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Tricare pay increase on its way, slowly

Tricare representatives reportedly kept their word to Whidbey General Hospital and drafted a rule recommending reimbursement rates increase to at least Medicare levels.

What the Department of Defense’s health care program envoys failed to mention in September was the protracted timeline gift-wrapped in enough bureaucratic red tape to completely cover a small planet.

“That was disappointing,” said Scott Rhine, Whidbey General chief executive officer, at Monday’s board meeting.

Tricare’s low reimbursements have created financial losses for the community hospital. A strongly-worded letter from the hospital was sent to Tricare in August, making clear the dire situation the reimbursement system had created. The possibility of not accepting Tricare in the future was mentioned, throwing a scare into Whidbey Island’s military community.

The hospital is currently reimbursed by Tricare 39 cents for each dollar for most services. Medicare reimburses 56 cents per dollar.

Good news arrived two months ago when a representative from Tricare Management Activity, which is responsible for managing the health care system, told Rhine that an evaluation would be conducted to investigate the reimbursement disparity.

Whidbey became a “critical access hospital” at the end of 2005, joining a group of approximately 1,200 other health care facilities in order to increase government-sponsored reimbursements. The designation specifically provides cost-based reimbursement for Medicare patients in smaller, rural hospitals. With Tricare, however, the move had the opposite effect because of a legislative oversight.

TriWest, the private sector contractor for the Defense Department that negotiates and arranges military health care contracts, assured the hospital in September a proposal would be drafted and presented to the Office of Management and Budget by Oct. 10.

“They drafted the proposed rule they said they would,” said Rhine with an inflection that promised less than auspicious news to follow.

The rule, once drafted, was forwarded as promised, but the road to the Office of Management and Budget is circuitous. The first step was to pass the document to Tricare Management Activities Office of General Counsel and then to Tricare Management Activities Operations, Rhine told the board. The general counsel will handle the proposal again in a final review.

The Tricare Management Activities deputy director next has his opportunity to spend quality time with the proposal, proceeding to pass it on to the Defense for Health Affairs assistant secretary who in turn hands it off to the Defense for Policy undersecretary. The well-worn document finally reaches the OMB. But wait, there’s more. If approved, the rule is printed in the Federal Register for final comment.

“And then they may or may not approve it,” Rhine said.

The timeframe, he added, is nine to 12 months.

Refusing to take the situation lying down, the hospital CEO said pressure needs to be continuously applied to legislators and Navy leadership.

“We need to organize,” he said. “It’s not just Whidbey General, it’s hospitals nationwide.”

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