The train wreck is here!

[BOHICA-FIGMO]

Lest any of you wet-behind-the-ears, I just want to serve my God-country-and-Uncle Sam crowd think that the tales of woe in military medicine are exagerated, let me add a new story. I can really only speak for my medical facility which is at a large AF base (6k+ AD) in a Air Combat Command. We are currently 60% manned in all providers (docs, optometrists, pharmacists, nurses, etc.), 25% in flight docs.

I found out today about the draconian measures that have begun as a result of the manning shortage. We are currently taking NO (zero, zilch, nada) new Tricare enrollees (even Tricare Prime!) other than active duty personnel and their dependents. Within the month, we will begin denying services to certain Tricare Prime beneficiaries who are eligible for care. It will start with dependents of retirees, but you don't have to be a freakin' rocket scientist to see the problem is not getting better.

Quality is going downhill, too. The military is even taking FMGs! No offense, but when we start accepting docs from St. Sunshine University of the Caribbean while denying scholarships to students accepted to top 25 allopathic schools, I start looking for it to start raining frogs!

I have heard and read similar stories at other Air Force bases. I don't know about those of you in the Army and Navy, but you UASF folks, God help you! You are in for a miserable 4 or 7 years in the trainwreck that is Air Force medicine.

---

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[UCBShocker]

Lest any of you wet-behind-the-ears, I just want to serve my God-country-and-Uncle Sam crowd think that the tales of woe in military medicine are exagerated, let me add a new story. I can really only speak for my medical facility which is at a large AF base (6k+ AD) in a Air Combat Command. We are currently 60% manned in all providers (docs, optometrists, pharmacists, nurses, etc.), 25% in flight docs.

I found out today about the draconian measures that have begun as a result of the manning shortage. We are currently taking NO (zero, zilch, nada) new Tricare enrollees (even Tricare Prime!) other than active duty personnel and their dependents. Within the month, we will begin denying services to certain Tricare Prime beneficiaries who are eligible for care. It will start with dependents of retirees, but you don't have to be a freakin' rocket scientist to see the problem is not getting better.

Quality is going downhill, too. The military is even taking FMGs! No offense, but when we start accepting docs from St. Sunshine University of the Caribbean while denying scholarships to students accepted to top 25 allopathic schools, I start looking for it to start raining frogs!

I have heard and read similar stories at other Air Force bases. I don't know about those of you in the Army and Navy, but you UASF folks, God help you! You are in for a miserable 4 or 7 years in the trainwreck that is Air Force medicine.

Ya that sure does suck. Medicare does the same thing, can't tell you how many times my patients are refused coverage saying that the patient does not need ambulance transport (healthy enough to go by other means) when my report basically shows that the patient in his or her final days and can barely even speak let alone move or sit in a wheelchair. Refused coverage for hospital visits when the policy says its covered... drugs, emergencies, required procedures... all denied for no good reason. Sometimes you can fight it, sometimes you can't. As long as money is the primary concern in healthcare (and I don't see that being able to change anytime soon), our healthcare system will remain a heaping pile of human (can you guess the word I was thinking of here?), with some exceptions [EDIT: Of course that is in comparison to an ideal system, which may not even be possible]. The military, from what I am hearing in this forum, is simply an accurate sample size of that system. Personally I believe its better in the military, but I have no experience to base that opinion on, which makes it virtually worthless to anyone but myself. The good doctors are the ones that just really want to be there and are willing to wade through the crap. To become a doctor because you think its all going to be lives saved and thankful patients is just not enough anymore... was it ever?

Sorry if the text seems a bit aggressive, not my intention, I just got off a 13 hour shift (no food for 9 hours) because of administration incompetence. But I guess I better get used to that too =)

 

[militarymd]

Medicare can and does deny coverage, but that is different from refusing to see patients.

 

[kingcer0x]

Isn't there a bill in congress that would open military medical care to reservists? Maybe someone ought to inform them of whats going on at your base.

Edit: reservists not currently on active duty

 

[QM1]

Isn't there a bill in congress that would open military medical care to reservists? Maybe someone ought to inform them of whats going on at your base.

Edit: reservists not currently on active duty

That language was removed from the bill, last week I think.

 

[UCBShocker]

Medicare can and does deny coverage, but that is different from refusing to see patients.

