Posted on 01/07/2017 7:47:16 AM PST by SandRat
The National Defense Authorization Act (S 2943) signed into law Dec. 23 orders an avalanche of changes to the TRICARE health care benefit used by service members, retirees and their families. It also makes sweeping reforms to how the military direct-care system is organized and operates.
The sheer number of changes and additional studies being mandated, filling 40 sections and 150 pages of the Act, is more impressive than any short list of highlights we might be able to review here.
“There’s a lot of good stuff in there. There’s a lot of stuff we’re still puzzling over,” said Dr. Karen S. Guice, acting assistant secretary of defense for health affairs. She will serve in that post only two more weeks, until the Trump administration assumes responsibility for the $50-billion-a-year military healthcare system and a beneficiary population of 9.6 million.
The authorization act for fiscal 2017 “is full of ideas, concepts and new things for us to tackle,” said Guice in phone interview. She added that it contains “a remarkable series of provisions that set forth some challenges [and] provides us with new authorities that we’re greatly looking forward to.”
But Guice emphasized many new provisions to modernize TRICARE and improve access will only accelerate reforms that the department already has been piloting or planning to adopt, though perhaps not at the speed Congress desired. The department’s guide has been recommendations of the 2014 Military Healthcare System Review, which then-Defense Secretary Chuck Hagel ordered to take a hard look at performance and outcomes at military facilities and through civilian purchased care networks, Guice said.
Beneficiaries have started to see the fruits of that effort in greater access to care and a nurse advice line. They will see more when the new generation of TRICARE purchased care contracts takes effect this year, and also with gradual rollout of MHS Genesis, the new electronic health records system. All this before many of the new defense bill initiatives kick in in 2018 and years beyond. Associations advocating for beneficiaries wonder how many changes the health system can implement before chaos rules.
Guice doesn’t sound worried for the staff she’s leaving behind.
“We have a lot of very experienced, motivated people who just like to tackle challenges,” she said. “Also, we are looking at this across the enterprise so it’s the Army, Navy, Air Force all coming together about how we actually do this.”
The Senate version of the defense bill had called for dismantling the medical headquarters of the Army, Navy and Air Force surgeons general. The enacted law is a compromise that directs a shift of key management functions done by the services to the Defense Health Agency, leaving the surgeons general to recruit, educate and train their military and civilian health care providers and to advise DHA on medical readiness issues.
“That’s an interesting construct,” said Guice. “And we’re kind of figuring out how best to optimize what Congress is intending to achieve.”
Congress staggered deadlines in the law across a span of years.
“They knew there was a lot of work here and allowed flexibility by pushing out some timelines or saying do this work and then the timeline kicks in,” Guice said. “I think they want us to take our time and get it right.”
There are gems in the law for families seeking more timely care.
One provision ends a requirement that TRICARE Prime users get referrals from primary care providers before using a neighborhood urgent care facility. Another provision mandates that military treatment facilities with urgent care clinics keep them open daily until at least 11 p.m.
Those “are both wins for families,” said Brooke Goldberg, deputy director of government relations for family issues at Military Officers Association of America. Other law highlights she noted require:
• Adoption of a standardized appointment scheduling system across all of military healthcare and also first-call resolution of appointments.
• New TRICARE contracts incentives to improve beneficiary access, care outcomes and enhanced beneficiary experiences.
• Adoption of new productivity standards for care providers in military treatment facilities, which should mean more on-base appointments.
• Military providers’ performance reports to include measures of accountability for patient access, quality of care, outcomes and safety.
Military families will be eligible by 2018 to buy vision coverage through federal employee health programs, explained Karen Ruediseuli, government relations deputy director for National Military Family Association. Retirees and dependents will be eligible for both dental and vision programs.
Some changes touted by Congress as not quite what they seem. For example, the planned narrowing of three insurance options – TRICARE Prime, Standard and Extra – down to two, with Prime still providing managed care and TRICARE “Select” offering a preferred provider network, is largely a name change push by DoD. Goldberg said it could even be “transparent to families who really don’t know the nuances of Standard vs. Extra.”
Many beneficiaries, she added, “just know they have to pay more if they see one [civilian] provider over another. Many have been using Extra, calling it Standard and not realizing it.”
Still to be determined “is what the preferred-provider network will look like and will families be able to easily discern which services will result in higher costs? And will they have access to providers who are low-cost?”
For example, current TRICARE provider networks include those who participate in Prime and agree to take a discount from the normal Medicare-based payment. But many providers willing to see Standard patients for its allowable fee will not see Prime patients with its lower fee.
“Will those providers be considered preferred providers under TRICARE Select, or will the Select network only include those who participate as part of the Prime network? If the former is true, then the transition likely will be smooth. If the latter is true, many more people could be hit with out-of-network charges, to the extent they aren’t grandfathered,” said Goldberg.
Adding some confusion is language that grandfathers current generations of military families and retirees from a new schedule of higher fees to hit those who enter service on or after Jan 1, 2018. But the law will require current beneficiaries to enroll in Select, as they do with Prime, and enrollment will carry a fee for retirees under age 65, beginning in 2020, if a government audit confirms improvements in quality care and patient access.
Guice took exception to one senator’s characterization of the new law as a “first step in the evolution” of military health care from “an under-performing, disjointed health system into a high-performing, integrated” one.
She noted a recent National Academy of Medicine study on military trauma care that found that over a decade of war the U.S. military had made unprecedented gains in survivability rates from battlefield wounds.
“I don’t think that’s reflective of an underperforming system at all,” Guice said. “The people who created that learning system of care are the same people who provide the in-garrison care. That is evidence we really do value constant performance improvement.”
