State Sen. Doug Henry, right, talks with John Morris, M.D., during a recent tour of the Vanderbilt Trauma Center.
photo by Dana Johnson
TennCare sits atop Capitol Hill agenda
Edith Taylor Langster
Continuation and improvement of essential access payments for TennCare is the most pressing issue facing Vanderbilt University Medical Center during the upcoming Tennessee legislative session.
State lawmakers will convene in Nashville Jan. 10, 2006, to begin the second session of the 104th General Assembly.
With support from the Davidson County Delegation, Vanderbilt fought hard for these special payments made to providers that serve a disproportionate share of TennCare patients.
Vanderbilt and other academic medical centers serve as a backbone for the system by providing access to care for underserved and uninsured patients.
Consistently one of the state's largest providers of inpatient and clinic services, VUMC has written off more than $264.5 million in losses based on costs since TennCare's inception a decade ago.
“When the Tennessee legislature returns in January, the continuation and improvement of these payments will be our top priority,” said Harry Jacobson, M.D., vice chancellor for Health Affairs.
“At the same time we will work with the Tennessee Delegation in the Congress to get the Tennessee DSH program restored to a level commensurate with DSH programs in other states.”
Vanderbilt's share of the $100 million in recurring funds included in the fiscal year 2006 budget is $10.6 million; this year's budget allocates an additional $50 million in one-time funds that are waiting for approval from the Centers for Medicare & Medicaid Services.
Important decisions regarding the implementation of non-pharmacy cuts in benefits are still to come, although Gov. Phil Bredesen indicated he is hopeful the state can avoid many of the proposed benefit cuts for adult TennCare enrollees.
Almost 200,000 adults have already been cut from the rolls.
Betty Nixon, Vanderbilt's assistant vice chancellor of Community, Neighborhood, & Government Relations, said health care for chronically and severely ill adults is a population of particular focus when considering that these patients are likely to come to Vanderbilt even if they are disenrolled from TennCare.
“We are in the process now of trying to work out specific issues with the administration about these chronically ill patients, and they really go disease by disease,” she said.
“Our estimated payment on the dollar of cost for TennCare is 51 percent, so, when you are losing 49 cents on the dollar, it is really hard to make it up in volume.”
The lack of a state funding mechanism for trauma centers is drawing concern locally when considering that top physicians are being recruited to work in states that benefit from surcharges on traffic fines and portions of cigarette, alcohol and sales taxes.
Nixon said trauma centers legislation to provide funding is an initiative of the Tennessee Public and Teaching Hospital Association (TnPATH), whose members include five of the six level-one trauma centers in the state.
“Trauma centers are a key element of the state's public health infrastructure for all Tennesseans,” she said. “State funding for these centers was in the budget until the 11th hour and 59th minute [last session], with a funding source of general revenue at that point. It will be back on the agenda in 2006.”
Drunk drivers, persons not wearing seatbelts and persons driving without insurance are among the group that pays for trauma care in other states, according to John Morris, M.D., director of Vanderbilt's Division of Trauma & Surgical Critical Care.
“Other states earmark certain revenue streams to go directly to the trauma center because of the large proportion of indigent care that is associated with trauma,” he said.
TnPATH's Anne Carr said she has been meeting with state officials about the issue to discuss creative ways to fund trauma care.
“We hope we can exhibit the need to have a fund for the trauma system and we hope that the legislative leadership and the folks in the executive branch can help us figure out where that funding comes from,” Carr said.
Sen. Doug Henry (D-Nashville) has represented Vanderbilt in state government for more than two decades and recently toured the trauma center and new $3.7 million, 29-bed, Vanderbilt Regional Burn Center.
“Probably most of the burn patients are either people with limited means or people without insurance, which means that Vanderbilt has to pay a very high cost of service for charity care,” said Henry, chairman of the Senate Finance Committee.
Fixed-wing airplane transportation has increased patient volume at the Vanderbilt Regional Burn Center from 180 to more than 600 patients annually, with another 2,500 outpatients per year at the new burn clinic.
“I don't think there is a way to overestimate the value of what you do for Tennessee and, of course, our neighboring states,” Henry said during a recent tour of the Trauma Center. “I think it is magnificent.”
House Representative Edith Taylor Langster (D-Nashville) shares her colleague’s regard for Vanderbilt.
"Sponsoring legislation for the university, I get to take the Vanderbilt message to my colleagues. I sponsored the legislation getting the special license plate for the wonderful new Children's Hospital. I also passed the bill to allow the Vanderbilt police to have blue lights. As a former police officer, I could relate to how important that was to the force,” Langster said.
An unprecedented 13 bills potentially impacting clinical and scientific research were filed during the first session of the 104th Tennessee General Assembly, according to David Mills, Vanderbilt's assistant director for State Policy & Legislative Affairs.
Mills said the proposed legislation, which covers topics including DNA, cloning and the transparency of pharmaceutical clinical trials, is of great concern when considering that laws passed in states including Massachusetts have driven away research, and its funding.
Tennessee receives nearly $500 million in clinical and scientific research funding from The National Science Foundation and The National Institutes of Health.
“Our basic argument about this is that scientific clinical research is not done in a state,” Nixon said. “If the states start doing their own designer legislation then the money is going to flow to states that are following the national guidelines.”
“Our goal is to be sure that Tennessee maintains a level playing field — a policy environment that promotes clinical and scientific research,” she added.
A new initiative this session will be to explore safe and effective ways to recycle unused pharmacy supplies. Currently all medications, opened or unopened, are thrown away when a person dies.
“Close to 30 states have figured out some legislation, and it is all over the map how they did it, to rescue those drugs that are sealed and still have shelf life to be distributed,” Nixon said.
“With the TennCare crisis and a lack of pharmaceuticals, this just seems like such a good idea.”