Summary of Survey Results

Attachment 3

Summary of Results of Previous three-year Survey Effort

SURVEY OF CIVILIAN HEALTHCARE PROVIDERS’ ACCEPTANCE OF NEW TRICARE STANDARD PATIENTS (SECTION 723 OF NDAA for FY04)

INTRODUCTION

- The Department of Defense has complied with the requirements of Section 723, NDAA for FY 2004 by completing the final year of an OMB-approved three-year survey strategy designed to determine civilian physician acceptance of TRICARE Standard patients.

- Section 723, NDAA for FY04, directed DoD to conduct surveys in U.S. TRICARE market areas to determine how many civilian healthcare providers are accepting TRICARE Standard beneficiaries as new patients; Section 711, NDAA for FY 06 provided additional questions which were included in the survey in FYs 2006 and 2007.

SUMMARY OF SURVEY RESULTS AFTER THREE YEARS

• Between 18,000 and 19,000 eligible physicians responded each year to the survey with annual response rates of 50%. Sampling all 50 states, Washington DC and over 100 local Hospital Service Areas:

  • There appears to be a high level of physician awareness with 9 of 10 physicians reporting awareness of the TRICARE program in general.

  • About 8 of 10 physicians accept new TRICARE Standard patients if they accept any patients at all.

  • Of the remaining 2 of 10 physicians who do not accept new TRICARE Standard, the most commonly cited reason is due to “reimbursement”, with one fourth of all comments received.

  • And, of those accepting new TRICARE Standard patients, 9 in 10 do so for all claims, rather than on a case-by-case basis.

  • Between 8 and 9 of 10 physicians accepting Medicare also accept new TRICARE Standard.

  • But there is variability in these results, across HSAs, states, and specialties reflecting opportunities for improving the general knowledge and acceptance of TRICARE:

    • State level- Focus on acceptance for Alaska and perhaps, Maryland; also Colorado, Hawaii, Oklahoma (2006 survey) and New York, New Jersey and Texas (2005 survey).

    • HSA-level: Washington DC; New York City (esp. Brooklyn), Raleigh, NC; Seattle and Olympia WA, Lihue/Kealakekua/Wailuku, HI; Dallas, TX.; Denver, CO; and Falls Church, VA.

    • Medical specialty- level: Psychiatrists lowest in Awareness and Acceptance.

CONCLUSION: The Department has found across three years significant levels of civilian physician awareness of the TRICARE program, and generally favorable acceptance of new patients using the Standard (indemnity) option. There are specific locations and physician specialties where there are opportunities to improve the TRICARE position.

SUPPORTING SURVEY INFORMATION

BACKGROUND AND APPROVED SURVEY METHODOLOGY

• Section 723 required DoD to:

  • Survey at least 20 market areas each fiscal year until all are surveyed.

    • The Department’s methodology complies with this requirement: after a pilot survey in FY 2004, the survey methodology approved by the Office of Management and Budget (OMB, 6 July 2006) is to survey 20 states each in FY 2005 and FY 2006, and complete the study with the remaining 10 states and the District of Columbia in FY 2007.

  • Consult with representatives of TRICARE beneficiaries to identify locations where TRICARE Standard beneficiaries are experiencing significant levels of access-to-care problems and to give such areas high priority.

    • The Department has complied with this requirement: input from beneficiary representatives was solicited and given high priority -- all locations recommended by beneficiary representatives were included in each year of the study; further, input was also solicited from the TRICARE Regional Offices resulting in additional sites incorporated into the survey.

  • Thus, in addition to state-wide market area surveys of civilian physicians, the Department also surveyed sub-market local areas called hospital service areas (HSAs). see attached listing reflecting:

    • FY 2005 survey of 20 states and 29 HSAs

    • FY 2006 survey of 20 different states and 38 HSAs

    • FY 2007 survey of 10 different states, Washington DC, and 52 HSAs.

  • Using a single-page mailed survey with telephone follow-up.

  • Sent to the billing managers of approximately 40,000 randomly picked doctors each year from two strata to provide local and state-wide estimates involving:

    • Up to 1,000 doctors within local, sub-market HSAs (e.g. Denver, CO).

    • Up to 1,000 doctors from selected states (e.g. Virginia)

  • Using American Medical Association’s physician data base to identify full-time, non-federal, office-based civilian doctors (MDs and DOs).

FY 2007 DETAILED SURVEY RESULTS

• Awareness of TRICARE:

  • In FY 2007, almost 93 percent of all responding physicians in 53 HSAs were aware of the TRICARE program (unweighted ranging from 77 to 100 percent) and 91% across 11 states (weighted, including HSAs, ranging from 86% to 97%):

    • Highest awareness in eight locations with 100%, such as Biloxi, MS; Destin, FL Jacksonville, AR; and Newport RI.; highest state averages were Alaska and Alabama (both 97%).