To comment, write Military Update, P.O. Box 231111, Centreville, VA, 20120 or email milupdate@aol.com or twitter: @Military_Update.
All I see is “ bla bla bla”
and all I exoect from “ reform” is its going to cost me more and limit choices
Yep, and I don’t see Tricare Life mentioned which partners with Medicare.
Nor all the restrictions that come with both. If it smacks of cosmetic even for a medical reason you are denied. I have Peripheral Neuropathy, while both cover the doc and meds, they don’t cover the orthotics or shoes and both are very costly. I’m not a DIABETIC, if I were It would all be covered. Neurologist says PN is PN regardless of the cause.
I have medically created vision issues that will require Lasix to fix, I’ve reached a point glasses will no longer work. Yet it is a Cosmetic issue according to Tricare/Meicare. BTW they caused the medical issue. Same as they did the PN. And the hearing loss, I paid for my hearing aids, and my glasses and refraction’s yearly. And I don’t wear cheap box store glasses. Zeiss are the best, in plastic. My bifocal now reads backwards. It minimizes print instead of magnifying it. Cataract implants are the prime cause of seeing at 2 different focal lengths and 2 different strengths with astigmatism, I didn’t have before, with Dry Eye Syndrome. Once in over 6 months cataract implants can’t be replaced.
I’m just a dependent, not even my husband who was 20 yr career Navy would get any different care.
I consider myself somewhat intelligent and all I saw was blah, blah, blah too. I love how Tricare has worked for me. I hope they do not screw it up. I have the Standard because Prime is limiting and not as good of coverage.
Me, too, I’m very happy with Standard. I hope they don’t muck it up.
I retired a couple years ago, signed up for Tricare Prime. A few months later we took a close look at Tricare Standard and made the switch.
We live the choice we now have and will never go back. The out of pocket expenses we have had to pay over the past couple years have not even approached the annual enrollment fee.
I’ve been retired for over 20 years and have Tricare and Tricare prime. In those 20 years I have not received any statements about how much they have paid for my medical bills. I have BCBS as my primary, so maybe they are paying the whole thing.
Why haven't you been getting mail statements? I've been retired and on Tricare Prime for over 25 years. I get a statement for every office visit and every instance of a prescription fill for both myself and my wife. On every statement has the entire, highly detailed breakdown. I'd be contacting my primary and get that fixed.
You should be receiving EOBs from BCBS showing what they paid and the adjustments. Being retired military, maybe you have 100% coverage. I have a deductible and pay for my coverage but, it is really reasonable. I had 2 surgeries in 2016 and thank God I have Tricare.
I get a billing statement from BCBS for office visits. They state how much BCBS paid minus the $10 copay. On the paper work there is a field for “Other Insurance” which is always $0.00. Maybe the health care provider does not send the bill to my secondary insurance Tricare Prime.
“Adoption of new productivity standards for care providers in military treatment facilities, which should mean more on-base appointments.”
Translation: The doctors are going to be urged to see more patients each shift, so will be rushed. Visits will be shorter and the doctor won’t be allowed to go into greater detail with the patient’s issues. Cattle call.
All of these restrictions on what is covered buf if a trannie wants a cutadickoffame it’s covered
My spouse lost his hearing from years of working in and close to the flight line ( not considered service connected ) and those hearing aids run about $6k - he got lasix years ago and have to say it was worth it!
I’ve been watching the You Tube vids, what I see is for astigmatism correction. Not seeing at 2 distances, 2 strengths and astigmatism. All courtesy of Cataract implants done years apart. Option 1 have implants replaced, Not feasible, option 2 low vision magnifying junk, already use that stuff, doesn’t work. Option 3 Lasix, which means more Dry Eye Syndrome. The cataract implants cause enough of that. Eyes burn even when closed to the point of pain.
I don’t see why it is considered a cosmetic issue when it is a medical issue. Glasses no longer work. And I’m at the point I can only blow up a computer screen so far and the words are still blurry. Driving is a big issue. If my husband didn’t take me to doc appointments I’d not be able to go. And his vision is worse than mine. He has holes in his retinas (cleaning chems from the Navy) and glaucoma and just getting over a partial cornea transplant. His hearing loss is jet engine noise, so is covered under disability. I have cheap $3,400 hearing aids vs his $6K ones that disability provides.
I didn’t cause my hearing loss, bad surgery did. Then they wonder why I loath and don’t trust doctors.
You really need to talk with an insurance professional, because your situation sounds like you are paying way too much money for health insurance.
BCBS as a prime is fine; especially if they pay everything but the copay. You are paying over %500 a year for Tricare Prime. You don’t break even until you have gone to the doctor/hospital for 50 visits - 50 copays! Unless there is another cost that BCBS isn’t covering!
I have Tricare Prime and a supplemental insurance; along with a slew of family health problems including cancer (my spouse). My health insurance cost doesn’t come close to my total medical bills had I not been insured. For me, it’s a good deal.
Gail, scanning the article, I don’t see any mention of TFL. However, I know I’ve just seen something regarding TFL. It might have been in the retiree newsletter I just received.
I’m pretty sure this set of revisions doesn’t affect TFL for those of us who are already retired.
You’re absolutely right re: seeing more patients. R.W. Bliss kicked my family out 10 years ago and I’ve not been back. Have no intention of going back. My doctor downtown is a godsend and I don’t pay anything out-of-pocket.
Hear, hear!
Please do not make me pay more. I’m poor enough as it is, and had to give half my retirement pay to my ex-wife.
Thank you Pat Schroeder. Bi-tch.
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