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The University of North Texas Health Science Center held its annual Convocation and White Coat Ceremony August 4 at Will Rogers Auditorium in Fort Worth.
The newest class of incoming health professionals were welcomed by faculty and applauded by more than 800 family, friends, and other guests.
The Convocation and White Coat Ceremony serves as a milestone on a student's way to becoming a professional, reminding them of the significance of the tradition they are joining. Participating were120 students of the Texas College of Osteopathic Medicine and 22 students in the new Physician Assistant Studies master's program. These incoming students received their traditional white coats, provided by TOMA, during the ceremony. The Graduate School of Biomedical Sciences welcomed 40 new students into its programs and the School of Public Health welcomed its 73 new students with gifts appropriate to their future profession.
Keynote speaker Dr. William Anderson, past president of the American Osteopathic Association, described the entering students as the leaders of tomorrow and noted how the health science center is experiencing tremendous growth and change.
Special guests included Dr. Ronald R. Blanck, the health science center's incoming president, and his wife, TOMA President, Bill V. Way, D.O. and his wife Darlene represented the association during the ceremony.
Supporters of the Convocation and White Coat Ceremony included the Arnold P. Gold Foundation; the Physician Assistant Studies Foundation; the Office of the President; the Robert Wood Johnson Foundation; the Texas Osteopathic medical Association; 1999-2000 Graduate School Distinguished Alumnus Gerald Cagle, Ph.D.; and the School of Public Health.
A reception followed the ceremony in the atrium of the health science center.
The Health Resources and Services Administration launched a new, five-year $15.4 million program to create a nationwide network of Public Health Training Centers at eight academic institutions.
The University of North Texas Health Science Center’s School of Public Health received a portion of the grant totaling $612,348. The health science center was awarded the grant through a collaborative effort with the University of Texas Health Science Center’s School of Public Health in Houston and Texas A&M University School of Rural Public Health.
The centers will be a training ground for some 100,000 public health students and practicing professionals each year to learn the latest techniques and practices to protect the public health.
HRSA is the leading Health and Human Services agency for improving access to health care for individuals and families nationwide. HRSA’s Bureau of Health Professions spends some $436 million annually to educate and train culturally competent and diverse health care providers who provide cost-saving primary care services to medically underserved communities.
The University of North Texas Health Science Center has been awarded the Texas Academy of Family Physicians’ Medical School Award. The TAFP Medical School Award is presented to those schools who have at least 25 percent of their graduates entering family practice residencies.
“We continue to encourage medical students to enter family practice. There continues to be a imbalance in the number of family physicians versus subspecialists in our state,” said Dr. Marcus Purvis, TAFP President. “It is an honor to recognize the University of North Texas Health Science Center. They have shared this vision, and are committed to producing the family physicians of tomorrow.”
The award was presented by Dr. Purvis during TAFP’s 51st Annual Session and Scientific Assembly in Arlington, July 27-30.
Over One-third of Physicians Age 50 or Older Plan to Retire Within One to Three Years
A Merritt, Hawkins & Associates survey also noted that another 16 percent of physicians in that age category plan to reduce their practice significantly and ten percent plan to see no patients or change careers. Survey respondents cited dissatisfaction with managed care as the primary reason for retiring early. (American Medical News, 7-24-2000)
The Department of Health and Human Services (HHS) justified the cuts, which would begin as early as October 1 and could impact as many as 750,000 elderly patients each year, by citing data obtained by federal investigators showing that Medicare pays far more for many of the anti-cancer drugs than do physicians, the New York Times reported. At least 120 members of Congress representing both parties signed letters to HHS expressing alarm about the plan and the manner in which it was announced unilaterally, while physicians said they would be forced to send many of their Medicare patients to hospitals for treatment, causing inconveniences and increasing Medicare costs. (New York Times, 8-6-2000)
The FTC charged Focusmedical.com and other Web sites with dispensing prescription drugs like Viagra and Propecia while falsely claiming that they were full-service medical clinics and that the prescriptions were being filled on their premises. The settlement bars the web sites from misrepresenting their medical and pharmaceutical arrangements and from giving out personal information about customers without their permission, while requiring the sites to maintain and keep records about confidentiality procedures. (Yahoo News, 7-13-2000)
Clinton appointed Harvard psychiatrist James S. Gordon, M. D., to chair the new commission charged with recommending federal guidelines for using alternative medical therapies. The commission will also recommend legislation or administrative action to maximize benefits of alternative medicine and minimize potential risks from unproven therapies. (Associated Press, 7-13-2000)
A Millennium Research Group study also noted that less than one percent of medical supply and device purchases currently take place on the Internet, but that the market for online purchases of medical products is expected to reach $27.3 billion by 2004. (Modern Healthcare, 7-10-2000)
Jury Verdict Research data noted that the 1998 median jury award of $755,530 was up 60 percent over the median award in 1996, AMNews reported. A sample of malpractice claims closed between 1994 and 1998 against physicians insured by CNA HealthPro revealed that 45 percent involved ambulatory care, the vast majority originated in a physician's office or clinic rather than in a hospital, the average payment per claim was higher for those involving ambulatory rather than acute care, and diagnosis-related claims outpaced those involving treatment-related claims in the outpatient setting. (American Medical News, 8-7-2000)
The House approved two amendments to an FDA appropriations bill: one that would allow Americans to buy prescription drugs in Canada or Mexico if U. S. regulators had already approved their use and they were made in U. S.-approved facilities, and a second amendment that would bar enforcement of regulations on travel abroad to purchase prescription drugs. Lawmakers noted that Americans sometimes pay more than citizens in other countries for the same popular medications. (Associated Press,7-11-2000)
A University of Colorado study of Medicare HMO and fee-for-service stroke patients found that HMO patients received substantially less skilled nursing, physical therapy and occupational therapy during their rehabilitation stay in a hospital, while fee-for-service patients received more care from attending physicians, neurologists, physiatrists and psychologists. Thee fee-for-service patients also had longer hospital stays and a greater number of outpatient visits to doctors, while the HMO patients received more outpatient physical therapy and occupational therapy and more home health care subsequent to shorter, less-intensive rehabilitation stays. (Journal of the American Geriatrics Society, 7-7-2000; Medical Industry Today, 7-10-2000)
A retrospective review of 428 closed malpractice claims against emergency physicians in Colorado between 1982 and 1997 found that those who were EM residency-trained had less than one-half of the occurrence of closed claims resulting in indemnity payments than did non-EM residency-trained physicians. (Journal of Emergency Medicine, August 2000; American Academy of Emergency Medicine, 7-18-2000)
