For Craig Becker, president and CEO of the Tennessee Hospital Association, the top priority for 2015 is securing Medicaid expansion in Tennessee … now, it looks like that could happen this year.
On Dec. 15, 2014, Gov. Bill Haslam introduced his Insure Tennessee voucher plan to provide an alternative coverage option to low-income Tennesseans who don’t qualify for either TennCare or federal subsidies. It’s estimated nearly 200,000 employed Tennesseans at or below 138 percent of the federal poverty level would be impacted by the pilot program designed to help them participate in employer-offered plans.
In responding to the plan’s announcement, Becker stated, “For the past two years, THA’s number one priority has been securing Medicaid expansion in our state, and today marks the beginning of this goal becoming a reality. I applaud the governor’s thoughtful approach to this vitally important issue and am grateful for his hard work with the Department of Health and Human Services in recent months.”
Becker added the Insure Tennessee plan is a meaningful alternative to traditional expansion. He continued, “I also believe Insure Tennessee helps provide a solution to the financial challenges hospitals across Tennessee have faced for the last several years as a result of extreme cuts in healthcare reimbursement.”
However, he recognizes there is still more work to do on behalf of the THA membership. Getting the plan through the Tennessee Legislature is the next challenge. “It’s most needed,” Becker said. “We’ve lost several hospitals in the last year. It’s going to be much tougher, especially for our small and rural hospitals to survive … and for our urban safety net hospitals to provide the level of services they do … if we don’t get expansion.”
Still, having the Insure Tennessee plan approved by HHS is clearly an important first step.
Other priorities for 2015 include passage of the hospital assessment, which allows Tennessee hospitals to put up $452 million to help fund the TennCare program and draw down federal match dollars at a 2:1 rate. Although passage has been fairly routine the last few years, there was initially some skepticism when hospitals first broached the subject of funding the state’s portion so Tennessee wouldn’t ultimately lose out on $900 million in federal funding support. “Hospitals have taken that on for the last five years,” Becker said. “The dollars used to come from the general fund.” Becker added he is hopeful the general fund might again pick up some of state’s portion of Medicaid funding down the line as the economy continues to stabilize.
Another ongoing priority, Becker said, is ensuring the state’s Certificate of Need program stays in tact. “There is no looming threat right now, but it’s always a concern,” Becker noted, adding the CON process levels the playing field for facilities across the state.
Russ Miller, CEO of the Tennessee Medical Association, is also eager to see more Tennesseans be able to access the healthcare system through a commonsense Medicaid expansion plan. Additionally, the TMA has a full slate of activities pertaining to professional development, membership resources, and advocacy planned for 2015.
Among some of their key priorities for the year are preparing members for ICD-10, finishing the work on payer accountability, looking at issues pertaining to graduate medical education and physician sustainability, and helping TMA members, in partnership with other healthcare professionals, navigate new payment models and collaborative care arrangements.
A major push for the TMA over the next 18 months is becoming recertified as a CME provider. Miller said the organization served as the state accreditor for continuing medical education until around 2005 but dropped that function for various reasons. “We thought it was time to bring it back,” he said.
The TMA already has a strong educational component within the staff and offers online CME courses alongside leadership development and training on the latest issues. However, going through the recertification process will allow the state association to provide more clinical content to physicians and other providers. “It will give us the ability to create more original content to meet the needs of the market and to get it to them faster without having to use a third party,” Miller explained.
Staying on an education theme, Miller said another issue is graduate medical education. “The Medicare program funds residency programs in every state,” he pointed out. Looking at concerns over physician sustainability and shortages in a number of areas, Miller continued, “You can get more doctors through medical school, but if residency positions don’t exist, you can’t finish training them.”
A cap of $50 million for GME has been in place in the TennCare waiver without any increase since the 1990s. “We’re asking the state to seek out more funding for graduate medical education,” he said of a hope the cap could be raised by $25 million. Miller was quick to add that doesn’t mean $75 million would be automatically funded, but at least there would be room for growth that doesn’t currently exist.
“Taking the long view, doctors often stay where they do residency. We want to keep doctors in Tennessee so we don’t have access issues for our citizenry.”
On the advocacy side, Miller said, “First and foremost is the continuation of the work we started last year on payer accountability.”
He expects legislation to be introduced in 2015 that addresses an issue he said has been an ongoing problem regarding commercial insurers making changes, often to fee schedules, mid-term in a contract cycle rather than waiting until the end of the contract and re-negotiating with all parties at the table.
“What we heard from our doctors is they just needed more predictability,” Miller said. He added it’s difficult to plan for the year when contracts could be unilaterally changed with little notice. “We spent almost every week with the insurers this (past) summer to tweak (the proposed legislation) it to make sure we don’t have unintended consequences,” Miller noted of working earnestly to get insurer’s input.
The TMA has also played a part in addressing some of the larger societal issues facing Tennesseans, including prescription drug abuse. Noting limited resources make it difficult for any one organization to make a big impact, Miller said this has led to more statewide collaboration. “It takes a lot of organizations working together to move the needle a little bit,” he pointed out. In addition to creating classes on the subject to help providers appropriately diagnose and treat patients with powerful opioids, TMA has also joined colleagues in educating the public and Tennessee Legislature about the issue.
Miller said much of the coming year’s work is an investment in the future to ensure Tennessee continues to have realistic rules and regulations, a good practice environment, fairness in reimbursement, and improved population health. “We want to make our state a great place to be a doctor,” he said of TMA’s ongoing mission.
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THA’s New Leadership
During the annual meeting this past November, the Tennessee Hospital Association membership elected and installed the 2015 board of directors.
Mark Medley, senior vice president and president of hospital operations for Franklin-based Capella Healthcare, was installed as chairman. A Fellow of the American College of Healthcare Executives, Medley is responsible for the operations of 14 acute care and affiliated Capella entities throughout the United States. Previously, he served as a hospital CEO and division CFO for LifePoint Hospitals and began his career with HCA. Prior to his current THA role, Medley served as chairman of the state association’s Council on Government Affairs and received the THA Small or Rural Hospital Leadership Award in 2013. He has also served on the boards of the THA Solutions Group and the Tennessee Rural Partnership.
Keith Goodwin, president and CEO of East Tennessee Children’s Hospital in Knoxville, was installed as chairman-elect and will step into the chairman’s role at the 2015 annual meeting in Nashville this coming November. Goodwin has served in his current position with ETCH since 2007. Prior to that, he spent more than 28 years at the Nationwide Children’s Hospital in Columbus, Ohio and also served as CEO at the Children’s Hospital of Austin for three years. In addition to being a member of the boards of THA, Children’s Hospital Alliance of Tennessee and Hospital Alliance of Tennessee, Goodwin serves on the boards of the East Tennessee Foundation, Metropolitan Drug Commission and Knox County Imagination Library.
Reginald Coopwood, MD, president and CEO of Regional One Health in Memphis, handed the gavel over to Medley and stepped into his new role as immediate past chair. He also will serve as speaker of the THA House of Delegates in 2015. Coopwood received his medical degree from Meharry in Nashville and previously served as CMO for Nashville General Hospital and later as CEO of the Metropolitan Nashville Hospital Authority before accepting his current position in March 2010. Coopwood serves on the boards of March of Dimes, QSource and Mid-South e-Health Alliance, among others.