TennCare implemented cost targets for eight episodes of care, in which physicians receive a bonus when they come in under target or a penalty when their costs exceed the target. TennCare spending takes up nearly a third of all state spending, and even with only eight care episodes in place, the new reimbursement model saved the program $14 million last year.
Some physicians argue the cost targets are unfair because patients in rural areas do not have access to facilities that would lower costs, penalizing physicians for factors they cannot control.
“The problem we have in Tennessee is that our Medicaid program refuses to listen to input from the people who are actually delivering the care,” Tennessee Medical Association president-elect Matthew Mancini, MD, wrote in the Knoxville News Sentinel. “Our concerns and suggestions for improvements have been repeatedly ignored, and doctors have grown increasingly frustrated by a lack of transparency, and inaccuracies and inconsistencies in how the state measures healthcare providers’ performance.”
TennCare officials said they understand physician concerns and will take them into consideration, pointing to the fact that they already rescinded the penalty for ambulance transportation but added they will not stop the state’s transition to value-based care.
“We usually take those recommendations,” said Brooks Daverman, director of strategic planning for TennCare, according to Nashville Public Radio. “We do want to move from just paying for volume to paying for value. We’re open to recommendations on how we do that … but it’s very easy for someone to say that we’re not listening.”
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