The U.S. Defense Department fails to appropriately track and coordinate referrals to private specialists for its beneficiaries part of its managed care plan, according to a new U.S. Government Accountability Office report.
The report released this week determined that data regarding the process and tracking of beneficiary referrals to specialists was "incomplete and unreliable." Specifically, the GAO found that the five military treatment facilities they reviewed only received between 20% to 77% of the reports required by private specialists to submit detailing the beneficiary's visit.
The Defense Department's managed-care option, called Tricare Prime, has 5.1 million beneficiaries as of March. It includes active duty military members and their families.
The Defense Department has guidance in place when a beneficiary is referred to a civilian specialty care provider by its military treatment facilities. The specialist is required to submit a record of the beneficiary's visit back to the primary care manager at the military facility to ensure continuum of care.
Additionally, the military facility is required to enter into its management system if the referral was completed within 180 days of its issuance. The GAO found the five military treatment facilities they reviewed couldn't accurately determine if the referrals were used. For instance, one military treatment facility indicated that 75% of its referrals were not used but officials told GAO they didn't actually have time to determine the status of the referrals within the 180-day period.
The GAO also found that staff at facilities already using the new electronic health records system called Military Health Genesis were not properly trained about how to process referrals appropriately. For example, officials at two of the facilities reviewed told GAO they didn't know how to aggregate data on reports from specialists even though the new system has that capability.
In response to the report's findings, Tom McCaffery, the principal deputy assistant secretary of defense for health affairs, said he agreed with the GAO's findings. He said the department is working on improving staff training to improve the referral process and use of the Military Health Genesis EHR system as it's rolled out.
