A call to action: Restoring healthcare access and combat readiness for service members

In October 2023, TRICARE, the civilian health insurance provider for U.S. Armed Forces military personnel, retirees, and dependents, implemented a sweeping change in its reimbursement policy by adopting Medicare’s ambulatory surgical center (ASC) rates. Although the intent may have been administrative alignment, the unintended consequences for military readiness and orthopaedic access have been severe.

Orthopaedic conditions remain the leading cause of non-deployability among active-duty service members. Injuries such as shoulder instability, anterior cruciate ligament (ACL) tears, and ankle sprains often require timely surgical intervention with implantable devices — such as suture anchors, screws, and graft fixation systems — to restore function and expedite return to duty. Although TRICARE does reimburse for certain implants, it imposes caps that frequently fall short of covering the number and type of implants required to perform these common procedures to modern standards. This shortfall puts surgeons in a difficult position: Either absorb the cost, modify the procedure, or defer care altogether.

Many orthopaedic surgeons may not realize that a significant number of service members are referred to civilian providers because their care either exceeds the capabilities of the local military treatment facility (MTF) or the MTF lacks the capacity — limited OR time, surgeon availability, or access to required resources. Civilian support is not an exception; it is a critical extension of the military medical system.

Reimbursement rates for procedures involving implants — particularly those performed in ASCs — have changed significantly under the new model. Procedures such as shoulder arthroscopy, which are staples of orthopaedic sports and military medicine, have seen dramatic reductions in facility payments. For many civilian practices near military installations, these reimbursement shifts have made it financially unviable to continue offering critical care to TRICARE patients, increasingly leading to access limitations for service members and their families.

To quantify the impact of this update, the Society of Military Orthopaedic Surgeons recently surveyed large orthopaedic private practices near major military installations. Responses from practices in both the Eastern and Western TRICARE regions revealed troubling trends:

• More than 60% of respondents reported a significant decrease in the number of TRICARE patients they have seen since October 2023.
• More than half have discussed or implemented caps on TRICARE patients or specific procedures — particularly arthroscopic surgeries involving implants.
• Nearly 80% of respondents reported challenges including delays in care, inability to cover implant costs, and a reduced willingness to accept TRICARE patients.

The responses included powerful statements:

• “We’ve had to cancel several scheduled ACL reconstructions because reimbursement wouldn’t cover even the implant costs.”
• “We used to perform these procedures weekly for military dependents; now we refer them elsewhere — sometimes out of network or out of state.”
• “Our surgeons want to support the mission, but the current rates are financially unsustainable for our ASC partners.”

Compounding the issue is the limited capacity of MTFs. Already stretched by deployments, training, and staffing shortfalls, many MTFs rely on partnerships with civilian ASCs to meet the surgical demands of TRICARE beneficiaries. These partnerships are now collapsing.

This is more than a billing issue — it’s a readiness crisis, and orthopaedic surgeons are on the front lines. When service members wait weeks or months for care that should be provided within days, their ability to return to duty is jeopardized. The nation cannot afford that delay in an era of global uncertainty.

Orthopaedic surgeons understand the financial pressures that may force practices to limit care for TRICARE patients. They recognize that the current reimbursement model makes it difficult — if not impossible — to provide essential procedures in civilian ASC settings.

But this is also the orthopaedic community’s moment to advocate. Orthopaedic surgeons across the country — particularly those in practices near military installations — can make their voices heard by reaching out to their elected federal and state senators and representatives. Surgeons can also share their experiences with national and state surgical societies, participate in data-collection efforts that demonstrate the impact of these policy changes, and educate local military leadership on the challenges and barriers to timely care for their personnel.

The collective voice of the orthopaedic community is powerful. Surgeons can use it to restore access, preserve readiness, and ensure that their nation’s service members receive the care they deserve.

Retired Army Brig. Gen. Kory Cornum, MD, is managing director of the Society of Military Orthopaedic Surgeons.

Retired Navy Capt. Matthew T. Provencher, MD, MBA, FAAOS, is a professor of surgery and orthopaedics at Uniformed Services University of the Health Sciences. Dr. Provencher is the second vice president of the American Orthopaedic Society for Sports Medicine and a past president of the Society of Military Orthopaedic Surgeons.

Retired Col. Dean C. Taylor, MD, FAAOS, is a professor of orthopaedic surgery at Duke University.

Retired Army Col. John M. Tokish, MD, FAAOS, is a professor of orthopaedic surgery and vice research chair at Mayo Clinic Arizona. Dr. Tokish is a past president of the Arthroscopy Association of North America.