Report says Tricare management flaws could cause health provider shortage

The Pentagon's method for measuring the ratio of Tricare health providers to beneficiaries is flawed and could result in a shortage of providers in heavily populated areas, according to a new report from the General Accounting Office.

Contractors managing Tricare, the Defense Department's health insurance plan, try to make sure there are enough providers for all the beneficiaries in each region, according to Tricare spokeswoman Jenny Stathis. But according to the GAO report (03-592T), the Defense Department does not always receive complete information on service standards from Tricare contractors managing the regional networks.

For instance, GAO found quarterly reports from contractors in five of 11 Tricare regions that included less than half of the required data that Defense needs to assess whether the health insurance plan is meeting service standards. Under the service standards, beneficiaries should be able to see a doctor for urgent care within a day of requesting an appointment and should not have to spend more than 30 minutes in the doctor's office waiting room for scheduled nonemergency visits. They also should not have to travel more than 30 minutes to reach a doctor's office for routine care.

The report also recommended that the Defense Department set up a centralized system to handle beneficiary complaints. Currently, complaints arrive through a variety of venues and are "often handled informally or on a case-by-case basis," the report said. Because there is no central evaluation process, Defense has difficulty identifying broader access problems, according to GAO.

Stathis said that beneficiaries can relay their concerns to Tricare management through e-mail, letter, fax or phone. The complaints are then filed in a customer service tracking database and are analyzed, she said. Also, Tricare management conducts a beneficiary satisfaction survey and monitors the results closely, Stathis said.

Defense Department managers need to fix these administrative problems associated with Tricare before awarding new contracts for health care providers in June, the GAO report said.

Draft versions of the new contracts would streamline the process for credentialing providers and simplify patient referral procedures, but requirements to file all claims electronically could discourage some providers from participating, the report cautioned. Some providers are unable to file claims electronically: in fiscal 2002, providers filed roughly one quarter of claims electronically, according to the report.

The Defense Department defended the e-filing requirement, saying it would cut claims processing costs.

Stay up-to-date with federal news alerts and analysis — Sign up for GovExec's email newsletters.
FROM OUR SPONSORS
JOIN THE DISCUSSION
Close [ x ] More from GovExec
 
 

Thank you for subscribing to newsletters from GovExec.com.
We think these reports might interest you:

  • Going Agile:Revolutionizing Federal Digital Services Delivery

    Here’s one indication that times have changed: Harriet Tubman is going to be the next face of the twenty dollar bill. Another sign of change? The way in which the federal government arrived at that decision.

    Download
  • Cyber Risk Report: Cybercrime Trends from 2016

    In our first half 2016 cyber trends report, SurfWatch Labs threat intelligence analysts noted one key theme – the interconnected nature of cybercrime – and the second half of the year saw organizations continuing to struggle with that reality. The number of potential cyber threats, the pool of already compromised information, and the ease of finding increasingly sophisticated cybercriminal tools continued to snowball throughout the year.

    Download
  • Featured Content from RSA Conference: Dissed by NIST

    Learn more about the latest draft of the U.S. National Institute of Standards and Technology guidance document on authentication and lifecycle management.

    Download
  • GBC Issue Brief: The Future of 9-1-1

    A Look Into the Next Generation of Emergency Services

    Download
  • GBC Survey Report: Securing the Perimeters

    A candid survey on cybersecurity in state and local governments

    Download
  • The New IP: Moving Government Agencies Toward the Network of The Future

    Federal IT managers are looking to modernize legacy network infrastructures that are taxed by growing demands from mobile devices, video, vast amounts of data, and more. This issue brief discusses the federal government network landscape, as well as market, financial force drivers for network modernization.

    Download
  • eBook: State & Local Cybersecurity

    CenturyLink is committed to helping state and local governments meet their cybersecurity challenges. Towards that end, CenturyLink commissioned a study from the Government Business Council that looked at the perceptions, attitudes and experiences of state and local leaders around the cybersecurity issue. The results were surprising in a number of ways. Learn more about their findings and the ways in which state and local governments can combat cybersecurity threats with this eBook.

    Download

When you download a report, your information may be shared with the underwriters of that document.