Senate sub eyes TennCare payment system, not Medicaid expansion

Sen. Doug Overbey, R-Maryville, is on a new state Senate Subcommittee on TennCare and Long-Term Care Oversight and reports that whether Tennessee should expand its Medicaid program is not the committee’s purpose although it could be, according to Georgiana Vines.

The purpose of the committee is to look at two issues — a TennCare choices program and long-term care, and Gov. Bill Haslam’s TennCare payment reform initiative, Overbey said.

The federal Patient Protection and Affordable Care Act has a provision for an expansion of Medicaid, which is TennCare in Tennessee, to cover people making up to 138 percent of the federal poverty level. Haslam in March declined $1.4 billion in federal funds to cover about 140,000 uninsured Tennesseans under the terms the money was offered.

…“In some ways, it (Medicaid expansion) is connected (to the committee’s work), and some ways, it’s not connected,” Overbey said.

The Tennessee Journal, meanwhile, has a report the subcommittee hearing, wherein TennCare officials said they had decided to delay the start of the controversial new payment and quality control system for health care providers, the first phase of which had been scheduled for launch next month.

Dr. Wendy Long, the TennCare Bureau’s deputy director, told a Senate health subcommittee Thursday the bureau will try to make the new payment model “even more transparent” and more consistent — “where it makes sense to be consistent” — in response to the concerns and suggestions of provider organizations.

She did not specify a new start date, but the delay isn’t expected to be lengthy. Long also said an initial six-month period of data collection, after which key providers are to begin sharing risk under the system, might be extended, though not for 18 months as suggested by the Tennessee Hospital Association.

State officials, from Gov. Bill Haslam down, have been adamant that the existing medical payment system cannot be sustained. And even as Long announced the delay of the planned “retrospective episode-based” reform, she said providers now know what’s coming and should begin making changes before the program starts.

…The concept, one Arkansas already has begun using, is to make someone in each type of medical issue, or episode, responsible for the full range of care, including lab work, surgery, physical therapy, prescriptions, and other services. To ensure efficiency, this Principal Accountable Provider (PAP), or quarterback, will be given incentives — a bonus if costs and quality fit within certain measurements, or a reduction in payment if there are “excess costs.”