Doctors face hard choices due to TennCare cutbacks

The oath states physicians “will apply, for the benefit of the sick, all measures which are required.”

But under TennCare reductions, doctors have to decide whether to keep treating patients who no longer have their office visits paid for. And when drug coverage is cut back, physicians are forced to choose which drugs patients need most.

Some doctors are having those decisions made for them. Vanderbilt University Medical Center in Nashville, for example, has established a policy on how to deal with patients who are cut from TennCare.

Vanderbilt will ask uninsured patients to pay a deposit if they can and will work out payment plans for them. The policy states that appointments already scheduled won’t be canceled and that future care will continue, unless a comparable option is found.

“If no other suitable source of care is available, you will continue to treat the patient,” the policy reads.

In Jamestown, Tenn., Dr. Leonard Carroll says he’s not going to turn anyone away who needs treatment after they’ve lost coverage.

But his generosity has limits. “I’m going to keep doing it until I can’t pay my bills,” said Carroll, a general surgeon who has a private practice. “It may get so bad I’ll have to move, but I sure hope not.”

At least 570,000 of the 1.3 million people on TennCare will see their health care benefits reduced or eliminated altogether in an effort by Gov. Phil Bredesen to overhaul the financially troubled public insurance program. So far, about 115,000 people have received termination letters, and 380,000 people have gotten notice that their drug coverage is being limited.

Dr. Larry Mason, a family physician in Byrdstown, Tenn., said the TennCare changes have had little effect on how he practices medicine. He said in the past he’s been careful not to over-prescribe drugs, an issue that proponents of cutting TennCare cite as contributing to the program’s financial problems.

“We’ve always tried to keep people on six drugs or less because it reduces the risk of drug interaction,” he said. He will, however, be more conscious of prescribing generic drugs when possible, and he’ll give away all the free samples he can.