Tennessee Hospital Association Study Links Increase in Emergency Department Visits to Doctors’ ‘Reluctance’ to Treat TennCare Patients

A 31% increase in the number of emergency department visits to Tennessee hospitals over the past three years is mostly because primary care physicians are unwilling to treat people in TennCare, the state's Medicaid managed care program, according to a new study, the AP/Memphis Commercial Appeal reports. The study, released Dec. 12 by the Tennessee Hospital Association, considered emergency visits at 113 of 125 acute care hospitals in the first six months of this year and compared that data with the same period in 1999. According to the study, emergency visits by TennCare beneficiaries rose by 62% during the first six months of 2002, with many of those visits for nonemergency services. Craig Becker, president of THA, said, "When TennCare patients cannot find doctors willing to see them or take care of them in a timely manner, they have little choice but to turn to hospitals who do not turn patients away." However, TennCare spokesperson Lola Potter referred to an annual survey of TennCare beneficiaries by the University of Tennessee Center for Business and Economic Research that showed a decline in emergency care rates (Gerome, AP/Memphis Commercial Appeal, 12/13). According to the annual survey, emergency treatment for adults covered by TennCare fell from 14% to 7% between 1993 and 2002, and for children, the percentage decreased from 13% to 5% (TennCare survey, 8/29).

Governor-Elect Should Make TennCare Reform a Priority
In related news, a 34-member health care advisory board urged Tennessee Gov.-elect Phil Bredesen (D) to make it a top priority to examine the situation of thousands of state residents who have been cut from TennCare, the Nashville Tennessean reports. Bredesen, a former health care executive at HealthAmerica, created the board to address issues with TennCare, which insures about 1.4 million people, according to the Tennessean (De la Cruz, Nashville Tennessean, 12/13). The state has been conducting an eligibility reverification process, required by a waiver approved earlier this year by the federal government that allows the state to restructure TennCare eligibility and benefits. About 159,000 current TennCare beneficiaries are expected to be found ineligible under the new program guidelines. Some TennCare advocates believe that many of the beneficiaries who will lose coverage might still be eligible for the program (Kaiser Daily Health Policy Report, 12/9). Panel members named a number of other potential problems with current TennCare procedures, including low reimbursement rates, tardy payments and a reverification process that requires those eligible to contact the bureau. "We are not alone among states in confronting difficult problems with health care costs and Medicaid, but we are unique in having a chief executive who knows that stuff already and is well-respected for that knowledge," Gordon Bonnyman, managing attorney for the Tennessee Justice Center in Nashville, said (Nashville Tennessean, 12/13).