Tricare Rant

[Chonal Atresia]

I few months ago I posted a thread about the sudden influx of Tricare patients into my practice. I solicited ideas as to why this happened and if anyone else was experiencing this phenomenon. This post is a follow-up to my previous post and a plea to all those active duty docs seeing Tricare.

DON'T DUMP PATIENTS! I can't tell you how many people I've seen in the last 2 months (retirees, dependents and active duty) who have been tossed to the "network" so the military doesn't have to deal with them anymore. Trying to get records (i.e. notes, imaging, labs, studies, etc) is impossible and these patients are never given anything by their referring providers (whether PCP or specialist). I end up having angry patients who were told that "everything necessary was sent" when, in fact, nothing ever is. Occasionally, I will come across someone who has taken the initiative and secured records on their own, but nobody is ever told to do so by the referring provider. Usually, I end up having to repeat everything, which pisses off patients and wastes taxpayer dollars. It's become a running joke in our clinic of 40+ surgical providers that if the person is a new "Tricare patient," the sex and birth date on the charge ticket are probably wrong, too.

I personally never refer someone (either for a 2nd opinion or to another service) without giving them a physical copy of all their clinic notes, lab results, sleep study results, allergy test results, imaging CDs, etc. I assure you that this practice is not currently happening in the military. Nobody seems to care. I don't want to hear about how "busy" people are with collateral military duties. Providing patients with necessary records before referring them to someone else is part of being a doctor/provider.

If you are still active duty and dumping patients as described above, shame on you! You are doing these patients as well as civilian providers who are trying to take care of them a great disservice. To those of you that take the time to provide these patients with the records that they need, I applaud you. Continue to do so.

Rant over.

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[jabreal00]

I few months ago I posted a thread about the sudden influx of Tricare patients into my practice. I solicited ideas as to why this happened and if anyone else was experiencing this phenomenon. This post is a follow-up to my previous post and a plea to all those active duty docs seeing Tricare.

DON'T DUMP PATIENTS! I can't tell you how many people I've seen in the last 2 months (retirees, dependents and active duty) who have been tossed to the "network" so the military doesn't have to deal with them anymore. Trying to get records (i.e. notes, imaging, labs, studies, etc) is impossible and these patients are never given anything by their referring providers (whether PCP or specialist). I end up having angry patients who were told that "everything necessary was sent" when, in fact, nothing ever is. Occasionally, I will come across someone who has taken the initiative and secured records on their own, but nobody is ever told to do so by the referring provider. Usually, I end up having to repeat everything, which pisses off patients and wastes taxpayer dollars. It's become a running joke in our clinic of 40+ surgical providers that if the person is a new "Tricare patient," the sex and birth date on the charge ticket are probably wrong, too.

I personally never refer someone (either for a 2nd opinion or to another service) without giving them a physical copy of all their clinic notes, lab results, sleep study results, allergy test results, imaging CDs, etc. I assure you that this practice is not currently happening in the military. Nobody seems to care. I don't want to hear about how "busy" people are with collateral military duties. Providing patients with necessary records before referring them to someone else is part of being a doctor/provider.

If you are still active duty and dumping patients as described above, shame on you! You are doing these patients as well as civilian providers who are trying to take care of them a great disservice. To those of you that take the time to provide these patients with the records that they need, I applaud you. Continue to do so.

Rant over.

Same problem with VA patients referred to me. I just have to go off what the patient says they were referred for and usually repeat some testing.

 

[militaryPHYS]

I'm sure many are dumped which is unsat. If the consult never gets to the specialist we have a whole other problem. MTF's which have implemented central booking would have this problem. Consult placed by PCM --> Access for specialist is too far out or non-existent --> central booking quickly diverts the consult to network.

This is good information to know and think about as access to care standards and beneficiary care is forcing more out to network. Systems should be set in place for medical records to be sent.

If it is referring provider's fault then shame on them. If it is failure of another MilMed system there might be avenues to improve.

 

[Gastrapathy]

@Chonal Atresia dude, they don’t care. They’re in survival mode. They’ll just say that you can have the patient fill out a record request and bring 200 pages of nonsensical AHLTA downloads with a 4-6 week processing time.

