Kaiser Permanente Made Access to Physicians ‘Cumbersome’, Los Angeles Times Reports
The Los Angeles Times reports that although Kaiser Permanente, the largest HMO in California, "promoted itself in a [1990s] advertising campaign as an HMO whose patients were 'in the hands of doctors,'" the MCO was actually "making it difficult for its Northern California patients to see doctors." The Times story is based on a review of internal Kaiser Permanente documents, including minutes of private meetings and emails among doctors. In one of the "most striking" documents, Dr. Robert Pearl, CEO of a Kaiser physician group, described how "we chose not to provide our patients with what they desired." The Times says that a "long-standing" Kaiser practice was to make patients wait for doctors' appointments to "save money" and "control demand." During a July 2000 meeting, Pearl told the Kaiser Permanente board that the HMO historically "believed that making patients wait for a routine primary care appointment was less costly and would lower utilization"; that "wait lists for specialty consultation were the best means to control demand"; and that if the HMO supplied enough urgent care appointments to meed demand, the "demand would only increase and we would again be short of appointments." However, Pearl said the "assumptions proved wrong," and the HMO did not save money because many patients "persisted until they got past a cumbersome telephonic triage system."
The approach also "was inconsistent" with Kaiser's long-term business strategy, Pearl said. In 1998, Kaiser launched a national advertising campaign stating that the HMO was "distinctive" because its patients were "in the hands of doctors," who could decide what treatments to provide without getting approval from the HMO. The Times reports that at the same time, Kaiser officials were "redesigning their approach ... to emphasize increased use of nondoctors." As demonstrated by internal emails obtained by the Times, some Kaiser officials worried that the greater reliance on nondoctors "did not square with the slogan." Other emails show doctors "grappling with vexing patient access problems, frustrated at their inability to provide patients with adequate care." For its part, Kaiser "denies it was misleading anyone" with the advertising slogan. In an interview with the Times, Pearl said, "Particularly in the late 1990s and onto the present, we have been the leader at making access easier" (Rohrlich, Los Angeles Times, 9/1).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.