HEALTH PLANS: KP’s Halvorson talks–Merlin responds,and I comment

Things Halvorson said….

In his remarks to (video, no transcript yet) The Commonwealth Club as interviewed by Chris Rauber, who was being rather too nice—although that’s mostly the fault of the stupid written Q&A format the Commonwealth Club uses (You’d think that something vaguely modeled on the UK system would grok the concept of a follow-up question), KP CEO George Halvorson said a few interesting things:

“One of the things we need in American health care is an extremely high level of transparency” (more on that later George!)

Any time you get to a pure single payer system you get a health care system that rations <snip> if you want a good look at single payer look at the medical systems in our prisons.” I agree with him in his specifics about transparency and how it would be better to have a system with providers competing properly with better information, but with that type of rhetoric is his next job at NCPA or at PRI? C’mon George! Every health care system rations—something John Goodman is actually right about. The question is, how is it done? Just accusing single payer systems of rationing and actually bringing up the erroneous bogeyman of Canadian patients crossing the border puts Halvorson in a camp of wingnuts with whom he ought not to be associating himself.

And as for that transplant program. “It was an excellent program” but on the administration of the list “we just screwed up.” Methinks that David Merlin, the fired administrator of that program and the source of the LA Times story does not agree. Here’s what he said in response in a letter to the SF Business Times today:

Whistleblower: Kaiser’s kidney ills not tied to CEO’s absenceAs the person who exposed the Kaiser kidney transplant program tragedy to state and federal officials and the media, I¹m certain the majority of Kaiser kidney patients are as insulted as I by George Halvorson¹s attempt to portray KP¹s unwillingness to speak up and/or take responsibility due to his six-week absence. KP¹s transplant program had been in operation over 18 months prior to his hospitalization in April 2006. The massive clinical and administrative failures had been identified by Kaiser senior officials long before this. Around May of 2005, a majority of the 48 northern California Kaiser nephrologists (kidney specialists) called an emergency meeting of senior KP physicians (including Robbie Pearl, M.D., CEO of the 6,000 member TPMG physician group) and demanded the fledgling Kaiser kidney program be shut down due to overwhelming concerns of patient neglect and associated health issues and that all 2000-plus patients be sent back to UCSF and UC-Davis Medical Centers.These problems didn’t suddenly surface at the time Halvorson became ill. His comment that the kidney crisis was kept from him during his six-week recuperation rings hollow and his assertion that United Network for Organ Sharing thought Kaiser was transferring one patient, and not 2,000, is both ridiculous and irrelevant. Kaiser (TPMG) doctors were responsible for the day-to-day care of these patients, not UNOS.Kaiser has attempted to portray their internal problems as administrative issues, but as an experienced health-care administrator who personally witnessed the internal operations, I can tell you with certainty the problems stemmed from clinical issues due to inadequate staffing of properly trained physicians and nurses and the personal in-fighting between Kaiser transplant surgeons and transplant nephrologists.Kaiser violated the covenant of public trust between patients and physicians. Thousands of real people endured unnecessary pain and others suffered unnecessary death. In health care, the unnecessary death of a patient is the strongest indicator of quality of care or in Kaiser’s case, lack of care. It doesn’t get any more clinical than that.David MerlinFormer director, Kaiser Kidney Transplant Program San Francisco

It’s worth saying again that the crux of this whole thing is not only was there a screw-up of huge proportions on the UNOS-Kaiser hand-off, but there is the strong suspicion–highlighted by what Merlin says and intensified by Halvorson boasting about the successful outcomes of the transplants that were done–that the KP surgeons were cherry-picking their cases and leaving the marginal ones on the waiting list (if indeed they ever got onto the "new" waiting list). If the meeting between the nephrologists and the senior Permanente staff Merlin talks about took place, you can bet that that was at least one topic of conversation.

Which leads back to Halvorson’s opening remark about transparency.
The longer KP keeps the details of its arrangements between the plan
and Permanente secret, the more this type of suspicion will come up. I
don’t want to pre-empt other media, but suffice it to say that more
influential organs than THCB are still sniffing around this.
And of course we have still heard nothing from anyone at the Permanente
Federation about the transplant fiasco. Can’t Robbie Pearl find time in
his busy schedule to fit in one interview? We’re waiting….

In addition a little noticed recent change in California law means
that KP now actually has to allow some formal member representation. To
this point they’ve been a free-floating non-profit responsible only to
a board that is more or less hand-picked by the CEO, with minimal
outside regulatory interference. It doesn’t have to be that way. Group
Health Cooperative of Puget Sound is (like it says) a cooperative with
formal member representation, and you can bet your sweet bippy that
there are lots of KP members who’d like to hold its feet to the fire.