    • Lowest awareness in Cleveland, OH (77%), Washington DC (81%) and Madison, WI (83%); and lowest state averages were Maryland (86%) and Ohio (88%).

    • By Specialty, across the states and HSAs, OB-GYN and Ophthalmologists were the most aware (95%) while psychiatrists reflected the least awareness (almost 80%).

  • Prior years: 2006 (93% in 38 HSAs and 89% in 20 states); 2005 (91% in 29 HSAs and 83% in 20 states).

• Accepting new TRICARE Standard patients of those accepting any new patients:

  • In FY 2007, 84 percent of HSA and 83% of state-level physicians accepted any new TRICARE Standard patients (ranging from 41% to 100% across the HSAs and 72% to 88% across the states).

    • Highest acceptance (100%) in five small HSAs (e.g. Ainsworth NE, and Aitkin, MN, and also Iowa City, IA (94%); highest state average was Kentucky (88%).

    • Lowest acceptance in Olympia, WA (41%), Washington DC (62%); lowest state average was Alaska (72%)

    • By Specialty, across the states and HSAs, office-based hospitalists and Ophthalmologists were the highest acceptors (91% each); psychiatrists the lowest (55%).

  • Prior years: 2006 (82% in HSAs and 84% states-wide) and 2005 (81% in HSAs and 79% states-wide).

• Accepting TRICARE Standard patients for all claims.

  • In FY 2007, 92 percent of physicians in the HSAs and 91% across the 11 states accepting new TRICARE Standard patients accepted those patients for all claims, rather than on a claim-by-claim basis (ranging from 80% to 100% across the HSAs and an adjusted/weighted 85-92% across the states).

    • Highest accepting (100%) for all claims in seven small HSAs (e.g. Ainsworth NE, and Aitkin, MN) and also larger physician-populated areas such as Wausau, WI (99%) and Iowa City, IA (97%); the five highest state averages were all at 92% (i.e. Ohio, Florida, Kentucky, Missouri and Alabama).

    • Lowest accepting all claims were Prescott AZ (80%) and Joplin, MO (81%) for HSAs and, for states, Alaska and Washington DC (both 85%- where WA DC is treated as both a state and HAS for U.S. coverage purposes).

• Prior years: 2006 (91% across 38 HSAs, 91% across 20 states), and in 2005 (90% across both the 29 HSAs and the 20 states); and 89% in 2004’s Pilot study of 20 locations.

• Reasons cited by 2 of 10 Doctors not accepting new TRICARE Standard patients:

  • The most frequently cited reason physicians gave for not accepting new TRICARE Standard patients was due to “Reimbursement” (this issue was cited in all three years by about one-fourth of the physicians and also in about one-fourth of all their comments, across HSAs as well as states).

  • Reimbursement was the number one reason in the 2007 and 2006 surveys, and the second highest reason given in 2005).

  • Other top reasons were:

    • “Not accepting patients” such as accepting no new patients, or “panel is full”).

    • “Miscellaneous” reasons such as “Doctor’s policy” or “not a signed provider”).

• The FY 2006 and 2007 surveys also reveal that TRICARE (any form) tends not to be a substantial part of doctor’s practices across an HSA, ranging from an average of 1% in HSAs to up to 20% in two HSAs (Clarksville, TN (26%) and Jacksonville AR (22%)); the range of HSA medians is lower (from 1% to 20%)

• The 2007 survey shows that 84 percent of the HSA and state- sampled doctors accept new Medicare patients (81% and 83% respectively in 2006)

• And 8 of 10 doctors accepting new Medicare patients also accept new TRICARE Standard patients (88% in 2007 and 87% in 2006 HSAs; 86% and 87% across the weighted states for these years, respectively.

  • HSAs with low acceptance were Olympia Washington (45%) and Washington DC (70%); while states were Alaska (82%) and Maryland (83%).

FY 2004 to FY 2007 Locations for the

DoD Survey of Civilian Physician Acceptance of TRICARE Standard

FY 2004 (Pilot) survey sites:

• Round 1 (6 locations- telephone survey): Anchorage, AK; Boise, ID; Colorado Springs, CO; Fredericksburg, VA; Las Vegas, NV; and Rochester, NY.

• Round 2 (14 locations- mail and telephone follow-up): Atlanta, GA; Bainbridge Island, WA; Buffalo, NY; Cheyenne, WY; Fayetteville, TN; Greensboro, NC; Jackson, MS; Laurel, MS; Meridian, MS; Philadelphia, PA; Portland, OR; Princeton, NJ; Utica, NY; and Williamsburg, VA.

