Capt Hank
02-04-2005, 15:25
** DoD Aims to Improve TRICARE Standard
Last year, Congress tasked the Pentagon to develop a plan to ensure that patients can find providers who are taking new patients, assist those who need help in finding a doctor, and survey locations to determine where there may be problems with having enough participating providers to meet beneficiary needs.
The Defense Department now has a provider directory for Standard users available on the TRICARE website at: www.tricare.osd.mil/standardprovider.
Each TRICARE region's Managed Care Support Contractor is required to provide assistance 24 hours a day, 7 days a week, to locate network providers within their regions for all TRICARE beneficiaries (including Standard). Those who need assistance in finding a TRICARE-participating doctor can call:
North Region: 877-874-2273
South Region: 800-444-5445
West Region: 888-874-9378
Perhaps most important, the FY 2004 Defense Authorization Act mandated that DoD conduct nationwide surveys to determine the numbers and proportions of providers, by region, who are accepting new TRICARE Standard patients. These surveys of civilian physicians also were intended to gain insight into the reasons why doctors choose to accept (or not accept) Standard. The surveys began in 2004 and will continue in at least 20 areas each year.
The results of the first 20 market area surveys can be viewed at: www.moaa.org/Legislative/TRICARESurvey.asp. Provider participation in TRICARE ranged from about 50% in Alaska and Bainbridge Island, WA to nearly 90% in Cheyenne, WY and Laurel, MS. Among doctors who wouldn't accept new TRICARE patients, the most frequently cited reasons were "reimbursement issues" (28%), "only take certain insurance" (19%), and "too busy" (18%).
One concern is that Office of Management and Budget officials refused defense health leaders' original request for a 12-question survey, limiting the survey to only three questions as to whether doctors were accepting any new patients; whether they were accepting any new TRICARE Standard patients; and if not, why not (with preset response options). With only this limited data, DoD officials were unable to determine, for example, whether "only take certain insurance" may mean the doctor works for an HMO that doesn't accept patients not enrolled in the HMO.
The limited survey provides significant information, but still leaves many questions open about providers' perceptions and misperceptions about TRICARE coverage, claims processing timeliness, and administrative issues. One important issue is development of a provider participation standard below which TRICARE officials must pursue active efforts to increase participation.
Last year, Congress tasked the Pentagon to develop a plan to ensure that patients can find providers who are taking new patients, assist those who need help in finding a doctor, and survey locations to determine where there may be problems with having enough participating providers to meet beneficiary needs.
The Defense Department now has a provider directory for Standard users available on the TRICARE website at: www.tricare.osd.mil/standardprovider.
Each TRICARE region's Managed Care Support Contractor is required to provide assistance 24 hours a day, 7 days a week, to locate network providers within their regions for all TRICARE beneficiaries (including Standard). Those who need assistance in finding a TRICARE-participating doctor can call:
North Region: 877-874-2273
South Region: 800-444-5445
West Region: 888-874-9378
Perhaps most important, the FY 2004 Defense Authorization Act mandated that DoD conduct nationwide surveys to determine the numbers and proportions of providers, by region, who are accepting new TRICARE Standard patients. These surveys of civilian physicians also were intended to gain insight into the reasons why doctors choose to accept (or not accept) Standard. The surveys began in 2004 and will continue in at least 20 areas each year.
The results of the first 20 market area surveys can be viewed at: www.moaa.org/Legislative/TRICARESurvey.asp. Provider participation in TRICARE ranged from about 50% in Alaska and Bainbridge Island, WA to nearly 90% in Cheyenne, WY and Laurel, MS. Among doctors who wouldn't accept new TRICARE patients, the most frequently cited reasons were "reimbursement issues" (28%), "only take certain insurance" (19%), and "too busy" (18%).
One concern is that Office of Management and Budget officials refused defense health leaders' original request for a 12-question survey, limiting the survey to only three questions as to whether doctors were accepting any new patients; whether they were accepting any new TRICARE Standard patients; and if not, why not (with preset response options). With only this limited data, DoD officials were unable to determine, for example, whether "only take certain insurance" may mean the doctor works for an HMO that doesn't accept patients not enrolled in the HMO.
The limited survey provides significant information, but still leaves many questions open about providers' perceptions and misperceptions about TRICARE coverage, claims processing timeliness, and administrative issues. One important issue is development of a provider participation standard below which TRICARE officials must pursue active efforts to increase participation.