California Investigators Set To Visit Kaiser Call Centers as Part of Probe
This week, the California Department of Managed Health Care will visit Kaiser Permanente's call centers as part of its investigation into whether the HMO lets unlicensed workers make medical decisions that affect members' access to care, the Sacramento Bee reports (Peyton Dahlberg, Sacramento Bee, 1/21).
The investigation was sparked by a nurse voicing concerns that call center staff were not handling calls appropriately, increasing the possibility of members receiving inaccurate information and having their care delayed.
The department's investigation centers on Kaiser's use of scripts that call center personnel follow when taking calls from members (California Healthline, 1/12).
Call centers are staffed with non-medical personnel as well as nurses and physicians. Calls initially are answered by non-medical staff who ask questions from scripts physicians have written.
Callers are given appointments or are transferred to an advice nurse.
Investigators are considering whether Kaiser is in violation of a 2003 law that prohibits unlicensed workers from deciding how quickly someone receives medical care.
Kaiser opposed the 2003 law, arguing that the law could be interpreted as a way to prohibit its style of scripted calls.
After the measure was enacted, Kaiser said the use of scripts is legal because phone clerks do not make medical decisions, but simply follow instructions physicians have written.
DMHC has not indicated whether it agrees with Kaiser's interpretation of the law.
Investigators have asked for copies of hundreds of Kaiser's call scripts, but Kaiser has denied those requests, calling them "proprietary."
DMHC spokesperson Lynne Randolph said the investigation could take several more months and could address other complaints, including allegations that phone clerks are encouraged to limit how many calls they transfer to nurses.
Patient Response to Probe
Since the Bee's publication of the department's probe, many people have contacted the paper to voice concerns or praise for the Kaiser system.Kaiser spokesperson Gerri Ginsburg said Kaiser will not respond to complaints brought to the Bee "out of respect for privacy laws" (Sacramento Bee, 1/21). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.