 

[Chonal Atresia]

@Chonal Atresia dude, they don’t care. They’re in survival mode. They’ll just say that you can have the patient fill out a record request and bring 200 pages of nonsensical AHLTA downloads with a 4-6 week processing time.

Sadly, I know you’re correct.

You’d like to think that these referring active duty providers would appreciate the situation that these patients are in but they just don’t want to be bothered.

 

[haujun]

I bet you have much more support where you work. Sometimes I get assistance from caseworker in my clinic but most of time I do all the admin work. I am not even authorized to use printer in my office. I print out my last note for my patients to take it for a second opinion and my NCOIC tells me that it is against regulation to give patient’s note this way.

 

[haujun]

I few months ago I posted a thread about the sudden influx of Tricare patients into my practice. I solicited ideas as to why this happened and if anyone else was experiencing this phenomenon. This post is a follow-up to my previous post and a plea to all those active duty docs seeing Tricare.

DON'T DUMP PATIENTS! I can't tell you how many people I've seen in the last 2 months (retirees, dependents and active duty) who have been tossed to the "network" so the military doesn't have to deal with them anymore. Trying to get records (i.e. notes, imaging, labs, studies, etc) is impossible and these patients are never given anything by their referring providers (whether PCP or specialist). I end up having angry patients who were told that "everything necessary was sent" when, in fact, nothing ever is. Occasionally, I will come across someone who has taken the initiative and secured records on their own, but nobody is ever told to do so by the referring provider. Usually, I end up having to repeat everything, which pisses off patients and wastes taxpayer dollars. It's become a running joke in our clinic of 40+ surgical providers that if the person is a new "Tricare patient," the sex and birth date on the charge ticket are probably wrong, too.

I personally never refer someone (either for a 2nd opinion or to another service) without giving them a physical copy of all their clinic notes, lab results, sleep study results, allergy test results, imaging CDs, etc. I assure you that this practice is not currently happening in the military. Nobody seems to care. I don't want to hear about how "busy" people are with collateral military duties. Providing patients with necessary records before referring them to someone else is part of being a doctor/provider.

If you are still active duty and dumping patients as described above, shame on you! You are doing these patients as well as civilian providers who are trying to take care of them a great disservice. To those of you that take the time to provide these patients with the records that they need, I applaud you. Continue to do so.

Rant over.

I performed procedure and send it to specialist (same specialty) for a second opinion when my patient requests one. Most of time if not 100% my patients get repeated procedure despite supplying all the information to include pathology report etc. Maybe they don’t trust military information. So I am hesitant in performing procedure before referring the patient out.
When I was alone for 4 months ( 3 doctors’ job) I referred most of PCM consult requests to outside and was on-call and did inpatient consults for 4 months. I lost few weeks of leave. It really sucked for me and the patients. In civilian practice the hospital would have used locum provider.
As for leave...in military you get 30 days of leave per year but this does not mean that you can use them. Read fine prints in HPSP contract and remember the HPSP scholarship is not scholarship. You have to pay it back in time and selfless service...

 

[Gastrapathy]

Doing a procedure and then referring out a patient for follow up care will always result in duplicate work. I’m not going to make clinical decisions based on a report from someone I don’t know. I’m not protected by the federal government if I screw up. There’s absolutely no incentive to trust anything.

 

[Cooperd0g]

Here are a few issues I have had lately - the consult process through my main hospital is completely jacked up. If I put too much detail, they will cancel it and not even tell me! They are telling me that the consulting physician never sees the actual consult note - WTF? This is not how it was when I worked at the big hospitals where we could see exactly what was written in the consult. The other issue is that for a decade or more, my small clinic had been primarily focusing on health benefit to the detriment of readiness and active duty. So people are being pushed to the network because things came to a head this past spring. And since our consult system is so messed up through this hospital system I'm not surprised that the info is not flowing well.

 

[backrow]

You know what I hate, I hate when I get a patient from the civilian network with no records, no CD, no nothing, and when they come in they say “I don’t know why I’m here”. Sometimes they’ve been seen for years by these civilian practices who don’t take the time to give the patient records.

