Care Delayed, Care Denied

UPDATE 3: On June 24, 2013, the California Department of Managed Health Care (DMHC) issued a $4 million fine against Kaiser Permanente for limiting patients’ access to mental health care. The DMHC’s enforcement order is available here.

Have you, or a family member, ever used Kaiser’s mental health care services? If so, have you experienced appointment delays? Share your story with us and submit your experience here.

View press releases issued by NUHW (click here) and by the DMHC (click here).

Press links: Capitol Public Radio, Los Angeles Times, Sacramento Business Times

  • The DMHC also issued a Cease & Desist Order against Kaiser. The state agency found Kaiser to be in violation of state law in four broad areas. Specifically:

  • Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Instead, large numbers of Kaiser’s patients were required to endure lengthy waits for appointments in violation of California’s “timely access” regulations.

 

  • Kaiser’s internal record-keeping system contained numerous proble
    ms – including a parallel set of “paper” appointment records that differed from the HMO’s electronic records – that hid patients’ lengthy wait times from government inspectors.

 

  • Kaiser failed to adequately monitor and correct its violations of state law. Records show that Kaiser was aware of its violations, but failed to take action to correct the problems.
  • Kaiser provided “inaccurate educational materials” to its members that had the effect of dissuading them from pursuing medically necessary care and violated state and federal mental health parity laws.

UPDATE 2: On March 18, 2013, the California Department of Managed Health Care released a report affirming the findings of NUHW’s November 2011 complaint to the agency. 

The DMHC’s report details the results of its investigation of Kaiser Permanente’s mental health services in California. The state agency cited Kaiser for multiple violations that have now been referred to the DMHC’s Office of Enforcement, which is responsible for imposing legal and financial penalities on HMOs.

The DMHC’s report includes the following findings:

  • Kaiser committed “systemic access deficiencies” by failing to provide its members with timely access to mental health services. Instead, large numbers of Kaiser’s patients were required to endure lengthy waits for appointments in violation of California’s “timely access” regulations.
  • Kaiser’s internal record-keeping system contained numerous problems – including a parallel set of “paper” appointment records that differed from the HMO’s electronic records – that hid patients’ lengthy wait times from government inspectors.
  • Kaiser failed to adequately monitor and correct its violations of state law. Records show that Kaiser was aware of its violations, but failed to take action to correct the problems.
  • Kaiser provided “inaccurate educational materials” to its members that had the effect of dissuading them from pursuing medically necessary care and violated state and federal mental health parity laws.

A 3-page PDF summary of the DMHC’s report which affirms the findings of the earlier NUHW complaint is available here.

You can view the actual DMHC report here.

Click here to download our Press Release in response to the DMHC’s findings.

Press links here:

Huffington Post

KPBS Radio

Associated Press

San Francisco Chronicle

Sacramento Bee

Sacramento Business Journal

Orange County Register

KQED’s California Report

Vacaville Reporter

Vallejo Times- Herald

Medscape Medical News

Kaiser Permanente’s failure to provide timely and appropriate mental health services

The subject of articles in USA Today and the Huffington Post, “Care Delayed, Care Denied” documents in clear detail how Kaiser Permanente, California’s largest HMO, systematically understaffs its mental health services in violation of California state law, leaving some patients to suffer delays in receiving treatment they have already paid for and urgently need.

Click here for a pdf of NUHW’s 35-page report, “Care Delayed, Care Denied.

Update: NUHW filed a complaint with the California Department of Managed Health Care and requested an investigation into the report’s findings. Coverage in The San Francisco Chronicle, the Sacramento Business Journal and on KQED, KTVU and Univision.

 

Executive Summary

With more than 6.6 million members, Kaiser Permanente is California’s largest HMO and plays a massive role in the state’s healthcare delivery system by operating more than 35 hospitals and several hundred clinics across the state. Less well known, however, is Kaiser’s role in providing mental health services to Californians. Ranking perhaps second only to the State of California, Kaiser is one of the state’s largest providers of mental health services. The Oakland-based company guarantees its members a full array of inpatient, outpatient and emergency mental health services provided by several thousand mental health professionals. Each year, thousands of Kaiser’s members seek treatment for conditions ranging from autism, anxiety and bi-polar disorder to depression, schizophrenia and suicidal ideation.

TimmDespite Kaiser’s pledge to provide comprehensive mental health services to its members, an in-depth analysis suggests that the HMO’s mental health services are sorely understaffed and frequently fail to provide timely and appropriate care. Patients often experience lengthy delays in obtaining services, an overreliance on “group therapies,” and frustrating obstacles that push many patients to forgo care or seek treatment elsewhere at their own cost.

