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.