On October 19, the House Armed Services Subcommittee on Military Personnel heard testimony on the defense health care programs, including TRICARE, the military’s health care plan.
Chair John McHugh (R-NY) said that the Department of Defense faces the challenge of providing “the highest quality of care in an environment where health care costs are rising dramatically,” and stated his concern that “the administrative requirements of TRICARE may be reducing the availability of TRICARE providers or inhibiting providers from participating.”
Affirming that “military health care is an integral function of military readiness,” Rep. Vic Snyder (D-AR), an M.D., said he had received “numerous” complaints from physicians regarding TRICARE, ranging from “onerous bureaucratic requirements to being told they could not participate because there were already enough providers in that field.” Rep. Snyder added, “It is my hope that we can begin to address the administrative requirements at today’s hearing…I hope that managed care support contractors will fix this problem immediately, and allow all qualified doctors to participate in the TRICARE program.”
Health Net Federal Services, Inc. President James Woys stated that Health Net is the “managed care support contractor for the TRICARE North Region” and asserted, “Health Net is constantly making provisions to ensure [that] access to healthcare is available.” Mr. Woys described the Domestic Abuse Victim Agency, which was created by Health Net in 2004 to support victims of domestic violence and sexual assault. The program has placed advocates at 45 stateside military installations to increase support for domestic violence and sexual assault victims across the four services; the Air Force has asked for victim advocacy coverage at an additional 24 bases. Mr. Woys explained that advocacy support includes “safety planning, evaluation of the victim and their family’s needs, accompaniment to medical appointments and law enforcement agencies, and ongoing support as needed to ensure the victim has the opportunity to use all available resources.” In August 2005, he said, Health Net advocates assisted 317 newly reporting victims.
Holly Puritz of Mid-Atlantic Women’s Care said that her practice, established in 1997 as a result of the merger of eleven independent ob-gyn practices, pulled out of TRICARE in March 2005 due to “quality of care concerns, administrative hassles far worse than any other third-party payer, and low reimbursement.” According to Ms. Puritz, although “private insurers and Medicaid recognize that a morphology ultrasound of an OB patient at 20 weeks gestation is appropriate and clinically useful,” Health Net informed Mid-Atlantic Women’s Care this year that an ultrasound could only be covered “if there is a TRICARE-authorized medical indication.” She labeled Health Net’s policy “a breach in standard of care” and said that her practice had covered the cost of the ultrasound for their patients. Ms. Puritz also complained that the TRICARE provider for maternal-fetal medicine referrals, Portsmouth Naval Hospital, was inefficient. “We have had high-risk pregnant women wait up to four weeks for a diabetic consult. One of my partners spent five hours of her own time trying to get her pregnant diabetic patient seen at the Navy Hospital when her sugars were dangerously high. She finally sent the patient, chart in hand, to Labor and Delivery so that someone at the Hospital would take ownership for this woman’s care,” she said, adding, “These barriers to care are not acceptable.” In addition to administrative problems, Ms. Puritz cited “woefully inadequate” low reimbursement as another reason for leaving TRICARE, noting that “TRICARE pays $1,537.10 for nine months of obstetrical care and delivery, compared to a commercial payment of $2,281.39.”
