Children’s Hospital Colorado stresses TRICARE reimbursement woes, expanded pediatric screening

Greg Raymond, joined by Chief Medical Officer Dr. DeStefano, briefed the council on Children’s Hospital Colorado’s role in Southern Colorado, clinical volumes, and financial pressures tied to TRICARE reimbursement changes.

Raymond said the Defense Health Agency implemented a Medicare‑based reimbursement method for TRICARE that applies adult payment logic to pediatric services. "That doesn't translate," he said, and reported an estimated $22 million revenue reduction locally in the last fiscal year tied to that methodology change. He said Children’s Hospital Colorado has agreed to remain in‑network temporarily to protect TRICARE families’ access while federal legislation and congressional offices work toward a more sustainable solution.

The presenters also highlighted quality and safety work: expanded ED suicide screening approaches that now reach near‑universal screening for patients over age 10 in the ED; enhanced transport and regional alliances with UCHealth for specialty transfers; and outreach and training programs for military medical personnel and community providers. Raymond described an example of a near‑fatal cardiac arrest at school whose survival involved school AEDs, EMS, UCHealth rotor transport and pediatric quaternary care.

Why it matters: The TRICARE payment change disproportionately affects pediatric centers in defense communities, and the temporary in‑network decisions preserve access for affected families while advocacy continues at the congressional level. Council members pressed for additional data on TRICARE impacts and asked for follow‑up information about clinical services for gender‑diverse patients and past surgical practices.

Next steps: Raymond said the hospital will continue outreach with federal legislators and provide additional detail to council on TRICARE and any follow‑up information requested about clinical programs. The presentation was informational; no council action was taken.