|By Kate Harrison Belz, Chattanooga Times Free Press, Tenn.|
|McClatchy-Tribune Information Services|
Meanwhile, pediatricians in the state say they are concerned about their patients and their practices' finances after seeing the impact of state-issued changes to CoverKids -- the program that provides free health coverage for children and pregnant women who do not have insurance but make too much to qualify for TennCare.
The changes to CoverKids are among a series of recent cost-saving measures made by TennCare and other insurers over the past two years that have hit children's hospitals' bottom lines to an unprecedented degree, said Dr.
Children's at Erlanger for example, has lost more than
"We're seeing increasing cuts to the children's hospitals that threaten the level of care that we provide," Kohrt said. "We have not had to cut any services -- yet. But we continue to face financial pressure."
One of the key changes that has worried both hospitals and pediatricians was a switch in how the state administers CoverKids, which covers 60,000
State officials have said there is an 85 percent overlap between the providers in the old network and new one, and that 696 pediatricians are in the TennCare Select network.
But leaders with the
And for all doctors, the change means markedly lower reimbursements.
At Berman's practice, fees for office visits dropped about 16 percent. Other fees dropped 30 percent or so. The worst, Berman said, were reimbursements for vaccinations, which plummeted from over
Some pediatricians have opted to stop taking CoverKids altogether.
In a letter the KidsCount doctors drafted to patients in July, they wrote that it was impossible as a small practice to accept such a large number of patients and deal with such lower reimbursement rates -- so they stopped taking CoverKids altogether.
"We truly regret having to make this change," the letter said. "We have developed many close relationships with our CoverKids families."
Goetz added that staying on the BlueCross network was problematic because of how commercial negotiations between BlueCross and hospital systems could mean certain hospitals were unintentionally left out of CoverKids.
"The state could prevent similar situations in the future because we have more control over the Select network," Goetz said.
Children's hospitals are facing more pressures besides the CoverKids switch.
Changes to how BlueCross reimburses for labs and changes to the TennCare's "rate corridor" -- calculated payment rates hospitals -- have also translated to over
Such decisions have had an "extremely adverse effect" on children's hospitals ability to give "the safest and highest quality care to all children in our state," said a letter from the
Children's hospitals need to be treated completely differently than community hospitals, members of the group explained during their meeting Monday with Commissioner OVERSET FOLLOWS:of Finance and Administration
The intensity of the services are usually significantly greater. More caregivers are always required. Overall expenses are greater. And children's hospitals are heavily dependent on
Between 55 and 65 percent of all patients treated at Erlanger are on
"What seems like a small cut can be disastrous for children's hospitals. The cuts are much deeper now," he said, adding that whatever TennCare cuts also is trimmed from the federal match as well.
And the children's hospital leaders are worried cuts will only continue.
Kohrt said state leaders were "very receptive" to the hospitals' concerns, and agreed to begin meeting regularly with the group.
"We have historically stayed in contact with the
The group did not discuss the recent controversy surrounding a lawsuit filed against TennCare, which argues that thousands in the state -- including children -- have faced inordinately long delays in obtaining coverage.
But Kohrt said the discussion did touch on the issue of
If the state is facing a shortfall and the federal government is offering to put money toward expansion, Kohrt asked "why would we go forward with cutting services to kids?"
The most important thing right now, he said, is keeping the channels of communication open.
"We have to continue this dialog, and stress that the shortfall shouldn't be borne on the backs of these kids."
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