FY 2005 Survey Locations (mail and telephone follow-up):

FY 2005 29 local sub-market, HSA- survey sites (p = identified by Beneficiary representatives or TRICARE Regional Office):

• Sacramento, CA (p)

• San Diego, CA

• Monterey, CA (p)

• Boca Raton, FL (p)

• Tallahassee, FL (p)

• Belleville, IL

• Waukegan, IL

• Peoria, IL (p)

• Evansville, IN

• Fort Wayne, IN (p)

• Indianapolis, IN

• Lafayette, IN (p – Tippecanoe County)

• Battle Creek, MI (p)

• Kalamazoo, MI (p)

• Santa Fe, NM (p)

• Brooklyn, NY (p)

• Syracuse, NY

• Watertown, NY

• Charleston, SC (p)

• Columbia, SC

• Killeen, TX

• San Antonio, TX

• Arlington, TX (p)

• Corpus Christi, TX (p)

• Houston, TX (p)

• Olympia, WA

• Spokane, WA

• Seattle, WA (p)

• Eau Claire, WI (p)

FY 2005 State-wide market area

survey locations:

• Alaska

• California

• Delaware

• Idaho

• Illinois

• Indiana

• Kansas

• Massachusetts

• Maine

• Mississippi

• Nebraska

• New Jersey

• New Mexico

• New York

• South Carolina

• South Dakota

• Texas

• Washington

• Wisconsin

• Wyoming

FY 2006 Survey Locations (mail and telephone follow-up)

FY 2006 38 local sub-market, HSA- survey sites (p = identified by Beneficiary representatives or TRICARE Regional Office):

• CO- Aurora (p)

• CO- Denver

• FL- Gainesville (p)

• FL- Panama City (p)

• GA- Atlanta (p, excluding zip codes surveyed ‘04)

• GA- Columbus) (p)

• GA- Savannah

• HI- Hilo (p)

• HI- Kealakekua (p)

• HI- Lihue (p)

• HI- Wailuku (p)

• HI- Waimea (p)

• IA- Des Moines (p)

• KS- Manhattan (p)

• KS- Junction City (p)

• ME- Bangor (p)

• MI- Grand Rapids

• MI- Mount Clemens

• MT- Helena (p)

• NY- Staten Island (p)

• NC- Fayetteville (p)

• NC- Raleigh

• OK- Enid (p)

• OK- Oklahoma City

• OK- Lawton

• OR- Salem (p)

• PA- Johnstown (p)

• PA- Lancaster

• PA- Pittsburgh

• TX- Dallas (p)

• TX- El Paso (p)

• TX- Temple (p)

• TX- Wichita Falls (p)

• VA- Charlottesville (p)

• VA- Virginia Beach

• VA- Falls Church

• WI- La Crosse- Sparta (p)

• WI- Tomah (p)

FY 2006 State-wide market area survey locations:

• Colorado

• Connecticut

• Georgia

• Hawaii

• Iowa

• Michigan

• Minnesota

• Montana

• Nevada

• New Hampshire

• North Carolina

• North Dakota

• Oklahoma

• Oregon

• Pennsylvania

• Rhode Island

• Utah

• Vermont

• Virginia

• West Virginia

FY 2007 Survey Locations (mail and telephone follow-up)

FY 2007 53 local sub-market, HSA- survey sites including WA DC (p = identified by Beneficiary representatives or TRICARE Regional Office):

• WA DC

• AL- Mobile

• AL- Montgomery

• AR- Jacksonville

• AR- Little Rock

• AZ- Mesa

• AZ- Phoenix

• AZ- Prescott (p)

• FL- Destin (p)

• FL- Jacksonville

• FL- Orlando

• FL- Sarasota (p)

• GA- Albany (p)

• GA- Atlanta (p, repeat of survey ‘04)

• IA- Ft Dodge (p)

• IA- Iowa City (p)

• KY-Hopkinsville

• KY- Louisville

• LA- New Orleans (p)

• LA- Shreveport (p)

• MD- Baltimore

• MD- Clinton

• MI- Sault Ste Marie (p)

• MN- Aitkin (p)

• MN- Park Rapids (p)

• MO- Joplin (p)

• MO- Springfield

• MO-St Louis

• MS- Biloxi (p)

• NE- Ainsworth (p)

• NM- Las Cruces (p)

• NY- Plattsburg (p)

• OH- Cincinnati (p)

• OH- Cleveland (p)

• OH- Dayton

• OH- Lima (p)

• OH- Toledo (p)

• OR- Madras (p)

• OR- Prineville (p)

• RI- Newport (p)

• RI- Providence (p)

• SC- Charleston (p)

• SC- Columbia (p)

• TN- Chattanooga (p)

• TN- Clarksville

• TN- Greensville (p)

• TN- Nashville

• TX- Ft Worth (p)

• TX- Houston (p)

• WA- Olympia (p)

• WA- Spokane (p)

• WI- Madison (p)

• WI- Wausau, (p)

FY 2007 State-wide market area survey locations:

• Alabama

• Arkansas

• Arizona

• Florida

• Kentucky

• Louisiana

• Maryland

• Missouri

• Ohio

• Tennessee

• added: Alaska repeating survey in 2005

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