San Francisco Business Times – November 10, 2006
by Chris Rauber
State health regulators have widened a probe of Kaiser Permanente’s process for handling complaints beyond its ill-fated kidney transplant unit and into other operations of the health-care giant.
The state Department of Managed Health Care’s investigation now covers Kaiser’s entire California system and includes a broad spectrum of quality-of-care and oversight issues, said Denise Schmidt, a spokeswoman for the DMHC, which regulates HMOs and other managed-care plans.
The investigation involves the Kaiser Foundation Health Plan’s responsibility for overseeing the quality of care at its medical centers and medical groups, including the Permanente Medical Group in Northern California, according to DMHC.
Schmidt said the investigation expanded when regulators realized that problems at the kidney unit may have been a small piece of a larger puzzle.
“In this case, the kidney program (is being) closed down,” she said, “so if they correct the way that particular program handles grievances, that’s not going to solve the problem.”
Cindy Ehnes, the department’s director, originally said the investigation would be finished last month, but that was before its scope was expanded.
A pattern of problems
At stake in the broadened DMHC probe is whether Kaiser is in compliance with California’s Knox-Keene Act, which regulates the state’s managed-care plans.
The investigation is expected to end in the first quarter of 2007, possibly in January, Schmidt said.
The probe will also look at specific cases, including that of Robin Libitsky, a Southern California patient who died in Kaiser’s care, and a Kaiser plastic surgeon in the Sacramento area accused of sexual misconduct and weapons offenses.
Kaiser officials declined to comment on the expanded DMHC investigation. “We’re not going to be able to go into that, except to say we’re working with the department in a collaborative manner,” said Matthew Schiffgens, senior issues management director for Kaiser Foundation Health Plan.
However, Kaiser was willing to share comments about recent improvements to its internal complaint-handling system.
Ed Glavis, Kaiser’s Northern California vice president for administration, said Nov. 8 he’s now in charge of making those changes in the region. (A counterpart in Southern California has similar responsibilities there.) Instead of administering complaints and grievances at the medical-center level, customer-service areas will report to him.
“Now, they are my accountability,” Glavis said. “We have a single accountable person, and we’re developing common processes so members have a single experience no matter where they raise their questions.”
In other changes, Glavis said, Kaiser is creating a new data system to generate detailed reports about customer complaints for medical center and regional leaders, and adding a training department “to increase the skill of the staff.” It will open two complaint resolution centers in Pleasanton and Roseville by next summer “to address more complex issues.”
Room for improvement
Kaiser launched its kidney-transplant program in September 2004, bringing in-house work that had previously been done at University of California medical centers in San Francisco and Davis.
After revelations of persistent problems with the unit and under pressure from state and federal regulators, Kaiser announced in May it would shut down the San Francisco kidney transplant program and began transferring patients back to the UC centers.
On Aug. 10, the department fined Kaiser a record $2 million and required it to make a $3 million contribution to charity in response to the shortcomings in the kidney unit.
At the time, the DMHC began a more limited probe of Kaiser’s complaint and grievance process pertaining primarily to the kidney transplant unit, following disclosures earlier this year of serious problems with that program over the last two years. Citing reports by patients and their families, media and regulators had reported that complaints about lengthy delays and confusion in the kidney program were frequently ignored or referred back to the subject of the complaint.
Although Kaiser’s recent moves to improve customer service are in part a response to the kidney fiasco, Glavis stipulated that the changes were put in motion in late February. That’s before the media and regulators were aware of many of the kidney unit’s problems, but after Kaiser officials had been informed about them by former kidney unit administrator David Merlin.
“The challenge is how you handle these things,” said Kevin Billingsley, president and CEO of Indianapolis-based Perception Strategies Inc., a health-care consulting firm. “You have to address a systemic problem with a system (and provide) an outlet for complaints where someone actually has the authority to do something about it.
“Complaints often go to people who have no clout,” Billingsley added, “and then you haven’t addressed anything.”
Speak truth to power! Woo hoo!
As far as recieving complaints and filing grievances at Kaiser/Hawaii. Compliance is not addressing these issues and reporting them to the appropriate Agencies to assign accountability where it is neccessary.
Please widen the probe across seas to our Region…
Good luck getting anyone in Hawaii to address any problems at Kaiser. It’s only going to happen if so many people make the same complaints that a scandal ensues. Hawaii regulators are useless and Kaiser knows it. Kaiser used to count on the DMHC to be useless too, but hopefully that will change with this investigation. Not holding my breath however.
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“You have to address a systemic problem with a system (and provide) an outlet for complaints where someone actually has the authority to do something about it.
“Complaints often go to people who have no clout,” Billingsley added, “and then you haven’t addressed anything.”
This quote is interesting. Kaiser never had an interest in resolving member complaints. Member Services should have had an advocacy role but Kaiser didn’t employ it that way. Instead, the grievance process was utilized as a warning flag that there was eminent danger to the organization. Contrary to what this article implies, complaints actually do go to someone with “clout” – the spin committee who try to pass responsibility off entirely or widdle it down to the lowest common denominator ie. the nursing staff in my case. And when the DMHC pointed out that there is a systemic problem at Kaiser, it is not necessarily in the grievance process/Member Svcs it goes far beyond that and is rooted in the culture of the organization – self-preservation at all costs.
When you read this article, the State has identified the problems as lack of internal over-sight ie. peer review and QA. They are saying that the fox is guarding the hen house and effectively rubber stamping “issues” or practicing defensible medicine knowing that they have the power and the resources to stop people cold. Instead of admitting that there is a problem with the actual quality of the practice/delivery of medicine for whatever reasons, Kaiser comes back and with solutions that address the customers experience or perception of the problem. Now, we have someone in charge of fixing the problems in No Cal- Ed Glavis (can anyone comment on his tenure at Kaiser – how many hats has he had within the organization??? Seems to be around for ever) – so now the CSAs will be reporting to him — garbage in, garbage out.
Common processes, data systems, enhanced training of staff, reports, resolution centers … how will this change the fundamental problems that aren’t simply administrative in nature. I am expecting that the release of the DMHC report and sanctions will be major and hope that if Kaiser is allowed to internally monitor itself that there will be an enhanced auditing system in place that will help members/patients ensure that they are getting factual based answers and not just spin.