TRICARE Survey Results

Transcription

1 TRICARE Survey Results (05/21/13) The Problem Since the transition of TRICARE managed care services from TriWest to UnitedHealth Military and Veterans Services on (UMVS) on April 1, 2013, the California Medical Association (CMA) has received a number of reports from physician practices that are experiencing various difficulties. Among the difficulties reported are significant delays in processing of authorizations and referral requests, long hold times, website problems, difficulty registering for secured access to the UMVS portal and contracting problems. CMA, along with the County Medical Societies, conducted in mid April a survey to identify areas of concern related to the TRICARE transition, so that we can work with the new contractor to ensure the problems are addressed and resolved quickly. During the transition period, UMVS has committed to meeting with CMA weekly to address TRICARE issues physicians are experiencing. CMA member practices that are experiencing problems are encouraged to contact CMA at (800) or economicservices@cmanet.org. For more information on the TRICARE transition, see CMA's TRICARE Transition Guide, available free to members in the online resource library at Survey Summary The survey gathered data from 321 practices representing physicians from over 27 different specialties in 31 different counties within California over a period of 5 business days. While 78% of respondents report they were part of the TriWest TRICARE network prior to the transition, 46% report they were never approached by UMVS to participate in the new TRICARE network. Of the physicians who reported they were in the TRICARE network before the transition to UMVS yet were not solicited to be part of the UMVS TRICARE network, almost half report a significant percentage of existing TRICARE patients whose care may be disrupted because UMVS did not ask them to join the new network. Almost 3 out of 4 respondents indicated they experienced various difficulties with the transition to UMVS, 42% of whom indicated those problems had a negative impact on patient care. California Medical Association: (800) or memberservice@cmanet.org Page 1 of 13

2 Almost 1/3 of the practices report the difficulties during the transition negatively impacted patient care, 25% of which were primary care practices. The delays in processing authorization and referral requests negatively affected patient care as many practices were forced to reschedule patients or were unable to refer them to the needed specialist. Physicians report that delays with the contracting process at UMVS, confusion about the contract amendment, and difficulty obtaining clarification from UMVS about various contracting questions contributed to difficulties for both physicians and patients with the transition. Several practices reported their patients were assigned to new primary care managers in error. Survey Results as of April practices representing physicians in 31 different counties and over 27 different specialties responded to the survey. 1. Were you contracted with TRICARE through the TriWest (prior contractor) network prior to 4/1/13? Yes 78% No 22% 2. Did you receive a new contracting packet from UMVS inviting you to participate in their new TRICARE network? Yes 54% No 46% 3. If no, have you contacted UMVS to obtain a contracting packet? Yes, I was told someone from contracting would call me but I haven't received a call yet 7% Yes, I was told they would mail a contracting packet to me but I haven't received it yet 10% Yes, and I received the contracting packet 8% Yes, I left a message but never received a call back 4% No 58% Other (please specify) 14% California Medical Association: (888) or economicservices@cmanet.org Page 2 of 13

3 Other (sample) - An envelope was sent from Untied Healthcare with nothing in the envelope! Then received messages wondering why we did not return contract! - I was told United Health Care is 30 days behind in contracting, and to wait until May 1st to submit a letter of intent for Dr. Sheehy. He has been contracted all along with TriWest and now he is not under contract with the new transition. No one knows why. - I received an amendment to my Tricare Participation Agreement on 04/11/2013. I believe that's the UMVS contract packet. - We are not contracted, but we accept assignment. To date we have had no problems. If we did have a problem, I would contact our UH rep Christina Hernandez who meets with us quarterly & through and has resolved every issue we have had with UH. - I was told on to wait about 30 days and call back for contracting for things to catch up. - When we inquired, we were told that we were already contracted through United Health Care and didn't need a contract. - I was told nothing was changing other than the billing address. - We were not told in advance that we had to be United Health providers, we figured we are Tricare providers and it would mesh together...it wasn't our choice. - I was told numerous times that they would packet. Eventually spoke with representative who said that they would not be ing anything and to go to CAQH which we did. April 1st we are not on provider list, spoke with representative and was told that we have to call again in 30 days! - Initially, the first document sent was an amendment to our existing contract. A government amendment to a commercial product contract. It took a long series of calls before I finally enlisted the aid of my physician advocate for the commercial lines of business and she connected me to a contract negotiator at UMVS. At that point I was able to obtain a full contract document which proposed a 20% decrease from our existing contract. - I was informed that our provider is now on a "list" and we would be contacted and sent a contract. - We called and received the initial forms to complete, however we are already getting patient calls that they need to transfer, because they got a letter saying I can't be their doctor anymore. They are wondering what I did to get kicked off the panel. California Medical Association: (888) or economicservices@cmanet.org Page 3 of 13

