Federal Daily News
Tricare has few options for increasing access to civilian providers
Tricare Management Activity is severely limited in what it can do to expand beneficiaries' access to civilian health care providers, according to a report from the Government Accountability Office.
Providers are generally leery of accepting Tricare patients because of the Tricare fee structure. Providers’ concern about Tricare’s reimbursement rates — which generally are set at Medicare rates — continues as a long-standing issue, according to the report, released June 2. The fee schedule has more recently been cited as the primary reason civilian providers will not accept Tricare Standard and Extra beneficiaries as patients, according to TMA’s surveys of civilian providers.
Although TMA can increase reimbursement rates in certain instances, such as when it determines that access to care is being affected by the level of reimbursement, such increases do not address the systemic problems presented by the fee schedule, GAO said. Also affecting health care delivery is the shortage of certain provider specialties, such as mental health care providers, at the national and local levels. Because these shortages are not specific to the Tricare program, there are limitations as to what TMA can do to address them.
In addition to national shortages, Tricare beneficiaries’ access also may be impeded in certain locations where there are insufficient numbers and types of civilian providers to cover the local demand. For example, in Tricare’s West region, a prime service area in northern California had provider shortages in 21 different provider specialties, including allergists, obstetricians, psychologists and psychiatrists.
“TMA has attempted to address civilian provider shortages,” the report said. “One step TMA has taken is the adoption of a bonus payment system that mirrors the one used by Medicare for certain provider shortage areas.”