There are basically two types of Department of Social and Health Services (DSHS) that we deal with: CUP, which has a limited provider pool (which they have refused to expand for optometric physicians since I opened my clinic in 2001) and poor reimbursement. The other type of DSHS is generally referred to as “Open Plan” and allows the patient to see a larger pool of providers who are reimbursed at better rates (regardless of what CUP claims). Patients have reported to me that they were “recommended” to choose the CUP plan or not even
given a choice.
It’s likely that releasing physicians from the shackles of CUP will allow jobs to be created beyond any losses due to the demise of the financial mess that paid $6.1 million to 80 employees – that is $76,250 per person or about what I make as a physician running my own clinic. Don’t they have computer systems that review electronic submissions and process payments to providers? How many people does it take and what level of education would put them in that pay grade? Honestly, I expect that most of these workers are low-paid office workers with overpaid management. $6.1 million dollars put back into our local economy is very likely to instantly infuse money for job creation to small providers.
I am floored that the CEO sights printing “large amounts of member materials” as a reason for large financial loss to our community. The federal mandates that healthcare providers must comply with to decrease printing and move to electronic health records and paperless offices should be of number one concern for CUP, so they would have been dramatically decreasing printing in the coming months and years anyway.
I don’t know that the replacement option will be any better or worse than the situation we left behind, but the state group that reviewed CUP’s application must have seen that the organization did not meet enough of the state requirements to win the contract back.
I believe there is definitely more to this story than “poor CUP.” And it’s only fair to look at the possible positive side of this change.
Shelby Wickhorst is an optometric physician at Vision 162 in Northeast Vancouver.
