Newspaper Article-Military health plan is hassle for families

[militarymd]

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DDS grew up in xxxx, married an Army man and traveled the world raising an Army family in some beautiful and dangerous places.

Now , the family is back and still on active duty, but xxx has a problem.

"I'm embarrassed and ashamed of my city," she said Thursday, "for not taking care of their military."

Her experience as a military wife trying to get health care here is outrageous.

XXX is a nurse by training...so she knows the subject.

this area is home to some 2,000 active-duty military families and another 74,000 or so retired military families, Army figures show. They are insured by Tricared, a DOD agency that functions like the military version of Blue Cross Blue Shield.

The problem is that few doctors in xxxx accept Tricare.

"A very small % of teh 197 family doctors and 37 pediatricians here accept Tricare, confirms xxxx, X director of the xxxxx County Medical Society.

When it comes to specialists, the story's the same.

That means military families must drive to xxx,xxxx and xxxx (hours away) for routine and specialty care. That's a hassle and expense for officers' families, such as xxx. For lower-paid enlisted families, it can be a nightmare.

[cont]

 

[militarymd]

Picture a young military wife with a husband deployed. Her 2 yo has an appt with a Tricare doctor in xxxx (40 miles). Her 5 yo is in day care. She has to take off work, if her boss will let her, find someone to pick up and sit with the 5 yo if she runs late getting home, and spend precious dollars on gasoline for the trip. If there are f/u visits, she has to do it all again.

It happens all the time. Military families take children to xxxx (2 hours away) to have their tonsils removed, to xxx (40 miles), to see ENT, and to xxx (60 miles) for GI, to cite examples I've heard.

What about the xxxx Army clinic on xxxxx base? Doesn't it offer medical care?

Yes, and the xxx has seen a 24 percent spike in patients visits in the last year. xxx says teh doctors there are excellent, but they still refer to specialists off-post, and we know what that means.

Interestingly, the thousands of Defense Department workers and contractors who suppor the base don't have Tricare. they are covered by private insurance. And, yes, they pay thousands a year for it.

Why won't more doctors accept Tricare? Those who do tell xxx that "it's the least we can do" for our troops, expecially in wartime.

The short answer is this is a nationwide problem. Tricare has a reputation as slow to pay, tight with reimbursement dollar and hard to deal with, according to medical insiders.

Remember, doctors not only practice the healing arts, they run businesses. Can we really expect them to tie up staff 45 minutes on every Tricare pre-clearance?

Good enought answer? Can we help our troops ? We'll look at those questions in depth in this space beginning Sunday.

 

[resxn]

I've already made it quite clear that I'm not accepting Tricare in my civilian job to start next year. The reason is that the reimbursement for a start-up practice requires just far too much effort. It's sad that I don't feel like I can really help the very people I've been serving for the last 3 years.

 

[militarymd]

I've already made it quite clear that I'm not accepting Tricare in my civilian job to start next year. The reason is that the reimbursement for a start-up practice requires just far too much effort. It's sad that I don't feel like I can really help the very people I've been serving for the last 3 years.

We all have priorities:

1) self/family
2) god
3) country
4) etc...

Whatever the order is.....self/family comes first.

I would not feel sad over doing what you need to do to take care of you and your family.

 

[Homunculus]

damn. remind me to never get stationed or ever visit "xxxx". a city so bad tey took its name away 🙁

are people from "xxxx" called "xxxx"ians or "xxxx"ers?

seriously though-- i'm glad a news organization is picking up on this. it'll be intereresting to see where it goes.

--your friendly neighborhood jesting caveman

 

[former military]

We all have priorities:

1) self/family
2) god
3) country
4) etc...

Whatever the order is.....self/family comes first.

I would not feel sad over doing what you need to do to take care of you and your family.

ETC is the 4th core value?

 

[IgD]

Can you post the link to that story? Why block out the parts??

 

[militarymd]

Can you post the link to that story? Why block out the parts??

Same reason we don't have your identity. The paper doesn't have an online version...I just copied it straight from the hardcopy I get at home.

 

[DropkickMurphy]

We all have priorities:

1) self/family
2) god
3) country
4) etc...

More like
1) self
2) daughter and girlfriend
3) profit
4) friends
5) country (although for sufficient #3, I'm willing to change which #5 I support within reason)
6) rest of my family (mother, father, siblings, etc)

 

[IgD]

Same reason we don't have your identity. The paper doesn't have an online version...I just copied it straight from the hardcopy I get at home.

Are you saying your identity is in the article? It doesn't make sense not to post the reference.

 

[MedicalCorpse]

Are you saying your identity is in the article? It doesn't make sense not to post the reference.

Just going out on a limb, but perhaps he wishes his home town to remain private?

--
R

 

[MedicalCorpse]

ETC is the 4th core value?

Sigh.

We've gone over this before...

The only USAF "Core Value" is "STFU and do as you're told, regardless of whether that constitutes negligence, malpractice, or a crime against humanity".

It's all explained right here: http://www.medicalcorpse.com/shutup.html

--
R

 

[former military]

Sigh.

