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Philpott: Tricare rate cuts alarming to doctors

May 7, 2017 Updated: May 15, 2017 at 10:28 am
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Dr. Jennifer Brooks, a retired Navy commander with a doctorate in clinical psychology, is a Tricare network health care 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 health care 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 health network with a revised fee deal.

The new "payment arrangement," Brooks was startled to discover, would have her accepting a "30 percent" discount off maximum allowable charges. By law, the Tricare maximums can't exceed Medicare rates.

Brooks reviewed her current contract, signed a few years ago with a Humana subcontractor, and found she was accepting 10 percent less than Medicare pays. The new contract, to take effect Jan. 1, would have Brooks accept another 20 percent cut.

"By reducing reimbursement rates so drastically," Brooks warned, "Humana is creating a situation where working for Tricare becomes an entry-level therapy position.

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."

Providers and beneficiaries might be alarmed by the prospect of falling provider fees, but they would be wrong to assume Tricare officials or members of Congress share their concerns, at least right now.

The initial agreements to providers to accept 30 percent off Medicare rates will be, for some therapists, only the start months-long negotiations.

Officials say 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," said Navy Capt. Edward Simmer, deputy director of the Tricare Health Plan in Falls Church, Va.

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To comment, write Military Update, P.O. Box 231111, Centreville, VA, 20120 or send email to milupdate@aol.com.

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