
DATE: Thursday, April 17, 1997              TAG: 9704160495

SECTION: LOCAL                   PAGE: B3   EDITION: FINAL 

TYPE: MILITARY

SOURCE: BY DEBRA GORDON, STAFF WRITER 

                                            LENGTH:  106 lines

SOME ARE LOSING THEIR PATIENCE GETTING TRICARE APPOINTMENTS

Clare Wegener wants to picket outside her Tricare Prime clinic.

Beth Webster has a complaint letter to Tricare officials on her home computer.

Crystal Ham is just thankful she's leaving the country this summer and won't have to deal with the local health care system anymore.

These military spouses feel cheated and frustrated by a health insurance plan they say doesn't resemble the one they signed up for.

They're sick of waiting 30 minutes or more to talk to a nurse when they need to schedule an appointment. Tired of being told their feverish children can wait two days to see a doctor. Weary of paying out of their own pockets to see a civilian doctor because they can't get in at their clinics.

Webster, of Chesapeake, calls it ``misaligned expectations.''

When she signed on with Tricare Prime, the military's version of a Health Maintenance Organization, she says she was told she could get appointments within 24 hours when she or her children were sick.

And, in fact, a government publication about Tricare Prime that is distributed in Hampton Roads says, ``If you are sick, you will be seen within one day.''

Officials with Mid-Atlantic Tricare, which oversees the program in Hampton Roads, say that brochure should have been distributed only outside the region. When Hampton Roads was a demonstration project, it contracted with Sentara Health System to provide Tricare Prime services to 72,000 military dependents and retirees at eight clinics. Each family is assigned to a particular clinic.

That contract requires that ``urgent patients shall be seen within 24 hours.''

But what does urgent mean?

In true emergencies - such as a broken leg, chest pain, anything that is life-threatening - patients are directed to the nearest emergency room, said Air Force Capt. Donald Cole, who heads the Tricare Mid-Atlantic office's marketing department.

But for less-obvious problems, such as a 102-degree fever in a 2-year-old, the decision about an appointment is left to the triage nurse, whom most Tricare Prime members must call before seeing a doctor.

The nurses manning the Tricare Prime phones 24 hours a day, seven days a week, rely on their experience and training and a sophisticated computer program to help them make decisions. They type in information about callers' symptoms and the computer spits out a treatment recommendation, ranging from home remedies to an immediate doctor's appointment to calling 911.

And if the nurse recommends an appointment in two days, says Karen D. Cannon, who manages the nurse-on-call program for Sentara, it's because that's when she feels one is necessary, not because it's the earliest one available.

If someone needs to see a doctor and there are no appointments available, she said, the nurse faxes a note to the clinic and asks someone to call the patient and schedule an appointment.

``Ninety-five percent of the time we're able to do just that,'' said Dr. William Threlkeld, Sentara Tricare Prime's managing medical director. ``Our physicians are flexible, they do work in patients.''

But to the worried mother who wants her child seen immediately, any wait is frustrating.

It happened to Webster in February. She called at 7 a.m. on a Monday morning to get an appointment for her daughter, whose eye was red and swollen shut. She was told the earliest slot available was late afternoon the following day. She ended up taking her daughter to an urgent care center and paying the $60 fee herself.

``We're thinking about getting off of Prime,'' she said. She and her husband, a Coast Guard officer, have been Prime members since October, when they transferred here from Maine.

In fact, in a recent survey of local Tricare Prime members, about one in three said they didn't get an appointment on the day they wanted.

And nearly half said they had problems getting the Prime phone.

Sentara officials have promised to resolve the phone gridlock. They plan to begin a pilot program soon at the Little Creek clinic in Norfolk that would let Tricare Prime members bypass the nurse program and directly book appointments at the clinic, Threlkeld said.

If it works, it will be implemented in all the clinics, he said.

That would be just fine with Leah Benzineb, of Virginia Beach.

One day she fell suddenly and couldn't walk straight. She called the nurse that Friday night. The nurse told her there were no appointments available until Monday but that she would fax a note to the clinic asking someone to call her. Benzineb said no one called her back, so she finally called the clinic herself and was told she could come in the next day.

That day she waited three hours to see a doctor, she said, and was diagnosed with a bulging eardrum ready to burst.

``I never use the clinic unless I have to,'' she said, ``but when I use it, I want to know that it's available to me and my children.'' ILLUSTRATION: Photo

BETH BERGMAN/The Virginian-Pilot

Clare Wegener of Norfolk is one of those frustrated with Tricare

Prime's health care system. Some military families are complaining

of long waits for appointments and trouble getting through on the

telephone to speak with triage nurses who can set up appointments

with doctors.

Graphics

INFOLINE BOX:

To leave your comments about the Tricare Prime system or your own

experiences, call INFOLINE at 640-5555 and press CARE (2273). Leave

your name, daytime phone number and your message.

JOHN CORBITT/The Virginian-Pilot