NASHVILLE - While the Tennessee Medical Association supports Gov. Bill Haslam's Insure Tennessee plan, the state's largest physicians' organization says that shouldn't be construed as an endorsement for Haslam's payment reforms for providers.
TMA President Douglas J. Springer of Kingsport said in a statement that the group indeed does back Haslam's plan to use federal Medicaid dollars to extend health insurance to an estimated 200,000 low-income adults, over half of whom work.
But, he said, "what has concerned and confused many Tennessee physicians is the state's implementation of the Tennessee Health Care Innovation Initiative, or TennCare payment reform."
State officials, Spring said, "have lumped payment reform into the Insure Tennessee conversation, but they are two entirely separate issues, and it's important for all Tennesseans to understand the difference."
Insure Tennessee "is about covering more people under health insurance plans with a sliding scale of pay assistance or subsidies," the TMA president said. "TennCare payment reform is about changing the way TennCare compensates healthcare providers for treating patients."
State officials have been working to move TennCare, the state's Medicaid program, from a fee-for-service to a "value-based reimbursed model" in which TennCare pays for an entire episode of care as opposed to a single visit to the hospital or doctor.
The Haslam administration's goal "aims to reduce its overall healthcare costs by rewarding providers for achieving specific goals, and penalizing those who exceed cost thresholds for episodes of care," Springer said.
He said that physicians understand the concept of TennCare analyzing cost data and using it to drive efficiency. And the state, using a federal grant, is one of the first states to move to the model.
"It is true marketplace innovation and we have a real opportunity to bend the cost curve and improve quality with the experimental program, if we get it right," Springer said.
But, he added, "so far, we are not getting it right. We have serious concerns, for instance, about how the state is reporting data back to providers about their episodes of care. The data has to be timely, accurate and consistent."
Providers must be able to see the data to "learn from it to be able to alter their treatment patterns to reduce variation," Springer added. "The state needs to be accountable for making this happen or the payment reform initiative will not work."
While it is a "universally acknowledged truth that our healthcare spending is out of control and we have to do something about it," Springer said, it "also matters to patients because physicians will no longer participate in TennCare if the state ignores input from healthcare providers and pushes ahead with a flawed process for payment reform."
"If the process is not fixed now, in the early stages, the problems will only worsen as the state adds more episodes of care and expands from TennCare to commercial insurances," Spring added.