Researchers compared census data from two time intervals, noting that, as employer-sponsored insurance coverage declined from 1989 to 1993, the amount of the nonelderly population without insurance increased from 16.2 percent in 1989 to 18.2 percent in 1993, and the number of children without insurance grew from 16.4 percent to 17 percent, the Wall Street Journal reported. From 1994 to 1998, when Medicaid coverage dropped due to welfare reform, the population of uninsured non-elderly persons also grew from 17.3 percent in 1994 to 18.4 percent in 1998, while the number of uninsured children grew from 14.5 percent to 15.6 percent. (Health Affairs, July/August 2000; Wall Street Journal, 7-17-2000)
The Senate approved a measure, attached to the agricultural bill it is currently debating, that would allow pharmacists and drug wholesale distributors to purchase and import drugs that have been shipped from the U. S. to other countries and would require the Secretary of Health and Human Services to certify that there would be cost reductions and no safety risks to U. S. consumers. The U. S. House recently passed similar measures, while the White House has not taken a formal position on the proposal. (Associated Press, 7-19-2000)
HCFA published its 2001 physician fee schedule on July 17 with a 60-day comment period, indicating that Medicare expects to pay physicians $39 billion in 2001, up from $37 billion this year, reported Medical Industry Today. The 2001 payment will be a blend of 75 percent resource-based RVUs and 25 percent the old charge-based system that reflects historical costs, while the fee schedule system will be entirely RVU-based by 2002. (Medical Industry Today, 7-28-2000)
The groups sent a joint letter to HHS Secretary Donna Shalala and HCFA Administrator Nancy-Ann Min DeParle insisting on a delay at least until October 1, stating: "Inview of the material operations deficiencies and lack of testing identified below, the decision of HCFA to implement the outpatient PPS on Aug. 1, 2000, is arbitrary, capricious and an abuse of discretion," Modern Healthcare reported. The letter warned that, if the PPS is not postponed, software problems could delay payment to hospitals and lead to insolvency of some providers. (Modern Healthcare, 7-24-2000)
Aetna's price hike will be part of its effort to offset higher pharmacy, hospital and other medical costs and to turn around its low-profit health care operations after it sells its financial services business to ING Group later this year, reported the Hartford Courant. Aetna said that it will increase premiums starting in this year's fourth quarter to reflect higher-than-expected hospitalization, outpatient surgery and emergency room visit costs.(Hartford Courant, 7-30-2000)
Published in the Federal Register and scheduled to take effect October 1, the Medicare hospital payment changes would require hospitals to absorb greater costs before qualifying for outlier payments-- the extra Medicare payments hospitals receive for the most expensive cases. Similar changes required hospitals this fiscal year to spend 27 percent more than last year to receive the outlier payments, while the latest changes would require hospitals to spend at least 25 percent more next year on a patient's care, or $3,500, before qualifying for the extra payments. (Philadelphia Inquirer, 8-2-2000)
Despite concerns expressed by the American Hospital Association and other hospital trade groups that imperfections in the system's billing system would lead to delayed payments and provider insolvency, and demands that implementation be delayed until alleged defects in the system are corrected, HCFA has launched the system and said it will soon release a contingency plan in the event that computerized billing systems at either hospitals or fiscal intermediaries do not work, Modern Healthcare reported. Among the changes to be made to the draft plan, HCFA noted, is an increase of temporary payments from 70 percent of the hospital's historical Medicare payment level to 85 percent, which HCFA believes will assist hospitals in maintaining cash flow without jeopardizing the Medicare Trust Fund. (Modern Healthcare, 7-31-2000)
The Harvard University Medical School survey, funded by a $230,000 grant from the Robert Wood Johnson Foundation and to be conducted in December, will ask members of New Jersey's 10 largest HMOs to evaluate the effectiveness of their treatment, ease in obtaining it and helpfulness of medical and HMO staff, reported the Bergen Record. The survey is also being field tested as a possible standard for other states, agencies and businesses. (Bergen Record, 8-3-2000)
Under new HCFA standards, transplant centers may now get approved in one year instead of being required to operate on non-Medicare patients for two years before seeking Medicare approval, Yahoo News reported. HCFA changed the approval standard after being persuaded by research indicating that the volume of transplants performed by a center is a better predictor of outcomes than the number of years of experience. (Yahoo News, 8-3-2000)
Department of Health and Human Services Secretary Donna Shalala signed final regulations, as mandated by the Health Insurance Portability and Accountability Act of 1996 (HIPAA), requiring any health care organization that electronically exchanges data such as claims submission, health benefit eligibility verification, referral authorization and medical service documentation to use standard transaction formats and billing codes, Modern Healthcare reported. The final rules, published in the Federal Register, spell out standard code sets for medical diagnoses and procedures, while other final codes are pending on standard identification numbers for providers, payers and employers. (Modern Healthcare,7-31-2000)
The American College of Osteopathic Emergency Physicians (ACOEP) has granted the honorary title of Fellow of the ACOEP to John L. Urbanek, D.O., of Houston.
Dr. Urbanek was among 29 osteopathic emergency physicians recognized for their contributions to the field of emergency medicine and the ACOEP at the April 27th meeting of the ACOEP Board of Directors in Scottsdale, Arizona.
Dr. Urbanek will be formally recognized for his achievements at the Fellowship Ceremony to be held during the AOA Convention/ACOEP Scientific Seminar in Orlando, Florida, on October 30, 2000.
The Physician Oncology Education Program (POEP) awarded 28 Texas medical students scholarships to attend cancer education programs or cancer-related community events this year.
Among those students were Matthew Margolis and Tad Pierce, both members of the TCOM Class of 2001 at the University of North Texas Health Science Center at Fort Worth.
POEP provides Texas physicians and medical students with state-of-the-art information about cancer prevention, screening and early detection. Scholarship funds are available from POEP each September.
The POEP Web site is: www.poep.org.
The Texas Academy of Family Physicians selected Samuel T. Coleridge, D.O., of Fort Worth, as vice president at its 51st Annual Session and Scientific Assembly. Dr. Coleridge assumed his duties July 29 at the annual Installation Banquet and Ball.
Dr. Coleridge is currently Professor and Chairman in the department of Family Medicine at the University of North Texas Health Science Center at Fort Worth. Actively involved in his Academy, Dr. Coleridge has served on numerous TAFP committees and commissions over the years. He is currently chairman of the Family Practice Residency Program Advisory Committee of the Texas Higher Education Coordinating Board.
During his year as vice president of the TAFP, Dr. Coleridge will work with the president and the other officers in leading the Academy. As an officer, he will meet with state legislators and testify before legislative hearings as an advocate of family doctors and the patients they serve.
TAFP, the state’s largest medical specialty organization, promotes and assures the maintenance of high quality health care, has 31 local chapters and is a state chapter of the American Academy of Family Physicians. It provides its members with a unified voice for family medicine and continues to be one of the most patient oriented, public health focused groups in Texas.
