Medicare warns Kaiser on kidney care

Coverage at S.F. center is at risk unless compliance with federal rules is proved.

By Dorsey Griffith — Sacramento Bee Medical Writer

The Medicare program has threatened to halt coverage for all end-stage kidney care at Kaiser Permanente’s San Francisco transplant center unless the health plan can convince regulators it has complied with federal regulations.

The Department of Health and Human Services, which administers Medicare, told Kaiser Foundation Health Plan officials that they have until June 15 to submit a corrective action plan or risk losing coverage of kidney dialysis, transplant and other renal failure services.

“There are a lot of services someone with kidney failure requires,” said Jeff Flick, regional administrator for the Centers for Medicare and Medicaid Services. “Sometimes they include a transplant. Otherwise, they need dialysis or related care. The funding for all of that would stop.”

If Kaiser fails to demonstrate that it has fixed the problems, Medicare coverage will end Aug. 12, a move that would force more than 1,000 kidney patients who get services at the San Francisco facility to seek Medicare-covered treatment elsewhere.

“Obviously, we take this matter very seriously,” said Matthew Schiffgens, Kaiser’s issues management director. “We are going to take all necessary corrective actions to ensure that the San Francisco transplant program is in compliance with Medicare regulations and that we can continue to care for our patients during this transition period.”

The notice does not affect Medicare coverage of other Kaiser Permanente care, or the kidney speciality care offered at other Northern California Kaiser Permanente facilities.

The Medicare letter, which arrived one month after an unannounced, five-day federal inspection of the program, is the latest in a series of regulatory actions taken in recent weeks in response to administrative bungling of Kaiser’s 2-year-old transplant program.

News reports in early May detailed the health plan’s missteps in transferring hundreds of members from university medical center transplant waiting lists to their own, newly developed program in San Francisco.

As a result of a state order and several lawsuits, Kaiser then opted to indefinitely suspend operations and transfer its patients back to the university centers.

Kaiser officials have said the transplant center will remain operational until all of its patients have successfully been transferred to one of the university centers. Doctors there have continued to see kidney disease patients and have performed several transplants as organs have become available.

Specifically, Medicare cited three areas where the Kaiser program is out of compliance: “governing body and management,” “patients rights and responsibilities” and “director of a renal transplantation center.”

Flick would not elaborate on the areas of concern, but said the health plan also received a 50-page report detailing the federal government’s correction demands.

Schiffgens, of Kaiser, said the concerns stemmed from administrative problems, as well as difficulties communicating with patients.

Many patients reportedly sat in limbo during the transition to Kaiser’s own transplant program, losing precious time on the transplant waiting list. The state has since helped orchestrate transfer of the same and additional patients back to either UC Davis or UCSF kidney transplant programs.

Asked what effect the loss of Medicare coverage would have on the existing program, Schiffgens declined to speculate.

“We don’t anticipate anything but coming into compliance with this,” he said.

More:

Los Angeles Times — Transplant Errors May Cost Kaiser