There are two types of Medicaid clients in our community – those served under managed care plans – of which there are currently three in Clark County, including CUP. The other clients have fee-for-service (FFS) Medicaid. In managed care, plans contract with providers at an agreed upon rate; under FFS, the provider rates are set by the state.
There are very few providers that see members under FFS Medicaid because the reimbursement is low, usually below cost. Conversely, most primary care and specialty care groups are contracted with CUP. I refute Dr. Wickhorst’s assertion that “CUP has a limited provider pool…and that coverage is better under the open pool.” There is almost no primary care practice available to take a FFS patient and virtually no specialty care providers willing to see FFS patients. CUP has more than 80 eye care specialists for 47,000 members – that is hardly a limited provider pool. I further refute Dr. Wickhorst’s statement that FFS remuneration is better than CUP’s – this is patently untrue in my practice experience. CUP has no record that Dr. Wickhorst has ever applied to be on the CUP panel, and thus he has no direct experience with CUP compensation or operations.
Dr. Wickhorst states that “releasing physicians from the shackles of CUP will allow jobs to be created beyond any losses…” I do not feel “shackled” by CUP and think that I can speak for most contracted providers in making that statement. CUP is a pleasure to work with. CUP pays their claims timely and electronically adjudicates over 90 percent of submitted claims. CUP has a robust care management department that helps practitioners with the most difficult patients. CUP executes their responsibilities with great care and professionalism.
Dr. Wickhorst opines that management is overpaid and that the demise of the CUP enterprise will infuse money for job creation for small providers – really? The wages quoted include payroll taxes and benefits. CUP has many professionals in nursing and information technology and all CUP salaries are competitive in our marketplace. CUP has the lowest administrative overhead of any Washington Managed Medicaid plan – it is a very lean and efficient organization. The printed member materials of concern to Dr. Wickhorst are required by state Medicaid contract – this is not CUP’s choice to make.
Although Dr. Wickhorst is uncertain if the replacement plans will be any better or worse than the current state, I feel differently. I feel certain that the two “apparently successful bidders” will not be able to serve the enrollees in Clark County as well as CUP does now. I do not believe that these companies, that are not even based in Washington state, are likely to treat me, my staff and our patients in the same way that CUP does now. I do not want our limited state revenue to go to out-of-state, for-profit healthcare companies and to Wall Street. I will do everything in my power to have CUP restored as a managed care plan in Clark County. I feel certain that I speak for most providers in Clark County.
Dr. Donald Murray Thompson is the founder of Evergreen Pediatrics Clinic, located at 505 NE 87th Ave., Suite 120, in Vancouver. He can be reached at 360.892.1635.