Existing wireless medical telemetry systems may be at increased risk of electromagnetic interference (EMI) if they continue to operate in the range of frequencies in which most medical telemetry devices are currently operating. To address this risk, the Federal Communications Commission (FCC) has created a new Wireless Medical Telemetry Service (WMTS) that will allow medical telemetry systems to operate on an interference-protected basis. A copy of the letter from CDRH can be found at: http://www.fda.gov/cdrh/safety/emimts.html
Health professionals are notified of important labeling changes for all dosage forms of Mellaril. The new changes include a boxed warning, a change in the indication, contraindications with certain other drugs, and new recommendations for baseline monitoring and overdosage treatment. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/safety00.htm#mellar
Health professionals are notified of important revisions to the safety labeling for Relenza. The labeling has been revised to more clearly reflect that serious respiratory adverse events have been reported in patients with or without known underlying respiratory disease, and to incorporate additional updated safety information. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/safety00.htm#relenz
Health professionals are notified of a voluntary recall of SangCya (Cyclosporine Oral Solution, USP (MODIFIED), 100mg/mL), 50 mL bottle. A study in healthy volunteers has identified that SangCya is not bioequivalent to Neoral oral solution when mixed with apple juice as recommended in its labeling. SangStat is taking this Class II recall action with the knowledge of the FDA. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/safety00.htm#sangcy
Health professionals are notified of severe hypersensitivity reactions following reintroduction with Ziagen. Fatal hypersensitivity reactions are a described risk associated with the use of abacavir. Recent reports indicate that severe or fatal hypersensitivity reactions can occur within hours after Ziagen reintroduction in patients who have no identified history or unrecognized symptoms of hypersensitivity to abacavir therapy. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/safety00.htm#ziagen
For the 2000--01 influenza season in the United States, lower than anticipated production yields for this year's influenza A(H3N2) vaccine component and other manufacturing problems are expected to lead to a substantial delay in the distribution of influenza vaccine and possibly substantially fewer total doses of vaccine for distribution than last year. A more precise estimate of the vaccine supply will be available as production progresses during the summer. Because many vaccine providers currently are planning their fall vaccination activities, CDC and the Advisory Committee on Immunization Practices (ACIP) are issuing adjunct influenza vaccination recommendations beyond those made by ACIP on April 14, 2000 (1). The adjunct recommendations are specific to the 2000--01 influenza season. The article may be found at: http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4927a4.htm
Update to the WARNINGS section in the labeling. Cases of life-threatening pancreatitis have been reported in both children and adults receiving valproate. Some of the cases have been described as hemorrhagic with a rapid progression from initial symptoms to death. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/depako.pdf
Voluntary Recall of Rabies Vaccine, IMOVAX Rabies I.D. http://www.fda.gov/cber/fprecalls/rabvac072800.htm
| DATE RECALL INITIATED: | July 28, 2000 |
| LOT NUMBERS / EXPIRATION DATE: |
P0313-3 04/16/2001 P0030-2 04/16/2001 N1204-2 02/27/2001 |
| MANUFACTURER: | Aventis Pasteur S.A,. Lyon, France |
| DISTRIBUTOR: | Aventis Pasteur Inc., Swiftwater, PA |
| REASON: | IMOVAX Rabies I.D. (Rabies Vaccine) is used for pre-exposure prophylaxis against rabies. In the course of routine stability testing, Aventis Pasteur learned that the potency of lot number P0313-3 had fallen below specification 24 months after manufacturing. Although this product met all specifications at the time of release, its potency fell below specification prior to the product's expiration date. Lot numbers P0030-2 and N1204-2 are also being recalled as a precautionary measure since all three lots were prepared from the same initial bulk lot. |
The firm recommends, as a precaution, that patients who were vaccinated with one of these lots for pre-exposure prophylaxis---and who remain at risk for rabies exposure---should either be tested to measure the presence of antibodies and be vaccinated as needed (if the testing will not substantially delay vaccination), or be revaccinated.
Voluntary withdrawal of Helixate lot number 670H071E. This lot of Helixate was tested for Factor VIII potency using a reagent known as FVIII-deficient plasma. During a routine quality assurance investigation of the testing procedure, Bayer learned that Lot 670H071 may not retain its labeled potency if held at room temperature (25° C) for 3 months. The product will remain stable if stored at 2-8° C. Further investigation has confirmed that the cause is not related to a stability issue with the product but is attributed to the reagent used during the initial testing. As of this date there have been no adverse events reported in association with this lot of Helixate. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/helixa.pdf
Voluntary withdrawal of Kogenate lot numbers 670H071C and 670H076. This lot of Kogenate was tested for Factor VIII potency using a reagent known as FVIII-deficient plasma. During a routine quality assurance investigation of the testing procedure, Bayer learned that Lot 670H071 may not retain its labeled potency if held at room temperature (25° C) for 3 months. The product will remain stable if refrigerated. Further investigation has confirmed that the cause is not related to a stability issue with the product but is attributed to the reagent used during the initial testing. As of this date there have been no adverse events reported in association with these lots. A copy of the letter may be found at: http://www.fda.gov/medwatch/safety/2000/kogena.htm
After 13 years of decline, gonorrhea rates in the United States increased by more than 8% from 1997 to 1998. Prior to this upswing, gonorrhea rates declined by more than 64% between 1985 and 1997.
Gonorrhea rates in Texas increased more than 23% from 1997 to 1998. The 1998 annual rate was 168 per 100,000 population, versus 138 in 1997. The implementation of improved STD reporting systems and targeted STD screening efforts such as the Infertility Prevention Project were significant factors in the upswing. From 1998 to 1999, gonorrhea rates in Texas dropped slightly from 168 to 163 per 100,000 population. (Bureau of HIV and STD Prevention, Texas Department of Health)
The National Minority AIDS Council's (NMAC) Patients' Guide to HIV Medicines is now available online. The guide can be downloaded at www.nmac.org/treatment/treatpub.htm.
NMAC has written the guide to update people living with HIV/AIDS about HIV medications in a concise, easy-to read format. It is meant to answer questions about HIV medications and the blood tests used to monitor HIV infection. It also includes a self-assessment designed to encourage dialogue with doctors. The guide is available in English, Spanish and French.
To request a hard copy of the guide, please contact NMAC at info@nmac.org or call at 202-483-6622 and ask for the publications coordinator. (Texas Department of Health)
The FDA approved the Da Vinci Surgical system for laparoscopic surgery, noting that it can perform precise movements in tiny spaces and could eventually be refined to perform better microsurgery than currently possible. The device is currently being tested in other types of surgeries, including heart bypasses and heart value replacements. (Associated Press, 7-11-2000)
HHS Secretary Donna E. Shalala announced the release of new CDC pediatric growth charts that are not only updated and more representative of the U. S. population, but which will now include a new assessment for body mass index (BMI). This key tool will help identify weight problems early on in children. These growth charts will be used by pediatricians, nurses and nutritionists to monitor children’s growth.
Secretary Shalala and Surgeon General David Satcher also announced that the Surgeon General will convene a workshop this fall to develop a national action plan to address weight problems and obesity.
The new charts are published in a report, “CDC Growth Charts: United States.” The report and the corresponding data are available on the CDC Web site at: http://www.cdc.gov/growthcharts. A more comprehensive report will follow in the fall.
Health care professionals have new evidence and tools to help patients quit using tobacco, according to a report issued June 27 by the U. S. Public Health Service (PHS). A private sector panel of experts convened by the federal government has challenged all clinicians, insurance plans, purchasers, and medical school officials to use the evidence in the new guideline to make treating tobacco dependence a top priority.