4 - They told me to call back 30 days later and do not think I will be accepted in the network because it's too full. - UMVS faxed an info update form to us. When they would not negotiate payment rates above 80% of Medicare rates, we chose not to contract with them. - Yes, was told I would be put on a list to receive a packet. Have not received. - Didn t think we needed a contract. Thought affiliation with Triwest would just transfer. - I called twice and was told they were backed up, never received any return calls or as per their instruction. We did receive a packet after April If yes (to question #2), did you choose to participate with TRICARE through the UMVS network? Yes 79% Haven t decided yet 14% No 7% If no, why? (sample) - We were confused about what the contract was. Did not understand what we were participating in. - Unable to get reasonable reimbursement rate. To complicate matters, UMVS network did NOT process our request to opt-out so we are having to dispute the status of our contract with them. - Rate at 85% of Medicare is not acceptable - It was difficult getting the correct contract type from UMVS. We are a group practice and they kept sending individual contracts to our providers. We finally received a group contract and tried negotiating a better reimbursement rate. The 80% of CMAC that was offered in the contract they sent was not acceptable by our group. I contacted the network specialist and tried to negotiate an acceptable agreement. I was not successful in getting in touch with the correct representative. I was later told on 4/3 that UMVS automatically enrolled providers that they say did not respond to the agreements that were sent. They stated that a signature was not required for participation due to the amendment that was sent out. This contradicts the original information that was sent with the agreement stating that the agreement must be signed in order to be a participating provider. - Returned the contract not realizing that the contract was at a much lower rate than previous. We have made multiple calls to our contact but no answer. I am going to cancel the contract if we don't get a resolution to this issue. We cannot survive on 80 percent of Tricare standard rates. California Medical Association: (888) or economicservices@cmanet.org Page 4 of 13

5 - Reimbursement is NOT acceptable. We saw persons with Tricare standard only, & those in the managed care plan were seen if there was an authorization approved to our practice. - Reimbursement rates are so low. - They decreased the fee schedule to 80% of Medicare allowable and hid this fact. - We are in the process of giving our 90 days notice. We tried to negotiate a contract with UMVS but we were told we had waited too long. It took me a minimum of 6 weeks to get a hold of anyone who knew anything about the contract. There was no possible way to negotiate within their time frame. We cannot afford to see Tricare patients with the current contract offered to us. It is an 18 percent decrease to our current contract. We are also disappointed in the lack of professionalism of the people we have been dealing with. - Had considerable difficulty in getting appropriate response from TRICARE/UHC. Our multispecialty group received about 20 different contracts...and only needed ONE for whole group which we never received after considerable communication. We also asked for a different rate, at least one that matched our current Tricare contract via Blue Shield. After months of back and forth and no resolution, we sent and opt out letter, which was ignored and all our MDs were loaded at rate we had not accepted. We now have sent a term letter (for material breach of contract) along with a proposal of what we will accept...our demographic in San Diego County has MANY Tricare members and we DO want to serve them... no word yet. In the meantime, we are stuck with a contract that is NOT acceptable. Extremely frustrating and disappointed in UHC processing/communication and incorrect information. - Want to but UHC Tricare has been uncooperative in approving amendments; since a contract was not signed by 4/1/13 our group is not a participating provider and unable to see tricare patients; did have over 201+ Tricare patients - However, we received the package about a week after the transition happened. I had called several times prior to April 1 to obtain information regarding the contract and to make sure everything was in place and was never able to get a confirmation one way or the other. - I have been working on contracting with UnitedHealth and Tricare since Jan 16th. I have worked with four people from both United and Tricare and still do not have a final contract. I made many calls and s to the first gal I was working with...after 2 months, I finally reach someone that tells me that she left that department. Nice. Now, we are trying to start over again???? - Tried to contact them regarding issues with the contract. I did not receive a response back. So, I declined the contract. As some of the issues were being resolved per your newsletters, I tried to contract them towards the end of March. I was told I would California Medical Association: (888) or economicservices@cmanet.org Page 5 of 13

