I want you: But Not Your Kids, Familes, or Pets…….. (TRICARE families report worse access to care than commercially insured, uninsured)

“Families who are covered through TRICARE report worse access to healthcare than people with private plans—and even the uninsured, according to a new study (1).”

Alright, alright, maybe adding the pets to the title was pushing it, but it’s meant to be sarcastic anyway. Deplorable, despicable, unthinkable. But the title isn’t exactly the whole picture of the study. The study itself (2) reports on barriers to care and not willful neglect or access shortcomings:

“Children in military families, who receive health insurance through the TRICARE program, face barriers to care such as frequent relocations, unique behavioral health needs, increased complex health care needs, and lack of accessible specialty care (2).”

            Having been a Soldier in the Army, it’s the barriers that limit access, not the actual Tri-Care itself. Other people may have different experiences, but after 25 in the Army, with 3 kids, our needs were always met. I am but one beneficiary. The study professed that how TRICARE-insured families perceive health care access and quality for their children compared to their civilian peers’ perceptions remains unknown. The study reported:

“Military families whose children had complex health or behavioral health care needs reported worse health care access and quality than similar nonmilitary families (2).

            I can’t argue with the perceptions of the families reporting. But the title of the article seems to sensationalize the plight of military families. The data points of (a) complex health, and (b) behavioral health needs is a far cry from the global insinuation of the title “TRICARE families report worse access to care.” The article says “The purpose of this paper is really to highlight where there is a need and hope that those who are in a position to act upon and make the changes dive more into this area.” It’s not to bash Tri-Care as if Tricare itself sucks. Are there gaps? Sure there are as with everything, nothing is perfect, but the study concludes with a reasonable statement:

“Addressing these gaps may require military leaders to examine barriers to achieving acceptable health care access across military treatment facilities and off-base nonmilitary specialty providers, particularly for children with complex health or behavioral health needs (2).”

            The article did summarize a good point:

“Solutions that could be considered, according to the study, include reducing the administrative steps needed to allow families to seek care off-base, more effectively monitoring how resources within military medical facilities are deployed and identifying where there are the most notable geographic access gaps (1).”

But hey…….. Let’s fill those gaps

REFERENCES

1. https://www.fiercehealthcare.com/payer/tricare-families-report-worse-access-than-commercially-insured-uninsured

2. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2019.00274

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Robert Duprey MD

Robert P. Duprey Jr studied medicine as a 2nd career medical student who went to medical school in his 40’s after honorable discharge and ‘retirement’ from 25 years in the US Military (USCG & US Army). He was a registered nurse (RN) with specialty training as a psychiatric RN in the US Army for 15 years. During this time he also became a Master’s level psychotherapist in 2002. While on US Army active duty he also became a Psychiatric Nurse Practitioner while working full time in 2011. He served as a Psych NP on active duty, to include a combat tour in Iraq, until his ‘retirement’ in 2014 and moved to Philippines with his 3 children. At this time he started medical school overseas at Oceania University of Medicine based out of Samoa accredited by Philippine Accrediting Association of Schools, Colleges and Universities (PAASCU). He continued to work as a Psych NP throughout medical school to support his children and to not have to take out loans for medical school tuition. Originally from Rhode Island, he completed medical school clerkship rotations throughout the USA with a graduation in May 2019 earning the esteemed credential of MD. He has successfully completed USMLE Steps 1, 2CS, and 2CK. He will take Step 3 this September as he applies for Psychiatry Residency. Having been and RN, NP and now MD, he is a believer of Physician led multidisciplinary healthcare teams 

  6 comments for “I want you: But Not Your Kids, Familes, or Pets…….. (TRICARE families report worse access to care than commercially insured, uninsured)

  1. Steve O'
    August 19, 2019 at 8:37 pm

    One may look at the root of the mess that is Tricare, and see the broader mess of the American Healthcare industry. I note with pride that Dr. Duprey served in the only branch of the military which proves its own worth to the citizenry, the Coast Guard.
    There are certain tasks which contribute to the prosperity of the citizens in a country. In America, as we are a nation of individuals, this measure is the only one that deserves attention – the individual prosperity of the citizenry.
    There are many noble professions held by good people which unfortunately add nothing to the prosperity of the citizenry. The military is one of them, with the exceptions noted. It is paid for by extraction of funds from the aggregate citizenry, without replenishing in equal measure their ability to prosper. It merely drains the fruit of productive labor, and wastes it.
    As Eisenhower said to his speechwriter Emmet Hughes in preparing a speech on the week after Stalin died,

    Here is what I would like to say. The jet plane that roars over your head costs three quarter of a million dollars. That is more money than a man earning ten thousand dollars every year is going to make in his lifetime. What world can afford this sort of thing for long? We are in an armaments race. Where will it lead us? At worst to atomic warfare. At best, to robbing every people and nation on earth of the fruits of their own toil.
    “Now, there could be another road before us—the road of disarmament. What does this mean? It means for everybody in the world: bread, butter, clothes, homes, hospitals, schools—all the good and necessary things for decent living. …

