Passport works; choice may not

June 5, 2012

Editorial | Passport works; choice may not

Not only has Passport Health Plan cleaned up its act but a recent state audit of the non-profit, Medicaid managed care provider for Jefferson and 15 surrounding counties included this important finding:

“Patient satisfaction with the health care provider remains high.”

Passport, in its 15 years of operation, has received high marks for patient health and satisfaction. Its recent foray into some foolish, lax spending and accountability practices by former executives has been largely corrected and appears not to have affected the basic mission of patient care.

Still, it appears that Passport — which by all accounts provides very good care to more than 170,000 low-income and disabled people — come Jan. 1, 2013, will be forced to compete with private, for-profit Medicaid companies such as those operating elsewhere in Kentucky.

State and federal officials say this is about competition and choice.

We say the Passport region needs to be afraid. Very afraid.

Three private, for-profit companies won state contracts last November as a Medicaid cost-savings initiative by the administration of Gov. Steve Beshear. Not only was the start-up a disaster of bureaucratic confusion and delay, horror stories continue to pour forth on a daily basis of battles people face to get basic health care they took for granted under Medicaid services previously run by the state.

Dr. Bill Collins, a Pikeville dentist, testified before the legislature earlier this year about the struggle to get services authorized for patients with some of the most severe dental problems in Kentucky. Abcesses, entire mouths full of rotted teeth and life-threatening infections — all have been subject to managed care demands for more documentation, denials and delays as patients suffer needlessly, he said.

Dr. Collins said since the session ended in April, the situation is no better — so bad, in fact, most oral surgeons east of Lexington simply refuse to treat Medicaid patients. That means patients in need of advanced dental care must travel to the University of Kentucky, the closest place available.

“Last week, I sent three patients to UK who needed full-mouth extractions,” Dr. Collins, a family dentist, told The Courier-Journal. Full-mouth extractions is dental-speak for cases where a patient’s teeth are so badly rotted every single tooth must be pulled.

It’s not just dental care suffering under the for-profit model that serves about 560,000 people outside the Jefferson County region.

Jodi Mitchell, executive director for Kentucky Voices for Health, an oversight and advocacy organization, said confusion abounds and patient access to care appears threatened by situations where one of the companies, Coventry Cares, is locked in contract disputes with three major hospitals, Appalachian Regional Healthcare (with eight Eastern Kentucky hospitals), Baptist Healthcare System (five Kentucky hospitals) and King’s Daughter’s Medical Center in Ashland.

And Sheila Schuster, a longtime mental health advocate, said getting basic mental health services, such as the right prescription drugs and adequate hospital care, remains a constant battle for patients and their doctors outside the Passport region.

While the state Cabinet for Health and Family Services struggles to deal with individual problems, it has failed to correct them system-wide, according to advocates. Dr. Schuster said she is not optimistic about allowing the for-profit companies to muscle their way into the Louisville market come Jan. 1.

“It’s scary,” she said.

It is very scary.

We have already urged state officials to work harder to fix the problems outside the Passport region. But someone, somewhere, needs to figure out how to spare Passport patients and health care providers what the rest of the state is going through.