Bredesen promises annual increases for TennCare doctors
FRANKLIN (AP) — In hopes of convincing skeptical doctors to support his TennCare overhaul, Gov. Phil Bredesen said Friday that he will propose annual increases in reimbursement for participating physicians.
Doctors, who have long complained of low and slow payment for treating TennCare patients, have largely supported the governor’s efforts to improve the $7.3 billion health insurance program but are expressing concerns about his bill, particularly its definition of “medical necessity.”
They say it’s too restrictive, and that determining the necessity of a medical procedure or medication should be left to the doctor and patient.
Bredesen told physicians at the annual meeting of the Tennessee Medical Association that he considers the definition “a foundation stone” for his TennCare changes.
“All I’m asking is that we have to start taking costs into account when we make these decisions about it, start looking to the least-expensive method of care that is safe and effective,” he said. “The end goal is still to meet the needs of the patient, but to do it in a way that lets us control costs.”
Bredesen said he knows some doctors also don’t like his plan to require all enrollees to purchase antihistamines and gastric-acid reducers over the counter, instead of by prescription.
Bredesen cited a Memphis doctor who said young cystic fibrosis patients must have the gastric drugs. The governor said there have to be other answers, where private businesses or hospitals could help in such instances.
Also, the governor is setting up a safety net where funds would be available for such cases.
The governor also said he wants to attract doctors back to TennCare. “I know this is a group that has been treated poorly,” he said.
First, the governor said, doctors should be paid promptly, and the state needs to clearly say what will be covered and what won’t.
Second, Bredesen said, “I’m a firm believer that we need to at least commit to modest annual increases in reimbursement rates.”
Third, the governor said, a strong disease management program would make it easier for doctors to do their job, along with improving patient care and saving money for the state.
Also, Bredesen said his administration is looking at ways to reduce red tape in order to convince doctors to participate in TennCare.
“The bottom line is we cannot do this with an adversarial relationship with providers and I’m going to do everything in my power to repair the adversarial position we’ve gotten into with a lot of our providers,” the governor said to applause.
Dr. Michael McAdoo of Milan, a former president of the TMA, said he had hoped the governor would be more specific about how he intends to rebuild the network of doctors in TennCare.
“The physicians in the state of Tennessee have shouldered the program and some have left millions of dollars on the table in unpaid claims,” he said.
McAdoo was pleased to hear the governor planned to increase reimbursement, which he said hasn’t happened since TennCare’s inception in 1994, but he wants to know what the governor means by “modest.”
Bredesen declined to say how much money he would put toward provider raises.
“I’m just trying to affirm to them that I know some adjustment is important and appropriate. If you don’t do that, you’re just balancing it on the backs of doctors and hospitals,” the governor told reporters after the speech.
McAdoo acknowledged there are concerns about several aspects of the governor’s plan, particularly the medical necessity provision, but said it’s “not a deal breaker.”
“We want to be a team player. We want to work with him. Hopefully we will have something that is livable and useable and will meet the needs of the patient,” McAdoo said. “We’re dealing with human beings and illnesses and flesh and blood and not just words.”