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Limit Hospital Visits, Hospitals Plead -- Other Ideas to Relieve Burden Include Small Copay, Higher Rates

Posted on: Thursday, 23 February 2006, 12:00 CST

By Lucas L Johnson II Associated Press

NASHVILLE - Cutting down the number of patient visits to emergency rooms is a good start for hospitals looking to offset additional costs resulting from cuts to the state's health care program, hospital administrators told lawmakers Tuesday.

The administrators told a legislative subcommittee that they have seen an increase in emergency room and inpatient care since Gov. Phil Bredesen cut 190,000 adults from TennCare and reduced benefits to thousands of others.

Many of those disenrolled choose the emergency room as a last resort for treatment, forcing hospitals to cover the costs without reimbursement. About a third of Tennessee hospitals lost money last year, according to the Tennessee Hospital Association.

"The challenge for hospitals and other providers is directing those patients to the appropriate level of care," said THA vice president Michael Huggins. "Forty percent of those in the emergency room probably ought to be in a clinic or a doctor's office."

Pending federal approval, patients still on TennCare in July would be subject to more limits that restrict the number of doctor visits, hospital stays and tests covered by TennCare. Those benefits currently are unlimited.

If approved, TennCare patients would be limited to 12 doctor visits per year and 20 days of hospitalization, TennCare officials said.

The budget presented to the General Assembly by Bredesen on Feb. 7 has estimated $55 million in savings from the cuts.

TennCare covers 1.2 million poor, uninsured and disabled individuals and makes up about 26 percent of the state budget. State funds cover about a third of the $7.5 billion program, and the federal government pays for the rest.

As for those individuals who go to emergency rooms without coverage, Rep. Richard Montgomery said they should be charged a copay, even if it's only $5.

"We need to make someone reach into their pocket a little bit so they won't go to the hospital like that," said the Sevierville Republican.

Whatever the case, Rep. David Shepard, D-Dickson, said hospitals need assistance.

"We need to do some things to take the burden off you," Shepard told the administrators. "You're the primary care clinic; you're everything."

Hospitals are hoping to get some relief under a proposal in the governor's budget to give a rate increase for the first time in five years to medical professionals who care for TennCare enrollees.

"That will help us in offsetting these cuts," Huggins said.

It's also possible that Tennessee hospitals could join other states in receiving disproportionate hospital payments, Huggins said, which would allow Tennessee to get federal money to pay hospitals for unreimbursed Medicaid and charity care.

Finance Commissioner Dave Goetz said no decision has been made as to whether Tennessee will join Hawaii, the only other state to offer such payments.

"But we are very concerned about providers," Goetz said. "As the health care environment changes, it could make sense to pursue some of those traditional Medicaid mechanisms."

Source: Commercial Appeal, The

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