HEALTH PLANS: Kaiser, kidney transplants, (sigh)

This Kaiser kidney transplant thing isn’t getting any better—today they’re setting up an “internal enquiry”. There’s no way that lawsuits and legislative activity won’t result soon. And as Eric Novack chastises me for my favoritism, this is from one of the “good guys” in American health care. If it was (say) Tenet or Golden Rule I would be piling on a lot more. I certainly am feeling much more dismay than I would were it one of those others…

What’s worrying is that there was a lot of basic incompetence in the administration of the Thrive campaign (internal documents left on public servers, domain names not reserved, etc, etc). I had hoped that that incompetence would be contained within the marketing department, not allowed to spread into the important areas of clinical care.

I hope there is another side to this story, but at the moment don’t you think KP would have been better off taking 1% of the $40m it dumped into its Thrive campaign, and using it to have an impartial expert consultant take a hard look at this new kidney center’s practices before and as it was opening. After all they are the ones who’ve been stressing that preventative care is cheaper and better quality than trying to patch things up after the fact.

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  1. I hate 70% of you. You have no CLUE what you are saying. I am one of those patients in the Kaiser Nor/Cal Transplant Program, having had a kidney transplant 17 years ago. What is coming out about this program is utterly horrifying, and how any of you can defend Kaiser or debate the merits of transplants makes me ILL. You should be ashamed of yourselves. And I know none of this is coming from UCSF or Davis. And I know Dr. Inokuchi personally (she was one of my docs at CPMC). And I know the program has been crap since it started (good luck getting a call back for a simple question about dental pre-meds).
    This scandal is far bigger than y’all seem to realize. A lot of people died for no reason.
    And for my surgery, Kaiser saved a fortune. $40k a year for 17 years plus health care costs related to dialysis would have been far more than the transplant cost plus rejection meds.

  2. So, Jack, you’re not going to define your terms?
    Quod erat demonstrandum.

  3. Tom (again),
    Your last comment missed the point. Country to country comparisons of transplants and other utilization rates are not at all meaningless if you don’t assume that cultural attitudes towards health and trade-offs are all the same.
    It is perfectly meaningful to compare two countries, one of which spends twice as much (per capita) as another for a certain condition in order to see what they get out of it. If the country that spends twice as much actually has worse outcomes after controlling for demographic conditions and lifestyles, then it is reasonable to conclude that the country that spends more is wasting its money.
    The different cultural attitudes come into play only in more nuanced cases, such as when country A spends 50% more than country B and gets 15% better outcomes in return. In that case, the people of both nations could decide that their system is better depending on what their values. But no reasonable value system would want to spend money for no return. And that, unfortunately, is what it appears the US gets in many cases.

  4. Tom,
    What will change when US healthcare becomes “socialized” (government as single payer) is that the full cost will suddenly become clear. No longer will wages be suppressed (largely invisible) to cover the 1/3 or so of the bill that businesses currently support. Instead, that extra money will become part of the federal budget and will be paid for in taxes. If and when that happens, people will see what they are paying better than they do now, and will interpret the payments as a loss more than they do now. When that happens, the US will make the same trade-offs that every other nation makes and will constrain wages/fees just as other nations do in order to control costs.
    It isn’t just health insurance that costs twice as much here as other countries, it’s physician services, hospital stays, drugs, etc., etc. The cost of insuring people would be greatly reduced in a single payer system, but that doesn’t even get us halfway to healthcare costs in line with other nations. The increase in pressure to bring our costs in line would have to aimpact providers as well.

  5. > the US is wasting MILLIONS OF DOLLARS for transplants
    > that result in no improvement in aggregate health care
    > outcomes.
    > They are NOT cost effective healthcare.
    [fighting with every ounce of my will to avoid sarcasm]
    Who says “improvement in aggregate health care outcomes” is a goal of transplantation? Or even of Medicare? What do you mean by “cost effective”?
    Last year, there were about 2,000 heart transplants. The price per each was around $250K. About 70% of recipients survive at least five years with a generally good quality of life. There is no cheaper alternative. Yes, I am leaving things out. Tell us how this is “not cost effective”.
    Kidney dialysis costs about $40K/year. There are about 325,000 people on kidney dialysis each year. About 30% of patients survive at least five years on dialysis. A kidney transplant costs about $40K. There were about 17,000 kidney transplants last year. About 80% of recipients survive at least five years, and enjoy a much better quality of life versus dialysis. Yes, I am leaving things out. Tell us how this is “not cost effective”.
    > When the US finally switches over to socialized
    > medicine, transplants will become much rarer
    > than they currently are
    Nonsense. Much heart transplantation and nearly all kidney transplantation are paid for by socialized medicine in the USofA, right now, today. What do you imagine will change this?
    Contrary to Matthew, country to country comparisons of transplantation or other utilization rates are nearly meaningless because different peoples have different attitudes about health, and life, and death, and technical interventions, and service levels, and drugs, and social solidarity, and a host of other things related to health and well-being and social goods, and (not least) differing abilities to pay. There is no “right” amount of medical services to consume, and I think it as presumptuous for us to say that too little is consumed in England, as it is for a Canadian to say too much is consumed here.