Exactly true, however I wish it were true that patients were not refused to be seen in the civilian world. Of course I am not speaking about arriving in an emergency room bleeding or something, that would of course be illegal to turn away, and the same applies for the military (assuming you can actually get to the military hospital). But I had a patient where the care facility refused to take her because they couldn't prove they would be paid, and the hospital also refused to take her back. Also, in many offices, if you can't pay the day of your visit, your getting turned away, simple as that. Its really sad. The only way to have a great healthcare system is if taxes were raised, supremely, but then we would be heading to a type of government that has already been proven incompatible with basic human psychology.

Again thats not say that the healthcare system is worthless, I am just saying in comparison to an ideal system it is lacking. There are tons of problems, but our system also does a lot of good. We have to take the good with the bad, even if they are not in equal proportions. I believe there is more good than bad, but we tend to emphasize the bad and simply accept the good... kind of the same reason so many people think psychics are actually endowed with some kind of great power... they guess right once, and who cares if they missed 4 times along the way.

 

[USAFdoc]

Lest any of you wet-behind-the-ears, I just want to serve my God-country-and-Uncle Sam crowd think that the tales of woe in military medicine are exagerated, let me add a new story. I can really only speak for my medical facility which is at a large AF base (6k+ AD) in a Air Combat Command. We are currently 60% manned in all providers (docs, optometrists, pharmacists, nurses, etc.), 25% in flight docs.

I found out today about the draconian measures that have begun as a result of the manning shortage. We are currently taking NO (zero, zilch, nada) new Tricare enrollees (even Tricare Prime!) other than active duty personnel and their dependents. Within the month, we will begin denying services to certain Tricare Prime beneficiaries who are eligible for care. It will start with dependents of retirees, but you don't have to be a freakin' rocket scientist to see the problem is not getting better.

Quality is going downhill, too. The military is even taking FMGs! No offense, but when we start accepting docs from St. Sunshine University of the Caribbean while denying scholarships to students accepted to top 25 allopathic schools, I start looking for it to start raining frogs!

I have heard and read similar stories at other Air Force bases. I don't know about those of you in the Army and Navy, but you UASF folks, God help you! You are in for a miserable 4 or 7 years in the trainwreck that is Air Force medicine.

What worse........not taking new enrolles like you descibed, or what happens at my base (we are missing 4 of our 6 docs with no replacement in sight and TRICARE is still enrolling patients to fills the panels of those docs we no longer have). This has increased our "effective panel sizes" to about 4000 patients per doctor.

At these panel sizes you can work 14 -16 hrs a day and still not get the job done.

Shame on you MAJCOM ! You sold your soul to TRICARE and sold the patients and medical staff as well.

 

[BOHICA-FIGMO]

What worse........not taking new enrolles like you descibed, or what happens at my base (we are missing 4 of our 6 docs with no replacement in sight and TRICARE is still enrolling patients to fills the panels of those docs we no longer have). This has increased our "effective panel sizes" to about 4000 patients per doctor.

At these panel sizes you can work 14 -16 hrs a day and still not get the job done.

Shame on you MAJCOM ! You sold your soul to TRICARE and sold the patients and medical staff as well.

Not sure if it was a MAJCOM call or a MDG/CC call. The solution is more docs and decent reimbursement rates for Tricare. But, that costs $$, so I guess we can't spare a couple of F-22s to pay for it .

 

[USAFdoc]

Not sure if it was a MAJCOM call or a MDG/CC call. The solution is more docs and decent reimbursement rates for Tricare. But, that costs $$, so I guess we can't spare a couple of F-22s to pay for it .

our clinic "throws away" money in the form of referrals that did not need to happen, labs that did not need to be ordered, OTC meds that need not be on the formulary, patient visits for 3 hours of a runny nose because there is no co-pay etc. etc.

the above in-efficiencies are mainly due to many unsupervised novice PAs having to function as docs, undermanned clinics, and senior admin leasdership failing to make the tough calls to fix a clinic.

 

[Monty Python]

........ The solution is more docs and decent reimbursement rates for Tricare. But, that costs $$, so I guess we can't spare a couple of F-22s to pay for it .

Current federal guidelines call for an approximately 4.7% reduction in Tricare reimbursement rates to civilian physicians effective 1 January. There will be more and more civilian folks refusing to see Tricare pts.

 

[BOHICA-FIGMO]

Current federal guidelines call for an approximately 4.7% reduction in Tricare reimbursement rates to civilian physicians effective 1 January. There will be more and more civilian folks refusing to see Tricare pts.

Holy freakin....! You mean they are going to reduce the Tricare reimbursement rates even more ?!?!? And they are cutting the number of military physicians ?!?!? Who do they expect to give our troops, families, and retirees health care, a freakin witch doctor?!?! "TRICARE for life" my @$$ !!

