Cooper: Find a way to save clinics

Cooper: Find a way to save clinics

December 29th, 2018 by Clint Cooper in Opinion Free Press

A nursing student takes the blood sugar reading from a health fair attendee at the 15th annual Hamilton County Minority Health Fair in 2017.

Photo by Robin Rudd /Times Free Press.

Some rural health care clinics that provide a valuable lifeline to residents of small communities without hospitals are fighting to stay afloat while Tennessee's Medicaid pass-through program figures out how to properly reimburse them.

On the surface, we understand the complexities involved. The TennCare clinics, as part of the federal rural health clinic program, are due wraparound payments to help ensure patients will have access to doctors, nurses and services. But TennCare, in order to cut down on fraud and waste that is too often genetic with bureaucracies, is attempting to create new rules for billing procedures at the state's 150 or so rural health clinics.

When one clinic overbills TennCare by $191,000, as one in Tiptonville did in February, we all have a problem. Our money, after all, is part of the pass-through money going into the program.

So, it is vital that new — better? less-complicated? more precise? — rules be created. That takes time, we understand. So officials put a moratorium on wraparound payments in place. Then another one. Then another one (which ends in April 2019).

In the meantime, the clinics are surviving on regular TennCare payments for services and whatever backing the clinics had to begin with.

The problem is, the payments for services are nowhere near the cost of treatment, much less the cost of maintaining the personnel and services involved. And rural health clinics, officials say, have none of the negotiating power of larger hospitals and more sizable medical practices.

Thus, many of the clinics are having difficulty making ends meet. The threat is that some of the clinics would close before the new rules are completed, severing that lifeline to medical care in communities that are more sparsely populated. And, compounding the problem, some of the potential closings are in the same regions where rural hospitals have closed in the past decade.

The executive director of the National Association of Rural Health Clinics, Bill Finerfrock, told the Nashville Tennessean the moratorium ought to end. If 49 other states have figured out rules for reimbursing their clinics, he wondered, why can't Tennessee?

We agree, but we also want TennCare to get the rules right.

In the interim, without knowing details of what's possible, we wonder if there is a way of disbursing minimum wraparound payments. Surely, minimum payments — with the potential of truing up when the new rules are written — would be better than no payments at all. That way, the clinics would have a little more money on which to operate, and rural residents wouldn't have to worry about not treating that persistent cough or that severely sprained ankle.

We hope, if the rules take much longer, TennCare will consider that or some other short-term solution for the clinics.

Getting Started/Comments Policy

Getting started

  1. 1. If you frequently comment on news websites then you may already have a Disqus account. If so, click the "Login" button at the top right of the comment widget and choose whether you'd rather log in with Facebook, Twitter, Google, or a Disqus account.
  2. 2. If you've forgotten your password, Disqus will email you a link that will allow you to create a new one. Easy!
  3. 3. If you're not a member yet, Disqus will go ahead and register you. It's seamless and takes about 10 seconds.
  4. 4. To register, either go through the login process or just click in the box that says "join the discussion," type your comment, and either choose a social media platform to log you in or create a Disqus account with your email address.
  5. 5. If you use Twitter, Facebook or Google to log in, you will need to stay logged into that platform in order to comment. If you create a Disqus account instead, you'll need to remember your Disqus password. Either way, you can change your display name if you'd rather not show off your real name.
  6. 6. Don't be a huge jerk or do anything illegal, and you'll be fine.

Chattanooga Times Free Press Comments Policy

The Chattanooga Times Free Press web sites include interactive areas in which users can express opinions and share ideas and information. We cannot and do not monitor all of the material submitted to the website. Additionally, we do not control, and are not responsible for, content submitted by users. By using the web sites, you may be exposed to content that you may find offensive, indecent, inaccurate, misleading, or otherwise objectionable. You agree that you must evaluate, and bear all risks associated with, the use of the Times Free Press web sites and any content on the Times Free Press web sites, including, but not limited to, whether you should rely on such content. Notwithstanding the foregoing, you acknowledge that we shall have the right (but not the obligation) to review any content that you have submitted to the Times Free Press, and to reject, delete, disable, or remove any content that we determine, in our sole discretion, (a) does not comply with the terms and conditions of this agreement; (b) might violate any law, infringe upon the rights of third parties, or subject us to liability for any reason; or (c) might adversely affect our public image, reputation or goodwill. Moreover, we reserve the right to reject, delete, disable, or remove any content at any time, for the reasons set forth above, for any other reason, or for no reason. If you believe that any content on any of the Times Free Press websites infringes upon any copyrights that you own, please contact us pursuant to the procedures outlined in the Digital Millennium Copyright Act (Title 17 U.S.C. § 512) at the following address:

Copyright Agent
The Chattanooga Times Free Press
400 East 11th Street
Chattanooga, TN 37403
Phone: 423-757-6315