TMA Redoubles Advocacy Efforts Surrounding Episodes of Care

October 5, 2017 

The Tennessee Medical Association, the state’s largest professional association for physicians, is strengthening its push for much-needed improvements to the TennCare episodes of care program.

The announcement coincides with the departure of TMA’s payment reform consultant, Jackie Woeppel, who recently accepted a position with the TennCare Bureau. Woeppel for the past two years traveled the state to visit practices upon request, give presentations about episodes of care, and help practices understand reports and analyze data. The role was funded through a federal innovations grant administered by the State of Tennessee to offer educational and consultative resources to medical practices and was consistent with TMA’s mission to help physicians successfully navigate the transition from fee-for-service to value-based reimbursement.

“Our members are frustrated, and we feel that as physicians’ strongest voice on this important issue, TMA must work harder to address longstanding concerns about data collection, data reporting and accuracy, and overall transparency of the episodes of care program. We are devoting our staff resources to amplifying our members’ ongoing frustrations and concerns,” said Nita W. Shumaker, MD, a Chattanooga pediatrician and 2017-2018 President of TMA.

TMA has notified the State that it will not seek a replacement for the consulting position or continue participating in the grant.

“We’ve been at the table since 2012, working with state officials in the spirit of cooperation, but our overall advocacy efforts have unmet goals,” said Dr. Shumaker. “While TMA initially supported the State’s efforts to create an alternative payment mechanism that would help control costs and promote quality care, the design and practical implementation of the program is flawed and has not improved to an acceptable level.”

Dr. Shumaker noted that the State has not implemented many important recommendations from physicians who have voluntarily served on Technical Advisory Groups, and has either ignored or not appropriately acted upon repeated calls for improvements.

TMA President-Elect Matt Mancini, MD of Knoxville testified in a Senate Health Committee hearing on episodes of care on Oct. 4. TMA officials are also meeting with state policymakers this fall to once again lay out physicians’ concerns and will seek legislative action in 2018 if fundamental issues continue to go unanswered.

Doctors and other healthcare providers are encouraged to share their comments on the Ti2 online reporting tool. TMA worked with the Tennessee Hospital Association, Tennessee Medical Group Management Association and Tennessee Association of Mental Health Organizations to develop Ti2 as a way to gather feedback, aggregate issues and ask the TennCare Bureau and managed care organizations for changes to the episodes of care reporting process. Initial feedback via Ti2 echoes what TMA says it has repeatedly heard from member physicians.

Visit tnmed.org/episodes to learn more about TMA’s advocacy efforts on this issue.