6 receive a phone call back within 24 hours. It didn't happen. So, I called them back, and they told me they were backlogged. I still have not received a call. 5. If yes (to question #4), have you received written confirmation of the effective date of the contract with UMVS (e.g. copy of fully executed contract with effective date)? Yes 62% No 38% 6. Approximately how many TRICARE patients do you currently have in your practice? % % % % % None yet (new to TRICARE) 6% 7. Have you experienced any issues with UMVS since the transition on April 1? (Select all that apply) No 25% Long hold times 30% Website problems 35% Delays in authorization/referral determinations (i.e. beyond 5 business days) 30% No response to voic message 15% Delays in response to contracting inquiries 23% Difficulty getting set up with EDI 8% Provider directory problems 11% Eligibility and benefits 21% Not applicable-i chose not to participate in the new network 3% Other 18% 8. Have you experienced any issues during the TRICARE transition that have had a negative impact on patient care? No 58% Yes 42% Personal stories (sample) - Delays in getting referrals authorized is putting our patients' health at risk. Delay of care when we cannot confirm a new patient's eligibility. California Medical Association: (888) or economicservices@cmanet.org Page 6 of 13

7 - Had to reschedule a surgery because of lack of authorization. Told that things were so busy that a verbal could not be given. Patient had mother fly into town to take care of children - Requested an urgent oncology referral after the surgery but still have not received the auth. - Have had to cancel/reschedule patient visits because the authorization we requested was still being processed more than 5 days after it was requested. We had an acute patient that we were not able to see because no information could be given on status of authorization. - Pregnant pt with concerning abnormal ultrasound done at local hospital. I'm trying to get a follow up ultrasound with perinatologist, but cannot get it approved. - I have had to reschedule patients due to prolonged contract negotiations, which is certainly not in the best interests of our mutual patients. Items previously agreed to have not been honored in my amended contract, and I have had to reschedule Tricare patients because I have been told to hold my billings until June 1, The whole process has been very discouraging and frustrating. - We had a child with a probable fractured elbow. My staff had trouble getting the authorization and then there was no physician name given along with it. The child was maintained in a sling until we could get them seen by the appropriate orthopedist. It took an extra 4 days to get this done. - >20 scheduled patients with no update or movement on pending auth requests more than 7 business days. Severe disruption in care. Arbitrary formulary changes stable on previously approved medication with TriWest now non formulary with UMVS. - Delay in admission for in-patient services - Yes their automated phone system does not work and sends you to the wrong area. Much conflicting info given by United Health employees and they are very confused. Have not been able to get contracting done and started about 4 months ago. Initially told if I had a United contract that was all I needed and then found out I needed a United Tricare contract. No one there seems to know what they are doing. - We are in a city that has an air force base. We have many retirees and their families. Because of this, now, three-month debacle, our patients cannot be seen by their providers. Procedures are being put on hold, as patients are afraid of being stuck with a large bill. Patients that cannot wait for treatment are having to travel one hour, minimum to find another provider that takes Tricare. - Authorization for a surgery for fracture that was sent as a stat has not been authorized yet and we were told it will be at least Friday before we hear and it was sent on 4/3/2013. California Medical Association: (888) or economicservices@cmanet.org Page 7 of 13

