Clinic officials clarify enrollment changes at town hall

  • Published
  • By Don Branum
  • Air Force Academy Public Affairs
U.S. AIR FORCE ACADEMY, Colo. --  The 10th Medical Group commander held a town hall meeting at the Community Center auditorium here Jan. 17 to answer questions from the retiree community about the medical group's decision not to accept new Tricare Plus enrollments.

Those who turned 65 before Jan. 1 and are currently enrolled with the 10th MDG may continue to receive care at the Academy Clinic, said Col. Timothy Ballard, who emphasized that the change primarily affects future enrollment.

Those under 65 may retain their enrollment until their 65th birthday, Ballard said. They may still fill prescriptions and receive radiology services at the Academy clinic even after they turn 65.

The enrollment changes were originally scheduled to take place this month, but many retirees received letters in December -- in some cases, only weeks shy of their 65th birthdays, Ballard said.

"I realized late that we did a pretty horrendous thing to those of you who have birthdays in January," he said. "In three weeks, you'd be out the door."

So 10th MDG officials pushed the implementation date for the enrollment changes back six months, from Jan. 1 to June 1, Ballard said. Patients whose 65th birthdays fall between Jan. 1 and May 31 may continue to receive care through the 10th MDG and will get help finding a new primary care manager in the Colorado Springs area.

Tricare Plus allows patients to receive similar access to care as those enrolled in Tricare Prime, according to a Tricare fact sheet. Under the plan, retirees and their family members can receive an appointment with a military treatment facility within one week rather than on a space-available basis.

The Air Force Academy Clinic has offered Tricare Plus enrollment in previous years and will continue to provide health care to most of those already enrolled, but the clinic could not continue to offer the benefit to people "aging in" to Tricare Plus and Medicare, Ballard said.

Fort Carson's Evans Army Community Hospital is still accepting Tricare Plus patients, said Tim Jordan, who heads the hospital's Medical Management Division.

"Our current enrollment is 68,000, including 2,500 on Tricare Plus," Jordan said. "We're still taking new patients, but we're having the same challenges" stemming from an influx of roughly 2,700 Soldiers who will form a new aviation brigade there.

Whether patients could enroll depends on the providers available at Evans and patients' specific needs, Jordan said. Retirees may be able to enroll at Evans community-based clinics in Colorado Springs in the future, but enrollment at the clinics is currently restricted to active-duty service members and their families.

The Veterans Administration will also accept new enrollments, but the VA benefit only covers veterans, not family members, said Maj. Oscar Olipane, a senior group practice manager here. Veterans wishing to enroll with the VA must visit the Colorado Springs clinic on 25 North Spruce Street.

The TriWest and Medicare websites, http://www.triwest.com and http://www.medicare.gov, each offer provider lookup services, Ballard said. On the TriWest site, select "beneficiaries," then click on the "find a doctor" link at the top of the page. On the Medicare website, click on "physician compare" near the bottom of the page and select either internal medicine or family practice.

In addition to the Tricare Plus enrollment change, 10th MDG family practice providers have identified roughly 200 patients whose health care needs exceeded the clinic's capabilities. Those patients may receive help from the 10th MDG and TriWest in finding a new provider in Colorado Springs, but they must select a new internal medicine primary care manager by Feb. 2, or the group will initiate a primary care manager change for them.

The decision to limit enrollment and transfer high-acuity patients will allow the 10th MDG to provide its current patients with the best possible level of care, Ballard said.

Providers assign patients with acuity levels, which roughly measure the intensity of care required. Patients at most base clinics fall into the lowest category, Ballard said, but several patients at the Academy's family practice clinic fell into higher categories, beyond family practice providers' capabilities. Ballard asked the providers to identify those patients, 60 percent of whom had acuity scores above 15 and some of whom had scores above 20.

"We had patients with liver failure, on a transplant list, with 10 or more medications," Ballard said. "They truly needed a higher standard of care. Normally we would move them into internal medicine, but it's overenrolled."

The Internal Medicine branch is currently 60-percent staffed, Ballard explained. Its manning calls for five providers, but one of those providers is deployed at any given time, and another position is currently vacant.

Manpower reductions resulting from the 2008 Base Realignment and Closure Commission, combined with an increase in total enrollment from 29,000 in 2008 to more than 30,000 today, have forced the medical group's providers to make hard choices about how to continue to provide the best possible level of care, Ballard said.

Under a Defense Department initiative called Patient Centered Medical Home, family practice providers had to reduce their panels from 1,500 patients to 1,250 patients, Ballard said. This means better care for patients and less stress on providers who currently see between 25 and 30 patients per day.

However, it would also require the 10th MDG to drop 3,000 people from its rolls. Ballard said he was determined not to let that happen. Instead, he shifted providers from the Academy's acute care clinic. This allows the Academy to keep its current patient load but means the acute care clinic will now be open to cadets only.

"We have to provide 24/7 care for these cadets, many of whom don't have cars, many of whom can't get access to appointments outside the Terrazzo," Ballard said.

Medical group officials will look at the manning situation at least twice a year, Ballard said. The 10th MDG will announce any future changes to enrollment on its Facebook page at http://www.facebook.com/10thMedicalGroup.