HEALTH PLANS/HOSPITALS: Kaiser needs to set up a major external review

Here’s the latest LA Times article in the series on an issue for Kaiser Permanente that is clearly not going away: Kaiser Transplant Patients Express Their Fear and Fury

And up from the comments from Harvey Frey MD, is the core issue that KP must deal with now before they get put in the "just like the rest of the egregious bastards" category: Harvey says:

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!

I don’t know if this little blog has any influence, but here’s what I’m calling for. Kaiser needs to set up not an internal inquiry as they’ve started, but a major league external investigation headed by a serious independent medical heavyweight. They must also agree to abide by its recommendations for insulating the (largely salaried) Permanente physicians from the suspicion (as voiced by Harvey), and I hope not the actuality, that they are making medical decisions for their own personal profit.

Don’t forget that capitation as a movement died because the public felt that doctors were withholding care for their own financial advantage. The same thing is becoming understood about FFS–or rather that doctors/the system does too much for their own advantage not for the best care of patients. KP or more accurately The Permanente Medical Group needs to get itself out of that similar ethical hole, and given that it largely pays it physicians with salaries, it ought to be able to make sure that, not only in perception but also in reality, it is working for patients’ best interests.

Because, as I said in a private email exchange last night, if we can’t trust salaried physicians at what has been–to those of us in the  health policy world at least–one of the few institutions that has been an innovator in care and care management on a population basis, who can we trust?

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