We've gone over this before...

The only USAF "Core Value" is "STFU and do as you're told, regardless of whether that constitutes negligence, malpractice, or a crime against humanity".

It's all explained right here: http://www.medicalcorpse.com/shutup.html

--
R

Yes, now I remeber the STFU.... See Travis F Urologists

 

[MedicalCorpse]

Yes, now I remeber the STFU.... See Travis F Urologists

I guess that would include the very, um, flamboyant guy who sang show tunes in the O.R. and who ran into a lightpole while drunk and on call ca. 1999. That was when we got the word from command that we weren't supposed to drink while we were on call (duh).

And the O-6 with the Scandinavian name who had homesteaded at Travis for nearly 10 years.

And the "Mayo Clinic" guy who used 40 BAGS (yes, folks, 120 liters) of glycine on a patient during a TURP, yet who had the unmitigated gall to ask me, when the patient's sodium came back at 109 and he attained the GCS of asparagus, whether the patient had suffered "hypoxic brain damage" due to some anesthesia mishap. It's in my second book: "Look, you can't have hypoxic brain damage without hypoxia, and his sat has been 100% throughout, so...maybe it has something to do with his sodium being 109? Hmmm?"

Although, granted, I left Travis in 2000. At that time, anesthesia (and, specifically, anesthesiology) was the designated receiver, if you get my drift.
I'm sure my good friend 7by11 can confirm that this is (hmpfhph!) no longer (hmfpfhph!) the case (bwahahahaha!).

--
R

 

[former military]

I guess that would include the very, um, flamboyant guy who sang show tunes in the O.R. and who ran into a lightpole while drunk and on call ca. 1999. That was when we got the word from command that we weren't supposed to drink while we were on call (duh).

And the O-6 with the Scandinavian name who had homesteaded at Travis for nearly 10 years.

And the "Mayo Clinic" guy who used 40 BAGS (yes, folks, 120 liters) of glycine on a patient during a TURP, yet who had the unmitigated gall to ask me, when the patient's sodium came back at 109 and he attained the GCS of asparagus, whether the patient had suffered "hypoxic brain damage" due to some anesthesia mishap. It's in my second book: "Look, you can't have hypoxic brain damage without hypoxia, and his sat has been 100% throughout, so...maybe it has something to do with his sodium being 109? Hmmm?"

Although, granted, I left Travis in 2000. At that time, anesthesia (and, specifically, anesthesiology) was the designated receiver, if you get my drift.
I'm sure my good friend 7by11 can confirm that this is (hmpfhph!) no longer (hmfpfhph!) the case (bwahahahaha!).

--
R

Yes... the man with the "alternative life style" apparently told it only to the bottle. The arrogant Mayo guy had tons less talent than he thought he did. The other guy, the one with the hitler mustache, still has a hitler mustache as a civilian. In fact, without the restrictions of the military, he is able to make it look even more hitleresque.... luckily I dodged most of that crowd and worked with my favorite type of people- the ones the USAF hates most- hardworking, smart guys that do the right thing. My class has already separated. Class, in general, separated from military medicine many years ago.

 

[7by11thenout]

I have just reached self actualization....


I accept responsibility for everything done in the OR. The Surgeons will tell you, "I am ultimately responsible for everything in My OR", but I (anesthesia) know differently.

1. IF the surgeon doesn’t know that his patient is on coumadin and I call him to cancel the case, and he says how did you find that out? (I said “I read the first page of his chart” Case from 2002 - Today I would add, “and it is my fault for not noticing this sooner and bringing it to your attention)

2. If the surgeon consults for Thoracic Epidural for flail chest, but the patient is not a candidate for neuraxial technique. Later I get blamed for not giving pain control even though the surgeon only wrote for 1.5mg in 3 days; I will now say to the surgeon "It is my fault for not being home with the patient when he had his syncope and catching him before he fell"

3. IF the surgeon can not work alone based on his credentials, and looks at me and says "what do I do now?" Instead of saying "consult your college as you were supposed to do hours ago" I will say "I am sorry I didn’t do a urology residency - my bad"

4. If the surgeon cuts through the right ventricle and the aorta in a redo heart with the saw - I know it is my fault for not reminding him that he should do a lateral approach, and if the patient does not survive it is not the surgeons fault - it is mine since I could not get the perfusionist to go on pump fast enough

5. If over 1/2 our anesthesia staff is deployed, but the surgeons want to add extra OR's to the day even though they don’t book all the time in the existing ORs - instead of say in the interest of patient safety the OR nurses and anesthesia team need a day off a week - lets not add rooms until you fill all the existing rooms - I think I will say " sure lets add two more rooms, and I will staff two myself running back and forth from room to room"


Ha Ha -

IF tricare wont pay for the Autism treatment of my friends child, or the speech treatment of another friends child, I will say it is my fault for not being the tricare rep and implementing change.

If tricare sends me a bill for my treatment at a civilian hospital on a rotation when I got a needle stick I will say, Sure I'll pay for it it was my fault I should have been more careful - I know you want the civilian hospital to pay for it as workmans comp, but I did not work for them I work for the USAF so I'll just pay it...

