TRICARE Management Activity Desperately Needs A New Name!

TRICARE Management Activity Desperately Needs A New Name!

I began seeing red at roughly 3:00 pm on the afternoon of Monday, August25, 2008. This is a new way of seeing red for me. I have been in a serious funk since then, and when I am in this kind of funk; my typical positive, good natured and humorous self goes on a far away vacation. Damn… I wish I could join myself on my vacation because I sure as heck could use one! The only way out of this funk is to share the truth, and in doing so, hopefully be giving voice to countless others to speak their truth as well.

When I began seeing red on Monday, I knew right then and there that I would end up here, sitting at my desk late at night after my children were in bed, writing about this. I had some initial concerns that I might be viewed as whining or complaining. There are two philosophies I strongly believe in; timing is everything and nothing is coincidental. Sure as timing would have it because nothing is coincidental, I received an email tonight from someone at a very prominent military publication questioning if more military members and spouses are not speaking up about the travesty that our military healthcare system is because they might be viewed as whining and complaining. Bingo! So here I sit typing away.

Please humor me while I describe my Monday to you. We (yes… all six of us) live in a two story 1,300 square foot rental. Our linoleum needed to be replaced, as seams were lifting and torn in one spot. We had to rearrange our home for the day… in our living room; eight foot couch (the chairs and antique bureau went in the garage), nine foot across entertainment center with bookshelves, and other shelving, and the following “items” which are typically in our kitchen went to the living room for a vacation… treadmill, antique secretary, the fridge, computer armoire (huge), and our front loading washer and dryer. The stove and our antique dining room table (my grandparent’s first purchase after marriage – fully extended 9x 4 feet) and all the chairs; yep they went on vacation to the back patio for the day! The living room was already “living enough”.

So… all was fine. Granted there were a few tough moments, but we Warner’s made do and made jokes as always! It was later that afternoon when all hell broke loose and I began seeing red. You see, I had made an appointment to take Isaac (our oldest) to see Eva (our family Nurse Practitioner) to get the Exceptional Family Member Program (EFMP) paperwork filled out in order to enroll him in TRICARE’s Extended Care Health Option (ECHO program, so he can begin receiving ABA. We never bothered to enroll Isaac in either program because of the inability to access ABA for Nathan once he was enrolled in both programs.

Nathan began ABA in July after waiting for over two years. Nathan started receiving ABA services thanks to MY Big Mouth; AKA - networking and advocacy in our community. My first contact with Nathan’s current BCBA was in early April, and she was not yet signed up with TRICARE. Nathan has responded beautifully to ABA, and while we know that is not the end all be all, we want Isaac to benefit from ABA as well.

Back to seeing RED! I love Eva. The kids love Eva. Angie who is Eva’s Medical Assistant is very efficient, full of kindness, and she is just plain great at what she does. After checking Isaac over and looking at a couple observations done recently by therapists in our home, Eva was filling out the EFMP paperwork for Isaac. At the end of our visit, Eva handed me an envelope, and I am still devastated. And still seeing red… red, red, RED!

The envelope… I told her that I “think I know what this is”… one of those surreal moments. She is letting us go because of TRICARE’s re-imbursement rates. She is letting all of her 100 plus, TRICARE patients go. She is not renewing her TRICARE contract so she can keep her doors open. I am seeing RED all over again just thinking about it! Eva told me that TRICARE’s typical re-imbursement rate is ONE THIRD of what civilian insurance re-imbursement rates are… Nice… Priceless for TRICARE.

I did check this out, given my medical background and “prowess”. TRICARE’s re-imbursement rate is comparable to that of Medicare and Medicaid. Our military members and dependents receive care and services that is comparable to that which our elderly do if they are dependent upon Medicare. Our military members and their dependents also receive care and services which are comparable to that of welfare. Welfare… and we’ve heard that before and heard that said through dialogue with other members practitioners via the members.

The United States of America should be ashamed of the way we provide healthcare benefits to our children with autism, to our military members and their families (regardless of whether there is a disability or not), our military retiree’s, and our elderly.

Which leads me to, of course, autism and the email I received from the reporter questioning if more members are not speaking up regarding TRICARE because they don’t want to be viewed as “complaining”. There is a difference between complaining to complain, and complaining and offering solutions. That is what we military spouses and parents who complain do; we offer solutions. And MAN! Have we offered solutions, again and again and again. Our solutions have fallen on deaf ears, and the deaf ears of one doctor in particular, who has an ethical and moral obligation and the authority to put our solutions into action.

I would like to introduce you to Dr. (Major General) Elder Granger. Dr. Granger happens to be the Deputy Director for TRICARE Management Activity. You can read his bio HERE. One of the things that struck me was upon reading Dr. Granger’s bio, was the Fellowship he received from the Henry KAISER Medical Fellowship for Medical Excellence and Leadership upon graduation from the Arkansas School of Medicine in 1980.