The PHS guideline, “Treating Tobacco Use and Dependence: A Clinical Practice Guideline,” contains evidence-based information about first-line pharmacologic therapies (bupropion SR, as well as nicotine gum, patches, inhalers, and nasal sprays) and second-line therapies (clonidine and nortriptyline). It also highlights new evidence about how telephone counseling can help patients quit.
“There has never been a better time for health professionals to help their patients break free from the deadly chronic disease we know as tobacco addiction,” said David A. Satcher, M. D., Assistant Secretary for Health/Surgeon General. “Starting today, every doctor, nurse, health plan, purchaser, and medical school in America should make treating tobacco dependence a top priority.”
The guideline is aimed at practicing clinicians. Studies have shown that more than 25 percent of U. S. adults smoke and that 70 percent of them would like to quit. Of those smokers who try to quit, those who have the support of their physician or other health care provider are the most successful. Data show that only half of the smokers who see a doctor have ever been urged to quit.
The guideline concludes that tobacco dependence treatments are both clinically effective and cost-effective relative to other medical and disease prevention interventions. The guideline urges health care insurers and purchasers to include, as a covered benefit, the counseling and pharmacotherapeutic treatments identified as effective in the guideline and to pay clinicians for providing tobacco dependence treatment, just as they do for treating other chronic conditions.
Copies of “Treating Tobacco Use and Dependence: A Clinical Practice Guideline,” and a consumer guide called “You Can Quit Smoking” are available by calling 1-800-358-9295 or writing to Publications Clearinghouse, P.O. Box 8547, Silver Spring, MD 20907-8547. Or, select http://www.surgeongeneral.gov/tobacco/default.htm.
A Centers for Disease Control survey of parents of 34,442 children 19- to 35-months- old in 50 states noted that 80 percent of toddlers received five of the six recommended vaccinations in 1999. The rates for most vaccines remained unchanged from the previous year, with the exception of the chicken pox vaccine, which jumped to 59.4 percent in 1999 from 43.2 percent in 1998. (Associated Press, 7-7-2000)
Some children enrolling in schools or child-care facilities this fall will face new immunization rules for hepatitis A, hepatitis B and chickenpox (varicella), effective August 1. Plus students in public and private schools and child-care facilities must be up to date on all their immunizations, according to Kristin Hamlett of the Immunization Division at Texas Department of Health (TDH).
The hepatitis A vaccine requirement affects only those children attending school or child-care facilities in 32 counties along the Texas-Mexico border. Since August 1, 1999, two doses of hepatitis A have been required for children 5 years and older, born on or after Sept. 2, 1992. As of August 1, 2000, this requirement expands to include younger children enrolled in licensed child-care facilities.
Two-year-olds must get one dose of hepatitis A vaccine on or after their second birthday. Children in this birth group - born on or after Sept. 2, 1992, must have two doses by the time they turn 3. Children with proof of a previous hepatitis A infection do not need to be vaccinated.
Studies show that 50 percent of children in the 32 border counties in Texas have been infected with hepatitis A by age 10. During the last 10 years, an average of 39 cases of hepatitis A infection per 100,000 population a year was recorded in this area. The U.S. Centers for Disease Control and Prevention recommends routine hepatitis A vaccinations in areas that average at least 10 cases per 100,000 population a year for 10 years.
Also as of August 1, the existing requirement for hepatitis B vaccine expands to include a group of adolescents. Previously, children born on or after Sept. 2, 1992, had to show proof of receiving three doses of hepatitis B vaccine by age 5. As of August 1, children born on or after Sept. 2, 1988, also must be vaccinated against hepatitis B. These children may receive the vaccine at any time before age 12, but proof of vaccination will not be required until 30 days after their 12th birthday. Children with proof of a previous hepatitis B infection do not need to be vaccinated.
Before recommendation for universal infant vaccination against hepatitis B, about 30,000 children and adolescents were infected annually in the country. A large number of people infected with hepatitis B early in life become chronic carriers who can continue to transmit the disease. Vaccination against hepatitis B is the only way to decrease the number of chronic carriers.
Chickenpox (varicella) vaccine or a history of having had chickenpox disease is required for two groups of children as of August 1. The first group is children born on or after Sept. 2, 1994, who are 12 months of age or older. A second group, children born on or after Sept. 2, 1988, but before Sept. 2, 1994, must show proof of vaccination or a history of having had chickenpox by 30 days after their 12th birthday.
Before the vaccine, about 4 million cases of chickenpox occurred each year in the United States, with up to 200,000 patients having complications including an average of 100 deaths.
Other vaccines required at various ages are polio; diphtheria, tetanus and acellular pertussis (DTaP); Haemophilus influenzae type b (Hib); and measles, mumps and rubella (MMR). Children who have not completed a particular series of shots may attend school or child-care facilities if they have received at least the first dose and are on schedule for the remaining doses as soon as medically possible.
"Children vaccinated at the earliest recommended age always meet state immunization requirements," said Robert Crider, director of TDH's Immunization Division.
Editor's Note: The hepatitis A vaccine is required in these 32 border counties: Brewster, Brooks, Cameron, Crockett, Culberson, Dimmitt, Duval, Edwards, El Paso, Frio, Hidalgo, Hudspeth, Jeff Davis, Jim Hogg, Kenedy, Kinney, La Salle, Maverick, McMullen, Pecos, Presidio, Real, Reeves, Starr, Sutton, Terrell, Uvalde, Val Verde, Webb, Willacy, Zapata and Zavala.
A listing of the minimum state vaccine requirements for Texas children can be viewed with this story at the following Web address: http://www.tdh.state.tx.us/news/ac071400.htm
A Centers for Disease Control and Prevention's National Center for Health Statistics report also noted that 61 percent of women in that age group reported having a mammogram in 1994, and only 27 percent reported having one in 1987, noted Yahoo News. Age-adjusted breast cancer death rates for women fell to 19 deaths per 100,000 in 1998, compared to 23 per 100,000 in 1990. (Yahoo News, 7-26-2000)
On July 7th, Texas Health and Human Services Commissioner Don Gilbert announced the suspension of the state’s attempt to recoup $34 million in Medicaid claims paid to physicians and other health care professionals over the past 22 years.
The problem began this past June when thousands of physicians and other health care professions in the Medicaid program received letters from the National Heritage Insurance Company (NHIC), the state Medicaid contractor. The letters instructed physicians to correct 409,000 claims submitted between 1977 and 1999. Corrected claims were to be submitted within 45 days or money they had already received was to be repaid.
In communicating news of this action to TOMA, President Bill V. Way, D.O. noted: “I know that many Texas osteopathic physicians felt this recoupment program was the last straw. Doctors felt like they were being whipped by the Medicaid program. You’ve been through the Medicaid managed care rollout fiasco, the re-enrollment hassle, and now this. I am thankful that Commission Gilbert listened to us and reacted as quickly as he did.”
