To that end, all such physician charge and fee surveys undertaken by this project shall:
The goal of this project is to improve pediatrician participation in TennCare, with pro-competitive results.
]]>The current tables are available at the Cover Tennessee website.
]]>"A state plan for medical assistance must . . . provide such methods and procedures relating to the utilization of and the payment for, care and services available under the plan to assure that payments are consistent with efficiency, economy, and quality of care and are sufficient to enlist enough providers so that care and services are available under the plan at least to the extent that such care and services are available to the general population."
This provision requires states to establish payment rates adequate to assure Medicaid clients: (1) reasonable access, and (2) services of adequate quality. State Medicaid payment rates and methods of payment must be sufficient to attract enough providers so that care and services are available to the Medicaid population at least to the extent they are available to the general population in the geographic area. Rates must also be sufficient to assure quality of care.
In general, attempting to contain unnecessary health care costs is a good thing. State Medicaid programs are frequently the single-largest expenditure a state budget has in any given year. It's natural that states want to cut costs when possible; limiting payments to providers is certainly one way to improve the fiscal bottom line (at least in the short term.) However, to comply with federal law and continue to receive matching federal Medicaid dollars, the states must honor the equal access provision, or the provision should be altered accordingly.
The American Academy of Pediatrics recognizes that adequate payments are essential for health care reform.
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For parents of children with TennCare
(All sessions held at First Presbyterian Church)
Monday, July 21, 12:00 - 1:00 pm
Saturday, August 16, 10:30 - 11:30 am
Tuesday, August 19, 5:30 - 6:30 pm
(All sessions held in Conference Room A of Cumberland Medical Center
Monday, July 28, 6:00 - 7:00 pm
Tuesday, August 5, 12:00 - 1:00 pm
Monday, August 25, 12:00 - 1:00 pm
(If you are unfamiliar with the access problem at hand, you might want to start by reading our article Good Coverage, Poor Access.)
You can complete our survey for Cumberland County community leaders here.
Contact us with your information and ideas.]]>
]]>January 2001: Seeing little progress in nearly three years, the plaintiffs file a motion to show cause why the defendants should not be held in contempt of court for failing to comply with the consent decree. The Court concluded the defendants were not in compliance and appointed a Special Master to oversee a compliance plan.
June 2004: Again, seeing little progress, the plaintiffs file a second Motion to Show Cause.
October 2004: The Court denied the motion, stating, "The State has made progress toward compliance in some areas. However, these efforts have not produced the results mandated by the consent decree six years ago." The Court's Special Master provides a comprehensive set of specific metrics and timeline for implementation
January 2007: The five appointed Monitors publish a report on progress toward compliance: "The State Defendants have failed to establish current, substantial compliance with the Consent Decree." The report went on to say, "Screening is only effective if it leads directly to treatment and diagnosis. The more important measure of the efficacy of the Defendants' efforts to comply with Medicaid law is whether children are appropriately diagnosed and treated."
]]>Ranked at the bottom for Medicaid participation were Tennessee's private pediatricians. In the survey, only 19.6% of pediatricians indicated their willingness to see all children with TennCare. Even correcting for pediatricians who were not taking new patients in general, Tennessee still came in dead last.
Tennessee pediatricians, like their counterparts nationally, identified concerns about paperwork as a barrier to participating in TennCare. The authors of the study also found a correlation between poorer reimbursement and decreased physician participation.
One reason why Tennessee pediatricans might score so low relates to one of the peculiarities of TennCare as a Medicaid program: the sheer number of managed care organizations (MCOs) in the program, and the historical instability of those programs. For a pediatrician to self-classify as "full Medicaid participation" during the survey period, he or she would have to be credentialed by eleven different TennCare plans, some of which would be outside of his or her geographic area, and some of which were already in financial receivership.
Source: Steve Berman, Judith Dolins, Suk-fong Tang and Beth Yudkowsky. "Factors That Influence the Willingness of Private Primary Care Pediatricians to Accept More Medicaid Patients." Pediatrics 2002;110;239-248.
]]>In 2003, there were a total of 1,108 FTE general pediatric physicians estimated to be actively practicing direct pediatric primary care in the state. Of this total, 718, or 65 percent, were reportedly practicing in the four metropolitan counties of Davidson, Knox, Hamilton, and Shelby.
In 2004, there were a total of 681.0 FTE self-reported general pediatric physicians actively practicing direct primary care in the state. Of this total, 284, or 41.7%, were reportedly practicing in the four metro counties, while 397, or 58.4%, were practicing in the rural counties.
Comments: The 2004 data indicate that the disparity between rural population and rural pediatrician supply began to equalize somewhat. However, these data also suggest that the number of urban pediatricians dropped from 718 to 284 in a one year period, which seems erroneous.
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