Which all comes back to the relationship between the plan and the
doctors. If you hide it, you look suspicious. You only need read the comment below this post on THCB
suggesting that Kaiser is encouraging doctors to scrimp on needed care
and is directly splitting the resulting profits with them. But so what
if KP is paying its physicians $250K a year each? That may well be what
it takes for them to get the best physicians, and why wouldn’t they
want to do that, and more importantly why wouldn’t their members want
that too?

The point is that if KP is truly to be a member-focused organization
that explicitly delivers health care according to certain guidelines
and practices, and does it as well as possible within that mission,
than it has nothing to be ashamed of and should be openly showing what
it does.

Otherwise it’s no better than the rest of them (no need for a long diatribe about Wellpoint here
but it’s pretty discouraging that KP was playing the same dirty tricks
in its tiny individual insurance business), and the high falootin’
rhetoric of Halvorson is moving beyond the verge of being hypocritical.
And it certainly gives him and KP no moral platform to start talking
about how the whole health care system should be reformed in their

Which is a pity, because as you all know, I’m not sure that’s such a
bad idea. And what’s worse is that every time that KP gets itself in
the news for the wrong reasons it gives the opponents of rational
health reform one more weapon with which to bludgeon the reform
movement as a whole. It’s pretty hard to counter the argument that says
"you want to turn us all into Kaiser Pemanente and those bastards kill people and get rich from doing it." And that argument will indeed be made, so it would be nice to have some ammunition for the defense.

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  1. I appreciate the feedback on how to find the list of Board members at kp.org. It would have been more helpful to have this under the “member” heading. Or at least have informed the Call Center staff how to provide this info if members request it.
    But as a 20+ year Kaiser member and former Kaiser employee, making access to this info difficult and time-consuming seems simply part of the Kaiser culture and has historically kept member input and participation at a minimum. I am hoping that this will begin to change with the enactment of SB 108, which BTW I got my State Senator, Al Lowenthal (D Long Beach) to introduce because I was getting increasingly frustrated by the lack of any mechanism or opportunity for member participation at Kaiser. So I can TOTALLY relate to Cody Kuhn’s assessment of Kaiser.
    Note to Kaiser members who want to communicate concerns, etc. to the Board: I would recommend printing a separate letter to each Board member, each in its own individual and sealed envelope and then mailing these together in one large envelope to Victoria Zatkin, who is apparently the main staff person to the Board at the address given on the website. It is my upstanding that a new Board subcommittee is in the process of being created to deal with its new responsibility under Section 1369. Not sure about the accuracy of the current list, however, I understand that a new Board member was selected in December to fill a vacancy and will be announced by press release following the Board’s March meeting, so very soon…

  2. The have placed the listing of the Board of Directors for Kaiser Foundation Health Plan and Kaiser Foundation Hospitals on kp.org. It is difficult to find, as you must select that you are first a “media representative”, then select “About Kaiser Permanente”, then “Executive bios”, then “Looking for our board of directors?”.
    I have seen some comments that several of the directors listed have resigned, so I do not know how current the listing is.
    I unfortunately would not expect anything more from Kaiser than an outdated list along with a general mailing address. Real member representation would be too onerous for Kaiser’s insular and infallible management.

  3. Just a footnote: The California law referenced above is SB 108, which before being signed by the governor in 2005, was passed unanimously by both the Senate and the Assembly and went into effect in January of 2006. For more on the legislative details, go to http://www.leginfo.ca.gov It does away with a longstanding loophole for all federally qualified HMOs in the state (not just Kaiser) which had allowed them to ignore Section 1369 of the Knox-Keene Act, which reads as follows:
    “Every plan shall establish procedures to permit subscribers and enrollees to participate in establishing the public policy of the plan. For purposes of this section, public policy means acts performed by a plan or its employees and staff to assure the comfort, dignity, and convenience of patients who rely on the plan’s facilities to provide health care services to them, their families, and the public.”
    These HMOs must all now establish and publicize (per the related regulations, it varies somewhat by ownership status) mechanisms for soliciting and acting on member/consumer input to the HMO’s “public policy.”
    After more than a year’s delay, Kaiser is finally informing its members of their rights, by a notice inserted in the March Partners in Health quarterly publication mailed to all members. This notice informed Kaiser members that it is the Board of Directors that “establishes public policy”, that members who would like to provide input should write the Board, and that a list of Board members is available at http://www.kp.org or by calling the Member Service Call Center (for Southern California, at any rate) at 800-464-4000. Unfortunately, when I checked the website I could find no list of Board members and when I called the Member Service Call Center, the service representative I talked to could find nothing on the website either and said that she had no idea how to get me a list of Board members.
    Perhaps this shortcoming of Kaiser’s will be addressed when the California State Department of Managed Health Care (DMHC) completes its investigation of Kaiser’s statewide member complaint system which was triggered by the Northern California kidney transplant program problems and shutdown. Note: The report was supposed to be released in late 2006 and then in January, but has been delayed for some reason. I sent an e-mail to PR at the DMHC last week, but have not yet heard back about when to expect this report to appear.