF before seeking inpatient care from civilian providers. While the Coalition recognizes that DoD is trying maximize savings in Tricare by encouraging the use of military providers, beneficiaries who incur the higher costs associated with Standard do so because they either want complete freedom of choice of providers or cannot get into Tricare Prime. The Coalition strongly recommends that all NAS requirements be eliminated for Tricare Standard.


OTHER CONCERNS :


Before the Coalition concludes its testimony, it would like to briefly mention two other concerns that are closely related to the Tricare program. First, the almost 400% increase in premiums recently for the Continuing Health Benefits Program essentially leaves military beneficiaries without an affordable COBRA benefit. The Coalition strongly recommends the premiums for CHBP be reduced to a more affordable level for uniformed services beneficiaries leaving military service.


CONCLUSION:


In conclusion, The Military Coalition is cognizant that many of the initial problems with Tricare (especially the Prime program) resulted from growing pains as Tricare was implemented throughout the country. This Committee has been instrumental in attemting to help slove these problems and some have been resolved or at least ameliorated, and the Coalition would like to express its deepest appreciation for the Committee's role.

Nevertheless, Tricare remains seriously flawed in that it does not provide a uniform health care benefit for all military beneficiaries. This fundamental flaw must be remedied through Congressional action as soon as possible. The Coalition is also very concerned about the increasing difficulty that both the Prime and Standard programs seem to be having with locating and retaining quality health care providers. (Once again.........ain't this what we're talking about???---Gimp) The Coalition urges this Committee to take immediate measures to strengthen both the Tricare Prime and Standard (old CHAMPUS) options so that Tricare becomes a viable health care benefit.


----END----

It appears your 'contemporaries' are in strong disagreement with your position, huh Superfella???


It also appears your 'slip' of prejudice and bias is 'showing' once again!


Just asking.


PS------------I just got this in my E-mail this morning. Seems that "ridiculously low cost TRICARE" plan of yours is subject to some hefty increases if this administrations DoD has their way..........

*******

Dear Supporter,

The Department of Defense has been considering plans to double or even triple health care fees for military retirees - which could mean an increase in cost of up to $1,000 annually for some vets . You can take action on this issue today. In less than 3 minutes you can support a new, bipartisan bill that will protect Veterans from dramatic increases in health care costs.


Senator Frank R. Lautenberg (D-NJ) and Senator Chuck Hagel (R-NE) have introduced legislation to limits increases to TRICARE military health insurance premiums, deductibles, and co-payments. Senators John Kerry (D-MA), Robert Menendez (D-NJ), Blanche Lincoln (D-AR), and Mike DeWine (R-OH) are cosponsors of the bill.


Tell your Senator to support the Lautenberg-Hagel Military Retirees' Health Care Protection Act.


Just as American Troops have protected us, it's our responsibility to take care of them when their service ends. Click here to take action now.

Thanks again for your support.

Sincerely,
Paul Rieckhoff
Executive Director
IAVA (Iraq and Afganistan Veterans of America)

*******

[Arrow]

Most contributors to this thread have heard me say this before; I've seen the best and the worst of VA health care in four different regions of the country. (I'm in agreement with Reb on those VA Hospital Administrators)Even though the worse made me fighting mad I'm really really concerned about privatising the VA.

We need to remember the resources the VA has available to themfor research and treatment ofcombat related injurysuch as spinal cord injury, (SCI) traumatic brain injury (TBI) from bomb blast, andpost-traumatic stress disorder (PTSD).The medical community outside the VA just can not touch the resources of the United States Government for ongoing research and treatment of combat related injuries.

On a personal level I have seen the camaraderie that takes place in VA hospitals between brothers and sisters thatare in dire straights. Yes, there is a lot of bitchin' and moanin' but they also know that they have clout to get something done if push comes to shove. It may come in the form of one mad mama, wife, son or daughter raisin' hell with the hospital administrator, then on to the congressional reps but sustained rapid fire will get results.

I have a very strong opinion abouta government that has the money to make war and put the best of every generation in harms way. We are under moral obligation to be willing to spend whatever it takes to put the survivors of that war, shot to hell as they may be, on a path of recovery to a life that will allow them to live as well and as comfortably as is reasonable to expectconsidering the injuries they have sustained.

Some things to be considered: (click on link)

US Medicine

US Medicine

VA Testimony

Spinal Cord Injury Awareness

[Gimpy]

Extremely important and relevant 'considerations' these are Arrow.

Thank you for your continued efforts to educate and inform those among us who may be unaware or unwilling to understand the facts and importance of this issue.

[Arrow]

Originally posted by Gimpy Extremely important and relevant 'considerations' these are Arrow.

Thank you for your continued efforts to educate and inform those among us who may be unaware or unwilling to understand the facts and importance of this issue.

Steve,

My post was more about presenting some considerations that were being left out of the discussion. I sure didn't mean to come across as giving a lecture or give the impression that others opinions are not as informed or educated as my own.

Privatisingveterans health care is as germane to the discussion as anything that I presented. It's no good at all to have all the latest treatment programs and walk into a filthy hospital ran by an administrator who's disdain for our veterans has infected his staff. Ireally understandwhy many veterans that have encountered these circumstances believe the only solution for VA hospitals is to shut 'em down.

Thanks forlistening...

Arrow>>>>>>>

[Gimpy]

Originally posted by Arrow

Steve,

My post was more about presenting some considerations that were being left out of the discussion. I sure didn't mean to come across as giving a lecture or give the impression that others opinions are not as informed or educated as my own.

Privatisingveterans health care is as germane to the discussion as anything that I presented. It's no good at all to have all the latest treatment programs and walk into a filthy hospital ran by an administrator who's disdain for our veterans has infected his staff. Ireally understandwhy many veterans that have encountered these circumstances believe the only solution for VA hospitals is to shut 'em down.

Thanks forlistening...

Arrow>>>>>>>

Arrow,

My comments were not intended to indicate you were giving us a "lecture". Nor give the impression that your opinion was intended to seem more educated or more important than others in the sense of its' clarity' and purpose.

I do believe however that "privatising" VA health care because there may be 'isolated' cases of VA administrators who fail the "system" is kinda like executing the entire family of a career criminal because of one individuals misdeeds.

I do agree that many veterans may feel as you have described with regards to cases of those who "walk into a filthy hospital ran by an administrator who's disdain for our veterans has infected his staff."............

I also believe that it's discussions like this, that provide the necessary and factual information from folks like you and me and others who KNOW that these isolated incidents are in the minority. NOT the majority, and will also help disuade and prevent this type of improper "chracterization" of the entire system being diseminated within the veteran population.


Thanks again,