  6. Actually, this has me remembering a bunch of health services research I di 15 years ago. Back then transplants were considerably more cost-effective than dialysis, which we basically have an open checkbook for. Now to be fair we do more of that than most other countries too. And that’s the fair comparison, not transplants v overall mortality rates (assuming that’s the “outcomes” data you’re referring to.

  7. Lets talk about transplants in general. Compared other nations, our use of transplants is very liberal.
    Did you hear that? That means the US is wasting MILLIONS OF DOLLARS for transplants that result in no improvement in aggregate health care outcomes.
    When the US finally switches over to socialized medicine, transplants will become much rarer than they currently are, and for good reason. They are NOT cost effective healthcare.

  8. It’s unfortunate this situation has occurred, but I see it as an inevitable consequence of the emphasis being placed on “consumerism” in health care.
    Health care costs are “too high”, so health care providers are being squeezed by the government and health insurance companies to lower cost.
    I expect to see a lot greater reduction in the quality of care as consumerism and transparancy in health care pricing gains more momentum. Kaiser was just the first!

  9. I used to be a KP physician, but haven’t worked for the organization for a number of years. I am, however, a Kaiser Permanente member and, well, my care and my care experience has been terrific. I yelled hooray when I got my Kaiser membership back after two years with Blue Shield — getting care in the FFS wasteland.
    Here’s an example of how it works. I dropped in to the lab a few weeks ago to get some routine tests done. Two days later, I had an email with a hyperlink to my private mailbox on the KP website. Not only were my lab results there, but my doc had written a personal note. I had some things I wanted to see her about so I clicked over to the appointments section and was given a choice of an appointment at 11 that day or 3:30 that day or, if I preferred, the next day.
    I get my meds via the mail. I can order refills online. My doc has no problem communicating via email or telephone. All of this, and my co-pays are miniscule compared to what alot of non-KP plans offer.
    I don’t know what happened with this transplant problem I’ll bet you a million or so that the complaints came from UCSF or UC Davis, both institutions losing substantial transplant volume as a result of taking the service in-house. That is not to say that there wasn’t mismanagement. Undoubtedly, we will learn all of the details through more investigative reporting as well as the DMHC investigation. Please note that KP is not the only organization whose transplant program is plagued with problems–look at UC Irvine.
    That is not to apologize if the organization screwed up. All I am saying is that I have gotten and continue to get great care from knowledgeable, caring professionals. You couldn’t pay me to go back to the alternative.

  10. > the race for the EMR just distracted everyone
    > from looking at the serious management problems.
    Amen Brother! Preach it!

  11. This whole time I’ve been trying to raise awareness that a lot of the incompetence is in Kaiser’s technology management (including mismanagement of offshore consultants). Too many physicians wanted to get into technology (“where the money is”), and were put in charge of projects they weren’t qualified to handle.
    The cost of this corruption is being passed on to Kaiser members: the race for the EMR just distracted everyone from looking at the serious management problems.

  12. Make that $80 million spent on the Thrive campaign as Kaiser poured a second forty into it last year. As we’ve said from the beginning, Kaiser has ALWAYS been more concerned about image than patient care. Knowing this it is extremely disheartening to see Kaiser repeatedly described as being “on the side of the angels” even when all evidence points to the contrary.

  13. > I had hoped that that incompetence would be contained
    > within the marketing department, not allowed to spread
    > into the important areas of clinical care.
    Gee, Matthew, this is kinda funny. Over in the All Spending on Branded Drugs is Bad thread, marketers are presumed to be mystically omnipotent, and to cause poor clinical decision-making, while here you evidently presume that marketers are incompetent, and the whole healthcare system is held together by clinical-menchen in the face of all their incompetent meddling. Maybe the pharma marketers are cheating, what with all those psychoactive compounds and access to the water system…

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