Sen. Mike Rounds, R-S.D., wants to require the healthcare program that covers military families to assure “expedited” referrals to outside specialists in cases involving prenatal surgery.
Medical technology has advanced to the point that many of those “complex birth defects” can be cured or mitigated during the pregnancy, but military families have been missing the opportunity to get those treatments because of the slow TRICARE process.
It’s an issue that would directly affect a relatively small group of people, but has echoes of the Department of Veterans Affairs wait-times scandal that captured national attention in 2014.
“We’ve got individuals covered under TRICARE who are coming in and discovering that there may be a problem, or there was a problem, but by the time the referral was issued, it was taking several weeks to get that done, and in doing so they were going beyond the time period in which successful intervention was going to occur,” Rounds told the Washington Examiner.
Rounds learned of the problem from the Children’s Hospital of Philadelphia, which boasts one of the leading surgical teams in the country for treating spina bifida and other birth defects, such as Twin-Twin Transfusion Syndrome, in which one of the twins isn’t getting enough blood.
“They could be hitting stage one on a Thursday, but they could have lost the babies by Sunday — or Friday for that matter,” a spokeswoman for the hospital explained. “So it’s just so important to get an expedited, quick referral, because we can in some cases do laser therapy to help that situation and just a matter of a couple days can be too late.”
A bill to ensure military families meet such deadlines isn’t especially controversial, but it has hit a couple of political snags.
The hospital originally asked for the bill to mandate that patients be referred to a specialist within seven days of the diagnosis being made, but such a specific mandate wasn’t “accepted by Democrats” when Rounds first wrote the bill, he said. Instead, the revised language mandates an “expedited” referral and treatment.
“When you start saying seven days … I think the administration would have been concerned with legally complying with the law,” Rounds said. “[The hospital said], look, we prefer seven days, but we certainly will accept an ‘expedited manner’ because that would be better than the way it is today.”
The final version received bipartisan support. Sen. Bob Casey, D-Pa., cosponsored the legislation when Rounds offered it as an amendment to the National Defense Authorization Act in June, but the bill didn’t receive a vote.
If every senator agreed to back the legislation, it might receive unanimous consent to have a quick vote over the summer. Failing that, annual must-pass spending negotiations might be the next opportunity to get the legislation to the president’s desk.
And if that happens, Rounds would still regard the legislation as a victory, even though the deadline is less precise than he wants.
“What this does is say, ‘Time is of the essence.’ And when you change that by law, you change the protocol,” he said.