It’s a two way street. Happens both ways. Most civilian practices have extensively more clerical support than the military practice. Those civilian practices also don’t have to deal with rules such as “you cannot give patients records from the clinic, they have to go to patient admin” so I think these civilian practices should be ashamed of themselves and understand the predicament they are putting their patients in. Then trying to get records from those clinics becomes a fight of futility.

Ok, this is partly tongue in cheek, but get out of here with this broad-brushed slam against providers who may not have any say in what is happening. Now, if you hear of someone refusing to provide records then feel free to keel haul them.

 

[Gastrapathy]

At least for me this would be a one-way problem. We’re an open notes organization. No request needed since they already have them. Now, if someone wants more than that, you’re right, I don’t even see those requests. Clerks do clerk work.

OpenNotes – Patients and clinicians on the same page

OpenNotes is the international movement dedicated to making health care more open and transparent by encouraging doctors, nurses, therapists, and others to share their visit notes with patients.

www.opennotes.org

 

[Chonal Atresia]

You know what I hate, I hate when I get a patient from the civilian network with no records, no CD, no nothing, and when they come in they say “I don’t know why I’m here”. Sometimes they’ve been seen for years by these civilian practices who don’t take the time to give the patient records.

It’s a two way street. Happens both ways. Most civilian practices have extensively more clerical support than the military practice. Those civilian practices also don’t have to deal with rules such as “you cannot give patients records from the clinic, they have to go to patient admin” so I think these civilian practices should be ashamed of themselves and understand the predicament they are putting their patients in. Then trying to get records from those clinics becomes a fight of futility.

Ok, this is partly tongue in cheek, but get out of here with this broad-brushed slam against providers who may not have any say in what is happening. Now, if you hear of someone refusing to provide records then feel free to keel haul them.

I don’t disagree with you at all. I can only tell you how I practice and EVERYBODY that is referred for a 2nd opinion and/or to another specialty gets a copy of their clinic notes, labs, studies, radiology in hand.

This essentially never happens with Tricare. Assign blame where you will, it’s a major problem. I’m not going to get in a pissing match with you over number of support staff. I may have more ancillary staff, but I also routinely see 50+ patients/day. My note is dictated, printed and given to the patient before they leave the office.

 

[militaryPHYS]

If the administrative/monetary burden is that bad why not just further restrict the # of Tricare patients you see per day?

 

[Chonal Atresia]

If the administrative/monetary burden is that bad why not just further restrict the # of Tricare patients you see per day?

We do, but that’s a great solution to the problem.

Haven’t you argued in previous threads that former military docs should accept Tricare?

 

[backrow]

I think this rant should probably be more directed at the system rather than the physician. The current military note system has no great method for this to happen. There is a great opportunity for quality improvement here, but the systems based issue of our notes system doesn’t make it easy.

Some may think they are doing a good job in this issue by typing a very detailed consult, but not realize that all of that is lost once the referral is kicked to the network where all they usually get is a name and diagnosis.

 

[militaryPHYS]

I think this rant should probably be more directed at the system rather than the physician. The current military note system has no great method for this to happen. There is a great opportunity for quality improvement here, but the systems based issue of our notes system doesn’t make it easy.

Some may think they are doing a good job in this issue by typing a very detailed consult, but not realize that all of that is lost once the referral is kicked to the network where all they usually get is a name and diagnosis.

Agree. A rant is just that. It rarely accomplishes anything while generalizing blame.

I’m sure OP doesn’t care, but if it were me, since we know they are in an area with only a single local MTF I would talk to the department head of the specialty in question. If they are the ones sending them ask that the providers in the department do more diligence to procure studies/notes for the patients they are sending over. If it is central booking or referral management who is automatically deferring PCM consults out due to specialty provider access issues I would ask that the department head work with the director of healthcare business to ensure a system is set in place to procure studies/notes for the patients to take with them to the appointment. Either way it is unsatisfactory for a patient to end up in the network without any paper trail.

I would also be interested to hear an update on discussions had with regional tricare contractor regarding reimbursement negotiation since we know this is often times a regional issue that can be improved.

Successful or not, both of these things would be good information that could help the practices of the few people who participate in this forum, active duty or civilian.

