[Vision2020] MORE UI Ineptitude

[Saundra Lund]

Visionaries:

I know this will come as no surprise to some, but I continue to be
flabbergasted at the level of absolute incompetence exhibited by
"management" at the University of Idaho.  Perhaps the words 'ineptitude' and
'incompetence' are the wrong words, but I don't know WHAT else to call it
when the UI is renewing a contract with a health care provider (BPA, or
Business Psychology Associates) which has been flatly unable to provide
contracted services for the past year.  What are those people thinking?!?!?

With decisions like this, it's no wonder the UI is plagued with financial
difficulties.  Those difficulties will continue, IMHO, until those making
the foul decisions are "reassigned."

For those interested, below my signature I'm including an email I sent, at
*her* request, to Linda Peavey, Director of Benefits Services, following her
4/9/2004 presentation.  I never received a response, and this from a woman
who stood in front of us claiming to always respond to her emails.  For some
clearly insane reason, I expect better from someone whom the UI pays $53,000
a year for her "expertise."

If anyone has any suggestions about how to deal with this, I'd ***love*** to
hear them because I'm about at my wit's end.  It's difficult enough to have
a child with a chronic illness, but to be left high and dry by the UI's
unconscionable decision to renew a contract with a carrier with a proven
failure to meet its contractual obligations is . . . well, I have no words
that can be used in polite company to express my disgust and
dissatisfaction.

And, if anyone has an "in" with incoming president Tim White, *please* feel
free to pass this on to him!  It seems clear to me that Benefits Services is
in desperate need of his attention upon his arrival. 



Saundra Lund
Moscow, ID

-----Original Message-----
From: Saundra Lund [mailto:sslund@adelphia.net] 
Sent: Monday, April 12, 2004 9:53 AM
To: 'lindap@uidaho.edu'
Cc: Bill Lund (wrlund@uidaho.edu); 'Shirley Ringo'; 'Tom Trail'; Gary J.
Schroeder (gary@hideandfur.com)
Subject: BPA


Dear Ms. Peavey,

With respect to Friday morning's (9-10:30 AM) Benefits Forum and BPA
(Business Psychological Associates), you asked that I send you the names of
non-BPA psychiatrists in the area who do see children (under the age of 18).

First, though, I cannot adequately express my dismay, disappointment, and
absolute disgust that the UI would even consider renewing the contract with
BPA.  As you have known for many months, BPA is unable to provide contracted
services to the children of UI employees.  Due to decisions made by
"someone, sometime" UI has bought into the categorization neurobiological
(as distinguished from simple psychological) illnesses (which are the
leading cause of disability in the world) such as ADHD, Bipolar Disorder,
Schizophrenia, Autism, Alzheimer's disease, Tourette Syndrome, etc. as
"behavioral health" issues.  While we could debate the pros and cons of
terminology endlessly, I'll just say that the UI ought to be ashamed of
itself for selling out the health of children with genuine and recognized
*medical* disorders by splintering off their care.  While the effects of
such a decision may not have been known before the decision for FY04, you've
certainly had the information for FY05 consideration, and BPA should have
been dropped from consideration for its continuing failure to provide
contracted services to children.

I know from speaking with BCI (Blue Cross of Idaho) many times since the
switch from Regence that they are fully capable of providing the "mental
health" component of health insurance.  Indeed, according to three separate
BCI representatives, the approach the UI has taken has been rejected by
virtually all other Idaho employers precisely because of the kinds of
problems UI employees have experienced with BPA.

I'm not sure how you want to define "area," but I'm sending you information
about a small portion of "area" psychiatrists who do treat children.  As I
mentioned, BPA would not look further than 290 miles for participating
providers (interestingly, from BPA's own Web site:  "We expect patients to
travel no more than 25 miles to see a clinician for outpatient treatment.
However, in rural areas where clinicians are widely separated, some patients
may have to travel up to 50 miles").  So, I'm using the 280+/- miles BPA
used in sending you information.  Clearly, 280 miles is absolutely
ridiculous, but . . . 

Understandably, I'm not interested in running up my phone bill to gather
information BPA should be able to provide or someone at UI should have
researched.  So, I'm taking the easy way out and providing the names and
cities of AACAP (American Academy of Child & Adolescent Psychiatry) *only*
members.  You need to keep in mind that this list is *not* all-inclusive of
"area" psychiatrists who will see children -- there are several/many
"regular" (non-BPA and non-AACAP) psychiatrists I know of who will see
children, so an actual list of non-BPA "area" psychiatrists seeing children
would be much larger than the one I'm submitting to you.

