Improving our veterans' health care

By CHARLES STENHOLM

A little over six weeks ago, I brought together representatives of the Department of Defense, the Air Force, Foundation Health Federal Services, Dyess Air Force Base and the Abilene community to resolve concerns about the implementation of TRICARE, the military managed health care program, in Abilene.

I was proud to show the outsiders who joined me on the panel the high level of support for Dyess in the Abilene community as well as our ability to seriously tackle the challenges of dealing with the TRICARE program throughout our region.

When the two days of meetings were over, no one could claim ignorance about the issues facing TRICARE beneficiaries and providers.

Resolving problems

What came out of those meetings was more than a recognition of existing problems, but also an understanding of the process necessary to resolve problems, create long-term solutions, rebuild trust in the community and improve the TRICARE program nationwide.

To that end, a working group was created to tackle these issues.

The success of any group is dependent upon its leader and its members. Brig. Gen. Northington directed the group toward real solutions, and the local community contributed immeasurably to its success.

We owe a debt of thanks to Hendrick Health System and Abilene Regional Medical Center; Russ Brown and Burt Means, representing beneficiaries; and Pat Evans and Dr. David Bailey, representing the medical community.

Three of the issues considered by this team continue to be of great interest.

Claims-processing

The most pressing problem was the correct and timely payment of claims. Foundation Health, TRICARE administrator in Region Six, admitted problems with the claims processing system resulting in delays.

Although Foundation Health was in the process of resolving outstanding claims at the time of the town hall meetings, its officials quickly recognized the need to step up their efforts and brought in claims processing specialists to rapidly cut through the backlog of pending medical claims.

To resolve future claims-processing issues, the working group found several ways to improve the system. For example, they created a checklist for patients to ensure that they submit the information needed for the prompt payment of claims.

In addition, Foundation Health is providing education for providers including instruction on electronic filing of claims which will allow for quicker payment of claims.

Availability of care

Since the town hall meetings, there have been two efforts to increase the availability of care at Dyess and in the community.

I am pleased to confirm that the Air Force plans to provide approximately $9 million to upgrade Dyess Hospital. This funding will improve outpatient functions including pharmacy, radiology and laboratory services.

Additionally, Foundation Health Federal Services is recruiting physicians to increase the provider network.

This is an ongoing process, and I will be closely monitoring Foundation Health's progress in providing the services needed for the Dyess community.

Reimbursement rates

Physicians and patients were very concerned about the low rate of reimbursement authorized by the Department of Defense.

Some physicians found the rates paid by TRICARE to be lower than Medicare rates, and the Department of Defense is taking steps to raise these rates to the Medicare level.

Given current efforts to decrease the budget deficit and downsize the military, we all recognize that cost must play some role in determining how the government will provide health care to military dependents and retirees, but balance must be achieved.

In the next few months, I will be closely examining exactly what coverage has been promised to retirees and what dependent coverage is needed to retain current active duty members.

Health care in general and military health care in particular is an important issue that has a profound effect on a large number of people, and it is an issue in which I will continue to take the lead to ensure that patients receive the best care, that health providers are paid for that care and that we achieve this while living within budgetary constraints.

U.S. Congressman Charles Stenholm represents the 17th Congressional District of Texas, which includes Abilene and Dyess Air Force Base.