 

[backrow]

Agree. A rant is just that. It rarely accomplishes anything while generalizing blame.

I’m sure OP doesn’t care, but if it were me, since we know they are in an area with only a single local MTF I would talk to the department head of the specialty in question. If they are the ones sending them ask that the providers in the department do more diligence to procure studies/notes for the patients they are sending over. If it is central booking or referral management who is automatically deferring PCM consults out due to specialty provider access issues I would ask that the department head work with the director of healthcare business to ensure a system is set in place to procure studies/notes for the patients to take with them to the appointment. Either way it is unsatisfactory for a patient to end up in the network without any paper trail.

I would also be interested to hear an update on discussions had with regional tricare contractor regarding reimbursement negotiation since we know this is often times a regional issue that can be improved.

Successful or not, both of these things would be good information that could help the practices of the few people who participate in this forum, active duty or civilian.

Knowing the OP’s history from this board I would venture that they do care and may even think about providing that feedback if they still have some contacts back at the place, but the unfortunate reality is that things will get better for a bit, but then return to the norm because the system isn’t set up well.

What I mean by that is a few things:
1) Our EMR sucks. No sugar coating that, it’s one of the worst in the country and it’s downtime is measured in hours or even days per year.

2)The “in-house” referral system does not generate communication between providers. When a PCM puts in a consult the diagnosis isn’t even related frequently, the history is minimal, and there is no letter auto-generated or other info from the originating provider. The referred physician has to do all the legwork to get the patients history. (I will say that in non-routine referrals most PCMs will reach out and discuss in my experience).

3)The “in-house” consultation system does not generate any communication between providers. Unless the consultant types a letter and emails there is essentially zero communication back to the referring provider unless they go back and read the note. Letters to PCMs are essentially non-existent and are not “taught” in 99% of GME programs. In the “real world” to bill for a consult level one must send a letter back to the referring provider. This is not the case within mil Med. I frequently will email referring providers outside of AHLTA, but this is onerous and time-intensive sometimes.

3)There is no easy way to transcribe letters to providers.

4)if a patient gets a new consult because their old one expired it’s possible they get sent to the network with the prior doc never even having a clue (or a say in it). This causes them to show up with no prior notes.

So, overall our system is not set up well to communicate with other providers (that obviously wasn’t important to the bean counters for whom it was really made). We also don’t teach it well within our system because our “system” doesn’t demand it.

I wish there were a simple fix but I can’t even get folks to call when they put in something higher than a routine level consult, so this certainly isn’t going to be an easy fix.

Anyone know if Genesis does consult reports or something similar?

 

[absolutdokta]

Anyone know if Genesis does consult reports or something similar?

I would probably have to pull out the sat phone, GPS tracker, buy lunch, and go to the bathroom before trying. That about sums it up in terms of how long it takes to find stuff on genesis. I’ll ask our team “superuser”....though she admits the only special thing about the term superuser means people just complain to her more. I’ll report any significant findings.

 

[militaryPHYS]

What I mean by that is a few things:
1) Our EMR sucks. No sugar coating that, it’s one of the worst in the country and it’s downtime is measured in hours or even days per year.

Truth! Sounds like Genesis won't be the answer we've all been waiting for either.

This all goes back to the inconsistencies in our big system though. The things we cannot change (Tricare, AHLTA/Genesis) aren't worth complaining about unless you're on the committee or focus group with a goal to make them better. Outside of our mandated EMR, every MTF, every clinic, every sub-specialty seems to have a different set of business rules. When you combine inconsistent business practices with a crappy EMR you're looking at big, regularly occuring failures.

I agree that even if something changes in the short term it will drift back as people rotate out and time roles on. If the short term business practice solution is reliable, reproducible at other MTF's and applicable across services then it can be established as a best practice. I know DHA, AMSUS, etc. are actively looking for these examples to implement MHS wide as we all join together in the coming decade.

 

[BlackFrancis33]

I am 100 percent certain this is a problem in your practice as you say. I am also 100 percent positive the same s#!& happens the other way, civilian to military. The only way to prevent this is to require that all records, imaging etc are received before scheduling an appointment. That is what happens at NIH, Hopkins etc. We don’t have the manpower to make that happen in the MHS, so you just suck it up. I’m sorry it happens in your practice but I feel the same on a daily basis in the MHS getting patients from civilian practices.