The first lawsuit under Texas’ 1997 HMO liability law was filed against NYLCare 65 by the family of a 68-year-old man who killed himself after discharge from a 13-day stay at a psychiatric hospital. The family contended that NYLCare, its medical director and its psychiatric benefits management company insisted on the patient’s discharge against his physician’s recommendation. Although the defendants of the settlement did not admit wrongdoing, parties on both sides agreed that the case has made the state’s managed care companies less likely to overrule a physician’s recommended treatment. (Fort Worth Star-Telegram, 7-18-2000)
Nearly Two-thirds of Texas Hispanic Voters Say They Know Little or Nothing about the Children’s Health Insurance Plan (CHIP)
A bilingual Star-Telegram/Knight Ridder poll of the state's Hispanic population found that, despite CHIP's outreach efforts, 26 percent reported not knowing much about the program and 39 percent said they had never heard of it, the Star-Telegram reported. Seventeen percent of respondents reported knowing something about CHIP and nine percent reported knowing a lot about it. The state Health and Human Services Commission noted that the program for children from families earning less than 200 percent of the federal poverty level began enrolling children in May, that almost half of the 47,000 enrollees so far are Hispanic and that the state hopes to enroll as many as 400,000 children. (Fort Worth Star-Telegram, 7-23-2000)
Triad is considering upgrading the 122-bed hospital's computer system, cardiology services, women's services and diagnostic and imaging areas. Dallas-based Triad will have 31 hospitals by October and may add up to 20 more hospitals in the next two or three years, the Star-Telegram added, citing Triad CEO James Shelton. (Fort Worth Star-Telegram, 7-25-2000)
Texas began enrollment in its Children’s Health Insurance Program this May, one year after state lawmakers created the program and three years after Congress authorized $48 billion in matching funds for such a program, while states are required to use the first installment of the federal funds by September 30 or risk losing it. An estimated 40,000 children statewide have thus far enrolled in the program, which is expected to serve at least 400,000 uninsured Texas children under 19 whose families have an annual income at or below twice the poverty level. (Scripps Howard Austin Bureau, 7-7-2000)
Rural Texas hospitals receive $2.2 million from state tobacco settlement In 1999, the Texas legislature set aside $50 million dollars from the state's tobacco settlement, creating the Rural Health Facility Capital Improvement Program. The interest on the endowment provides a permanent $2.2 million annual grant - a unique result of the foresight of the Texas Legislature. Thirty-two rural Texas hospitals have been awarded the first $2.2 million to help with capital improvement needs such as:
Ninety-seven applications totaling $9.5 million were received by the Center for Rural Health Initiatives, the State Office of Rural Health, the agency responsible for administering the program. Dave Pearson, the program's administrator at the Center, said he was moved by the wide variety of projects for which facilities requested funding. "These funds are available to rural Texas hospitals in the form of grants and zero interest loans," Pearson explained. "This type of funding is extremely useful to rural facilities that are strapped for cash and in need of improvements." Robert. J. "Sam" Tessen, Executive Director of the Center, agreed with Pearson. "This program is an exceptional opportunity for rural hospitals to access much needed funds to deal with vexing building issues and equipment needs."
The implementation of the program is a direct result of collaborative efforts of rural hospitals, providers and the Center, who have partnered to make up the advisory committee which oversees the administration of the program. The final award decisions were based upon eligibility requirements set by the legislature, and review criteria established by the advisory committee. The Center, located in Austin, provides leadership in encouraging innovative responses to rural health care needs. The Center advocates and administers a number of programs and services designed to help rural health providers and communities proactively address the health care needs of rural Texans. Contact the Center toll free: (877) TEX-CRHI(839-2744); or by e-mail: rhi@crhi.state.tx.us.
Health care facilities often lose money when they sell medical equipment. When it’s time to replace equipment, hospitals and other facilities often store old equipment in a warehouse, where it loses value because buyers aren’t able to see it in use.
An online auction company based in Bryan has a solution. AuctionMart.com lets hospitals and clinics auction equipment on the Web while it is still in service, so potential buyers know exactly what they are getting. The company takes digital photographs of the equipment, collects data on it and rates its condition, then posts all the information on the Web and monitors the auction. Buyers can talk directly tot the sellers, and sellers get a better price and save money on storage.
There are no brokers in the middle of the deal – the company only sells equipment coming out of service directly from health care facilities.
For more information, contact Dale Hickson, at jdhickson@auctionmart.com; or call 979-260-8966, ext. 102. (Texas Innovator, July 2000)
United Healthcare of Texas, which serves 127,000 members in North Texas, was fined $17,000 for failing to respond to consumer complaints within 30 days, violating state advertising laws, using unlicensed agents and failing to report accurately several items on its annual statement. MetroWest Health Plan, which serves 3,000 members, was fined $1,500 for failing to provide complaint information requested by the department this year. (Fort Worth Star-Telegram, 7-12-2000)
According to Texas Insurance Department data, single-service HMOs, which cover only a specific area of health care such as vision or dental care, saw statewide enrollment rise some 25 percent, from 2.1 million members in 1998 to 2.7 million in 1999. Single-service HMOs are easier to administer and are less likely than basic-service HMOs to be hit by many rising health care costs such as prescription drugs, the Insurance Department noted. Total profits for single-service HMOs in Bexar County rose from $19.4 million in 1998 to $20.9 million in 1999. (San Antonio Business Journal, 7-17-2000)
The 32-bed institution, which is owned by Medina County and the city of Hondo and needs over $13 million to upgrade or replace outdated equipment, is soliciting Christus Santa Rosa Healthcare System, the Nix Healthcare System, the Baptist Healthcare System and the Methodist Healthcare System for a partnership arrangement, rather than issuing bonds or seeking a higher hospital district tax. (San Antonio Express-News, 7-11-2000)
The American Health Care Associations also noted that nearly 12 percent of nursing homes nationwide have been involved in bankruptcy proceedings. Those figures are being driven by pressure from reimbursement reductions in Medicare, which accounts for up to 70 percent of nursing homes’ revenue, and in Medicaid, which accounts for up to 12 percent, as well as from increasing liability premiums and a tight labor market. The Texas Insurance Department noted that nursing home liability insurance statewide totals approximately $250 million each year, or about $2,500 per bed. (Austin Business Journal, 7-17-2000)
While the majority of the commissioners said they support a tax rate increase, County Judge Lee Jackson said he expects an increase of 6 to 6.5 cents, rather than the 9-cent increase requested by Parkland's board, which would have raised current tax bills by almost 50 percent. Parkland said it needs the additional revenue for operational and capital costs, and to replenish depleted reserves, blaming its financial difficulties on cutbacks in state and federal aid and a growing number of uninsured patients. (Fort Worth Star-Telegram, 7-26-2000)
The Houston chain of ten hospitals and five surgery centers, formerly known as Columbia/HCA Healthcare Corp., is dropping its new name after only one month because another Houston-based health care company is already doing business as Entrust Inc., but was not discovered earlier because it had just recently trademarked the name, reported the Houston Business Journal. The hospital chain is now going by the name, HCA-The Healthcare Co., Gulf Coast Division and has pulled an advertising campaign announcing the Entrust name, on which it had spent about $250,000. (Houston Business Journal, 7-31, 2000)
The Texas Department of Insurance has posted information on more than 2,700 Texas insurers, including HMOs and third-party administrators on its Web site. Profiled information includes a company’s home office address, business telephone number and toll-free number; names of officers; length of time it has been in business; types of insurance it is licensed to sell; name and address of its attorney and notice of any lawsuits filed against the company in Texas; financial information; complaint information; and company history.
