No more Tricare?

[braumeister]

This could be a big deal.
I got a letter from my dermatologist today (I've been seeing him for about 15 years).

The letter says they will no longer see patients with Tricare/Champus, whether it's primary or secondary (Tricare is secondary to Medicare, for example), on the advice of their legal counsel.

The reason is that "a Federal judge in Florida ruled that any physician who billed services to Tricare or Champus would be considered a Federal contractor and would be required to comply with all the numerous rules and regulations which apply to Federal contractors (such as General Electric or IBM). As a small business, we cannot afford to complete all of this paperwork."

Has anyone else encountered this situation?
Is anyone familiar with the judge's ruling? Does it look like it will stand?

[SteveL]

the actual decision applies to hospitals, hospices etc.and not doctors.. for more details:
TRICARE Providers Are Federal Subcontractors, Says Judge: Constangy, Brooks & Smith, LLP

[donheff]

Quote:

Originally Posted by SteveL the actual decision applies to hospitals, hospices etc.and not doctors.. for more details: TRICARE Providers Are Federal Subcontractors, Says Judge: Constangy, Brooks & Smith, LLP

Hmm. So I wonder, is the dermatologist just ignorant or an ideologue who is using this as an excuse to flip the bird at government?

[mickeyd]

Quote:

Has anyone else encountered this situation? Is anyone familiar with the judge's ruling? Does it look like it will stand?

Sounds like patient dumping to me. Why not just look for another doc? Are you near a military base? If so try to get in there. I also have MC/TFL and I see a dermatologist quarterly at Brooke Army Med Ctr.

[dtbach]

Quote:

Originally Posted by donheff Hmm. So I wonder, is the dermatologist just ignorant or an ideologue who is using this as an excuse to flip the bird at government?

From the link;

"Although receipt of Medicare funds does not transform a health care provider into a federal subcontractor, ALJ Tureck found that Medicare was not analogous to TRICARE. The former, he said, is a federal financial assistance program that pays for medical services (presumably analogous to insurance), whereas the TRICARE contract at issue involved the actual provision of those services. (Based on this distinction, healthcare providers that are simply reimbursed through the TRICARE program, as opposed to those that have contracted to provide actual medical services, may still have a defense, but they shouldn’t count on it.)"

I wouldn't blame him. Would you want to put up with all the d*mn paperwork?

[braumeister]

Quote:

Originally Posted by dtbach I wouldn't blame him. Would you want to put up with all the d*mn paperwork?

I'm not blaming him at all; I completely understand what he's doing.
My concern is that this might be just the first ripple, and it might soon be impossible to find any doctor who will see us.

Since Medicare automatically bills Tricare For Life (TFL) as secondary coverage, this potentially affects everyone with Tricare or TFL coverage.

[dtbach]

Quote:

Originally Posted by braumeister I'm not blaming him at all; I completely understand what he's doing. My concern is that this might be just the first ripple, and it might soon be impossible to find any doctor who will see us. Since Medicare automatically bills Tricare For Life (TFL) as secondary coverage, this potentially affects everyone with Tricare or TFL coverage.

Figures. I'm 18 months out from getting Tricare but by that time, all of us will be in ObamaCare. Life sucks sometimes I guess. . . .

[samclem]

Quote:

Originally Posted by donheff Hmm. So I wonder, is the dermatologist just ignorant or an ideologue who is using this as an excuse to flip the bird at government?

Based on the letter Braumeister got, it sounds like the dermatologist is just trying to be a doctor, and he's relying on the advice of his lawyer.

The whole thing does seem a little strange:
-- (According to the link from SteveL) Why would hospitals be snared by this ruling, but not doctors (who also bill Tricare)?
-- Why would payment by Tricare make a provider a government contractor, but payment by Medicare does not?
-- The case will obviously be appealed--why should doctors do anything until the matter is settled?

[Rustward]

Quote:

Originally Posted by braumeister T... The reason is that "a Federal judge in Florida ruled that any physician who billed services to Tricare or Champus would be considered a Federal contractor and would be required to comply with all the numerous rules and regulations which apply to Federal contractors (such as General Electric or IBM). As a small business, we cannot afford to complete all of this paperwork." ...

Just to be clear, when a sizable company does business with the federal government, the entire company does not necessarily become a contractor to the government. Larger companies usually set up a "federal" division that is a contractor to the federal government.

For a time I worked for a major competitor of IBM and was asked to do some work for the U.S. Government Printing Office (GPO) for a few days. To make it happen I had to become a subcontractor to the xyz.Federal Corporation, which was a subsidiary of my employer. xyz.Federal corporation was indeed a Federal Government subcontractor. Strange, but stranger things have happened.

So, when, for example, if the General Electric company does business with the Federal government, the entire General electric company does not necessarily become a U. S. Government contractor. G. E. (and many others, no doubt) most certainly have federal divisions.

[donheff]

Quote:

Originally Posted by samclem -- The case will obviously be appealed--why should doctors do anything until the matter is settled?

+1 So why did this doctor do "something" when nothing has yet been changed for him. If doctors are ultimately brought under the "contractor" requirements he can always drop Tricare patients then, so why now? There is no way the application will be retroactive. The only legitimate reason I can think of would be to generate publicity about the potential impact of the ruling in the hope of forestalling it.

