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TMCNet: Cost-cutting TennCare changes worry some

[August 31, 2010]

Cost-cutting TennCare changes worry some

Aug 31, 2010 (Chattanooga Times Free Press - McClatchy-Tribune Information Services via COMTEX) -- Family members whose loved ones rely on durable and specialty medical equipment are concerned that a change to TennCare payments locally could disrupt their network of equipment vendors.


"What happens when you have no one locally to fit, repair and maintain a specialized wheelchair that for some folks is their only way to get around?" said Hixson mother Sherry Campbell. Her son Chad, 32, had a traumatic brain injury as a child and now relies on a customized wheelchair and tracheotomy equipment.

"That just worries me immensely," she said.

Aiming to cut costs, BlueCross BlueShield of Tennessee -- whose subsidiary Volunteer State Health Plan is one of three managed care organizations in the state to administer TennCare benefits -- recently signed a contract with Connecticut-based CareCentrix to handle the insurer's durable medical equipment benefits for TennCare enrollees. That includes specialty rehabilitation equipment, hearing aid batteries, tracheotomy supplies and other home medical needs.

The change means that, starting Nov. 1, CareCentrix instead of BlueCross will reimburse local medical equipment suppliers serving TennCare patients in the BlueCare or TennCare select networks. CareCentrix also will develop and maintain BlueCross' TennCare network of suppliers for those services.

But some patients are worried that the network will end up excluding local providers they've grown to trust. Local durable medical equipment providers already are fretting that CareCentrix's initial reimbursement rate offers are too low for them to accept.

CareCentrix's rates are expected to be, on average, 15 percent below reimbursements through Volunteer State Health Plan, BlueCross spokeswoman Mary Thompson said.

BlueCross doesn't yet have a number of how many suppliers have agreed to be a part of CareCentrix's network, since contracts were sent out just recently, Thompson said.

"I want to emphasize that we are working closely with CareCentrix to ensure that the TennCare members we serve will be taken care of and will continue to receive their equipment and supplies," Thompson said in an e-mail.

Eddie Jenkins, durable equipment manager for Access Family Pharmacy, said the company received a contract offer from CareCentrix last week that cut most of his payments by about 35 percent. He's still debating whether he can afford to be part of the network.

If he and other suppliers are unable to negotiate workable contracts with CareCentrix, Jenkins said, he'll be concerned for his clients.

"They lose the freedom of choice," he said. "You build a relationship, and they trust you and they're having to start over." Sharon Matthews of Signal Mountain said her son Robbie requires a specialty wheelchair after suffering a brain injury at birth. She's frustrated at the prospect of having another intermediary involved in TennCare payments, which she said already barely were covering her long-time medical suppliers' costs.

"I just can't believe we're going to pay someone that far away, when TennCare claims they already have money problems," she said. "When you put another person in the loop, of course these vendors are going to get less money" in reimbursements.

In this fiscal year the TennCare Bureau plans to save $3.4 million in state money by not increasing its reimbursements to its managed care companies for durable medical equipment, an area in which spending was on the rise, spokeswoman Kelly Gunderson said. The managed care companies were directed to find savings by revamping their durable medical equipment contracts, she said.

The bureau is monitoring the changes under way and will ensure enrollees have access to medically necessary services, she said.

"You're not compromising quality," she said. "We are observing, and we know we have to monitor and make sure our enrollees are still getting quality care." Local vendors are worried about the consequences of declining payments for durable medical equipment and specialty devices that greatly can improve quality of life for patients and prevent costly injuries such as bed sores.

Joel Holland, founder of Holland Medical in Nashville, said he hasn't yet decided if he can accept the contract offered by CareCentrix, which also cut his rates by about one-third. His company provides products such as walkers, power wheelchairs and oxygen tanks and has a branch in Chattanooga.

"If you continue to pay less and less and less, then the quality of the products and the services that go along with them have to suffer," he said.

NO JOB CUTS The payer change has not resulted in any job cuts at BlueCross, a spokeswoman said. Last year, after reporting a pre-tax loss of more than $95 million on TennCare, BlueCross cut 93 jobs in its TennCare division. More than half those cuts were achieved by not filling vacant positions or moving employees to new positions, and only eight employees actually lost their jobs, spokeswoman Mary Thompson said.

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