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As Oregon continues to contribute soldiers to military efforts overseas, their families at home rely on the Tricare military health system for care. At the same time, Oregon doctors are struggling with their consciences as they are urged to take Tricare patients despite relatively low reimbursement rates and a famously multi-layered military health care bureaucracy.

"Everybody has had bad experiences with Tricare," said James Lace, a longtime Salem pediatrician whose practice is committed to seeing underserved populations. About half of the children cared for by Childhood Health Associates are Oregon Health Plan patients. But its doctors find it difficult to take in Tricare patients, largely, they say, because of paperwork.

"You can’t tell someone to take a loss because it’s their patriotic duty," said Lace. "You have to pay the electricity and salaries. If you don’t have a margin you don’t have a mission."

Lace said his practice has learned to work within the OHP system and can therefore maximize reimbursement, working with the IPA that manages the health plan in his area. He doesn’t yet have that kind of relationship with Regence BlueCross BlueShield, which manages Tricare in Oregon. His calculations look like this: Private insurance pays around $65 to $70 per unit. OHP pays about $30 per unit, but adding case management fees and risk management returns at the end of the year, providers can bump that average up to about $50 per unit. That leaves Tricare, which is paying about $35 per unit, with no opportunity within its system to raise that amount.

As a Vietnam War veteran, Tom Coogan knows a thing or two about tough fights. But confronting a $2.5 million reduction in the state budget for durable medical equipment (DME) and services, combined with soaring gas prices, has frustrated even Coogan, a former Army combat medic who is director of industry affairs at Care Medical Equipment.

"It’s like being a prize fighter up against the ropes, just doing the rope-a-dope and trying to protect your face from damnation," he said.

For two years, the Department of Human Services, taking its cue from the federal Medicare allowable fee schedule, tried to reduce reimbursements on oxygen mobility equipment, powered wheelchair maintenance and other DME services by 20 percent. The Pacific Association of Medical Equipment Suppliers (PAMES) of Oregon and Washington appealed to the state’s Emergency Board and had that reduction overturned, said Coogan, who is president of PAMES.

The city of Elgin is one step closer to forming a health district to fund its clinic beyond Oregon Health and Science University’s June withdrawal, despite the tiny Eastern Oregon city’s council and mayor resigning in recent weeks.

The Oregon Legislature’s 2007 government standards and practices law, ORS chapter 244, required city officials in 97 cities in six counties that had previously opted out of filing statements of economic interest to begin doing so in 2008. The reports would have been due April 15; rather than file, four of Elgin’s volunteer city councilors – along with many other rural city officials – resigned, leaving three members in an unusual situation.

Joe Garlitz, Elgin administrator, said the remaining three city council members, including Mayor Carmen Gentry, resigned in order to give the county commissioners the ability to reappoint a quorum.

"If there’s no one left [on the council], then the county commissioner immediately appoints a quorum," said Garlitz. "That puts us back together in the most expedient way."

And that’s exactly what happened May 7 at the Union County Board of Commissioners meeting.

The chairman of the Oregon House Health Care Committee asked Willamette Dental officials on May 6 to study the audit and case histories of a 21-year-old autistic patient who allegedly was refused an appointment for months for an infected jawbone that caused severe pain.

Dr. Leigh Colby, a dentist with Oregon Dental Care, used this patient’s history as an example of the "pattern of abuse by all of the large capitated [Oregon Health Plan] dental providers," he said in a letter to the committee. "The pattern of abuse takes the form of ‘supervised neglect’ wherein these organizations set up internal processes and procedures that effectively bar patients – in particular children – from receiving essential dental treatment on a timely basis."

He told members of the interim committee that he and Dr. James Barta, who appeared with him, have been speaking out about such "stalling tactics" for 10 years, and wrote that "as long as the State provides reimbursement dollars on a prepaid ‘capitated’ basis, the financial incentive for this form of abuse is going to continue because the profit model for these operations is predicated on implementing ‘treatment stalling’ tactics."

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