California has some patient-friendly regulations on its books, meant to help patients get the care they need in a reasonable amount of time. One of those regulations is that patients shouldn’t have to wait more than 10 business days for a regular appointment with their health or mental health care provider.
Yet, Kaiser Permanente’s health maintenance organization in the state — rather than abide by the regulation — regularly made patients wanting mental health care wait longer than the 10 business days. In fact, in one case from 2010, the California Department of Managed Health Care (DMHC) fined Kaiser $75,000 for unreasonably delaying a child’s autism diagnosis for almost 11 months! The new report found that anywhere from 17 to 40 percent of patients waited longer than 14 days for an appointment.
Last week, the DMHC was again at Kaiser’s doorstep, finding that Kaiser kept two sets of appointment records to try and circumvent this regulation — a paper appointment calendar and an electronic health record calendar. The DMHC cited Kaiser for “serious” deficiencies in how it manages and provides mental health care services to its patients.
Kaiser Permanente is one of those enormous health care providers that seems to have lost the plot — providing reasonable and timely health care for its customers.
The latest Kaiser investigation by the DMHC was begun based upon a lengthy and detailed report (PDF) published in November 2011 by the National Union of Healthcare Workers — which represents 2,000+ health care employees at Kaiser. In other words, this is Kaiser’s own staff blowing the whistle on the horrible clinical practices they were forced to implement for their patients.
Here’s what the new DMHC report published last week concluded:
- Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Instead, large numbers of Kaiser’s patients were required to endure lengthy waits for appointments in violation of California’s “timely access” regulations.
- Kaiser’s internal record-keeping system contained numerous problems – including a parallel set of “paper” appointment records that differed from the HMO’s electronic records – that hid patients’ lengthy wait times from government inspectors.
- Kaiser failed to adequately monitor and correct its violations of state law. Records show that Kaiser was aware of its violations, but failed to take action to correct the problems.
- Kaiser provided “inaccurate educational materials” to its members that had the effect of dissuading them from pursuing medically necessary care and violated state and federal mental health parity laws.
This last point is particularly egregious because Kaiser — in multiple materials across multiple provider sites — suggested there were limits on mental health coverage visits. These limits haven’t been allowed — by law — since the federal mental health parity regulations went into effect in 2010. If you have a mental disorder diagnosis, your coverage is the same as it is for other health conditions. Yet in 2011, Kaiser was apparently still saying things like,
“We offer brief, problem solution focused individual counseling. Research shows many people improve in a single visit. For others, 3 to 6 visits can produce desired changes.”
“Health Plan contracts for up to 20 visits per calendar year with various copayments.”
If you read this, it may have dissuaded you from even seeking care, thinking your care would be arbitrarily limited by Kaiser (and not by what’s in your best treatment interests).
Of course, Kaiser claims that since the beginning of 2012, it has worked on fixing these problems. How convenient… yet this isn’t the first time Kaiser has been fined by the DMHC, so let’s just say that I’m a little skeptical of their “fixes.”
“The department feels these findings are really serious. Because of that, we are doing the immediate enforcement referral, which is unusual,” said Shelley Rouillard, chief deputy director of the Department of Managed Health Care.
Kaiser, get your act together. It’s shameful that you treat patients with mental health concerns as second-class citizens in California, and you don’t listen to your own employees. Instead, they have to turn to the regulatory agency in order to have their concerns addressed. In my opinion, that demonstrates a business organization that is clearly broken.
If you’re a patient of Kaiser’s HMO mental health system in California, I feel for you. The report linked above details practices that suggest Kaiser’s mental health patients are getting sub-standard care by overworked, underpaid, and unappreciated clinicians.
Read the full story: Kaiser mental health service reprimanded
Read the full DMHC Final Report: Routine Medical Survey of Kaiser Foundation Health Plan, Inc. Behavioral Health Services (PDF)