    It is more than the US Military that “rob(s) every people and nation on earth of the fruits of their own toil.” In medicine, it is the coders and the regulators, the auditors and the Quality Assurance Tiger Teams, which treat no wound nor heal any injury, but hijack the wealth produced by each citizen, that could improve the lives of many.
    The only moral justification for government is to make safe the place where each citizen can prosper to the limits of his or her ability. When prosperity dwindles and fades, the Government does not release its hand, but rather redoubles its interest in subverting the little that is left of the people’s wealth – that wealth that comes from prudent actions and thrift – until, as today, prudent actions and thrift becomes a sucker’s game.
    Perhaps medicine in America is failing because America is failing. No longer capable of manufacturing the abundance of its citizenry, and seduced by sly speeches and propaganda patriotism to make itself great again – but without trying, without earning, without saving, without suffering.
    So why does Tricare suck? It is a payment for a service contracted genuinely with citizens, as a promise for their forswearing productive work and working instead for the military that produces not one crust of bread except from the prosperity of others. Perhaps we cannot afford to spend, because we do not make. Of course, that’s a betrayal to the families on Tricare; but it was a premeditated con, a planned grift by a sweet-talking recruiter sitting at a desk in a comfortable office. That is why we are unable to spend what we did not already create.

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  2. Scribe/FormerPT
    August 19, 2019 at 4:37 pm

    My husband was an active duty dentist, Army, for 21 years. He now has Tricare for Life + Medicare. I am still too young for Medicare and use the Army facilities pretty much exclusively. In our experience for ourselves and our two children, it all depended on the location. The care was great but no frills. Access was another story. When my husband was first commissioned I was 5 months pregnant and due to have my first Rhogam shot. Ft. Sill wouldn’t give me a routine medical appt. for a few months and I didn’t qualify for an OB/GYN visit. Our sponsor (greatest idea ever) advised my husband to play the system – i.e., find the name of our assigned GP and call in directly, “this is Dr. XXX with DENTAC, could I speak with Dr. YYY.” He got in touch immediately with our GP and I had an appt. for Rhogam injection.

    Things proceeded well until I had a questionable breast mass. It was the height of the Gulf War and a lot of docs were deployed. So it took a 3-week wait for diagnostic mammogram, a 3-week wait for the sonogram, a longer wait for the ultrasound to be read, 3 weeks to schedule the fine needle biopsy, 3 weeks to get the results of that, 3 weeks to be recommended to the surgical triage list for excisional biopsy – which luckily was eventually negative.

    First child – about an hour post delivery I was led around the floor and shown where the sheets were should I wish to change my bed, etc. Second child – the head of OB had banned the practice of women changing their own beds but I was in a 6-bed ward. I couldn’t get a 6-week postnatal followup appt. (major med center) before we moved so I did go to a civilian after moving (too distant from an Army facility so I qualified for civilian care). I’ve had a few orthopedic surgeries in Army facilities and care was fantastic, results excellent.

    My husband, though, had prostate cancer diagnosed back in January and is just now starting treatment through the civilian system using Tricare for Life. Hawaii has a doctor shortage, which I anticipate worsening as government takes over more and more, and I anticipate similar will follow on the mainland.

    So yeah, government care isn’t bad – the docs get the advantage of having more power over patient compliance. However, access to the care to which you’re “entitled” is another story.

  3. Jesse Lee Belville,PA-C
    August 19, 2019 at 4:33 pm

    Lots of disruption in Tricare. Lots of hoops to jump thru. Military health care of soldiers is dropping, of their families on post at Malmstrum AFB, in Montana is poor. I just left a locums contract in February after 6 months. They are understaffed by military medical and civilian cintractors. They just dumped a lot of them. All services med care being consolidated under one roof. Very BAD idea. Many family members not getting care. Many active duty and their families NOT getting needed care. Many of the real problems being ignored due to Active duty MDs/DO’s with limited experience, many PA’s,NP’s with limited experience. They Miss A LOT. Referral to down town specialists for active duty or their dependants is often a forced issue. If the local folks are not being paid fairly for their services then folks will be referred elsewhere, travel expenses, increase costs for the unit/facility.Many problems, too much government, not utilizing FREE MARKET enough. Every one gets the short end.

  4. Randy
    August 19, 2019 at 3:38 pm

    I can just speak to my own experience, but I dropped TriCare since at the time it was my worst payor combined with giving me the most headaches with prior authorizations. I grew up in a military family and was in the military myself so know well the importance of TriCare, but eventually it wasn’t worth the hassles.

    • Deborah Sutcliffe
      August 19, 2019 at 6:15 pm

      Exactly what I was about to write! TriCare was a HUGE PITA as a solo family doc, and a terrible payor. I hung on for a long time as I am an Army brat with a retired father on TriCare, but eventually I just couldn’t do it. (Now as DPC family doc, I do have some patients on TriCare and the hoops are even worse— and I live 2+ hours from the nearest military base but trying to get speciality care approved is worse than pulling teeth!)

  5. Ben Van Raalte
    August 19, 2019 at 3:23 pm

    Unfortunately Tricare has dropped reimbursement to 80% of Medicare to be listed in their program. Of course the specialties that have hospital exclusive contracts don’t sign and get their regular rates. Surgeons have a hard time working for the anesthesiologist. The anesthesiologist frequently gets paid double what the surgeon does or more, and does not have the same overhead, or any followup visits. Tricare is covering a lot of procedures that other insurances do not, making the beneficiaries demand more treatments. Doing those procedures at low rates that other insurances consider not necessary is frustrating, when the patient demands coverage. Do you think any of these reasons have anything to do with the lack of doctors wanting to do a lot of Tricare?

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