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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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Sarahjdjack danielsMarcPat Salber Recent comment authors
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Sarah
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Sarah

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… Read more »

jd
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jd

Why hold me to a higher standard than you hold yourself?
jd

Tom Leith
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Tom Leith

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

jd
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jd

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… Read more »

jd
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jd

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… Read more »

Tom Leith
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Tom Leith

> 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. Sigh. [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.… Read more »

Matthew Holt
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Matthew Holt

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.

jack daniels
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jack daniels

Lets talk about transplants in general. Compared other nations, our use of transplants is very liberal.
However, our outcomes data are NO DIFFERENT THAN OTHER NATIONS WHERE TRANSPLANTS ARE NOT AS READILY AVAILABLE
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.

Marc
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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!

Pat Salber
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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.… Read more »

gadfly
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Oops, guess that url was too long. Try this one:
http://tinyurl.com/qa43v

gadfly
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From your mouth to the ear of the Ways and Means Committee! Kaiser is still prowling for payoffs to do the right thing: http://www.prnewswire.com/cgi-bin/stories.pl?ACCT=104&STORY=/www/story/04-17-2006/0004341393&EDATE=

Tom Leith
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Tom Leith

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

Matthew Holt
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Matthew Holt

Hi gadly…we’ve missed you!

gadfly
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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.