 

[dtn3t]

I understand that not getting paid very much from Tricare sucks, but it's our troops and their families that we are talking about. If these docs want to keep hiding in their offices making cash instead of going out to serve their country, the least they could do is take a little hit on money. May I'm just young and naive as an intern, who knows?

Instead of putting out a list of docs that will accept Tricare, what if we publish a list of docs that DON'T accept Tricare and post them somewhere and let the general public choose if they want to go to a doctor that doesn't accept military insurance because they loose a couple bucks? Again, just a young and naive opinion of an intern.

 

[militarymd]

that's right, you are.

 

[Homunculus]

that's right, you are.

the bitterness runs strong in this one, lol.

--your friendly neighborhood amused caveman

 

[militarymd]

the bitterness runs strong in this one, lol.

--your friendly neighborhood amused caveman

A colleague of mine left the Navy and went and did a pain fellowship at a high powered program in Lubbock, TX. After finishing his fellowship, he returns to the area where he served on active duty.

He, as a patriotic American, took Tricare.....within 2 years, he is bankrupt, and out of business....nothing needs to be added to that story for the young and naive out there.

 

[MoosePilot]

Reducing tricare reimbursements is a really dirty way to reduce benefits, because it's difficult to see from the outside. They can still trumpet full health care benefits to young families to recruit, but it's going to become a hollow benefit, because nobody's going to want to take it.

Recruiting and retention is going to be a major issue soon. The powers that be need to put it to the American people that there is no "peace dividend" and we've got to invest in our military.

 

[Homunculus]

within 2 years, he is bankrupt, and out of business....

so the *only* insurance he accepted was tricare? sounds more like poor business planning to me. isn't the "good part" of civilian life the ability to make those kinds of practice decisions?

i doubt he'll be in the poorhouse for long. money and anesthesiologists are not easily parted, lol.

i agree that the reimbursements decreasing is crap. but eventually they will get to a critical mass and this whole thing is gonna blow, regardless of the BRAC. maybe sooner is better than later.

--your friendly neighborhood prime caveman

 

[IgD]

"I found out today about the draconian measures that have begun as a result of the manning shortage. We are currently taking NO (zero, zilch, nada) new Tricare enrollees (even Tricare Prime!) other than active duty personnel and their dependents."

This is not uncommon in the military. Are you suggesting that the patients are left without any health care? My experience when this happens patients get "deferred to the network". This means patients are sent out in town to see a civilian provider and the military picks up the tab.

 

[militarymd]

so the *only* insurance he accepted was tricare?
--your friendly neighborhood prime caveman

To your friendly neighborhood young and naive cavemen,

In private practice, if they find out you take Tricare, you will wind up with ALL Tricare because NO ONE in their right mind will accept it.

So if you start taking it, pretty soon all your referrals will be Tricare.....unless you somehow decide which Tricare you will accept.

--

 

[Homunculus]

To your friendly neighborhood young and naive cavemen,

In private practice, if they find out you take Tricare, you will wind up with ALL Tricare because NO ONE in their right mind will accept it.

So if you start taking it, pretty soon all your referrals will be Tricare.....unless you somehow decide which Tricare you will accept.

--

again-- so the *only* insurance he took was tricare? did ne not get referrals from any other source? it's not that difficult to avoid referrals-- i saw cardiologists who were "too busy" for certain referrals all the time.

--your friendly neighborhood referral dodgin' caveman

 

[militarymd]

again-- so the *only* insurance he took was tricare? did ne not get referrals from any other source? it's not that difficult to avoid referrals-- i saw cardiologists who were "too busy" for certain referrals all the time.

--your friendly neighborhood referral dodgin' caveman

Being the only one who accepted Tricare (because of his sense of duty), led to mostly Tricare referrals....It happened....You think he filed bankruptcy, gave up his business, for fun?

 

[Homunculus]

Being the only one who accepted Tricare (because of his sense of duty), led to mostly Tricare referrals....It happened....You think he filed bankruptcy, gave up his business, for fun?

*mostly* tricare referrals-- sounds like he should have pushed for more referrals that were non-tricare, yes? sounds to me like he had a poor business plan in place if he relied on tricare for most of his income. moreover, why did he let it slide for two years? geez.

filing for bankruptcy isn't such a bad deal. the average entrepreneur fails 2 or 3 times before they find something that works. he'll live

--your friendly neighborhood capitalist caveman

 

[jetproppilot]

money and anesthesiologists are not easily parted, lol.

what are you implying?