[Tadpole]

Quote:

Originally Posted by braumeister This could be a big deal. I got a letter from my dermatologist today (I've been seeing him for about 15 years). The letter says they will no longer see patients with Tricare/Champus, whether it's primary or secondary (Tricare is secondary to Medicare, for example), on the advice of their legal counsel. The reason is that "a Federal judge in Florida ruled that any physician who billed services to Tricare or Champus would be considered a Federal contractor and would be required to comply with all the numerous rules and regulations which apply to Federal contractors (such as General Electric or IBM). As a small business, we cannot afford to complete all of this paperwork." Has anyone else encountered this situation? Is anyone familiar with the judge's ruling? Does it look like it will stand?

I tried to find out what it was all about. It looks like your doctor may fall under a health network or have a practice that is large enough to fall under the Office of Federal Contract Compliance (“OFCCP”) jurisdiction.
http://www.polsinelli.com/publicatio.../upd1010le.pdf

The judgment in it's legalese form posted by DOL:
http://www.huschblackwell.com/files/...daHospital.pdf

A more readable and interesting explanation can be found a little more than half way down this page:
HLW Print Version

It is called:
OFCCP Clarifies When Healthcare Providers Must Comply With Affirmative Action

It all seems muddy to me but I am not sophisticated enough to get the nuances such as the difference in Tricare/Champus and FEHB as opposed to Medicare. It appears to be related to administration with Tricare and FEHB operating with health provider contracts that make a network a big contractor and your doctor their subcontractor. It isn't just hospital related even though the court case involved a hospital. My take is that it is not individual doctor's offices that must be in compliance with contracting rules but that the onus of compliance would require doctor's to do more paperwork for the lead contractor's data base. But I'll stop with all my ignorance and "seems to be" and you can inspect for yourself.

[muppin]

I also live in the Cincinnati area and have received a similar letter from my dermatologist, perhaps the same group (five doctors). I am very concerned about this issue as while this group may be first, others are sure to follow. As far as getting another dermatologist, it is very hard to find one who is taking new patients.

[braumeister]

Thanks for the link, Tadpole.

Quote:

Generally speaking, if a healthcare provider has agreed to provide medical services to federal employees or military personnel, there is a good chance OFCCP will conclude that the healthcare provider is subject to its jurisdiction. Making matters worse for healthcare providers, OFCCP does not appear to be waiting for the results of its pending litigation before initiating compliance audits.

That makes it easy to see why they would become nervous enough to immediately drop Tricare patients.

Apparently another example of "too much government."

Guess I'll just try harder to stay healthy.

[dtbach]

Quote:

Originally Posted by braumeister Thanks for the link, Tadpole. That makes it easy to see why they would become nervous enough to immediately drop Tricare patients. Apparently another example of "too much government." Guess I'll just try harder to stay healthy.

An old military quote as I remember it went "Hello, we are from the government and are here to help". Yeah, right. In this case who exactly are they trying to help??

[Tadpole]

Quote:

Originally Posted by dtbach An old military quote as I remember it went "Hello, we are from the government and are here to help". Yeah, right. In this case who exactly are they trying to help??

Having worked for the government on the acquisition side, problems usually arose when a contractor who got left out of the contracts for some reason challenges the government selection process or something. I've never see quite this type of challenge, however. But without additional news or inside information it's hard to tell. It could come from someone wanting to create bottlenecks in a program they wanted to reduce the popularity of; it could come from an agency suddenly reinterpreting their mission to preserve their existence or expand their resource clawbacks; it could come from new blood looking for previous slackness in an agency; it could come from a threat of public complaints. Choose your poison when it comes to contracts.

I used to think that the government would save money if they took more risk of being defrauded. Everything that happened seemed to make the process longer, more complicated, more overhead ridden, and more micromanaged. Things just grow and grow and grow with staff to dot all the i's.

[Nords]

Quote:

Originally Posted by braumeister I'm not blaming him at all; I completely understand what he's doing. My concern is that this might be just the first ripple, and it might soon be impossible to find any doctor who will see us. Since Medicare automatically bills Tricare For Life (TFL) as secondary coverage, this potentially affects everyone with Tricare or TFL coverage.

Bingo.

Maybe your doctor is really listening to his accountant, who's suggesting that he seek higher reimbursable rates.

[braumeister]

Quote:

Originally Posted by Nords Bingo. Maybe your doctor is really listening to his accountant, who's suggesting that he seek higher reimbursable rates.

Yeah, there could be multiple issues here. Losing a bunch of long-time, low-reimbursable patients won't hurt him at all. It already takes six months to get an appointment even if you're a regular, and that's been the case with this guy for many years; he's very good and has a great reputation.

The thing that bothers me is that I'm afraid we'll start seeing plenty of doctors going this route. As you know, it's already tough to find doctors who accept Tricare (or even Medicare) patients in some parts of the country. It might get a lot tougher before long.

[Nords]

Quote:

Originally Posted by braumeister It might get a lot tougher before long.

It'll be interesting to see if the Tricare premium hikes (perhaps indexed to the CPI?) keep the doctors on board.

[ziggy29]

Quote:

Originally Posted by Nords It'll be interesting to see if the Tricare premium hikes (perhaps indexed to the CPI?) keep the doctors on board.

Doubt it. When the CPI reports 2% inflation, most people are "feeling" 6% inflation in food, energy and other essentials and health care costs are rising 12%, I don't think a 2% increase in reimbursements will keep doctors happy.

[Rustic23]

Sidebar for the no inflation group: Both Matell and Hazbro announced toy price increase of 6% to 20% due to higher labor cost and raw materials in China.