 

[Gastrapathy]

This is the meaningful quality stuff but don’t tell that to the pilot loving HRO gurus.

 

[absolutdokta]

I am 100 percent certain this is a problem in your practice as you say. I am also 100 percent positive the same s#!& happens the other way, civilian to military. The only way to prevent this is to require that all records, imaging etc are received before scheduling an appointment. That is what happens at NIH, Hopkins etc. We don’t have the manpower to make that happen in the MHS, so you just suck it up. I’m sorry it happens in your practice but I feel the same on a daily basis in the MHS getting patients from civilian practices.

Being on the forscom side I tend to get a lot of guys coming from the civilian sector after being referred off-post for ortho. definitely way more than when i was at the hospital during residency, probably just because of younger, more accident prone patient population i now see. the only paperwork i usually see is one from the civilian practice recommending 3 months of con leave after surgery. that appointment is usually after a call from a company commander saying "DOC!!!! does this guy really need 3 months of con leave?!?!"

most times I wasn't even the one that referred to soldier so I have to put on my detective hat and hunt through notes and piece things together so I can make him a recommendation, make the profile, and then explain things to the BC at the next profile review. not picking on ortho, just what i see because of my job, and to say that the door definitely swings both ways.

 

[xpert787]

You guys know that there is an online Tricare portal where patients can access their own records, including ALTHA notes and print them off? You have to be the sponsor, and you can access all dependent records as well.

 

[HighPriest]

FWIW: I do get patients from the nearby naval post without adequate records. I also get plenty of patients from local PCPs who are civilians with inadequate records. Frankly, it's about even odds either way. I can get on to epic and get records for civilian patients, and have to do so about 15% of the time. I can't access Tricare, but we always tell patients to hand carry their paperwork because we expect it will be an issue. At least where I am, this is definitely not just a military issue.

And, to be honest, most of the time the records are worthless no matter where they're coming from. imaging reports are ok, but I rarely have the actual images (which are far more helpful). Half of the time the note basically says "Dude here for COPD.....Physical exam for COPD....Assessment: COPD....Plan: 1 - Continue COPD stuff, 2 - Refer to ENT (50% chance of actually saying why), and the consult is for otalgia.

We don't have local military ENT, so it's never a second opinion. I usually have to send them back to post to get records if they saw an ENT somewhere else in the military system.

If they saw an ENT in the community, I usually do get records.

We do send records, both with the patient and to the provider, to try to prevent things falling through the cracks. We also have people who can answer phones and fax records on the spot if necessary.

But this is also a subspecialty clinic. The number of patients that i send for a referral or second opinion is probably far, far lower than a primary care clinic where they're sending out people all of the time. The volume is probably very incomparable. And, to be honest, most of the primary care docs in my community and on post seem like they're sending out everything. Stuffy nose? Go to ENT. Should you try something first? Nah, why? You're going to see an ENT....

 

[TheTruckGuy]

As others have noted, sometimes we expect them to be sent to the MTF, but for some reason or another they get sent out in town.

But this is also a subspecialty clinic. The number of patients that i send for a referral or second opinion is probably far, far lower than a primary care clinic where they're sending out people all of the time. The volume is probably very incomparable. And, to be honest, most of the primary care docs in my community and on post seem like they're sending out everything. Stuffy nose? Go to ENT. Should you try something first? Nah, why? You're going to see an ENT....

From what I hear, this is pretty common place in the civilian world as well. I was talking to a fiance of one of my sailors who was complaining how her PCP seems like she never actually does anything, just always sends her to specialists.

But it's certainly an issue in the military, at least where I am. I know when acute issues (broken bones, heat exhaustion, large lacerations, etc) show up in our clinic, I take care of it as best I can, and dispo directly to the relevant specialist (usually ortho) as needed. Some of the other providers are like "why didn't you just send them to the ER?" I think working hard and doctoring is hard sometimes.

