Health Care Happenings

Due to recent severe storms and tornadoes in Oklahoma, the Governor of Oklahoma has issued a State of Emergency. Due to this issuance, emergency prescription refills and referral waivers from some Prime beneficiaries are in effect.

Early Prescription Refills

Emergency Refill Too Soon Procedures have been implemented for through June 17, 2013 in the following counties:

• Cleveland
• Lincoln
• McClain
• Oklahoma
• Pottawatomie

To get an emergency refill, take your prescription bottle to any TRICARE retail network pharmacy. Contact Express Scripts at 1-877-363-1303 or search TRICARE’s network pharmacy locator to find the nearest network pharmacy.

If possible, you should visit the pharmacy where the prescription was filled. You can request assistance at another pharmacy; however, help provided is at the pharmacy’s discretion. If you use a retail chain, you can get medication from another store in that chain. If your primary care manager is available, he or she may call in a new prescription to any network pharmacy in the area.

Primary Care Manager Referral Waiver

The tornadoes impacted the areas around Tinker Air Force Base. Beneficiaries enrolled in TRICARE Prime or TRICARE Prime Remote are normally required to have a referral from their primary care manager (PCM) for any care provided by another physician, including urgent–or same day—care (with a few exceptions).

Because many beneficiaries may be displaced or unable to get to their PCM in the area around Tinker Air Force Base, the requirement to have a PCM referral has been waived. The waiver applies to care received between May 20, 2013 and June 19, 2013. During this period of time, TRICARE Prime beneficiaries living in the areas around Tinker Air Force Base may visit any provider for care without incurring additional point-of-service charges.

Please contact Humana Military Healthcare Services at 1-800-444-5445 to see if you qualify for the waiver.

To be or not to be–That’s not just a question posed by Shakespeare’s Hamlet, but a question military and veterans have been asking for years–When will medical record information be able to transfer seamlessly between the Departments of Defense (DoD) and Veterans Affairs (VA)?

                         ARE WE THERE YET!

No, not yet according to the DoD in a statement released today.

After an intensive 30-day review, the Secretary of Defense, Chuck Hagel announced that the Department’s best move forward to achieve seamless data transfer between the two medical systems and modernization of current software systems is to purchase a commercial product and not adapt the VA’s Vista electronic health record system.

Neither the VA’s Vista or the DoD’s equivalent, Alta, are up to the task.

“Both the DoD and VA systems are outdated–by choosing a commercial product in DoD, we will incur less risk and acquire a better system,” said the Under Secretary for Acquisition, Technology and Logistics, Frank Kendall.

Kendall further stated that compatibility with Vista will be a consideration in the contract competition.  Several vendors have indicated they have a Vista-base solution to help achieve transferability goals set by the President.

          Next Steps?

DoD will look at existing plans and capabilities and before moving forward, but expect 1-year to 18-months to have a contract in place for seamless transfer of health care data.

We know that the two Departments have been working on electronic health records transfer for decades.

While we now have another marker in the sand to gage progress…in the end, only time will tell!

SO WHAT DO YOU THINK?

Will the DoD-VA achieve their goal or will we have to, once again, reset the clock?

At MOAA we follow many issues which affect our members as well as the broader military beneficiary base.  The issue of physician reimbursement for the provision of outpatient services for those on Medicare, and the fact that TRICARE reimbursement is tied to Medicare rates,  is a prime example.

In December 2012, Congress once again postponed a scheduled reduction in Medicare physician and provider reimbursement rates to be paid under the Physician Fee Schedule.  Due to the Sustainable Growth Rate (SGR) formula, popularly known as the “Doc Fix,” reimbursement rates were scheduled to be cut 27% on January 1, 2013.  The delay, when coupled with the mandated budget sequestration cut of 2%, will now result in a nearly 30% reduction in January 2014.

There are calls from both inside and outside of Congress, stating that now is the time to permanently fix the SGR formula.  This has been fueled by a recent Congressional Budget Office (CBO) estimate that freezing payment rates at current levels would cost roughly $14 billion in 2014 and $138 billion over ten years.  In the past, the significant cost of repealing the SGR (often estimated at between $250 and $300 billion over ten years), hindered attempts to find a solution.  Thus, it would seem that now would be the best time for Congress to act – while the CBO projects the cost to be at a historic low.

Over time, these threatened payment cuts to physicians have exacerbated the problem and increased the cost of permanent reform.  This has resulted in placing beneficiaries and their healthcare providers in constant uncertainty about future payment and access to services.  Not surprisingly, according to numerous studies, it is becoming increasingly difficult to find primary care physicians, particularly for newly eligible Medicare beneficiaries and TRICARE beneficiaries.

MOAA has a long history in advocating for a permanent fix to this healthcare payment issue, and we recognize there may now be an opportunity for a long-term legislative solution to move to a sustainable and workable payment system.

For more information on this issue, read MOAA’s fact sheet on improvements to Medicare, and then take action by asking your legislator to cosponsor the Medicare Physician Payment Innovation Act of 2013.

