Friday, March 25, 2016

TOP STORY >> Military patients booted off rolls

Leader staff writer

“I pretty much feel like a second-class citizen now,” says a retired master sergeant, one of 1,400 area military-connected families who have had their primary care taken from them and wholesale transferred to either a quick care facility or to a nearly full base clinic.

The air base says it is prepared to take on the extra load.

The sergeant says, in 21 years of service, he “did what I was asked to do and went where I was told and the government does this.”

The “this” was revealed in a letter military members, retirees and families received from either the Jacksonville Medical Clinic or Cabot Medical Group saying that those two facilities would no longer be able to accept TriCare Prime patients.

The reason? TriCare officials wanted the two clinics to accept reimbursement for service 15 percent under what Medicaid pays.

That meant it cost more to care for the TriCare patients than the clinics were going to get paid.

“We were given 24 hours to accept the new deal from Humana, which manages TriCare. We argued to release the patients slowly to provide smoother care, but Humana said, once you are out of the network, no patients can be seen,” explained Jonathan Foster, manager of the Jacksonville Medical Care clinic.

“When did our health care become a negotiable item?” asked a retired Air Force technical sergeant. “This will affect a lot of people. I know change is hard, but this is a change that shouldn’t be happening.”

Foster said many of the patients had been with the clinic since 1998 when the last contract was signed. “We’ve been paid those rates ever since.”

That contract was actually signed with North Metro Hospital and the clinic had privileges with hospital so was able to treat the military-related patients under the contract. But the clinic gave up those privileges last year because of problems with the hospital management team and treatment of the clinic doctors.

The contract issues also have affected Cabot Medical Group clinic.

In a letter to the affected patients and on the Jacksonville clinic’s web page, Foster stated, “We regret to inform you that as of March 2nd, 2016 we are no longer a network provider with TriCare. We apologize for the short notice but Humana Military only gave us 24 hours notice. We have spent the last couple of months working really hard to negotiate a direct contract with TriCare. It has been a difficult decision for us to make but TriCare would not work with us.”

The statement continued, “We agreed to take a rate reduction, on what is already one of the lowest reimbursing insurances, we contacted our Congressmen and spoke to multiple people at Humana Military-TriCare about the effects this would have on our community, to no avail. We care deeply for our TriCare patients and we love serving you; however TriCare is demanding that we accept fees that are below our cost. We will continue to work to resolve this issue.”

In an interview with the Leader, Foster reiterated,”They were trying to make some pretty big cuts to our reimbursements that actually pushed our reimbursements below what it costs us to take care of patients, so we couldn’t accept those terms. We agreed to take a little bit of a cut, in the interest of keeping patient’s continuity care going, but we ultimately can’t take reimbursements that’s below what it costs us to take care of the patients.”

The two Air Force veterans, along with many other patients are not upset with the clinics or the new places they must go, but are upset with TriCare. “I fault TriCare more than anything,” said the technical sergeant.

“I get a card in the mail saying my new primary care manager is Arkansas Quick Care and that they will be accepting me as a patient March 25. But the clinic stopped accepting TriCare March 2. I called TriCare and asked what I needed to do between those two date and the response was ‘just call us if something happens.’”

Neither of the two military retirees has a problem with Dr. Terry Peery, the one and only doctor at Quick Care who now has 700 new patients. “We had an open house meeting there and he seems nice but its not the same as going to the doctor we’ve had for 13 years,”said the technical sergeant.

“The past couple of weeks, we have absorbed 700 new patients into our on-base clinic and our clinic is really going to continue that highest quality care they can for every individual who walks through that door,” said 2nd Lt. Margaret Kealy, spokesman for Little Rock Air Force Base.

Kealy added that the hospital clinic, part of the 19th Medical Group,is now at maximum capacity with a total of 14,700 patient.

The two military veterans and others have had meetings with U.S. Rep. French Hill, U.S. Sen. Tom Cotton, and U.S. Rep. Rick Crawford, all with no luck.

“Hill’s people seemed concerned, but no one else did,” the master sergeant said, adding that Crawford’s office said the military insurance provider did nothing wrong.

Foster said he and others from the clinic met Wednesday with Boozman and representatives from the other legislators’ offices. “They are looking at what can be done in the short term to help these military patients. But for long term it is a systemic problem that will have to be resolved at the national level,” he explained.

“These patients are friends, family and some have been with us for 25 years We hate it. But we can’t operate on a contract that would cause us to close our doors,” Foster said, adding that most of the released patients that he has talked o understand. “Our goal is to make sure they get the best care possible. We worry about patients falling through the cracks during the switch over.”

TriCare Prime is a managed health care option available to active duty service members and their families; retired service members and their families; activated Guard/Reserve members and their families; non-activated Guard/Reserve members and their families who qualify for care under the Transitional Assistance Management Program; retired Guard/Reserve members (age 60 and receiving retired pay) and their families; Medal of Honor recipients and their families and others who qualify

Those in the program have an assigned primary care manager (PCM) who provides most of the care and is the one to make any referrals to specialists.

The contract only affects those patients under TriCare Prime. Both the Jacksonville and Cabot clinic can and are still seeing patients who have TriCare for Life,TriCare Standard or other TriCare insurance.