By MELANIE KILGORE-HILL
Healthcare Leaders Respond to Block Grant Proposal
Reactions are pouring in after the release of Gov. Bill Lee's TennCare Block Grant Proposal, with two of the state's leading healthcare organizations cautiously supportive of the idea.
Russ Miller, CAE, chief executive officer of the Tennessee Medical Association, said the TMA supports the idea of flexibility for each state. "Federal rules and regulations on Medicaid programs tend to make some state do things that aren't a good fit," said Miller, who represents the state's 9,000 physicians and medical students. "What works here might not be the right fit for Massachusetts, so the uniqueness of markets and people served is something to be considered. We're always wrestling with cost, access and coverage."
While Miller recognizes validity of the proposal, he said implementation is what causes trepidation and understands a level of hesitancy until details reveal where savings would be made up. "Our caution is that haste can make even more waste in our healthcare system, so there needs to be methodical caution," he warned, pointing to potential pitfalls that surfaced during previous TennCare changes. "It took years to adjust when we upped enrolment by 700,000 into a managed care program, so any changes need to be methodically cautious," he said.
Miller also hopes leaders will turn to providers for input as to how the proposal would work and to set priorities and realistic expectations for savings. "We all want to control cost without compromising care," he said. "We can provide more services, purchase more goods, or put more people in a program. It's a delicate balancing act, because when your only answer is to put more people in, you have to limit services and people will scream about that, too. There are lots of mandates, and what the governor is asking for is relief to let us decide what's best for our people. We have a very robust system to treat people, but how do we spread our resources?"
He believes the proposed telemedicine focus could be an effective option for expanding resources, as would placing providers in an environment that would encourage more time with patients - and less with paperwork.
According to their Sept. 17 media statement, the Tennessee Hospital Association leadership is "encouraged that the Medicaid block grant proposal for the TennCare program will not reduce benefits, remove individuals from the rolls and has the potential for shared savings."
"Right now, we like what we've heard," said THA President and CEO Craig Becker. "We're intrigued and interested in shared savings, which has the opportunity to do different things."
In the statement, Becker emphasized that ensuring adequate funding for the program in the future is critical to continuing to care for some of Tennessee's most vulnerable residents and is a strength of the proposal. "The potential for shared savings in recognition of TennCare's historic fiscal responsibility also presents a great new opportunity for enhanced coverage for TennCare enrollees," he said.
The Tennessee Justice Center has been a vocal opponent to the proposed block grant. Executive Director Michele Johnson said the proposal is a dangerous, untested approach to a vital safety net program, and that it seeks to save money "on the backs of the poorest children and most frail seniors." Half of the state's children and 65 percent of nursing home residents currently rely on TennCare.
"The fact is we're already in a state with very little waste, that runs a very skinny program," said Johnson, who blames much of rising healthcare costs on medical inflation. "Can they squeeze out more? Maybe, but the federal government wants to save money, and the state wants to save money, too. The math doesn't work out."
But Becker said Tennessee's ability to run a trim program is what makes the proposal attractive. "We're not talking about getting additional dollars as much as dollars we've already saved the federal government, and getting half of that back," Becker said. "That's a definite positive, because our costs have been so much lower than every other state. It sure makes a whole lot of sense."
Miller said Tennessee's unique position as a healthcare industry leader only increases the proposal's chance of success but recognizes the political nature of the decision. "This is another alternative to the Affordable Care Act - and when you have options, you have people on both sides," he said. "Change is nerve wracking for anyone, because it's always creating winners and losers. Right now we've got a lot of people without care. We understand the need to expand the program, which should be a goal, but starting there and putting everyone in a new program without support would only threaten it for everyone. We've got to stabilize the program first and then add more weight to the design. At the end of the day, it's all about people taking care of other people, and we have to work in unison."