8 - Being on hold for over an hour and a half to find out why patients are receiving letters telling them that they are being assigned a new PMC, is due to the fact we are now a non-participating provider with Tricare. We were contracted with Tricare before United HealthCare took over the contract on 4/1/13. Now we are being informed that we need to start credentialing with Tricare again to become a participating provider. However, United HealthCare is not 100% clear that we can get our participating provider status retroactive to 4/1/ Our physician, [name redacted] should have been loaded as contracted effective Dr. has been contracted with Tricare well over 10 years. When the new contracts went out, UHC made a mistake and sent it to the old practice address of the physician (remember, he was contracted at the time of the transition, and loaded correctly so it was a clear administrative error on UHC's part). We received a communication from UHC indicating if the provider was contracted with Tricare and didn't term his contract, he would continue to be participating. On March 27th, Dr. s patients received a termination notice from UHC indicating that effective Dr. was no longer contracted. Clearly this has multiple issues as UHC only gave patients 4 days notification that they were being assigned a new PCP and did not allow anytime to get this corrected. Dr. resides in a very small, rural community and has take pride in serving our military veterans and their families for over 10 years. He would never abandon his patients. If he was to term from an insurance company, he would give fair notice to his patients and the plans. The contracting department has given us notice in writing that the contract would be retroed to as it was their error. The problem is that it is still not completed and we are having a terrible time getting patients referrals and authorizations for tests that need to be completed. Patient care is being impacted and all because of a "clerical" error on their part. We want to get this resolved, loaded correctly and given the ability to provide accurate and complete care to his patients. - After we realized that we signed the contract for 80% of Medicare, which is very unreadable, we tried to call them several times without any success. - Authorization for long term meds. Some patients have been on certain brand named meds for years and have done well. Now the insurance company wants me to change the meds to the new formulary. Sometimes the patient cannot use the delivery system on the drugs in the formulary and this means more paper work to get authorization for the preferred Rx's. ( very annoying and I don't get paid for it). - Over a hundred patients reassigned from one doctor to another, no referrals or patient care until this is fixed. Patients unable to access care. Patients directed to other offices. No Internet access to benefits/eligibility. We had a great system in place, with an organization that worked very hard for our armed forces and their families. United's handling of this is a total disgrace - Our patients with Tri Care Prime that need to select a Primary Provider have been randomly removed and given another Primary Care. We have had Nurse Practitioners California Medical Association: (888) or economicservices@cmanet.org Page 8 of 13

9 as PCP and UHC is now not recognizing them. This has affected our patient care significantly. The local UHC representative was not aware that Nurse Practitioner may be PCP Providers. The Patients are confused and upset when they are seen. We have had some referrals denied because we were automatically deselected as their PCP. - We submitted our signed contract Dec I called UHC Tricare Contracting Team the beginning of March 2013 after hearing nothing after submitting our contract. The 1st person I talked to said everything was ok but when I pushed for our effective date he said there was some info missing (drs date of birth). I called back the next day to give the requested info and was told they didn't actually need that but there was some "hold up" with our application and was told to call UHC Credentialing & UHC Network Mgmt. When I called there I was told "we don't handle TriCare" and was given the # of the Tricare Network Mgr (Chris Troupe ) who I left a couple of messages for but never heard back. On March 26 I called again regarding my concerns and was given the # of Chris Troupe's supervisor (Tamara Lueper ) who I left a message for and never heard back. On April 1st I called the contracting team again and spoke to Anthony who said "everything is in order" but unsure what the holdup was. Said he would call Chris Troupe directly and call me back the next day. I never heard back. I called the contracting team again on April 8, expressed my concerns/frustration to Sharmella who said the contract was "in finalization" and we should be getting something soon. Today we FINALLY received our executed contract. There is no "effective date:" listed but there is an "approved for processing " on there. During this delay we had to cancel our TriCare patients who were scheduled for appointments as we were told we would not be paid for seeing them. I checked the provider directory online today and found that only 2 of our 3 doctors are listed as providers so I will need to call UHC back to try and straighten this problem out...not a task I am looking forward to. We also had a new patient call today who said they called UHC/TriCare to sign up with us but was told that none of the doctors in our practice are providers. As a Champus/Tricare provider for over 25 years we have never experienced problems of this magnitude during previous transitions. - They will not fax authorization, they are mailing them to us and we must call them to get a verbal authorization, with hold times of 2 hrs. - We are still waiting to be contracted. Original contract was mailed in January, they never received it, sent out another one via FedEx, still not in the system. We have some referrals pending. I called UH told they could be seen out of network but that's a negative impact on patient because that implies more out of pocket. 9. Please feel free to share any additional feedback on your experience with the TRICARE transition. (sample) - Not off to a good start... California Medical Association: (888) or economicservices@cmanet.org Page 9 of 13

