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GAO-07-941R 1 (2007-07-31)

handle is hein.gao/gaocrptavni0001 and id is 1 raw text is: i Accountability * Integrity * Reliability United States Government Accountability Office Washington, DC 20548 July 31, 2007 Congressional Committees Subject: TRICARE: Changes to Access Policies and Payment Rates for Services Provided by Civilian Obstetricians About 111,000 women covered by the Department of Defense's (DOD) TRICARE program gave birth during 2006.' During their pregnancies, about half of these women received obstetric care from physicians and other providers practicing at military hospitals and clinics called military treatment facilities (MTF), while half received their care from civilian physicians and other civilian providers.2 In recent years, the use of civilian obstetric care has increased among TRICARE beneficiaries. In 2004, 51 percent of TRICARE beneficiaries delivered their babies at civilian hospitals; by 2006, 54 percent delivered at civilian hospitals. However, through 2005, some TRICARE beneficiaries reported difficulties obtaining obstetric care from civilian physicians.3 At the same time, some civilian physicians contended that TRICARE payment rates for obstetric care were too low.4 TRICARE reimburses physicians for most obstetric care using two global payments, one for uncomplicated vaginal delivery and the other for uncomplicated cesarean delivery, each of which is a single amount that covers a defined set of related services. In the case of obstetrics, these global payments cover a woman's prenatal visits, the physician's assistance at delivery of the baby, and postnatal care after the delivery of the baby. 'TRICARE offered health care to approximately 9.1 million active duty personnel, retirees, and their dependents in 2006. 2Obstetrics is the branch of medicine that addresses the care of women during pregnancy, childbirth, and the recuperative period following delivery. In addition to obstetricians, other physicians may provide obstetric care. In this report, we generally refer to physicians as the providers of obstetric care, but obstetric care may also be delivered by other types of providers such as nurse midwives and nurse practitioners. 3In general, TRICARE beneficiaries have shifted to civilian providers for outpatient care in recent years. From fiscal year 2004 to fiscal year 2006, use of civilian providers increased from 37 percent to 43 percent of total outpatient care provided. The trend toward increasing use of civilian providers may partially reflect changes in TRICARE beneficiaries' place of residence. Because of military base closures and shifts in the mix of TRICARE beneficiaries (such as additional reservists and their family members) the percentage of TRICARE beneficiaries who lived near an MTF declined between 2000 and 2006 from 55 percent to 48 percent. 4In fiscal year 2006, TRICARE paid $82 million to civilian physicians for outpatient obstetric care, which represented about 4 percent of the program's total outpatient payments of $1.9 billion to civilian physicians that year. The total TRICARE budget for fiscal year 2006 was about $39 billion. GAO-07-941R TRICARE Civilian Obstetric Care

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