As a mom who no longer has a provider for her children or herself I was put in a really tough position of attempting to locate a provider who would support both my husband’s and my decision to no longer vaccinate our children. Well how do you start that conversation… Are you accepting TRICARE for the next year? Are you willing to take four children into your practice and support our family’s decision to not currently vaccinate according to the “recommended” schedule and as we see appropriate? And are you experienced with this issue and that issue related to autism??? Oh forget it! I will have to take YOU and educate you. I am AGAIN starting from scratch for my children’s medical care.

Yes… that’s me folks “coming out of the closet” here on Autism Salutes talking about autism, and vaccines, treatment and insurance. It’s not just me… it’s my husband, my family, my husband’s family, and the families of an entire generation of children. When we have 1 in 67 children in the military with autism, and 1 in 67 in the civilian population with autism, I want to scream at the top of my lungs… HOUSTON We Have A PROBLEM! I knew when I started Autism Salutes this day would come and quite honestly I was getting tired of waiting for it. The adage of a time and a place for everything with me, I was waiting for a sign. With everything that has happened over the past few weeks, well… I took that as my sign.

David Kirby is the author of “Evidence of Harm”. This was one of the first five books I read after Nathan was diagnosed with autism. The sign??? David Kirby addressed the extremely concerning issue of how many of our military members are being permanently damaged and disabled by vaccines in an article he wrote for the Huffington Post, and you can read that HERE. I knew it was time. As if that wasn’t enough, within the next 24 hours after release of David’s Huff Po article, THIS went up on Age of Autism (the world’s only minute by minute online newspaper that is “all things autism”). David recommended that people visit Charlie in Wonderland, to read THIS. Jeanne just happens to be a very good friend of mine. At this point I was laughing and felt like walking into my backyard and hollering to the sky, “OK God! I GET it! I know it’s time!”

The importance of Dr. Granger’s BIO information in the big picture… I am quite sure that those of us who have done our research, know that KAISER is all to happy participating in vaccine “trials” and “studies”. Funny thing… when you google the Fellowship that Dr. Granger received for Medical Excellence and Leadership from the Henry Kaiser Medical Fellowship, Dr. Granger’s name is the only one that pops up. Also worth noting is the time frame… 1980.

Thank you Dr. Granger, for it is due to YOUR leadership of “a staff of 1,800 in planning, budgeting, and executing an $18 Billion Defense Health Program and… [Ensuring]…the effective and efficient provision of high-quality, accessible healthcare for 9.2 Million Uniformed Service members, their families, retirees and others located worldwide. Eva Nystrom met and exceeded those qualifications as a Nurse Practitioner, in fact she was better than any “doctor” I’ve met in this area and we’ve been here for almost 10 years; yet we are begging for healthcare because of your “leadership”, Dr. Granger.

Dr. (Major General) Granger has a seeming panache for making policy such as the ECHO program and Demo program look good on paper, but not in reality. You may want to read an article HERE. Then, because Dr. Granger states in this article (you should read it, if you haven’t already), “We didn’t want to give anybody the impression that we wanted to… sift out the bad and only tell the good. With that statement Dr. Granger is referring to a poll done by Zogby International, a polling agency. We gave Zogby the authority to put it out there – the good, the bad, and the ugly”. I do apologize, but Dr. Granger’s comments are a bit too… say 1966 circa, for someone who is the “authority” for TRICARE in 2008. I’m sorry, but I don’t think it’s appropriate for a man in a “leadership” position to be quoting Clint Eastwood to make his point. Plain and simple.

I did a little hunting on the net because the only links in the article were to Dr. Granger’s bio, and the military health system blog. I found the Zogby poll… you can read it HERE. Dr. Granger used the top statistic from this poll (77%) and mentioned nothing else. I think you should look at the poll results, and while doing so I recommend you look at not only the margin of error (+/- 4.8%) which is rather large, but the COOP4 as well. You can view the methodology and COOP 4 HERE. So there were potentially many who refused to participate in the survey. I find that intriguing.

As I stated, Dr. Granger has a panache for making policy look good on paper, but not in reality. Take for example, the Extended Care Health Option (ECHO) Program. There are currently over 13,400 military dependent children who have been identified with autism, but only 1,300 of those children have been enrolled into the ECHO program. Acceptance into the ECHO program is the only way our children with autism are able to receive medically necessary and medically prescribed treatment for their autism.

Dr. Granger appears to be, a legend in his own living room, and quite possibly in his own mind… again refer to his BIO. Everything is about HIS accomplishments and NOTHING about what he has actually DONE. That’s what I want to know, and think I have a right to know about Dr. Granger’s leadership. He may have held all those positions, but what did he do for the greater good while in those positions?

I offer a quote from Dr. (Major General) Elder Granger, “Anything we can do to enhance the quality of life for our service families is a benefit to the nation and our obligation to the men and women who serve”. I find that astounding, yet given my question above and the following… I find his words difficult to read, let alone believe.

