Tennessee physicians are unconvinced that new efforts to improve TennCare will make a difference, and the viability of the Medicaid-style program remains in question. But for now, they're at least willing to listen.
TennCare Director Mark Reynolds faced a skeptical audience when he spoke at a Jan. 26 Tennessee Medical Association gathering in Nashville, earning a measure of respect just by showing up. Previous directors had not been so willing to walk into the lion's den.
Reynolds, who started in April, acknowledges, "In the end, some things have to change at TennCare to assure its survival." He promised $75 million in long-delayed and new reimbursements to physicians for services provided and pledged to step up enforcement of prompt payment provisions in an effort to ensure TennCare's long-term viability.
"I believe that TennCare should not be abandoned," Reynolds told TMA members. He outlined a new legislative proposal and administrative actions that would create a $25 million fund to compensate physicians over an 18-month period for past underpayments. TennCare last month announced that it would release $109.4 million in funding for "essential providers," though hospitals will receive more than 80% of that total.
Reynolds says that state officials are "committed" to seeking court and legislative approval to pay off $50 million of debt related to the insolvency of Xantus Healthcare of Tennessee, a TennCare HMO currently in receivership. Tennessee's Department of Finance and Administration, which oversees TennCare, says that payments could begin within 90 days, pending legislative and judicial authorization.
Reynolds promises the "aggressive enforcement" of prompt pay laws and other contractual obligations of managed care organizations to ensure TennCare providers get properly reimbursed for their services. He says that most of TennCare's nearly 1.4 million enrollees will get their first opportunity to change managed care organizations since November 1998 when two new HMOs join the eight HMOs currently in the program, perhaps as soon as March.
It's a tall order, since the program has been plagued since its inception in 1994. No one knows for sure how extensive the problems are, but it's not uncommon for physicians to wait a year or more for reimbursements and for debts to run into six figures.
Molly Chaterjee, M.D., a Nashville OB/GYN with a solo practice specializing in maternal fetal medicine, says she is owed $224,000 by Xantus and Nashville-based HMO Access MedPLUS. She says that both HMOs blame "computer glitches" for withholding money since last April.
Predictably, Chaterjee is wary of Reynolds' new statements: "Until I see my payments, I'm not going to trust anything he says." Others at the TMA conference expressed similar sentiments.
New legislative requests unveiled at the conference include an undisclosed amount of money to expand the program's paltry medical oversight by appointing regional medical directors to respond to physicians on a more localized level. "We need to be able to create a focus on customer service because we just always assumed that someone else would do this," Reynolds says. TennCare currently has one part-time CMO for the whole state.
The exodus of physicians from the program reached the highest levels of medical leadership, as the 36-physician orthopedic practice of TMA President Barrett Rosen, M.D., pulled out last month. Reynolds called the departure "a signal that the state needs to listen how to figure out and how to implement changes."