Demonstration Project/Closed Network Provider Quality Standards


We have been trying to get feedback from the Tricare Management Activity (TMA), International SOS (ISOS) and Global 24 on specific quality standards used in the selection of the extremely limited network of providers under their Philippine experiment. So far we have gotten nothing back other than comments that pretty much say – Trust us, we know what is best for you and there is nothing to worry about as the more important issues of processing claims and vetting for fraud have been considered. In essence what we deduce from their comments about the program is as an experiment they are trying to learn lessons and make adjustments to the program on the levels of acceptance of the program by providers, beneficiaries. We don’t expect, nor will we accept, that another goal is to determine acceptable levels of death, infection and maiming of beneficiaries by using providers that are selected only on administrative requirements.

The following open letter was sent to Global 24 Support as well as TMA, ISOS, service organizations, RAOs and Stars and Stripes. If we get an answer we will post that here as well.

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We were told by your boss that there were no quality standards applied to providers in the experiment. The single criteria he referenced was that they were already on the certified list, meaning that they, at some point in the past, saw a Tricare beneficiary. He also clearly indicated and the slides also clearly indicated no real quality standards were considered. Instead it was clear the primary focus and ultimate requirement was that they agreed to process and submit claims and secondarily they passed an inspection to review past alleged fraud against Tricare. These are hardly quality standards to determine if Physicians provide minimally acceptable levels of care, are members in good standing with the normal associations, show a history of continuous annual CMA that is validated as acceptable to maintain minimal levels of competency, previous disciplinary actions for quality of care issues, removal of admitting privileges for cause, etc. Or issues with the minimum standards in hospitals such as unannounced inspections for cleanliness, minimum qualifications of staff in ERs, pathology, radiology, ORs, Recovery and ICU etc. Standards used by the facility to accept physicians for admitting privileges, infection control standards, hospital acquired infection rates etc.

When you mandate we use one or two physicians or a single hospital of “your” choice, it becomes extremely important that the extremely limited group of providers meet minimum standards that those mandated to see them know with confidence have been applied to the providers. Yet we have seen nothing to indicate any standards are being applied. Your comment below hardly demonstrates any level of review and in particular in the conspicuous absence of listing of standards which was even more conspicuous when completely absent from the PPT presentation. The blatant claim, “You will have access to providers who deliver high-quality  medical care.” and coming from TMA and ISOS with absolutely nothing to back it up and given their past history of empty promises only made the total absence of quality checks even more apparent and troubling as there is absolutely nothing to back up that claim and it conflicts with what we were told.

We know and were told by TMA that current TMA policy has no provisions for quality requirements for providers overseas for Standard beneficiaries, unlike in the states where approved providers are required to meet quality standards and where beneficiaries generally have hundreds to chose from instead of 1 or 2. TMA has never tried to limit access to care to the extreme extent they are doing in the Philippines with this experiment anywhere overseas. To do this without considering similar quality standards as are applied in the states is criminal and shows a complete lack of concern for the health and welfare of beneficiaries.

To claim, because this is an experiment and is set up to learn lessons and make adjustments should not include an experiment to see if patients survive treatment from overseas providers who have not been vetted for quality of care. While the experiment may be a valid approach to determine levels of acceptance of the program by providers and if the CMAC is adequately designed for local payment and even levels of acceptance by beneficiaries, using it to determine acceptable levels of death, infection and maiming of beneficiaries by using providers that are selected only on administrative requirements doesn’t seem to be appropriate but at present that appears to be one of the purposes of the experiment.

In America all health care organizations that limit access to care by dictating specific providers are required by law to provide a list of quality standards to all beneficiaries. While we are not in America, we are Americans and should be allowed the same consideration when our choices are dictated for us by an administrative entity.

Given your comment below please provide the specific reviews that are conducted. Please be specific and list each item and area reviewed including the expected standards providers are required to meet. If standards are applied due to membership, such as JCI or a local association, please provide a link to their specific standards. Since requirements for hospitals and physicians should be significantly different, please provide two lists, one for hospitals and one for physicians.

Since we are only days away from being mandated to use these providers, that we have no guarantee will provide quality care and who may put retirees, their wives and children in harms way it is imperative that this information be provided as soon as possible. If in fact there are quality standards and checks done, this shouldn’t be an easy request.

Thank your for your timely response in advance,

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About TRICARE Overseas Philippines

We are U.S. Military retirees working to insure we obtain the medical benefit promised in spite of the Defense Health Agency.
This entry was posted in Closed Network, CMAC Table, Emergency Care Access, International SOS, Tricare Management Activity (TMA), Tricare Overseas Program Philippines and tagged , , , . Bookmark the permalink.

4 Responses to Demonstration Project/Closed Network Provider Quality Standards

  1. jjjddd says:

    T.M.A. WANTS THE RETIRED MILITARY COMMUNITY TO TRUST THEM! RIGHT!
    “TRUST” IS A TWO WAY STREET! THEY REFER TO THE “RETIREE MILITARY IN THE PHILIPPINES AS THIEVES”! WHEREAS THE THIEVERY IS ALIVE & WELL IN THE U.S.A. ALSO AND T.M.A. & I.S.O.S. ARE THOUGHT OF AS FRAUDULENT & CROOKED INDENTITIES! BY EVERYONE ELSE!

    IT IS DECEMBER 6Th.! 25 DAYS UNTIL DECEMBER 31 St. & 1 JANUARY 2013 – DEMO DAY + 3 YEARS
    DON’T YOU THINK THAT THE FINAL RULES PROCEDURES SHOULD BE DISSEMINATED TO THE RETIREE’S & ALL THE PATIENTS!!!
    WEEKS – BEFORE THEY PICKUP THEIR PAY CHECKS & XMAS BONUSES – FOR WORKED PERFORMED IN 2012????!!!
    ON OUR BEHEST?!!!!!!!!!

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  2. Joe Godfrey says:

    I simply don’t believe this Demonstration Project/Closed Network is designed to work, don’t believe they have our, military retirees, interests at heart AT ALL. We are going to loose big time. Just another sham job by TMA.

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  3. Walter Graue says:

    Why should we, particularly those of us who have already been ‘guinea pigs’ when treated by “Military Medicine,” now be subjected to be ‘guinea pigs’ again, this time for a group of uncaring, lying, irresponsible money-grabbers?

    This bunch has no idea at all about how to manage and publish anything but disingenuous, meaningless falsehoods. Notice they never directly answer a question. They’re there to collect their pay-checks on our backs.

    I also dfisagree wiht the proposition that we collaberate on formatting a so-called “Tricare Handbook.” This appears to be bogus from the start, since we then would be initiating or translating Tricare instrucitons “sub-officio, and in doing so leave the door open to criticism or worse, attempted fraud from Tricare, ISOS, et al.

    I think that the individual who proposed this “handbook” (He ejected from our group due to slander and malicious lies) is now attempting to move back in with us. He is finding that his immitation group, with its immitation Internet address is obviously failing and he wants ‘back in’ probably because ‘Its cold out there.’ For example, we say to ISOS “We have this entry to guide our members in our handbook.” They say, “Invalid, that is not an official document,and you are trying to perpetrate fraud by representing it as our position on the matter.”

    Now is the time to put a stop to a potentially injurious influence re-introducing himself in stages, back into our group.

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  4. Walter Graue says:

    Paragraph 3 Line 1 should read “I also disagree with”
    Same paragraph line 3, Tricare instructions “sub-officio”
    paragraph 4 line 1 (He was ejected

    Sorry for the typos, divided attention. If you approve the post, please correct the above errors.

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