TennCare cuts threaten Nashville General hospital

Hospital that serves large numbers of poor may lose $10.5 million By Christina E. Sanchez • THE TENNESSEAN • February 4, 2010 Looming cuts to a health insurance program for the state's poorest patients could deal a devastating blow to Nashville General Hospital at Meharry. The governor's proposed $200 million in cuts to TennCare could mean a budget gap of $10.5 million for the public hospital, which has struggled financially in recent years. The proposal also would limit coverage for TennCare recipients, forcing hospitals to pick up what the health insurance plan won't. Gov. Phil Bredesen offered up the cuts in his budget address Monday as a way to help solve Tennessee's financial shortfall for the coming fiscal year. But supporters of the public hospital wonder whether Nashville General, and a sister safety net hospital, the Regional Medical Center at Memphis, would survive the cuts. The Med could see a $50 million funding loss. The hospitals serve large numbers of uninsured and uninsurable residents. "Poor people will not get the care they need if this is shut down," said the Rev. Jay Voorhees, a member of a clergy advocacy group, Nashvillians for Metro General. "It will affect people's ability to be healthy. Some of these people will die." Nashville General will work with other hospitals, the Tennessee Hospital Association and the Tennessee Association of Public and Teaching Hospitals, on solutions to deal with the cuts, the hospital's interim CEO, Jason Boyd, said in a statement. "Nashville General cannot absorb a $10.5 million cut, but is hopeful the state working in concert with the hospital advocacy groups can find a solution to fund hospitals that provide a high portion of TennCare, charity and unfunded care to the citizens of Tennessee," he said. Struggling to resolve financial constraints is a familiar scenario for the hospital. In early 2009, the hospital lacked money and had no reserve funds. Also, the hospital had $66.9 million in bad debt and charity in 2008, state department of health data show. The hospital authority tightened its belt and should end the 2010 fiscal year with a barely balanced budget, but then it faces the potential TennCare cut. "You can't lose $10 million without it affecting the services it's going to give," Voorhees said. Among the planned TennCare reductions: occupational, physical and speech therapy would be eliminated; in-patient hospital care would be capped at $10,000; hospice care would be eliminated; and patients would be limited to eight non-emergency doctors' visits a year. Pregnant women and children would be exempt from many of the limits. Cuts must be approved The TennCare Bureau must get approval to make the cuts from the U.S. Centers for Medicare and Medicaid Services. According to information provided by Dr. Joey Hensley, chairman of the state oversight committee on TennCare, only two other states cap payments for their versions of Medicaid. Texas has a cap of $200,000. Minnesota has a $10,000 cap, but it applies only to those who make more than 175 percent of the state's living wage. The cuts to TennCare have been on the table for almost two years. Cuts were supposed to occur during the current budget year, but federal stimulus funds temporarily filled the gap. Voorhees says people have known the cuts were coming, but no solution is given on how to give people health care. "Health care is a basic human right," he said. "There is never an answer on how we make sure folks are cared for."