JOHNSON CITY, TN (WJHL) – Chiropractors across Tennessee are asking the state to stop Tennessee’s largest insurer from slashing their reimbursements, arguing the cuts will force businesses to close and result in second-class patient care.
A spokesperson for the Tennessee Department of Commerce and Insurance says the agency has received more than 600 complaints collected by chiropractors about Blue Cross Blue Shield of Tennessee’s planned change.
BCBST alerted chiropractors in late June of its plans to drastically cut reimbursements to just $60 per visit beginning on October 1. The company calls it an attempt to bring reimbursements in line with the market, but chiropractors argue the change is unfair and illegal.
In July, the Tennessee Chiropractic Association asked TDCI to step in, listing five concerns about the proposal, including that the change violates the Affordable Care Act and state law. The association cited a 2009 state bulletin that told insurers they should be prepared to reimburse chiropractic physicians the same way they reimburse medical physicians and warned against discrimination.
“The undersigned TCA representatives implore the Department to take all reasonable and appropriate steps to prevent BCBST from implementing this proposed contract amendment creating a per diem model of payment for chiropractic services,” TCA said in its letter dated July 12. “The proposed per diem payment model will diminish patient care and will likely result in the closure of many chiropractic offices in Tennessee.”
Jones Chiropractic co-owner Ida Jones says the cuts will be devastating for the Johnson City business. According to Jones, roughly 85% of the patients at Jones Chiropractic are insured by BCBST. She says in past years the company has reimbursed chiropractors up to almost nearly $200 per visit.
“I don’t know how you’re expected to operate a business and have employees on a $60 per patient reimbursement when you’re used to having three times that or more,” Jones said. “The $60 fee that they will reimburse us doesn’t even cover the physician’s time and then we have employees who are certified. It’s going to (cost us) thousands, hundreds of thousands of dollars and I don’t see how you can operate a business on that.”
Like TCA, Jones argues BCBST is singling out chiropractors.
“We would almost be okay with it if it was an across-the-board to all providers,” she said. “It’s just hammering chiropractors and that is discrimination.”
BCBST Corporate Communications Director Mary Danielson says not only are the planned cuts legal, they are fair to chiropractors.
“We feel through our evaluation of that (state bulletin) that we are not in violation of any Tennessee law or the ACA,” Danielson said. “Tennessee state law entitles chiropractors to reimbursement, not to be reimbursed in the same manner as medical physicians. We don’t believe that using differing reimbursement strategies is unequal, but simply part of a recognition that medical providers, as with any other profession, have varying types of expertise, education, and skillsets. Those factors, among others, are always evaluated when establishing appropriate reimbursement amounts.”
Danielson says the change will not impact quality of care, but will save self-funded groups roughly $12 million and save the 80,000 Tennesseans who receive chiropractic care out-of-pocket expenses.
“It’s aimed at generating cost savings for our members who are always looking to keep their care as affordable as possible,” she said. “The overall goal is to always balance the quality of care being delivered to our members as well as the cost that they’re having to pay for that care. The new rates that we have set are going to be in line and still in some cases higher than what they’re already currently accepting from other insurers.”
TDCI says the agency is talking with BCBST about the change.
“At this time, the Department is currently reviewing the company’s announced change against existing statutes and regulatory guidance related to reimbursement for chiropractors,” Kevin Walters said. “We have not issued any guidance at this time but we are having conversations.”
TDCI says the reimbursement change is not the company’s only initiative aimed at bringing down costs. According to Walters, BCBST has also made changes to its approach to pain clinics “to address another area where outlier costs may be significant.”
Despite the hundreds of complaints statewide, BCBST reports none of the 70 area chiropractors have formally rejected the change.
TDCI is also talking with UnitedHealthcare about this issue, since the company is implementing a similar change. The company will move to a per diem payment policy for Tennessee chiropractors on October 1 as well. Optum, the company that manages UnitedHealthcare’s chiropractic network, reports it notified chiropractors of its planned change in June.
“This simplified payment method is consistent with the move of the entire healthcare system away from fee-for-service to payments that emphasize quality outcomes, which benefits both patients and providers, and it is consistent with applicable law,” Optum said in a statement. “Optum is not changing participation, covered services or restricting the services a chiropractor can render.”
TDCI reports the agency has received 37 complaints related to UnitedHealthcare’s chiropractor reimbursement changes.Copyright WJHL 2016. All rights reserved.