WASHINGTON — Military beneficiary groups and physician groups are watching closely how Medicare rates will fare under the deal on the debt ceiling that was agreed upon by Congress last month. Because TRICARE rates are generally set at those for Medicare, any changes to those rates could impact TRICARE reimbursement rates for civilian providers who treat beneficiaries.

“This has been an ongoing debacle with Medicare fees, and the can just keeps getting kicked down the road. Because, if there is a lowering in the Medicare fee payments, then of course TRICARE payments are tied to that. … A lot of doctors have quotas of how many Medicare patients they will take or TRICARE patients they will take. ... If those Medicare payments are lowered, then chances are we will have fewer doctors that will be a part of a TRICARE network,” Kathleen Moakler, director of government relations at the National Military Family Association, told U.S. Medicine.

The debt deal calls for nearly $1 trillion in spending cuts. Further steps in the process include a 12-member congressional “supercommittee” that must further identify $1.5 trillion in reductions by Nov. 23 and a vote on that plan by Congress on or before Dec. 23. Physician groups hope this is an opportunity for the committee to “fix” the sustainable growth rate (SGR) formula on which Medicare fees are based, but there is no guarantee of what the supercommittee will decide to do.

Medicare fees could also be vulnerable if Congress cannot come to an agreement on the overall plan crafted by the supercommittee by Dec 23. If that happens, then $1.2 trillion in automatic spending cuts are triggered – 50% from defense spending and 50% from domestic spending, which likely will involve Medicare payments to providers.

If the worst happens and fewer providers agree to accept TRICARE because of reduced fees tied to Medicare, there is some recourse, Kevin Dwyer, deputy chief for public affairs for TRICARE Communications and Customer Service, told U.S. Medicine.

“The law currently permits TRICARE to make exceptions, if necessary, to Medicare’s rates. In cases of demonstrated network inadequacy, to ensure an adequate network of providers or to eliminate a situation of severely impaired access to care, TRICARE may negotiate higher rates for our providers,” he said in a written statement.