 

[militarymd]

*mostly* tricare referrals-- sounds like he should have pushed for more referrals that were non-tricare, yes? sounds to me like he had a poor business plan in place if he relied on tricare for most of his income. moreover, why did he let it slide for two years? geez.

filing for bankruptcy isn't such a bad deal. the average entrepreneur fails 2 or 3 times before they find something that works. he'll live

--your friendly neighborhood capitalist caveman

His bad business plan was accepting Tricare...Once you start, that's all you will get when no one else accepts it.

How do you propose you stop seeing Tricare patients? Officers only? E-4 and above only?

 

[Homunculus]

what are you implying?

anesthesiologists make good (abeove average) $$$. and it is currently a "lifestyle" specialty. just head to the anesthesia forums, you'll see what i mean. this "poor guy" that declared bankruptcy i doubt is on welfare, lol.

--your friendly neighborhood non-gas caveman

 

[FliteSurgn]

Very few civilian providers in my location accept Tricare. Most of the specialties that I need for referral don't take it for the exact reason that x-mmd is speaking about. When you are the only provider in an area accepting Tricare, then your schedule soon becomes innundated with Tricare patients. A lot of those consults are crappy and won't pan out to any procedures (where you might be able to scrape out some extra money). So, you end up seeing a bunch of low paying outpatient consults that eat up spots that could have been filled with patients with better paying insurance.

I know most of consults are crappy because I see them all the time...unlike the civilians, I can't opt out. I see every bump, sore spot, funny mole, possible hernia, maybe hemorrhoid, rule-out gastritis, etc. that the PCPs can find. After sorting through all of that, my general surgery practice ends up with an average of 3 screening colonoscopies and two "operations" per week. Pathetic. If I were a civilian with this practice, I'd be bankrupt in much less than 2 years.

The only civilian surgical specialist in the area that takes Tricare routinely is the bariatric surgeon...because every patient he sees will end up with a gastric bypass where he'll make money on the procedure. If I want a plastic surgery, hand, or GI consult, the patients must drive at least 2 hours...unless the patient is clearly going to need a procedure. In that case, I call the local specialist directly and they will arrange the surgery. That is only on a case by case basis. If Tricare paid more (or more reliably) then more specialists might take it...of course, they would probably need to educate the PCPs on what really warrants a consult. I have had no luck in that regard.

 

[jetproppilot]

anesthesiologists make good (abeove average) $$$. and it is currently a "lifestyle" specialty. just head to the anesthesia forums, you'll see what i mean. this "poor guy" that declared bankruptcy i doubt is on welfare, lol.

--your friendly neighborhood non-gas caveman

I'm an anesthesiologist, Slim, I post on the anesthesia forum frequently, and your comment was a derogatory one.

 

[Homunculus]

I'm an anesthesiologist, Slim, I post on the anesthesia forum frequently, and your comment was a derogatory one.

lol-- let's take a poll and see who all thinks my remark was derogatory.

News flash-- a lot of people go into gas for the $$$. Not sure where you've been, but rads, gas, ophtho and derm are the last bastions of money/hour specialties. No one is going to be a "poor" anesthesiologist, unless they've lost their license, lol.

If i offended you by stating that anesthesiologists make good money, i apologize.

--your friendly neighborhood skinny caveman

 

[jetproppilot]

lol-- let's take a poll and see who all thinks my remark was derogatory.

News flash-- a lot of people go into gas for the $$$. Not sure where you've been, but rads, gas, ophtho and derm are the last bastions of money/hour specialties. No one is going to be a "poor" anesthesiologist, unless they've lost their license, lol.

If i offended you by stating that anesthesiologists make good money, i apologize.

--your friendly neighborhood skinny caveman

saying "money and anesthesiologists are not easily parted" and saying anesthesiologists make good money are 2 completely different things.

 

[Homunculus]

saying "money and anesthesiologists are not easily parted" and saying anesthesiologists make good money are 2 completely different things.

yeah, perhaps it was a poor choice of words. sorry for the confusion.

all i meant was that you won't an anesthesiologist without money-- not that they are misers or money grubbers, lol.

--your friendly neighborhood misunderstood caveman

 

[texdrake]

A colleague of mine left the Navy and went and did a pain fellowship at a high powered program in Lubbock, TX. After finishing his fellowship, he returns to the area where he served on active duty.

He, as a patriotic American, took Tricare.....within 2 years, he is bankrupt, and out of business....nothing needs to be added to that story for the young and naive out there.

Pain is one of the highest paying specialties, if your friend went backrupt after 2 years it wasn't because he took tricare. That is rediculous. Even if he took half his patients as tricare he should have been fine. I know a couple pain guys that make well over 500k a year.