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.”
and
“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)
11 comments
Will this lead to felony charges? If it doesn’t have that kind of consequence, what difference does it make that it is reported?
The only way to effectively impact on such heinous actions on patient care are sizeable fines and convictions that lead to incarceration.
People who run managed care are more likely to disrupt and minimize care, so if the consequences harm peoples’ lives, why is this not pursued as a crime?!
Joel is right – I work for Kaiser and they don’t give a damn about this sort of thing, even when fines are attached. They can run a cost analysis and likely find that it’s cheaper to pay the occasional fine that hire adequate staff to provide something resembling empirically based mental health care. It’s truly awful. Some of us have brought up this report and the prior Labor complaints that preceded it, and it’s as if we’re speaking some obscure ancient tongue – management just defers to their lies about “we can’t provide Cadillac care”, which is their euphemism for empirically driven treatments.
i had to fight for nearly 2 years with kaiser to get needed spinal surgery. they are horrible. in fact, without compare, the worst health care i have experienced.
Too bad. I found this post by searching for their services. Their website makes it seem like they really don’t offer services. And now, after reading this article I’m thinking of not even bothering and just continue to go it alone for my depression. That’s how I’ve been doing it all along.
Well – disappointed to read this, BUT, glad I found it. With 2 teenage grandsons recently transferred into Kaiser who have confirmed Dx from other Health Ins Group – it seems we should be rattling Kaiser’s cage. It’s true Kaiser seems reluctant to refer to specialists for any reason – medications are provided ‘ in consult’ by PCP and Specialist, we have been told. Since we have Bipolar Disorder in the family – we have provided all records by registered mail. At our local NAMI meeting I was told Kaiser stopped donating to NAMI because they provide their own mental health services now. I will be moving right along to check on this. This assessment sounds a bit like the VA mental health services.
20 years ago, before I knew that I was Bipolar, I went to Kaiser Oakland ER suffering from a near psychotic manic episode in which, by the grace of luck, I failed to bring an end to my life. I was an alcohol and drug abuser as well. After a brief examination by the on call psychiatrist, I was informed that I had to attend the Chemical Dependency Unit to get clean and Sober before they would even look at me for any underlying problems. Fair Enough.I quit and religiously followed their every instruction. Problem was, my manic state actually intensified of the next few weeks.
Without warning, I was ejected from the unit because, “you are disrupting the groups and we are not equipped to handle mental illness” I was handed a prescription for lithium and kicked to the curb, literally sobbing. I managed to stay sober. Over the next 4 years, the psychiatric department routinely refused my calls for treatment. I had two visits to a psychiatrist,two visits to individual therapists, no blood levels for lithium measured, and repeated requests to attend anger management classes, which I did to no avail. I lost my business, my ability to earn a living, friends and even family because of my erratic mood swings.
When finally I lost my Kaiser coverage due to my ability to pay, the dropped me like a hot rock and refused to allow me to reenlist due to my preexisting conditions.
I got insurance soon after. My new doctor took one look at me and told me that I was not dysthymic, but bipolar. Lithium was not an appropriate 1st line treatment for Dysthymia and my blood levels, unmonitored were toxic. I was switched to anti-convulsants, started individual therapy, and almost overnight, I was a transformed individual.I was back to work and began making friends again.
Kaiser deliberately misdiagnosed my condition likely for budget concerns: As a bipolar, I would have been afforded much more comprehensive therapies. What they did to me may not have been criminal in their minds, but ethically speaking, it was evil.
So now I’m back to Kaiser after 15 year’s absence. Guess what? They are insinuating that my treatment for biploar will be dependent upon my attendance of their Chemical Dependency Program, the same place that tossed me out twenty years ago. The people at the rehab don’t want me because they fear I’ll be disruptive, and the psychiatric people said that my condition is not treatable because I drink. This is news to me, since my bipolar is largely well modulated due to the treatment I received from my previous health care professionals over the last 15 years.
Believe me, this weary fight of anger suffers me far much more than it’s own remedies.
i am in oregon and have finally sought much needed mental health care . i tried 2 yrs ago and was told it really didnt exist . although i love my docs at kaiser ,,isnt mental health part of picture for holistic care . i tried this week and was promptly referred out to a place that wasnt really ok ..scam in fact (they dont like medicare plans)ALTHOUGH INTAKE PERSON AT KAISER SAID CALL ME BACK IF PROMBLEMS TO A NUMBER THAT NO ONE ANSWRS what a joke after filing greivance i must find my own in community and they will co pay i was a psych nurse many years and shame on kaiser
I’m just discovering this website and am very grateful for any forum that allows discussion about how to improve mental health services within managed care.
To catch people up from this post from Dr. Grohol, current wait times ACROSS California, North and South for therapy appointments average four weeks now and are only getting worse.
I am in the process of quitting Kaiser, after almost 8 years as a psychotherapist using the eye movement trauma therapy EMDR. I have been very successful at helping serverely traumatized clients lead better lives, but I’ve always done under severe time constraints. It is no longer safe for me to proceed at Kaiser so I’m opening up private practice.
You can get fully caught up with the story by reading 90daystochange.com, which I set up exclusively to provide advocacy for the multitudes of clients being underserved by Kaiser.
Happy reading!
I regularly have to wait 6 months between appointments with both my psychiatrist and lcsw. And when I do see them they don’t offer treatment besides their groups. Which I’ve gone through as I’ve been in kaiser psychiatry for over a decade. Last week my psychiatrist told me that she will not be working with me anymore other than refilling my sleeping pills because I am not complying with her treatment plan of going to groups over and over again. When I suggested she start offering individual care she ranted on that the case studies have shown that groups are the only thing that work.
I too went to Kaiser after suffering in silence for most of my life. Daughter happy with her mental health with them. First therapist diagnosed ptsd. Need to read material that was very poor copies and not even Kaiser materials. Then go to dbt. Stated we do not do individual sessions. Advised I kick my mentally ill daughter to the curb. I wasn’t about to discuss issues with strangers. I left disappointed. New appointment 3 months later, request a new therapist. Basically told same thing. If you want help you have to attend class at 10 am weekly. Then you can schedule to see a psychiatrist for medications. I’m going to go to the Womens Center instead. What the hell am I paying for.
I suffer from severe endogenous depression and anxiety. I also suffer from a nasty illness called cyclical vomiting syndrome which is a neurochemical disorder marked by prolonged and intense nausea and vomiting and an exacerbation of my depression. It is, thus, imperative that I see a medical doctor who has knowledge of this condition. The last time I saw a psychiatrist was In October of 2015, at which time I was informed that she was leaving Kaiser and I would need a new doc. The first appointment available was mid-January of this year. On December 15th I suffered a horrendous attack of cvs during whichI expressed suicide ideation. I was sent to Kaiser’s (locked) facility in Santa Clara (which is outstanding, by the way) The earliest follow-up appointment with a doc was again well into January. The irony here is that Kaiser’s mental health facility in Daly City is totally inaccessible to the mobility impaired without assistance. Thus I cannot attend even their IOP groups. Needless to say,I’m not a happy camper.