10 - Horrible, an absolute failure - The website could be improved. One feature would be to add electronic authorization submission. That could greatly improve our productivity. A positive experience is that the customer service personnel have tried to be very helpful with my concerns. - We never received any information regarding the transition from the previous insurance to United Healthcare. Why did they not update providers or come to the various counties in California discuss transition and new changes. The primary care physicians no less than the specialist. We are having to help them. Really should have had education seminars for primary care and specialty providers! - The contracting process has not gone well. Patients are concerned because our providers are not showing as participating. I am still not sure if we have a current group agreement and if we do, I do not know what our reimbursement rate is. - Horrible - This was a bad transition. I called multiple times to get the contract packet renewed. Wrong and misleading information was given each time. I finally called. The contract person at UHC and she was nice enough to indicate by e mail that since I am participating with UHC a demographic sheet would only need to be filled out. This was faxed to me and that was all that was needed. In this process I was on the phone for couple of hours! - I have gotten all my transitional info from the prior carrier, no help at all from the present carrier very disappointing. - We left several messages with contracting department over the past few weeks, still without any call back. - Generally not responsive. Phone calls are not returned. Information is not available. - I left several messages in the weeks leading up to April 1 without a call back. I attended a webinar hosted by UMVS. The hosts were not unable to provide a copy of the slide show nor were they able to answer the majority of the questions asked during the Q&A portions of the webinar. A follow up with the answers to unanswered questions was promised but never delivered. - It has been terrible. Can't get help when you get through to talk to someone. - We sent in our opt out notice in October of We were contacted REPEATEDLY To contract even though we were clear the rates being offered were below what we were getting with Tricare prior. In December we were told by a rep our opt out would be processed. On Tuesday of this week (4/9) we got an amendment to our Tricare contract (a contract we don't even hold) when I called I was told we were in network California Medical Association: (888) or economicservices@cmanet.org Page 10 of 13

11 and our opt out was never processed. I still haven't gotten that all sorted out as I keep getting the run-around on who handles that (UMVS or regular UHC credentialing). - VERY, VERY CONFUSING - Disaster - Going with United was a very disappointing change at least for Humboldt County. United Healthcare has a very minimal referral network here. The contract was disappointing itself. Then it's ridiculous to start off on April 1 when there is no working system to allow us to do any type of care referrals for Tricare patients. - Extremely disorganized transition. Every time we called UHC we received a different answer to the same question. Some told us we didn't need to do anything (contracts, billing, referrals). Overall, very confusing time for both providers and patients. UHC did not provide us with sufficient information during the transition period. - It appears that the new contractor was fully unprepared as of April 1 for implementation of the contract. - The contracting process with Tricare has been terrible. Several calls to connect with the contracting representative. Many versions of the amendments, delay in mailing corrected amendment, difficulty to negotiate language/rates 10. Have you attended any of the UMVS webinars on the TRICARE transition? Yes 18% No 42% I did not know they were being offered 40% Demographic Information Specialty Allergy 3% Cardiology 5% Dermatology 2% Emergency medicine/trauma/ Urgent Care 0% Endocrinology 0% Gastroenterology 4% General surgery 4% Infectious disease 2% Internal medicine, Family Practice, General Practice 20% California Medical Association: (888) or economicservices@cmanet.org Page 11 of 13

12 Neurology 4% OB/GYN 6% Oncology 4% Ophthalmology 6% Orthopedic surgery 5% Orthopedics 3% Other 8% Otolaryngology 3% Pain medicine 2% Pediatrics 6% Physical medicine & rehabilitation 0% Plastic & reconstructive surgery 0% Psychiatry 1% Pulmonary 2% Radiology 3% Rheumatology 2% Urology 4% Vascular surgery 0% *0% reflects at least 1 response from the county but less than 1%. County Alameda 4% Butte 2% Fresno 6% Humboldt 1% Imperial 0% Kings county 3% Los Angeles 7% Merced 2% Monterey 2% Napa 1% Nevada 0% Orange 3% Out of State 3% Placer 1% Riverside 9% San Francisco 0% San Bernardino 2% San Diego 26% San Joaquin 2% San Luis Obispo 0% Santa Barbara 1% Santa Clara 4% California Medical Association: (888) or economicservices@cmanet.org Page 12 of 13

13 Santa Cruz 0% Shasta 2% Solano 0% Sonoma 4% Stanislaus 2% Sutter 1% Tulare 2% Tuolumne 0% Ventura 8% Yuba 0% *0% reflects at least 1 response from the county but less than 1%. Number of physicians in practice 1 40% % % % % % >20 3% California Medical Association: (888) or economicservices@cmanet.org Page 13 of 13