Drawing on a survey of hundreds of Kaiser’s mental health clinicians as well as documentation from regulatory agencies, court filings, patients and frontline caregivers, this study finds that Kaiser frequently fails to comply with California laws aimed at protecting patients’ timely access to appropriate services. [1] Furthermore, it finds that Kaiser’s failures are systematic and often purposeful. Indeed, the scope and specifics of these failures are sufficiently grave as to merit investigation by state and federal authorities as well as actions for recovery of funds by public and private payers, including individual Kaiser members. For example, despite receiving more than $10 billion annually from Medicare to provide a full range of services, including mental health care, Kaiser appears to be miscoding patient evaluation procedures, which may result in fraudulent claims to the Medicare program.

The study’s key findings are the following: Bill

  •  Kaiser often violates California laws requiring HMOs to provide patients with “timely  access” toappropriate mental health services. Clinicians report that patients frequently endure waits of four weeks or longer for return appointments even though California law mandates a maximum wait time of 10 business days for both initial and return visits unless a licensed health professional has documented that a longer waiting time “will not have a detrimental impact on the health of the enrollee.”[2] Furthermore, many clinicians report that patients’ first appointments are often nothing more than group orientation sessions in which initial evaluations do not take place. When such evaluations finally do take place, clinicians report they are often cursory and insufficient, but nonetheless are coded as if they were thorough and complete. In a survey of 305 Kaiser clinicians, nearly 90 percent of the respondents reported there is insufficient staffing at their clinic to provide patients with timely return visits.  More than 75 percent reported that they are either frequently or very frequently “forced to schedule return visits further into the future than you believe is appropriate.”
  • Kaiser reportedly falsifies patient scheduling records in an effort to avoid being cited by  state regulators for lengthy appointment delays. Clinicians report that Kaiser often uses “shadow” scheduling records, deliberately miscategorized appointments, and false appointment cancellations to avoid detection of delays that exceed California’s “timely access” requirements.
  • Kaiser often funnels patients into group therapy even when individual therapy would be more effective. Kaiser often pressures its clinicians to assign patients to group therapy even when clinicians conclude that individual therapy may be more beneficial. More than 50 percent of Kaiser clinicians report that patients are either frequently or very frequently “assigned to group therapy even though individual therapy may be more appropriate.”
  • Kaiser reportedly performs initial patient evaluations and other mental health services that not only fall short of recommended clinical standards, but are coded incorrectly in possible violation of Kaiser’s contracts with both private and governmental purchasers.  In San Diego, Kaiser has reportedly directed clinicians to spend only half as much time as the clinically recommended minimum for interviewing, assessing and diagnosing patients. This reported “speed-up” of Kaiser’s assessment procedures can have serious implications. For example, short-cut evaluations lasting only 20 to 30 minutes may result in the misdiagnosis of patients’ conditions. Furthermore, Kaiser appears to be miscoding these procedures in a manner that may result in fraudulent claims to Medicare and other governmental and private purchasers. Interviews with clinicians indicate that Kaiser may be replicating this practice at many sites in California.
  • EmilyKaiser’s current mental health care deficiencies are part of an ongoing pattern of substandard care. During recent years, government inspectors have cited Kaiser multiple times for failing to provide patients with timely access to mental health services. For example, in 2005 the California Department of Managed Health Care (DMHC) cited Kaiser for failing to provide its patients with timely access to mental health care. In 2010, Kaiser was fined $75,000 for unreasonably delaying a child’s autism diagnosis for almost 11 months.In short, Kaiser’s systemic failures recall many of the well-documented abuses of HMOs from an earlier era – one that California believed its revised and expanded regulatory structure had long ago overcome. Kaiser’s substandard care also comes at the same time that the HMO is reporting record profits of $5.7 billion since 2009.[3]

To read the full report “Care Delayed, Dare Denied” please click here to download the pdf.


[1] Throughout this report, “clinician” is the term used to identify licensed mental health professionals of various designations. These clinicians include psychologists (PhDs, PsyDs, and EdDs), marriage and family therapists (MFTs), licensed clinical social workers (LCSWs), and psychiatric social workers.

[2] California Code of Regulations. Title 28. §1300.67.2.2(c)(5)(G).

[3] The figure for Kaiser’s “profit” or “net income” was obtained from audited financial statements and press releases issued by Kaiser Foundation Health Plan & Hospitals.