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Tricare patients keep their docs

Successful contract negotiations at Whidbey Community Physicians will make local Tricare patients breathe a sigh of relief.

An imminent crisis with the entire Medicare system, however, will take that same breath away.

Whidbey Community Physicans, the largest primary care group on the island, had watched the Tricare reimbursement rate drop to the point where renewing the contract with the military health care system was not an option. An announcement to that effect was made in March. Now the situation has changed as a re-negotiated contract with TriWest Healthcare Alliance, the privately held company contracted by the Department of Defense to administer the Tricare program, has been successful, at least in the interim.

“Whidbey Community Physicians was able to reach an agreement with Triwest that will allow us to care for our valued Tricare patients,” said Dr. Jerald Sanders, president of the group.

The agreement will not pad any of the physicians’ pockets, but it will allow Tricare patients services for now. The three programs available are Tricare Prime, Extra and Standard.

“The only thing that has any negotiation at all is with regard to Tricare Prime,” Sanders said. “And all they can negotiate is a small management fee in addition to the Medicare rates, but it doesn’t change anything with our other Tricare.”

Primary care physicians are getting particularly shorted when patients have Tricare as their secondary carrier. Two separate bills are processed and the copayment is never charged, negating a system that was put in place to emphasize at least a minimal level of financial responsibility for the patient.

“I think if you eliminate that, you’ve negated the purpose of the copay,” Sanders said. “People who still have Tricare as a secondary still exist. We’re still in the same game with that. To a degree you can’t limit those patients because of our obligations with other contracts.”

Tricare for Life, a Medicare supplement, is wholly unaffected by the Tricare contract. Those folks were never in danger of losing coverage.

“Even if we had cancelled the contract with Tricare and Triwest, that doesn’t change Tricare for Life,” Sanders clarified.

Approximately 1,500 Tricare patients rely on Whidbey Community Physicians for medical help. Cutting off the group would have been devastating to a significant portion of the local population.

Proposed reductions in Medicare could still bring on the recently averted disaster. To shave dollars off the national deficit years ago, Medicare was slated to be cut incrementally by 20 percent. Congress overrode the reductions twice, but it could now be time to pay the piper.

“Next January there is a 10 percent reduction in Medicare benefits planned and a similar reduction in 2009,” Sanders said.

The impending crisis is Medicare as a whole, the doctor added. And Tricare is along for the ride.

“A reduction in Medicare reimbursement directly translates to Tricare as all reimbursement is locked into Medicare rates,” he said. “Should this reduction be enacted, there is little chance that Whidbey Community Physicians or any other providers will be able to continue Tricare services.”

Staff at the Oak Harbor clinic have examined the problem from all angles, trying to discern what, if any, solutions exist.

“What you do is you look at your worst paying contracts and determine if you can afford keeping the contracts,” Sanders said. “And the worst paying contracts turn out to be Medicaid, Tricare and Medicare. That’s simple reality. Most practices are already limiting new Medicare patients.”

The festering health care problem does not lend itself to easy remedies. Generously insured politicians avoid the problem like the Bubonic Plague.

“Medicare is facing financial disaster within the next few years, yet no politician wants to tackle this gigantic problem,” Sanders said. “It’s the elephant in the house that nobody politically wants to deal with. Our senators and representatives, who have their own fully-funded health care, must hear from their constituents if change is to occur.”

The doctor urged the public to formally express their concerns in writing to senators and representatives.

“It is not inconceivable that the day could come when the doors are locked,” Sanders said of the reimbursement reduction repercussions. “Medical rates in general is an expensive game. But the whole process of providing medical services is expensive. The attitude of most people is that they’ve paid this much for insurance and they want anything they want, when they want it and want it to be paid for. There’s a huge collision coming.”

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