I also do my best to not send out referrals unless I have no idea what I'm doing, or have already failed at management. But I also deal with service members who doubt what I say because I'm not a specialist, and if I don't refer them to a specialist they'll just try and get an appointment with one of the other docs that's inclined to refer everything out.

 

[HighPriest]

From what I hear, this is pretty common place in the civilian world as well. I was talking to a fiance of one of my sailors who was complaining how her PCP seems like she never actually does anything, just always sends her to specialists.

It is. I meant this as something I get from PCPs everywhere, military or not.

And it is, I understand, sometimes not black-and-white.

There are PCPs out there who basically do everything that they can before they send someone to me. There are PCPs who never, ever do anything first. And then, as you stated, there are patients who just want to "see the specialist."

I think the latter happens, but I also think it's often used as an excuse to just not bother with a patient's complaint. If I see that excuse come from a doc who usually does a good job, I buy it completely. Some patients are just that way. And, frankly, they usually end up not giving me any grief at all, even when I just put them on a nasal spray and send them home. But there are certain people in the community where no one they send to me ever has anything done.

Now, I have a bit of a different perspective on that now that I'm out of the military. Patients who have just been tossed right off the cart by their PCP mean more visits for me, so that's billable appointments. But there's an ethical part of me that gets frustrated when I see a patient who could have been feeling better already if someone had just tried something, but now it's been 6 weeks and they're still suffering because someone didn't want to take the time.

 

[Chonal Atresia]

FWIW: I do get patients from the nearby naval post without adequate records. I also get plenty of patients from local PCPs who are civilians with inadequate records. Frankly, it's about even odds either way. I can get on to epic and get records for civilian patients, and have to do so about 15% of the time. I can't access Tricare, but we always tell patients to hand carry their paperwork because we expect it will be an issue. At least where I am, this is definitely not just a military issue.

And, to be honest, most of the time the records are worthless no matter where they're coming from. imaging reports are ok, but I rarely have the actual images (which are far more helpful). Half of the time the note basically says "Dude here for COPD.....Physical exam for COPD....Assessment: COPD....Plan: 1 - Continue COPD stuff, 2 - Refer to ENT (50% chance of actually saying why), and the consult is for otalgia.

We don't have local military ENT, so it's never a second opinion. I usually have to send them back to post to get records if they saw an ENT somewhere else in the military system.

If they saw an ENT in the community, I usually do get records.

We do send records, both with the patient and to the provider, to try to prevent things falling through the cracks. We also have people who can answer phones and fax records on the spot if necessary.

But this is also a subspecialty clinic. The number of patients that i send for a referral or second opinion is probably far, far lower than a primary care clinic where they're sending out people all of the time. The volume is probably very incomparable. And, to be honest, most of the primary care docs in my community and on post seem like they're sending out everything. Stuffy nose? Go to ENT. Should you try something first? Nah, why? You're going to see an ENT....

I do see patients being "dumped" without records by civilian providers; however, it is my experience that this practice is much more pervasive with Tricare (and VA) patients. Whether that's because referring providers don't want to/aren't "allowed" to provide records to patients or it's central processing's fault, I don't know. I do know that it's a big problem and huge inconvenience for both the patient and myself. These patients are already waiting 6-8 weeks just to see me because of limiting the # Tricare patients we see and the fact no one else will see them. When I was active duty (now over 5 years ago), I provided patients that I referred to other services/2nd opinion with clinic notes, labs, studies, radiology, etc in hand. It's the patient's medical record for crying out loud and I wasn't giving them originals. Whether I was in "violation" of some AR-blah, blah, blah I didn't much care.

I am just trying to be a good steward of healthcare dollars and do the right thing by the patient. Repeating allergy labs (when they were just done 2 months ago) and a CT of the neck, sinuses, etc not only delays patient care and runs up expenses, but it also exposed them to more unnecessary radiation.

Frustrating.

 

[backrow]

Whether I was in "violation" of some AR-blah, blah, blah I didn't much care..

Yeah, not so worried about that either, but when they’ve taken all the office printers away and only give you one central printer that sits behind some administrator who does care it makes it more difficult.

 

[backrow]

You guys know that there is an online Tricare portal where patients can access their own records, including ALTHA notes and print them off? You have to be the sponsor, and you can access all dependent records as well.