The Web site is: www.tdi.state.tx.us. After accessing the site, click on “Ins. Company Profiles” or “HMO Profiles,” which are listed under the heading “Quick Access.”
Those without Internet access can request information by phone at 800-252-3439.
In an attempt to overcome a mounting nursing shortage problem in the region aggravated by hospital expansions to accommodate Metroplex growth, Harris Methodist Fort Worth and John Peter Smith Hospital have begun to offer cash payments to employees who refer a new nurse to open positions. According to an audit by the Dallas-Fort Worth Hospital Council, this year's vacancy rate for critical care nurses grew to 16.9 percent, up from 12.7 percent last year. (Fort Worth Star-Telegram, 8-3-2000)
The jury award went to a former emergency room nurse who had reported to the Texas Board of Nurse Examiners that UTMB trauma teams were violating patients' rights by performing unnecessary procedures on patients who had legally refused the treatment, and maintained that UTMB, its trauma services director and former nursing administrator retaliated against her by using abrupt schedule changes, verbal harassment and unwarranted reprimands. A fellow plaintiff failed to prove that she also suffered retaliation. The defendants denied any wrongdoing and UTMB attorney Merle Dover, who is an assistant state attorney general, said she may appeal the decision, the Chronicle added. (Houston Chronicle, 8-3-2000)
The Texas Department of Mental Health and Mental Retardation has struck an agreement with ValueOptions to take over the enrollees of Magellan Behavioral Health, one of two managed care companies administering the region's NorthSTAR mental health and substance abuse plan, which did not renew its contract because of mounting financial losses. Value Options contracts with some 400 providers in Dallas, Collin, Rockwall, Ellis, Kaufman, Hunt and Navarro counties and, although only 13 providers who were in the Magellan network are not in the ValueOptions network, they will be invited to join ValueOptions and former Magellan patients will be able to continue seeing those providers who don't join. ValueOptions will be the only company participating in the Dallas area NorthSTAR program next year, while the state hopes to encourage competition by contracting with a second company starting September 2001. (Dallas Morning News, 8-3-2000)
Fueled by reports of a federal budget surplus of $211 billion, the Administration has called on Congress to provide $21 billion in Balanced Budget Act (BBA) relief to health care providers over the next five years ($40 billion over 10 years). The proposal also includes a comprehensive Medicare prescription drug benefit and a “lockbox” to preserve the Medicare surplus for the program’s exclusive use. Of the $21 billion, $9 billion would be earmarked for hospitals and other specified health care institutions, with the additional $12 billion subject to negotiation with Congress. For FY 2001, the President’s plan would:
$1 billion would be reserved over 10 years for policies supporting rural health care providers. Home health agencies (HHAs) also would benefit, with a FY 2001 payment rate increase to full market basket and a one-year delay in the scheduled 15 percent reduction in payments. Skilled nursing facilities would see a full market basket increase and an additional one-year delay in implementation of caps on therapy services.
June Gibbs Brown, Inspector General (IG) of the Department of Health and Human Services (HHS) has stated that the Office of Inspector General (OIG) will not take legal action against providers for “innocent errors, mistakes, or even negligence” leading to billing errors under the new outpatient prospective payment system (OPPS). In a June 23 letter, Brown assured hospitals that neither the False Claims Act nor the Civil Monetary Claims Law imposes sanctions unless offenses are committed “with actual knowledge of the falsity of the claim, reckless disregard of the truth or falsity of the claim, or deliberate ignorance of the truth or falsity of the claim.” According to Brown, the OIG is “very mindful of the difference between innocent errors and negligence (erroneous claims)’ on the one hand, and “reckless or intentional conduct (fraudulent claims)” on the other. Where erroneous claims occur, the hospital will be asked to return the money; however, no civil or criminal penalty action will be initiated. The new payment system was scheduled to go into effect August 1.
Final regulations implementing a home health care prospective payment system (PPS) were published in the Federal Register July 3. The new system will replace a BBA-mandated interim payment system in effect since October 1997. Under the final regulations, HHAs will be paid for each covered 60-day episode of care a beneficiary receives. As long as beneficiaries remain Medicare eligible, they may receive an unlimited number of medically necessary episodes of care. Payment for each 60-day episode will be based on national payment rates, ranging from about $1,100 to $5,900 depending on intensity of care, with adjustments for area wage differences. Outlier payments will be made when the costs of care are significantly higher than the specified rate. Medicare will begin paying HHAs under the PPS on October 1, 2000
Two articles in the July 5 Journal of the American Medical Association present very different pictures of the accuracy of last fall’s Institute of Medicine (IOM) report on medical errors. According to the report, 44,000 to 98,000 Americans die in hospitals each year from adverse events, many of them preventable. While researchers from the Indiana University School of Medicine were critical of the report, calling underlying data greatly exaggerated and recommendations premature, one of the report’s authors stood by its findings, stressing the need to avoid blame and address systemic flaws that cause errors. Though a number of medical error bills have been introduced in Congress, thus far, legislators have failed to agree on how best to deal with the issue.
(Prepared by Margaret J. Hardy, JD, Director of Government Relations, American Osteopathic Healthcare Association)
Mrs. Inez Suderman was appointed by Texas Governor William Clements as a member of the Agricultural Resources Protection Authority Board. Created by the 71st Texas Legislature, duties of the Board included setting policies and regulations regarding pesticide use in the state. Mrs. Suderman represented the consumer’s viewpoint on the panel.
The Texas College of Osteopathic Medicine’s fall convocation officially welcomed the Class of 1994 and also marked the 20th anniversary of the school. During the event, Mr. Ray Stokes and his wife, Edna, were honored when the conference room in Med Ed I-810 was renamed the “Ray and Edna Stokes Room.” Hired on April 15, 1969, Mr. Stokes was TCOM’s first employee, and Mrs. Stokes became TCOM’s second employee when she was hired as secretary and bookkeeper.
The annual celebration of National Osteopathic Medicine Week was observed September 9-15, marking the 116th year of osteopathic medicine. The focus was on the health care needs of the underserved with the theme, “One Hand to Heal, One Hand to Hold – Osteopathic Medicine Serves America’s Underserved.”
President George Bush nominated Colonel Ronald R. Blanck, D.O., for promotion to Brigadier General, Medical Corps, United States Army.
Whether you or your provider files a claim for payment of your medical bills under TRICARE, you need to know some basic rules to avoid claims processing problems. Leaders at TRICARE Management Activity (TMA) recognize that simplified claims processing is a key to beneficiary satisfaction with TRICARE, and they continue to implement improvements to claims processing procedures.
TRICARE participating providers are required to file claims for beneficiaries, and providers submit 97 percent of all TRICARE claims. However, if the provider is non-participating, the beneficiary may need to file the claim.
