Why changes to military insurance may affect all healthcare consumers in Kitsap
I hesitated to write this column because I am so angry. If you are a currently serving in the armed forces or have a family member serving our nation, after reading this column you might be angry too. Even if you have no military connection, yet live in Kitsap County, you will want to read about the changes to TRICARE health insurance because they could impact delivery of your healthcare services as well.
TRICARE is the insurance plan which covers healthcare for military personnel and their dependents. Regarding TRICARE, I am both a provider and a consumer. As a pediatrician, my clinic is contracted to provide medical services to children of military personnel. In addition, as the spouse of a retired Army Special Forces veteran, I rely on TRICARE health insurance to cover myself and my family.
TRICARE has provided good coverage for me and my family over the years, including specialty care when needed. However, as a physician, TRICARE leaves a little to be desired. Right now, TRICARE pays more than Medicaid but less than commercial insurance plans. Unfortunately, TRICARE drags their feet when paying for preventive health services, such as the administration of vaccinations to children. They don’t exactly refuse to pay for childhood shots outright... they just make it difficult, requiring three times the paperwork before coughing up a check. For instance, TRICARE attributes a “glitch in the system” as the reason they owe my practice more than $50,000 for services rendered more than three months ago. I cannot imagine how much they owe the clinics which are busier than mine.
The reason I am talking about the shortcomings of TRICARE insurance is that this week things got a little worse, which this community will feel very soon. The company overseeing TRICARE, Health Net Federal Services (HNFS), plans to slash payments to community practitioners by 15-25% as part of a six-phase payment reduction plan being rolled out over the next year. HNFS is currently in phase 3, so many clinics have not yet been notified. This sudden payment reduction will impact around 2,000 healthcare providers in Washington State, across all specialties (including primary care physicians).
Specifically, the clinics on the “list” are those who are reimbursed at 100% on the TRICARE payment scale. Never mind the fact that these clinics reached the maximum rate by providing high quality healthcare services for many years. Some clinics were informed directly by HFNS about the change, while others — such as mine — were not notified at all. When a member of my staff contacted TRICARE directly, they were unaware of any payment changes. After calling Health Net for two days, I learned that my clinic was on the list — exactly nine days before the April 1 deadline. The representative at Health Net Federal said, “We were planning on calling you soon.”
This change affects healthcare delivery in our community for a few reasons. Some clinics may close as a result of these proposed payments cuts, especially if serving a high number of patients on TRICARE. The primary care clinics will be hit hardest, including those providing rehabilitation services, such as speech, occupational and physical therapy. While clinics like mine will survive, we face the reality of not being able to accept new patients on TRICARE after the payment reduction. All ages of patients are being affected as well. Elderly patients have shared that their provider has stopped accepting TRICARE for Life, the comprehensive wrap-around Medicare coverage for TRICARE beneficiaries.
Research demonstrates that as access to primary care declines, emergency room and urgent care visits increase. Based on our experience last summer, it seems St. Michael Medical Center cannot meet the additional patient demand. Who could?
In the past, military families could receive care at Naval Hospital Bremerton when necessary. At one time, that facility had primary care and specialty clinics, an intensive care unit, labor and delivery floor, operating rooms, a 24-hour urgent care and an emergency room.
Today, there are fewer options for military families. Many of those service lines have been stripped bare or eliminated entirely. In 2014, Naval Hospital Bremerton’s emergency room reverted to a 24-hour urgent care. Then the urgent care cut back hours to 8 a.m. to 8 p.m. The ICU is gone. Last year, Naval Hospital Bremerton stopped delivering babies altogether. This week, three families told staff members that the primary care clinics at Naval Hospital Bremerton did not have room for new patients. Of course, the justification for cutting healthcare services at Naval Hospital Bremerton was that our community could provide the care the military could not.
What can be done? Most affected clinics have sent letters requesting their payments be maintained. I have done the same, and on Friday Health Net confirmed my rates will remain the same, for now. I've heard the same from at least one other provider. Health Net that has responded to some that their payment rate will remain unchanged, while others are still waiting. Every clinic matters in Kitsap County. And they need your help. Please contact your local, state, and federal lawmakers and let them know this payment reduction will cripple the delivery of healthcare services to military families. And every patient matters. If you are a service member or dependent of one, this directly affects your access to healthcare. Please contact Health Net Federal Services, your ombudsman and TRICARE insurance. Let them know how this payment reduction will affect you and your family.
The men and women serving and protecting our nation deserve to have high-quality healthcare for themselves and their loved ones. I am proud to provide some of that care as are many other local clinics and their owners. We are a community without a fully functioning military hospital. We are a community with a civilian hospital over capacity. And we are a community with a dwindling number of healthcare options for us all. Please do not let TRICARE (and Health Net Federal Services) put one more nail in our system's coffin.
Dr. Niran Al-Agba is a pediatrician in Silverdale and writes a regular opinion column for the Kitsap Sun. Contact her at niranalagba@gmail.com.
This article originally appeared on Kitsap Sun: TRICARE insurance changes could cripple Kitsap's healthcare system