I’ll admit that I didn’t....but sure enough, there it is on the Tricare Patient portal....all your records and dependents under the age of 12!

 

[HighPriest]

i printed out notes all of the time i was regularly asked not to do it by various ncos, and then i did it anyway

 

[militaryPHYS]

I’ll admit that I didn’t....but sure enough, there it is on the Tricare Patient portal....all your records and dependents under the age of 12!

I just logged on as well. Had no idea this existed. Thanks, @xpert787 !!

 

[HighPriest]

I just logged on as well. Had no idea this existed. Thanks, @xpert787 !!

It cost $4.4 trillion dollars of taxpayer money to make, the facility that houses the server employs 2,000 people, and now literally 3 people know about it. That sounds about right.

 

[militaryPHYS]

Gotta start somewhere

 

[HighPriest]

The Army in 5 years: "Well, no one is using this Tricare Portal. They must not want it. Let's cut the funding."

Also the Army: "Everyone needs to know that you can't stack things within 3 feet of the ceiling. Make them train on it every month for eternity."

 

[absolutdokta]

It cost $4.4 trillion dollars of taxpayer money to make, the facility that houses the server employs 2,000 people, and now literally 3 people know about it. That sounds about right.

Kinda like relay health. I remember getting harped on it every single morning at huddle and how important it is and how we are all bad people for not checking it. Can’t imagine how much that system was costing.....genesis rolls out and it magically goes away overnight, quite literally overnight.

 

[TheEarDoc]

I do see patients being "dumped" without records by civilian providers; however, it is my experience that this practice is much more pervasive with Tricare (and VA) patients. Whether that's because referring providers don't want to/aren't "allowed" to provide records to patients or it's central processing's fault, I don't know. I do know that it's a big problem and huge inconvenience for both the patient and myself. These patients are already waiting 6-8 weeks just to see me because of limiting the # Tricare patients we see and the fact no one else will see them. When I was active duty (now over 5 years ago), I provided patients that I referred to other services/2nd opinion with clinic notes, labs, studies, radiology, etc in hand. It's the patient's medical record for crying out loud and I wasn't giving them originals. Whether I was in "violation" of some AR-blah, blah, blah I didn't much care.

I am just trying to be a good steward of healthcare dollars and do the right thing by the patient. Repeating allergy labs (when they were just done 2 months ago) and a CT of the neck, sinuses, etc not only delays patient care and runs up expenses, but it also exposed them to more unnecessary radiation.

Frustrating.

You just described my biggest gripe with the VA CHOICE program and now the MISSION act. I send my patients to a specialist. Tri-west gets involved. Patient ends up waiting longer to see community specialist than they would have to see VA specialist and half the time the referred to specialist either doesn't do what was asked of them (not sure if they didn't get proper instruction/documentation from VA/Tri West or just did what they wanted), but it often times has led to longer wait times, repeated testing, and no better care, but more expensive care! And I spend hours each week calling to get records from providers in the community for patients who chose to go to said providers and then when stuff is not sent back they come to my office upset because no one from the community has called them back. It goes both ways.

And I can't give anyone anything here. I have to refer them to the release of information office to sign for it and print it out.......

It's frustrating on both sides of the fence.

 

[deuist]

So, overall our system is not set up well to communicate with other providers (that obviously wasn’t important to the bean counters for whom it was really made). We also don’t teach it well within our system because our “system” doesn’t demand it.

I used to work nights in the emergency department. On the rare occasion that I wanted to speak with another provider from a different specialty about a nonstat issue, I would simply send an encrypted email with the relevant data

 

[backrow]

I used to work nights in the emergency department. On the rare occasion that I wanted to speak with another provider from a different specialty about a nonstat issue, I would simply send an encrypted email with the relevant data

Which required you to take positive action and required a completely different computer program than the EMR and was not automatic.

Several EMRs will automatically create consult reports from a note and forward to the referring provider. Others will let the referring provider know their patient was seen. Many EMRs actually talk between the inpatient and inpatient side and let’s not even talk about the fact that some military ERs use some other EMR that has exactly zero connectivity to AHLTA/Essentris.