Case in point… In March of this year the Autism Services Demonstration Project was implemented. Since that time it has undergone two re-writings, and is currently undergoing a third. In January of 2007, Dr. Granger through TRICARE Management Activity solicited feedback from families impacted by autism, wanting information to better provide services to military dependent children with autism. In July 2007 a report was issued. You can read that HERE. Only one of the many issues was addressed even though the National Defense Authorization Act of 2008 allowed the latitude to address many more urgent needs and treatment requirements for our military dependent children with autism, and the latitude to do so immediately.

The NDAA '08 states that "The Secretary of the military department concerned may establish local centers on military installations for the purpose of providing and coordinating autism services for eligible dependents." The NDAA '08 also goes on to say, "The Secretary of the military department concerned is encouraged to enter into partnerships or contracts with other appropriate public and private entities to carry out the responsibilities of this section." There are organizations who’ve been ready to partner and contract with TRICARE Management Activity to expand the Autism Demo Project, and provide and coordinate autism services. Dr. Granger, Deputy Director for TRICARE was approached regarding this issue as those involved wanted to see this implemented under the Demo Project. This contract would have expanded the Demo, and expedited services and treatment that a large population of our military dependent children with autism could have received. Dr. Granger's response was "absolutely not". There was no reason given for his position and refusal to support a program that would have provided so many of our children with access to medically necessary treatment. Dr. Granger's denial of access to and implementation of a simple solution to provide our children with medically necessary treatment is unconscionable and unethical, given the oath he took as a doctor to, "First Do No Harm".

I would also like to point out that almost six months after the implementation of the Demo project, Dr. Granger is again soliciting input from families of military dependent children with autism. This solicitation came several weeks after initiation of the THIRD re-writing of the Demo project, and you can read the professional/parental feedback HERE. (Click on the comments button) It’s quite an impressive demonstration of what a failure the Demonstration Project is. I did not comment on his “blog”, I commented HERE on Autism Salutes.

Our military healthcare system is not premiere, as Dr. Granger would have you believe. In fact, the military healthcare system was addressed at the National Democratic Convention. Beth Robinson is a Marine Corps spouse, a mother, and she is disabled because she has Multiple Sclerosis. Beth gave a speech at The Democratic National Convention on August 27, 2008, in which she stated, “Military families are grateful for our medical benefits. But I am appalled by the state of the health care system in our country and frustrated by the limitations of military healthcare, which is inadequate and underfunded.” You can read Beth’s speech HERE.

I offer you another quote from Dr. Granger, “TRICARE Management Agency (TMA) must implement appropriate price caps to reduce the potential for paying inflated healthcare costs… Obviously it is not in the best interests of TRICARE or our beneficiaries to have a healthcare payment system in place that does not incorporate appropriate caps on provider fees.” Dr. Granger is obviously referring to having caps on provider fees being in the best interest of TRICARE. It would be in the best interest of TRICARE beneficiaries including retirees, to have TRICARE re-imbursement for medical services of any kind, equal to that of other healthcare re-imbursement. Again, think of our family’s immediate situation regarding our own healthcare provider.

Closure… yep you guessed it… another quote from Dr. Granger, “A healthy mind and body promotes happiness. It gives us a stress-free community, improves family life, and keeps us strong and ready for any mission great or small.”

In my opinion, this man, this doctor, who is in charge of our military healthcare, is so far removed from reality that it scares me beyond comprehension. Our kids suffer from poisoned minds and bodies. The stress that this brings to our families is for most inconceivable. Lack of treatment causes the harm to continue. Continued harm to our children brings continued stress to our families; a far cry from improving family life.

It is Dr. Granger who is NOT “strong and ready for any mission great or small”. If Dr. Granger was ready for the mission, effective solutions would have been implemented long ago.

As I said, TRICARE needs a new name. TRI-CARE-LESS. Dr. Granger could “care less” if our children with autism receive the medically necessary care they require. With autism impacting 1 in every 67 children, Dr. (Major General) Granger’s inaction and failure of leadership has threatened both the readiness and retention of our All-Volunteer Armed Forces. More importantly, Dr. Granger’s focus on managing costs has put the health of our members, spouses, children, and retiree’s in jeopardy. At what point did Dr. Granger decide that it was ok to only approve 2 days of a medically prescribed 14 day course of antibiotics for an “infection”? Because that is exactly what Dr. Granger has done. And since when did we place a dollar value on human life, especially that of a child with a disability? Because Dr. Granger has done that as well.

I reflect upon the words of our great President, John F. Kennedy, “If not me, then who?”. As an American citizen, a military spouse, and a mom to four (two happen to have autism), I have an obligation to speak out about much needed change in both current policy and current “leadership”. Dr. Granger should take a few notes.

Ohhh... and... you may want to watch THIS AGAIN... I think someone has some explaining to do!