HEALTH PLANS/HOSPITALS: Kaiser gets beaten up in LA Times

There’s a series going on in the LA Times suggesting that, after it created its own kidney transplant program, either through inefficiency, incompetence or worse, Kaiser Permanente caused a delay in the transplants of several kidney patients. This morning’s report, called Kaiser Denied Transplants of Ideally Matched Kidneys is pretty damning, suggesting that Kaiser deliberately refused to cover the transplants of some perfectly matched organs for donors at UCSF. The unstated reason is of course that they’d have to pay for them at UCSF whereas it would be money they’d keep within their own system if they could perform the transplant at their own new center.

As late as Wednesday afternoon, Kaiser officials adamantly denied that they had ever instructed UC San Francisco to turn away such organs. But after being confronted with evidence to the contrary by The Times, the officials called back to say that they could not stand by that position. One of Kaiser’s own kidney specialists had confirmed that he directed UC San Francisco to turn down at least one of the near-perfect-match kidneys, they acknowledged.

Now as far as I can tell we don’t really know whether those patients quickly got their transplants within the new Kaiser center, or what their outcomes were. And we don’t really know why Kaiser pulled its business from UCSF in the first place—Kaiser in S.Cal is still contracting out transplants to academic medical centers.

I tend to believe that Kaiser is in general on the side of the angels, so I’m waiting to see more about this before I cast any judgments. But whatever they saved in the first few months of this program pales in comparison to what these kinds of stories will cost them.


Categories: Uncategorized

Tagged as:

8 replies »

  1. Kaiser-Permanente is emphatically a for-profit organization. 50% of Kaiser’s annual billion dollar profit is paid to the Permanente Medical Group, and thence into the doctors’ retirement accounts.
    Fifty cents of every dollar NOT spent on health care directly benefits the doctors. Money paid to outside contractors comes right out of their pockets.
    The motivation behind the Kaiser denial of kidney transplants is clear.
    As for cooking their statistics, according to an ER doctor friend of mine who has worked there, they drive up their heart treatment statistics by referring out the riskier cases.
    They get away with their poor care by forcing patients into their mandatory arbitration system, and blackballing arbitrators who find big for patients.
    The only excuse for being a Kaiser supporter is ignorance of what they actually do!

  2. Matt Holt:
    “this is the case where the doctor is the insurer, and hopefully brings some professional ethics to the table”
    The people that make the money decisions are not the same people that care for the patients.
    Again I can’t understand why you are so quick to leap to the defense of the insurance company (they “bring some professional ethics to the table”), but insist over and over again that we cannot trust doctors’ professional ethics, but must manipulate them with economic punishments and incentives?
    BC/BS California is currently being investigated for dropping policy holders through devious means (claiming falsely that they violated the policy provisions) when they learned that the policy holders had expensive illnesses. This type of behavior is happening every place every day. How could anyone expect anything else? The decision makers never meet the actual patients, so they don’t have to see the pain and suffering of those they are hurting. They are responding to economic incentives, and all the economic incentives are aligned to benefit insurance companies at the expense of patients.
    The only way to change that is to penalize insurance companies when a patient suffers for lack of care. If Kaiser is assessed millions of dollars per patient denied a transplant, they’ll think again the next time this issue comes up.

  3. The CEO and board of directors at KP are all doctors?
    What are their names?

  4. Amy–this is the case where the doctor is the insurer, and hopefully brings some professional ethics to the table.

  5. Why should anyone be surprised about this? They were trying to provide “the best care for the lowest price”. Think of all the money they saved!
    This is precisely what happens when you put the insurer between the doctor and the patient. The insurer makes decisions that hurt or even kill the patient in an effort to save money.

  6. Eric–I will indeed admit that it doesnt look good.
    But I am biased in that I happen to know and like many KP folks on various sides of the business, and in general they’ve been forthright about trying to implement best care practices, and taken the lead on being concerned about care quality and the cost/quality trade off in a way few others have been. PLUS it’s basically a doctor run organization, and as you know my overall solution for healthcare is having doctors make decisions about how to spend a fixed health care budget. That’s bascially how KP works.
    However, in this case if the decisions were made to a) save money in the short term, or b) protect someone’s turf at patients’ expense, and patients suffered–which is the article’s drift–then it’s not good enough, and I’ll join you in the criticism. You may recall that their HR policies got a going over on THCB when they fired the Gadfly and then smeared her. I assume she’s enjoying hersself this morning, not that we’ve seen her here in a while.

  7. As a member and supporter of Kaiser, I agree with Matt, I want to hear more.
    What I fear most in the May 3rd article, is the statement

    “Meanwhile, doctors attempting to build a record of success shied away from riskier organs and patients, slowing the rate of transplants performed.”

    How will those in support of consumerism address quality ratings, when outcomes are no longer based on the ability of the surgeon/doctor, but rather are based on the condition of the patient?

  8. Matthew- brave of you to actuallly comment on such a negative view of an organization you view as the salvation to US healthcare.
    Were it that you were so circumspect about articles that put other organizations that you do not like in a negative light.
    It is, however, a rather damning article… as between the lines, it is easy to read ‘cost cutting’ and ?unintentional? bureaucratic snafus that seem to have clearly cost lives. This story sounds as big, or bigger, than any of the transplant-related scandals of the past several years.