Tricare Access

A GAO report published in June, prior to the debt-ceiling agreement, pointed out that concern about reimbursement rates is the primary reason civilian providers will not accept Tricare Standard and Extra beneficiaries as patients.

In that report, an analysis of access to civilian providers under TRICARE Standard and Extra,  GAO reviewed and analyzed TRICARE Management Activity (TMA) and TRICARE contractor data and documents. GAO also interviewed TMA officials, including those in its regional offices, as well as contractors.

According to the report, from fiscal year 2006 to 2009, 44,000 additional civilian providers (network and non-network) accepted TRICARE. However, the report also pointed out the implication of reduced Medicare rates for civilian providers.

“Concerns about TRICARE’s reimbursement rates — which generally mirror the Medicare program’s physician fee schedule — have increased by the uncertainty surrounding the annual update to these Medicare fees,” the report stated. “All of the contractors expressed concerns about the proposed decreases to Medicare rates and how that would affect providers’ acceptance of TRICARE patients. One contractor told us that providers already were expressing concerns about the Medicare rate decreases and that some providers said they would no longer accept TRICARE beneficiaries as patients if the rates were reduced.”

Medicare physician payment rates are already set to be cut by nearly 30% in 2012 due to the SGR formula, although Congress has usually intervened to prevent drastic cuts such as that.

Peter W. Carmel, MD, AMA president, told U.S. Medicine in a written statement that addressing the Medicare physician payment formula is the “fiscally responsible action’ that the supercommittee needs to take.

“The fiscally responsible action for the congressional debt committee is to repeal the Medicare physician payment formula that threatens TRICARE and Medicare patients and physicians,” he said. “The cost of a permanent solution to this broken system has already increased dramatically due to repeated short-term fixes and will rise to $500 billion in only a few years if Congress does not change course. The committee’s deadline comes just before a 30% cut is scheduled to occur on January 1, providing a critical opportunity to protect access to health care for seniors and military families.”

Still, if automatic cuts are instituted, Medicaid, and Social Security and Medicare beneficiaries would be exempt from the cuts, but providers would not. “Medicare cuts would be capped, limited to the provider side,” a White House summary of the debt deal stated.