COLORADO SPRINGS, Colorado — Children's Hospital Colorado worries patients will now have to travel outside Colorado Springs to get the care they need, "creating longer wait times by months due to a shortage of pediatric specialty providers throughout the state."
This week, the non-profit lost its legal battle against the Department of Defense. Children's fought to reverse TRICARE reimbursement cuts.
Children's expects to lose $17 million this year, which means some services will need to be cut back.
Changes to the reimbursement formula used by the military's TRICARE program changed on October 1, the beginning of the new fiscal year for the federal government.
Greg Raymond, the Children's Colorado President for Southern Colorado, said the hospital lost an average of $2 million per month for the final three months of last year.
"We are not able to absorb a $17 million loss. So, consequently, we are in the process of evaluating what that means for the clinical services that we're able to provide locally for kids," Raymond said. "And this is all kids, not just TRICARE kids, but all kids in our community."
He said approximately 70 percent of their revenue comes from the government either through Medicaid, the Child Health Plan Plus, or TRICARE. All of those funding sources pay below what the hospital bills to private insurance.
Children's said 17% of patients at the Colorado Springs hospital are a part of military families.
"If they have to go elsewhere it'll cause stress on military families," said Bob McLaughin with the Mt. Carmel Veterans Service Center. "16,000 children . . . use TRICARE in the state."
While the change in TRICARE reimbursement affects all pediatric healthcare providers nationwide, Raymond explained that Children's Colorado faces a disproportionate impact because of the large population of military families they serve.
"Children's Hospital Colorado, through our locations here in Colorado Springs as well as in Aurora, is the largest provider of pediatric benefits in the TRICARE system," Raymond said.
The reimbursement change happened through a rule change implemented by the Defense Health Agency which oversees TRICARE.
Raymond said the hospital is working closely with Congressman Doug Lamborn to try and reverse the rule. He also encouraged the group at Mt. Carmel to contact Senators Michael Bennet and John Hickenlooper for help.
"The way that we are looking to address it right now is through the National Defense Authorization Act and that would be a formal legislative action that would change the rule," Raymond said.
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