NEW TRICARE CONTRACTS SHAKE UP FEES FOR SOME STARTLED DOCS
Dr. Jennifer E. Brooks, a retired Navy commander with a doctorate in clinical psychology, is a TRICARE network healthcare provider in Pensacola, Fla. She specializes in treating mental health trauma of military patients, including medically disabled retirees suffering from combat-related, post-traumatic stress disorder.
In March, Brooks and behavioral healthcare therapists caring for beneficiaries across TRICARE’s 10-state South Region received new “contract packets” inviting them to continue to see their patients but as members of new behavioral healthcare network, this one run directly by Humana Military and with a revised fee deal.
The new “payment arrangement,” Brooks was startled to discover, would have her accepting a “30 percent” discount off TRICARE maximum allowable charges. By law, the TRICARE maximums can’t exceed Medicare rates.
Brooks reviewed her current TRICARE contract, signed a few years ago with Humana sub-contractor ValueOptions, and found she already was accepting 10 percent less than Medicare pays. The new contract, to take effect Jan. 1, would have Brooks accept another 20 percent cut on her therapy services.
“By reducing reimbursement rates so drastically,” Brooks warned, “Humana is creating a situation where working for TRICARE becomes an entry-level therapy position. Yes, all their therapists will have licenses. But the average length of time they have had those licenses will go down.”
For “a trauma therapist working with the military community, trust is a very big issue,” Brooks added. “Many of my clients with PTSD have told me that previous therapy was not effective because they were sent to a young person with no military experience whom they could not relate to” and the dropout rate was high.
Providers and beneficiaries might be alarmed by the prospect of falling provider fees for mental health therapy, but they would be wrong to assume TRICARE officials or members of Congress share their concerns, at least right now.
Last year Humana and HealthNet won the next generation TRICARE support contracts to deliver health services for the next five years. Humana is to run the new East Region, formed by merging the current North and South Regions. Health Net will take over the West Region contract from United Health.
Part of Humana’s winning bid included building its own network of mental health providers rather than rely, as it does now in South Region, on subcontractor ValueOptions. The initial agreements to providers to accept 30 percent off Medicare rates will be, for some therapists, only the start months-long negotiations.
TRICARE officials are monitoring progress by Humana and HealthNet as they build their networks. But they also know the contracts are designed around discounts to hold down costs to the government and secure profits for contractors.
“Our number one concern is that our beneficiaries get the care they need, that it’s high quality care and they get it when they need it,” said Navy Capt. Edward Simmer, deputy director of the TRICARE Health Plan in Falls Church, Va.
“We hope, to the greatest extent possible, that providers currently providing care to our patients are able to reach agreement with Humana and that they can continue to provide that care so there’s no disruption,” Simmer said. “But certainly if some of those providers do choose to leave our network, then we will make absolutely sure the patients they were seeing are immediately referred to another well-qualified provider so their care will continue.”
Asked if isn’t unusual for a contractor to press for a 30-percent rate cut off what Medicare pays, Simmer said discount negotiations are “between the contractor and the providers.” TRICARE leaders keep their focus is on whether the contractor provides a large enough network of “high-quality providers.”
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