Doctor payment cut could limit access for military families

Difficulty in getting approval for specialty referrals also breeds physician frustration with TRICARE.

By Elaine Monaghan, AMNews staff. April 10, 2006.

Washington -- Eliot Light, MD, a family physician of 21 years, is facing one of his toughest decisions thanks to a military insurance program doctors say suffers from red tape, low payments and baffling rules.

If Medicare cuts proceed next year, his practice in Pacific Grove, Calif., will consider dropping the quarter of its patients covered by TRICARE, the Dept. of Defense insurer, because Medicare and TRICARE pay are linked.

It would be a painful choice given the commitment he feels to military patients in a time of war. But unless the cuts are scrapped or replaced with a cost of living increase, he said, "I, along with most physicians I know, would have to look seriously at reconsidering our commitment."

Many doctors are unhappy with the program for 9 million active duty, National Guard, Reserve and retired patients and their dependents. In a recent AMA Member Connect survey, 43% said they would limit or stop their acceptance of new TRICARE patients in 2007, when the program's reimbursement, mirroring Medicare, is expected to fall 5%.

TRICARE not only pays poorly, it also follows the old gatekeeper model, requiring authorization for specialists. It is "just odious," Dr. Light said.

Monterey County Medical Society, of which Dr. Light is secretary, had great difficulty persuading ob-gyns to sign up, and they did so out of patriotism, he said. "With the race to the bottom of the reimbursement scale, we are just not sure how long the specialists can continue to see these patients," he added.