15% and 18%

The percent of women in today’s active force and the National Guard and Reserve forces.

354,000

The number of women veterans using VA health care.

2.3 Million

The population of women veterans in this country.

 It’s been an honor to watch history unfold over the years.  To think when I came into the military in early 1973, females included only a little more than 3% of the military population.

Now, 30 years later, that population has grown more than seven-fold and is expected to continue grow in the coming years–a population the Department of Veterans Affairs (VA) is agressively preparing to bring into its system.

And did you know, a significant number of women veterans today either don’t recognize they are veterans, the same as their male counterparts, or they don’t self-identify as a veteran.

I know, mind-boggling to me that, particularly in light of the last decade of growth in the ranks and the Iraq and Afghanistan wars, this is still an issue, three decades after I entered the military.

In an effort to address this growing population VA launched recently a Women Veterans Hotline–1-855-VA-Women.

The new call center was established to answer questions about services and benefits available to women veterans.

The center is another way VA hopes to encourage women to enroll in health care.

and finally, 6%

     The percent of women who are enrolled in VA health care.

Those enrolled in VA health care, like me, tend to have a great perception of the high quality of medical care they are receiving, according to the agency.

VA needs MOAA’s help, and yours, friends and neighbors to let women who have served know about the hotline and encourage them to call and learn more about about their medical,education, disability compensation, home loans, employment assistance, and many more benefits.

Or, you can call 1-855-VA-Women to find out information on their behalf.

A recent op-ed piece in a national newspaper suggested the military could save money by shifting to a health savings account plan instead of TRICARE.

Bad idea. Very bad.

Health savings accounts entail having a high-deductible insurance plan (usually something like a $5,000 deductible) and giving people the option to put away their own money to cover the first $5,000 with pre-tax money (similar to Flexible Spending Accounts offere by most employers — except the military — to let employees pay out-of-pocket heatlh care expenses with pre-tax money).

The difference is:

MOAA supports FSAs for currently serving military people because they give you a tax break on money you were going to spend anyway on health costs that AREN’T COVERED by TRICARE. (e.g. eyeglasses, contact lenses, dental deductibles and copays, etc.)

We also supported letting currently serving people pay their TRICARE Reserve Select, TRICARE dental and TRICARE supplement premiums with pre-tax dollars and letting retirees pay their FEHBP, TRICARE retiree dental and TRICARE supplement premiums with pre-tax dollars (this option is called premium conversion)…which gives them a tax break on premium dollars they’re already spending on health care.

In contrast, HSAs are designed explicitly to make you (instead of the government) use your own money pay for things that ARE NOW COVERED by TRICARE. They try to put lipstick on that pig by giving you a tax break on the extra money you’d be required to spend out of pocket.

But one problem is that people under HSAs often don’t actually put enough money in the HSA to pay for the needed care…so they lose both ways.

Net difference: FSAs and premium conversion are benefit improvements, whereas HSAs are a benefit cut — a big one.

Each year I storm on the Hill brings new and exciting experiences, and certainly great memories.

This time I was honored to serve with Col John Kittlelson, retired Air National Guardsman and President of our Great Plains Chapter in Sioux Falls, South Dakota.

As many of you know, our top Storming the Hill issues are to:  Sustain the 1.8% Military Pay Raise and Bar Unfair TRICARE Fee Hikes. 

Sustain the 1.8% Military Pay Raise

The President’s Budget for Fiscal Year (FY) 2010 recommends only a 1% pay raise for our currently serving troops and ignores the fact that Congress set in law back in 2003, that military pay would be tied to the average American pay raise in order to reduce the significant pay gap created by years of military pay caps, resulting is major retention problems for the Department of Defense.  The last 3 years of pay raises of 1.6% have already been the lowest in 50 years and not the 1.8% indicated by the Employment Cost Index.  MOAA members urged their legislators to increase the pay raise–that the prosed 1% increase sends the wrong message to troops especially during wartime.

Bar Unfair TRICARE Fee Hikes

On the TRICARE front, the President once again proposes shifting $25 billion in cost to military benficiaries over 10 years by (partical list):

• Raising annual fees by $1,000 or more for retired families of all ages
• Imposing means-testing of military retiree health benefits–which no other federal retirees endure
• Dramatically increasing pharmacy copays to approach or surpass the median of civilian health plans

These increases come on the heels of last year’s fee increases–the FY 2012 and FY 2013 Defense Authorization Acts already increased fees, including large pharmacy copay hikes, and required future increases at the rate of military retired pay growth.  Our members emphasized to their members of Congress that we’ve done our part–it’s now time to hold defense leaders accountable for efficiency shortfalls instead of taking the easy way out by forcing beneficiaries to again shoulder the financial burden.

We also didn’t forget the long-standing issues of Concurrent Receipt, the Survivor Benefit and Guard and Reserve Early Retirement inequities, urging members to do what they can to keep moving these critical needs forward.

Col Kittelson with Senator John Thune

See more about STH and To Take Action Yourself!

Representative Kristi Noem–newly appointed to the House Armed Services Committee