 

[MedicalCorpse]

I have just reached self actualization....

2. If the surgeon consults for Thoracic Epidural for flail chest, but the patient is not a candidate for neuraxial technique. Later I get blamed for not giving pain control even though the surgeon only wrote for 1.5mg in 3 days; I will now say to the surgeon "It is my fault for not being home with the patient when he had his syncope and catching him before he fell"

Apparently, all the AF surgeons who train at U.C. Davis swallow the party line that epidural analgesia is standard of care for every single human with multiple rib fractures, regardless of patient wishes or contraindications.

Allow me to quote from my own e-mail to someone on this subject:

You know, I had virtually the same discussion late one
night at Travis re: 86 year old Austrian-American lady who
fractured ribs falling off of ladder while cleaning gutter. Same bull
about "everybody at UC Davis with rib fxs gets epidural; that's
'Standard of Care'." I went to see patient; SpO2 100% on 2 l/m NC;
I ask her to do incentive spirometer: she maxes it out; she states she
will faithfully continue with IS. Her pain scale is 2. She tells me:
"Vat do you exshpect venn you fall off ze ladder; it vill hurt, yes, but
ze doctor tells me to breaze, then I breaze, ja?" She then tells me
she wouldn't give consent for an epidural, due to multiple vertebral
fxs secondary to MVA years before. I tell the resident, who instead
of shutting up, calls his staff in to fight with me. I ask for
literature...they just give me anecdotes. The lady pissed them off
by getting better over less than two days and leaving the hospital with PO
meds.

Nothing ever changes at Travis, it seems.

Anesthesia is at fault for every patient adverse outcome;
and epidurals are panaceas for everything from impotence
to the heartbreak of psoriasis (you're too young to remember
this commercial from the early 70s).

Oh, and if a surgeon insists on turning a "quick" SMA bypass into a suprarenal AAA without a central line (because he refused to allow
anesthesia to place one due to the patient's prior vascular surgery everywhere), then proceeds to have a three HOUR crossclamp time,
the patient's subsequent renal failure and death are directly attributable to the Reservist anesthesiologist and staff CRNA's decision to use ephedrine, a known selective alpha agonist (sic) which causes vasoconstriction and bad things to end organs, to keep the patient's BP out of the toilet so that she could survive to the ICU...

...where the CRNA insisted that we hook up the epidural, despite the fact the patient's BP was in the 70s, because:

"Dr. Jones, analgesia is different from sedation."
--O-3 CRNA one (1) month out of training, to me, O-4 Medical Director of Anesthesia

Plus ça change, plus c'est la même chose.

I bow to 7by11's Maslovian Apotheosis. She is Goddess, hear her roar.

An unworthy,

--
R

 

[Homunculus]

IF tricare wont pay for the Autism treatment of my friends child, or the speech treatment of another friends child, I will say it is my fault for not being the tricare rep and implementing change.

what are they trying to get covered? if it's an alternative medical therapy, it won't be covered any more than the civilian world. medically necessary stuff is covered (child psych, PT/OT, speech, hearing aids, augmentive communication, durable medical goods) but many of the experimental therapies are not. speech therapy should also be provided by the school, or if not schoolage the state health department via their county. have them tak to their pediatrician-- speech stuff shouldn't be that hard to get.

if you think your friends kids are really getting screwed for lack of funds for what seem to be medically necessary treatments, you can get alternative monies from ECHO (Extended Health Care Option). It's for AD dependents only. Qualifying conditions include:

1. moderate or severe MR
2. physical disability (includes autism)
3. multiple disabilities
4. infants and toddlers (age <3yr) with developmental delay
5. extraordinary physical or psychological conditions

Applied Behavioral Analysis (ABA), which is one of the popular therapies sought after by some autistic parents, can be covered through this program provided they meet the following:

1. must be prescribed by physician (diagnosis of PDD or autism must be stated, request for initial evaluation and plan of care, how frequent, duration of therapy (usually 6 months)

2. therapists providing ABA must be qualified
3. provides a supplement of up to $2500 per month
4. EFMP enrollment is a prerequisite

Echo also will fund home health care, which provides respite care for dependents already in ECHO-- this benefit is over and above the $2500 monthly limit

www.militaryhomefront.dod.mil (put "echo" in search box)
https://www.hnfs.net/common/caremanagement/ECHO+FAQs.htm (ECHO FAQ's)

i also have some contact numbers in case you would like to speak with someone more knowledgable about this than i am. PM me if you're interested.

--your friendly neighborhood EFMP, EDIS, IEP juggling caveman

 

[Homunculus]

4. If the surgeon cuts through the right ventricle and the aorta in a redo heart with the saw - I know it is my fault for not reminding him that he should do a lateral approach, and if the patient does not survive it is not the surgeons fault - it is mine since I could not get the perfusionist to go on pump fast enough

😱 😱

--your friendly neighborhood hopes he stays healthy at least 8 more years caveman