AACAP-only providers in distance order from Moscow, ID:

Howard Ashby, M.D. 
Spokane, WA
(84 miles)

Sandra Bremner-Dexter, M.D. 
Spokane, WA
(84 miles)

John Jaccard, M.D. 
Spokane, WA
(84 miles)

Richard Riley, M.D. 
Spokane, WA
(84 miles)

Bruce Miewald, M.D. 
Coeur d'Alene, ID
(85 miles)

Sandra K. Nelson, M.D. 
Coeur d'Alene, ID
(85 miles)

George J. Ullrich, M.D. 
Coeur d'Alene, ID
(85 miles)

Foster Cline, M.D.
Sand Point, ID
(129 miles)

Wajiha P. Karatela, M.D. 
Richland, WA
(153 miles)

Benjamin D. Pe, M.D. 
Richland, WA
(153 miles)

Bonnie Hartman, M.D. 
Ellensburg, WA
(190 miles)

William Mosiman, M.D. 
La Grande, OR
(207 miles)

Lokanadha B. Nimmagadda, M.D. 
Wenatchee, WA
(208 miles)

William Estabrook, M.D. 
Yakima, WA
(221 miles)

Douglas C. Dicharry, M.D. 
Bellevue, WA
(290 miles)

Andrea Eisner, M.D. 
Bellevue, WA
(290 miles)

Michael P. Golden, M.D. 
Bellevue, WA
(290 miles)

Catherine Harger, M.D. 
Bellevue, WA
(290 miles)

Kenneth King, M.D. 
Bellevue, WA
(290 miles)

Irving Kohlberg, M.D. 
Bellevue, WA
(290 miles)

Robert Small, M.D. 
Bellevue, WA
(290 miles)

H. Bartlett Vincent, Jr., M.D. 
Mercer Island, WA 
(290 miles)
 
Jennifer Vincent, M.D. 
Mercer Island, WA 
(290 miles)
 
Charles R. Wang, M.D. 
Bellevue, WA
(290 miles)

As you can see, there are *many* AACAP providers who will not contract with
BPA, so it's *not* that there are no "area" providers.  My understanding
(and I called BPA to make sure things haven't changed since the last time I
spoke with them) is that the nearest BPA provider who can provide medication
management for pediatric patients is in Boise, ***300*** miles away.  If I
extended the "area" for the list above to 300 miles, the list would lengthen
dramatically (I'm guessing more than double) because it would also include
the Seattle area (which, of course, is ridiculous, but . . . ).

Other things that I'll mention . . . 

According to the information the UI has available on its Web site, BPA
claims to have 48 "MD" providers in Idaho and Washington.  Only seven, or
about 15%, of those providers are available to Moscow UI employees (and that
seven includes an OD rather than a psychiatrist in Lewiston), and none
provide services to children.  Clearly, then, there is an issue of adequacy
of network providers for UI employees and families.  And, unlike the
problems with VSP, the work-around isn't a short drive once a year or paying
out of pocket and receiving a reasonable reimbursement.

I believe BPA's claims that they have worked hard to recruit more providers
in this area.  However, they have failed, and failed miserably, to do so.
This should tell you something.  BPA may be a reasonable choice for the
Boise area, but it certainly is *not* a reasonable choice for the northern
Idaho area!

Perhaps this is an issue the UI couldn't have foreseen prior to contracting
with BPA, but it *is* an issue that's known now and has been known for many
months.  It is absolutely unconscionable for the UI to even consider
renewing the contract with BPA given the lack of providers for children
specifically and the inadequacy of network providers in general.

But, that's not the only issue with BPA.  The research I have indicates that
prior to BPA, medication management could be provided by one's primary care
physician (PCP) or regular doctor.  Under BPA, medication management can
*only* be provided by a psychiatrist or a doctor of osteopathy!  It is
unfathomable to me why BPA would *exclude* PCPs but allow ODs, who have
absolutely no specialty training in psychopharmacology, to provide
medication management.

This, of course, significantly compounds the adequacy of network providers
issue:  were it not for this ridiculous limitation, a child's medication
management could be provided locally by the child's PCP solo or, if needed,
in consultation either with a BPA provider or a non-network provider via
phone.

I cannot encourage strongly enough that the UI should *not* renew the
contract with BPA due to their inability to provide contracted services to
the children of UI employees and BPA's nonsensical restrictions on who can
provide service.  You have known for *months* that BPA cannot fulfill its
contractual obligations in spite of huge recruitment efforts on their part
and plenty of time to rectify the situation.  It makes no sense at all that
the UI would even consider renewing a contract with a provider who has a
proven track record of not fulfilling its contractual obligation.

I've held off on doing so, but in light of the fact that the UI, left to its
own devices, is actually considering renewing a contract the provider is
unable to fulfill, I'm going to file a complaint with the Department of
Insurance and ask them to evaluate BPA's failure to provide contracted
services.  The DOI has expressed an interest in looking at the adequacy of
providers issue outside of an HMO setting, and this will provide them with
the opportunity.  I'm also going to ask that they look at the splitting off
of "mental health" benefits in light of the federal Mental Health Parity Act
of 1996 (MHPA).  While my understanding is that the Act applies to carriers,
it seems to me that employers have an ethical and moral obligation to abide
by the spirit by the law:  just because the UI can get away with skirting
the spirit of law doesn't mean that it *should*.  Indeed, it seems that a
fair amount of the financial problems the UI is facing are the result of
just such a mindset.

I hope the extensive but incomplete list of "area" pediatric providers who
*refuse* to contract with BPA helps you in your contract deliberations.


Sincerely,
Saundra Lund
1220 Highland Dr.
Moscow, ID   83843

(208) 882-2150