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In Tennessee, of the 130 critical care hospitals, 48 are
losing money. It
is also estimated that 42 percent of all hospitals are at
financial risk if the TennCare reform efforts are
implemented. By
signing up with TennCare, these hospitals waived
reimbursement features of Medicaid for uninsured patients.
Tennessee must fix this problem before implementing
any of these proposed changes. I
understand that some hospitals have been mismanaged, but
that is not the issue here.
By not having the Medicaid DSH payment, hospitals
lost 314 million federal dollars that would have helped
offset the lost revenue in 2006 alone.
We
must protect our hospitals from being driven out of
business by the certain flood of noninsured and illegal
aliens going to their emergency rooms for non-critical
care. People
that live in rural areas will have to drive further in
order to receive medical care for their children or
themselves. In
a true emergency this extra time may mean the difference
between life and death. Here's some facts about
TennCare that might surprise you:
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The enrollment as of December 31, 2004 was
1,357,700 people out of a total state population of
5,748,379.
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TennCare
covers 23% of the states population.
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Females account for 58% of enrollees.
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TennCare
is one of the largest government operated managed care programs in the country:
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$8.5 billion dollars was spent on
TennCare in FY 2005.
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TennCare
consumed of 26.34 percent of tax revenues.
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Medical spending was the largest expense at
$2.9 billion.
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Pharmaceuticals were second at
$2.4 billion.
TennCare
has had a growth rate of over 12 percent per year over the last 5 years.
The following is a breakdown of TennCare medical costs per category:
30.2 percent of all hospital inpatient expenditures were for:
1) Diabetes Mellitus
2) Disorder of fluid electrolyte and acid base balance
3) Non-dependant drug abuse
4) Septicemia
5) Short gestation/low birth weight.
18.2 percent of all hospital outpatient expenditures were for:
1) Non-dependant drug abuse
2) Diabetes Mellitus
3) Essential Hypertension
4) Other and unspecified disorders of joint
5) Other and unspecified disorders of back
14.7 percent of all physician expenditures were for:
1) General symptoms
2) Diabetes Mellitus
3) Health supervision of infant or child
4) Symptoms involving respiratory system and other chest symptoms
5) Normal delivery
As you can see, drug use and diabetes are common among the three diagnoses by cost. Drug dependency ranks fourth in the area of inpatient and outpatient mental health cost as well. Imagine the savings to taxpayers if
TennCare recipients simply changed their lifestyle.
There
are no easy solutions to fixing TennCare. This is not to say that it cannot be done. I not only believe it can be fixed, but it must be fixed. However,
taking close to 200,000 adults off the TennCare rolls is not the answer.
Better management of the system is required. Here are some
suggestions from Senate Bill 2862 and House Bill 2536 to help save money through better management practices.
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Drug
substitution: This requires the use of the least costly drugs that will effectively treat patients.
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Call to Maximize Federal Matching Funds:
This requires the state to seek two for one federal matching funds for safety net services.
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Disease
Management: Four percent of those enrolled in
TennCare consume 47 percent of the budget. (It would only make sense that we should carefully examine this area of
TennCare first).
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Drug Utilization Review:
This controls drug overuse and abuse. (The use of medicines was the second most expensive element of
TennCare at $2.4 billion. TennCare now restricts the use of five prescriptions per month but I believe these decisions should be left to the physicians. Some people need more than five prescriptions per month some people would need less).
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Home Health Care Support:
This would allow more people to stay home instead of using a nursing home.
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Therapeutic Substitution:
This requires the use of the least costly drugs that will effectively treat
patients.
REFERENCES:
1 Tennessee Hospital
Association
2 TennCare
Annual Report FY 2004-2005 To
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