Beneficiaries and providers should submit claims as soon as possible after the delivery of care. They must be filed within one year of the date of service, or within one year of the date of an inpatient discharge. When the beneficiary files a claim, it should be submitted using DD Form 2642 (patient's request for medical payment). Forms are available on the Military Health System/TRICARE Web site at www.tricare.osd.mil/ClaimForms/, or from beneficiary counseling and assistance coordinators (BCACs)/health benefits advisers at military treatment facilities, TRICARE regional contractors (or one of their TRICARE service centers), or TRICARE Management Activity, 16401 E. Centretech Parkway, Aurora, CO 80011-9066. Access to TRICARE contractors' Web sites can be obtained through the TRICARE site.
The beneficiary may also need to include a non-availability statement for inpatient care (obtained from the MTF), an explanation of benefits (EOB), or denial, from other insurance. Claims filed by the beneficiary should include photocopies of fully itemized bills from the provider, showing the cost for each service or supply provided, the patient's name, diagnosis or symptoms, place of service, number/frequency of each service, and date of care. Canceled checks or cash register receipts are not acceptable as itemized bills.
With claims for prescription drugs, the provider or beneficiary must include the pharmacy's billing form, showing the name, strength, amount and cost of each drug, prescription number, date filled, and the name and address of the prescribing doctor and the pharmacy.
A beneficiary who receives the services of a private duty nurse at home or in a hospital, must submit the nurse's daily notes with claims, the name of the doctor who is supervising the care, and prescriptions for medical supplies and durable medical equipment. Claims submitted for someone in the Program for Persons with Disabilities must include a copy of authorization for services, and a list of supplies or equipment received.
Persons filing claims should send copies of receipts. They should include the sponsor's Social Security number on all pieces of correspondence and attachments to claims. They should circle information rather than use a highlighter or marker on documents. Before submitting the claim, they should make sure the correct claim form has been completed, double-check all information for completeness, provide signatures where necessary, and include all necessary documentation listed above.
Beneficiaries and providers must mail claims and the accompanying documentation to the TRICARE contractor for the region where the patient lives. Address for filing claims may be found in the beneficiary handbook or on the TRICARE Web site. Active duty service members stationed overseas, and their families, file claims with Wisconsin Physicians Service (WPS).
When all necessary information is submitted with the claim, contractors are required to complete processing within 30 days. When they need additional information, claims processors will call or write to the beneficiary or provider, who must supply the information requested before the claim can be processed. To avoid delays, beneficiaries should keep copies of claims and the originals of all other documents sent to the claims processor or to TRICARE. When providers file claims, beneficiaries should keep copies of providers' bills.
Beneficiaries should verify that their information is correct in the Defense Enrollment Eligibility Reporting System (DEERS) data bank. Beneficiaries can review information in their DEERS file at most offices that issue military identification cards. They may also call DEERS, toll-free, at one of these numbers: 1-800-538-9552 (Continental U.S.), 1-800-334-4162 (California residents only), or 1-800-527-5602 (Alaska and Hawaii residents only) or write to DEERS Support Office, 400 Gigling Road, Seaside, CA 93955-6771.
Beneficiaries who believe their claims have been incorrectly processed or denied, may refer to instructions for disputing a decision and filing an appeal that appear on the back of every TRICARE explanation of benefits. For more information about filing and appealing claims, beneficiaries can check with a BCAC at an MTF or regional lead agent's office, with a health benefits adviser at the MTF, with a TRICARE service center representative, with the appropriate TRICARE managed care support contractor or with a debt collection assistance officer, if credit or collection issues are involved.
Beneficiaries may call claims processors at the following numbers to address their claims problems: Palmetto Government Benefits Administrators (PGBA), 1-800-225-4816 - for all regions except Southwest (Texas - except the extreme western area, Oklahoma, the majority of Louisiana and Arkansas) and Northwest (Washington, Oregon and northern Idaho); WPS, 1-800-404-0110 -for Southwest and Northwest. Active duty personnel and their family members stationed overseas can call a WPS claims contractor at (608) 224-2727.
Additional information on TRICARE benefits, claims filing and follow-up may be obtained through the Military Health System/TRICARE Web site at www.tricare.osd.mil.
A change was announced for the TRICARE program as it relates to Nonavailability Statements (NAS) and maternity care. Except for emergencies, maternity patients not enrolled in Prime will be required to obtain all outpatient prenatal, outpatient or inpatient deliveries, and outpatient post partum maternity care at a military treatment facility (MTF). The NAS is not required for maternity patients who have other health insurance (OHI), which pays primary to TRICARE. The OHI, must be a medical-hospital surgical plan, which at least covers inpatient hospitalization of the beneficiary.
This change is effective for all maternity care initiated on or after October 5, 1999, the effective date of Section 712© of the National Defense Authorization Act for Fiscal Year 2000 (Public Law No. 106-65). If care is unavailable at the MTF, an NAS will be issued. An NAS is an official Department of Defense document (DD form 1251) issued by the commander (or a designee) of a MTF which certifies that specific medical service was not available to a beneficiary at, or through, the MTF at the time the beneficiary sought the service.
The new Act reestablishes the requirement, which was previously eliminated under the National Defense Authorization Act for FY 1997. It changes the existing provision, which required an NAS for inpatient deliveries, but did not require an NAS of outpatient prenatal and post partum maternity care. For a beneficiary that resides within the catchment area (40-mile radius) identified by the zip code at the time care is rendered, an NAS will be required. The zip codes are specific for each MTF and are updated periodically. Beneficiaries should check with their local Health Benefits Advisor (HBA) or area TRICARE Service Center (TSC) to verify whether their residence falls within a zip code area where an NAS is required.
Beneficiaries will need one NAS for the entire episode of care. The NAS is needed for the first prenatal visit after the confirmation of the pregnancy, and shall remain valid for 42 days (six weeks) following the delivery. In the event of an emergency, beneficiaries should seek attention immediately at the nearest hospital.
Veterans often receive health care treatment at multiple Veterans Administration (VA) facilities across the country, and their medical records are kept where they received treatment. But they may not have a complete record at each facility, and may not have easy access to the records.
The Department of Veterans Affairs (DVA) is exploring ways to enable veterans to consolidate an electronic record of their VA and non-VA medical care and make it available to their doctors.
A prototype, called “Health e-Vet,” is intended to help veterans store medical data on a secure Web site they can access whenever and from wherever necessary.
The system has no Congressional funding and a pilot project may not be ready for several years, but DVA officials say “Health e-Vet could improve the quality of health care veterans receive.
For more information, contact Dan Maloney, at daniel.maloney@med.va.gov, or call 301-734-0107. (Texas Innovator, July 2000)
Base Realignment And Closure (BRAC) site - a military base that has been closed or targeted for closure by the Base Realignment and Closure Commission.
Catastrophic Cap - the maximum out-of-pocket expense in a fiscal/enrollment year for TRICARE covered services for TRICARE beneficiaries.
Catchment Area - geographic areas determined by the Assistant Secretary of Defense (Health Affairs) that are defined by a set of five (5) digit zip codes, usually within an approximate forty (40) mile radius of military inpatient treatment facilities.
Claims Processor - the sub-contractor that handles a particular region's TRICARE claims.
Coordination of Benefits (COB) - the process governing the payment of claims when you have primary Other Health Insurance (OHI) coverage in addition to TRICARE. Your other health insurance policy will normally pay for your benefits first; TRICARE coverage will usually be secondary.
Copayment - usually a flat-dollar amount (instead of a percentage of the total cost) that you pay for a prescription, medical service or supply, usually paid directly to the provider at the same time you receive service.
Cost-share - the portion of the allowable charge for medical services that you pay. Your cost-share is one of your out-of-pocket expenses that is applied towards your catastrophic cap.
Customer Service Representatives (CSR) - (Also known as Benefit Service Representatives (BSR) - representatives at the TRICARE Service Center or call center who assist you with enrollment, Primary Care Manager selection, benefit interpretation and any other matters that affect your access to care.
Deductible - the amount you must pay as a Standard or Extra beneficiary on your bills each fiscal year toward your outpatient medical care before TRICARE begins sharing the cost of the care. The only time a TRICARE Prime enrollee would have to pay a deductible is under the Point Of Service (POS) option. There is no deductible for TRICARE Prime coverage that is coordinated by your Primary Care Manager.
Defense Enrollment Eligibility Reporting System (DEERS) - a computerized database that lists all Active Duty and Retired military personnel and their family members who are eligible for TRICARE benefits. Remember to check DEERS periodically to make sure your information is accurate and up-to-date. Contact the DEERS Telephone Center at 1-800-538-9552 between 6:00 a.m. and 3:30 p.m. (PST) Monday through Friday. For personnel residing in California, call 1-800-334-4162, and those in Alaska or Hawaii, call 1-800-527-5602.
Emergency - a sudden or unexpected condition or the acute worsening of a chronic condition that is threatening to life, limb or sight requiring immediate medical treatment to relieve suffering from painful symptoms. Medical emergencies often include heart attacks, poisoning, convulsions, kidney stones and other acute conditions. Pregnancy-related medical emergencies must involve a sudden or unexpected medical complication that puts the mother, the baby, or both at risk. Claims for emergency services are to be paid when a consumer presents to an emergency department with acute symptoms of sufficient severity - including severe pain - such that a 'prudent layperson' could reasonably expect the absence of medical attention to result in placing the consumer's health in serious jeopardy. Emphasis is placed on the patient's presenting symptoms rather than the final diagnosis.
Enrollment Portability - allows TRICARE Prime enrollees to transfer health care coverage to another TRICARE Prime region. Transferring their health care coverage after their arrival at their gaining station ensures their coverage during the change of station move. Beneficiaries should not disenroll prior to arrival at their gaining station.
Health Benefits Advisors - military and/or civilian personnel stationed at the Military Treatment Facilities who are available to assist you with appointments, Non-Availability Statements and benefit interpretation.
Health Care Finder (HCF) - a medical clinician who specializes in authorizing certain medical procedures, physician referrals, hospital admissions and other medically necessary treatments.
Health Enrollment Assessment Review (HEAR) Form - a confidential questionnaire that assesses your current health status and habits.
Military Health System (MHS) - the total health care system of the U.S. uniformed services. The military Health System includes Military Treatment Facilities as well as various programs in the civilian health care market like TRICARE.
Military Treatment Facility (MTF) - a medical treatment center located on a military installation.
National Mail Order Pharmacy Program - a pharmacy benefit offered to eligible beneficiaries. Certain restrictions apply. Call 1-800-903-4680 or go to the web site http://www.pec.ha.osd.mil for further information.
Network - a group of credentialed health care providers who have signed agreements to provide services or supplies to TRICARE beneficiaries at a negotiated rate. The TRICARE network includes doctors, hospitals, pharmacies and other health care professionals. Network professionals will handle claims and other paperwork for you, and will receive payment directly from the claims processor.
Non-Availability Statement (NAS) - a certification from a military hospital that states that it cannot provide the care you need and indicates you may seek care from a civilian facility.
Non-Network Providers -
Other Health Insurance (OHI) - any primary health benefits plan other than TRICARE. These sources may include group employers, associations or private insurers. TRICARE generally pays secondary to OHI - meaning that you have to file your claim with the OHI first. Exceptions where TRICARE pays first include Medicaid, Maternal & Child Health Programs, Indian Health Program, TRICARE-specific supplemental insurance, Financial supplemental plans, and State Crime Victims Compensation.
Point-Of-Service (POS) Option - a special type of coverage that applies only when a TRICARE Prime enrollee receives non-emergency care that has not been coordinated/authorized by a Primary Care Manager.
Primary Care Manager (PCM) - the TRICARE Prime network physician or physician team who is assigned to you to provide your basic medical care and to arrange any specialist or hospital care you need. You receive maximum coverage under TRICARE Prime when your Primary Care Manager coordinates your care.
Program For Persons With Disabilities (PFPWD) - a financial assistance benefit program through which family members of active duty members receive supplemental benefits for the moderately or severely mentally retarded and the seriously physically disabled, over and above those medical benefits available under the TRICARE program. Authorization for PRPWD benefits must be requested from the Managed Care Support Contractor. For more information, contact your Health Care Finder or TRICARE Service Center.
Split Enrollment - if family members do not live together, they can split enrollment among two or more TRICARE regions when each lives in different Prime Service Areas within the United States. (Ex: The sponsor lives in Maryland, and the spouse and children live in North Carolina) Split Enrollment allows military retirees and their dependents to enroll in TRICARE Prime in different TRICARE regions without paying a separate enrollment fee in each area. (There are no enrollment fees for Active Duty Service Members or their dependents)
TRICARE Maximum Allowable Charge (TMAC) - the amount the U.S. government deems "customary and reasonable" which TRICARE uses to calculate the benefits it pays. As a carry-over from the CHAMPUS program, you will often see this referred to as CHAMPUS Maximum Allowable Charge, or CMAC.
TRICARE Prime Network Providers - health care providers who are credentialed and have signed a contract with TRICARE to provide services and supplies to beneficiaries at a negotiated rate. TRICARE Prime Network providers submit the claim forms for the beneficiaries.
TRICARE Prime Remote (TPR) - a special version of the TRICARE Prime benefit for Active Duty Service Members who live and work away from military installations in remote areas.
TRICARE Service Center (TSC) - a customer service center in your area where Customer Service Representatives/Beneficiary Service Representatives and Health Care Finders are located. You can visit the TRICARE Service Centers to get answers to any of your questions about TRICARE.
TRICARE Supplemental Insurance - health benefit programs designed specifically to supplement TRICARE benefits. They cover certain cost-share amounts and/or deductibles paid by TRICARE eligible beneficiaries.
Urgent Care - medical attention for a condition that, while not life or limb-threatening, could become more serious if not treated. Some examples of urgent care might include eye or ear infections and suspected bladder infections. This type of care, unlike emergency care, requires the authorization of your PCM when travelling away from home.
(Source: Maj. Paul D. Wuerdeman, Army Liaison Officer, TRICARE Management Activity; Paul.Wuerdeman@tma.osd.mil; (303) 676-3425; (DSN) 926-3425)
